The American Optometric Association and American Academy of Ophthalmology stand together in opposing the inclusion of the vision-only plans.
The word vision appears exactly twice in the 906-page House
version of the Patient Protection and Affordable Care Act passed in March 2010,
and the phrase vision care only once. These very brief mentions
have become the focus of a rift between practitioners and the vision plans that
cover some 85 million Americans.
According to vision plan executives, those few words could drastically
alter how they do business and possibly their subscribers overall eye
The act mandates that in 2014, health exchanges would come online to
provide health insurance for people who have no insurance through an employer,
and that the coverage must include oral and vision care for
children. However, the act would limit vision plans to participating in the
exchanges only if their coverage for children is bundled with a health
Efforts to repeal bundling provision
The National Association of Vision Care Plans (NAVCP), which represents
17 such plans in the United States, is lobbying to get that provision repealed
so its members can participate not only as a bundled benefit for children, but
also as a stand-alone benefit that subscribers could purchase
outside of their health insurance, according to NAVCP President Richard
Sanchez, who is also president and CEO of Advantica, a vision benefits company
in Clearwater, Fla. Dental plans, meanwhile, may participate either as a
bundled offering or as a stand-alone.
We think that the exchanges should have even more access to
care, Mr. Sanchez said in an interview. They should have
stand-alone vision plans and health plans, not
Consulting, National Association of Vision Plans. Vision Exam Utilization Study
(Study period: 20082009)
While the organization has already engaged congressmen and senators to
get the ban on stand-alone vision plans repealed in 2011, no sponsor has
stepped forward, he says.
Treating vision and dental plans differently in the exchanges could
potentially alter how vision plans operate if the health exchanges become major
purveyors of health insurance, said Al Schubert, vice president with VSP Vision
Care in Rancho Cordova, Calif. This could, over time, alter the vision care
delivery system, he said.
When you look at dental and vision care in United States today,
about 90% of the care is delivered by stand-alone dental and vision
plans, Mr. Schubert told Primary Care Optometry News.
So if the exchanges catch fire and they get large, you may have the
opposite effect to where stand-alone plans are not delivering the majority of
the care in the United States. That may have downstream impacts.
AOA, ophthalmology group oppose stand-alone plans in exchanges
Both the American Optometric Association and American Academy of
Ophthalmology in 2009 opposed the concept of having stand-alone vision plans in
the exchanges, whereas the American Dental Association and the National
Association of Dental Plans (NADP) were united that dental plans should
participate both by contracting with health plans and also as stand-alone
players, according to NADP executive director Evelyn Ireland.
Source: VSP Vision
The AOA and AAO stated their opposition to stand-alone vision plans in
the exchanges in a joint letter sent in 2009 to Sen. Debbie Stabenow (D-Mich.),
sponsor of the failed amendment that would have allowed stand-alone vision
plans in the final bill.
In contrast to increasing the essential integration of vision and
eye health services into covered services, stand-alone vision plan companies
aim to turn back the clock by continuing to segment vision from eye health and
seeking to impose misguided limits on the care that our patients
especially children receive, the letter stated. Such plans
are routinely mislabeled as complete or comprehensive when in fact they are
Michael X. Repka
Because of this opposition, the sponsoring senator took the
references to vision out of the amendment when push was coming to shove,
Mr. Schubert said.
The fact that we werent unified with a provider organization
had us excluded, Mr. Sanchez concurred.
Michael X. Repka, MD, medical director of government affairs for the
AAO, was not aware of NAVCPs efforts to get stand-alone vision plans in
the exchanges, but he was not surprised either. I would expect that this
is the time everybody is going to be out there looking to do those tweaks and
adjustments to the bill, he said in an interview.
Vision health vs. eye health
The objection to stand-alone vision plans in the exchanges gets to the
heart of defining what precisely vision care comprises, Stephen
Montaquila, OD, chair of the AOAs Third-Party Center, told
PCON. The AOAs stand has to do with tying eye care more
closely to overall health care and getting the health exchanges to recognize
that an eye examination should include a health assessment, not only a
refraction for vision correction, he said.
Our goal is for every American to get their eyes examined,
Dr. Montaquila said. The intent of health care reform is to develop a
better system for the delivery of health care. Mandating that a vision care
plan partner with a qualified health plan gets to that point. And they will be
required to comply with the important consumer protections afforded through the
law. These include oversight through guaranteed public participation and
assurances of adequate supply and access to providers.
He called the concept of bundling vision with health care a better
system for the delivery of eye care services, with the goal of providing total
care rather than an a la carte program where the patient could end up missing a
piece. Otherwise, its conceivable that a person could have health care
coverage but not vision care coverage.
Added Dr. Repka, It is difficult to separate vision and eye health
from each other; we have an arbitrary divide of refractive correction or
routine eye care from medical eye care. This is confusing for the patients and
Interpreting vision care in the act
Writing the regulation of what precisely vision care means
in the act is another task that the AOA, AAO and vision plan providers have
engaged in. Mr. Sanchez and Mr. Schubert said their concept of vision
care mirrors that of the professional societies, but that stand-alone
vision plans are better equipped to meet the broader goals of improving access
to eye care.
NAVCP has called attention to its own study that showed consumers with a
full-service, stand-alone vision plan are twice as likely to get an annual
comprehensive eye examination as those who get vision coverage bundled with
their health plan. The study, which Ingenix Consulting conducted, showed a
utilization rate of 33% for the former vs. 16% for the latter.
The study also revealed that 36% of patients with stand-alone coverage
received an eye examination in consecutive years compared with 22% of patients
with a bundled plan.
Patients with stand-alone vision benefits develop longer, deeper
and more lasting relationships with their eye doctors than those with bundled
insurance, Rob Lynch, CEO of VSP, told PCON in an interview.
As such, stand-alone patients are more likely to have a health care
experience that has a more impactful role on the broader spectrum of their
VSP offers subscribers an Eye Health Management Program, which focuses
on early detection and management of both eye and related health conditions. A
study commissioned in 2008 found that patients with diabetes in the program had
annual health plan costs of $6,682 vs. $8,074 in the traditional health care
model group and claimed other cost benefits in lost time and turnover.
Heading into 2011, NAVCP members are having an ongoing
dialog with the provider groups to try and bridge their differences, Mr.
Sanchez said. by Richard M. Kirkner
- The American Optometric Association can be reached at 243 N.
Lindbergh Blvd., St. Louis, MO 63141; (800) 365-2219;
- The American Academy of Ophthalmology Governmental Affairs Division
can be reached at 1101 Vermont Ave. NW, Suite 700, Washington, DC 20005-3570;
(202) 737-6662; www.aao.org.
- The National Association of Dental Plans can be reached at 12700 Park
Central Drive, Suite 400, Dallas, TX 75251; (972) 458-6998; email@example.com;
- The National Association of Vision Care Plans can be reached at 91
Purdue Road, Suite 200, Indianapolis, IN 46268; (317) 328-4633;
- Vision Service Plan can be reached at