As major players in optometry choose sides, HHS said it is still
evaluating the issue and will provide more details in a future guidance.
The American Optometric Association has made it clear
that it supports the current language of the new health care law that allows
for stand-alone vision plans to participate in the state insurance exchanges by
working with qualified health plans. VSP has made it equally clear that it
supports inclusion of stand-alone plans on their own. Now state optometric
associations are beginning to weigh in.
The Patient Protection and Affordable Care Act of 2010
established Affordable Insurance Exchanges to “provide competitive
marketplaces for individuals and small employers to directly compare available
private health insurance options on the basis of price, quality and other
factors,” according to the U.S. Department of Health and Human Services
(HHS).
Dori Carlson |
The exchanges, which are mandated to become operational
by Jan. 1, 2014, are intended to enhance competition, improve choice and
provide small business the same opportunities as large businesses.
“In the passage of the affordable care act,
Congress established that within the state level health insurance exchanges
only qualified health plans offering the 10 essential benefits may sell
insurance within the exchange,” AOA President Dori Carlson, OD, told Primary Care Optometry News. “One exemption that Congress
created was the inclusion of standalone dental plans.”
Stand-alone vision plans may participate in the
exchanges by partnering with qualified health plans, added Dr. Carlson.
“There’s no issue about their participation, though there are
differences in how they may participate,” she said.
HHS has determined that each state deciding to set up an
exchange will have the flexibility to specify their state’s essential
health benefits offered by the exchanges, VSP board chair, Tim Jankowski, OD,
told PCON in an interview.
“By 2012 year-end, each state opting to have an
exchange must have its benefit and exchange structure defined,” Dr.
Jankowski explained. “In 2014, the uninsured, individuals and small
businesses will have the option to go into exchanges. By 2017 everyone, if they
choose, can purchase through exchanges.”
Tim Jankowski |
HHS ‘still evaluating issue’
In mid-March, HHS released a final rule to implement the
exchanges. The final rule noted that “a small number of commenters sought
clarification on whether stand-alone vision plans could be offered through the
exchanges.”
In response to the comment, HHS stated: “HHS is
still evaluating this issue and plans to provide more details regarding
offering other coverage through an exchange in future guidance.”
“The fact that HHS held open this issue on
stand-alone vision plans is significant,” Dr. Jankowski commented,
“particularly because the rule was issued as a ‘final’
rule.”
AOA: stand-alone vision plans must partner with health plans
“The AOA strongly supports the integrated approach
to delivery of eye health care,” Dr. Carlson told PCON, “and is
working toward that with the pediatric vision essential benefit that we fought
hard for, won and are now working to see implemented as new coverage open to
millions of children, with a comprehensive eye exam and follow-up care at its
core.”
She said by stand-alone vision plans partnering with
qualified health plans, this “step toward integration is a positive one
because the seamless delivery of eye health and vision care better serves
patients and doctors.”
In a letter directed to VSP and published on the AOA
website in November 2011, Dr. Carlson stated, “We [supported] an end to
artificial restrictions on our services imposed by health plans, including
stand-alone plans whose business model isolates optometry from the rest of
health care as if somehow vision care ‘stands alone’ from primary
health care.”
In a statement posted on the AOA website in February
2012, she said, “Our profession’s future stands to be severely
compromised if we allow profit-driven private corporations to define our role
in health care as simply providers of refractions, glasses and contact
lenses.”
VSP: stand-alone plans important for access to care
Dr. Jankowski said the mission of VSP Vision Care, which
he noted is a not-for-profit entity, “is to increase access to eye care by
directing patients to optometrists. [The 119 million] individuals who have
vision insurance through a stand-alone plan see their eye doctor two times more
than those who have a benefit bundled with a medical health plan.”
He said that qualified health plans will be able to
participate directly in the exchanges, which will put them at an advantage over
stand-alone vision plans.
“If stand-alone vision plans are not able to
participate directly (without partnering with a qualified health plan) in the
exchanges, competition will be limited given that every major health plan
already has a relationship established with a vision plan,” Dr. Jankowski
said. “Even in the instances where stand-alone plans are connected with a
health plan, independent doctors will see a decrease in patients – not
only because eye exams will drop when bundled with health plans, but also
because optometrists have historically faced challenges accessing patients
through a health plan network.”
Three states support stand-alone plans
In mid-February, the California Optometric
Association’s (COA’s) House of Delegates passed a resolution
supporting the inclusion of stand-alone vision plans in the state’s
insurance exchange, according to a press release issued by the association.
“Stand-alone plans provide access for patients to
continue seeing their optometrist for eye care and can be a valuable channel to
make sure optometrists are fully integrated as the primary providers for
patients’ vision and medical eye care,” COA President Movses
D’Janbatian, OD, said in the release.
About a week later, the Hawaii Optometric Association
(HOA) issued a similar statement.
“The HOA board and membership fully understand the
important service that stand-alone plans provide to their patients,” the
HOA said in a press release. “Stand-alone plans allow the more than
500,000 individuals in Hawaii the accessibility and choice to continue seeing
their optometrist for primary eye care.”
Around the same time, the Maryland Optometric
Association testified to the Maryland House Committee on Health and Government
Operations in support of stand-alone vision plans participating directly in the
Maryland exchange, according to VSP.
In her February 2012 statement, Dr. Carlson said,
“I understand the important role that vision plans have played in many of
our practices over the past 20 years. However, many vision plans are continuing
to resist the legislative, regulatory and marketplace changes that the AOA has
been confronting head-on since the health care reform debate began.”
She said this resistance threatens optometry’s
future and she urges vision plans to join the AOA’s mission and agree
that: every American’s health plan should include a comprehensive eye
exam; vision plans must contract with qualified health plans in the exchanges;
vision plans use optometrists to provide full-scope care; they support equal
medical plan credentialing for ODs and MDs; and ODs and MDs receive equal
payment.
Mike Kreidler, OD, MPH, FAAO, a former member of
Congress and the current insurance commissioner of Washington State, wrote an
open letter to the profession that was posted on the AOA website in February.
In the letter, Dr. Kreidler said he has “strongly
favored the seamless approach to the delivery of eye health care throughout the
national debate over health care in 2009 and 2010,” and that he has urged
Congress “not to relegate vision care to stand-alone service status, like
dental services, within state exchanges.”
He asks in the letter, “How do we integrate the
role of primary eye care providers? … We either advance the profession or
we do not. Stand-alone is a step backwards.”
“The idea of full medical integration is an
admirable goal, but how do we get there?” Dr. Jankowski said. “If we
exclude one of our primary access points while we try to get medical access, a
lot of doctors will not be able to survive. Are we willing to take this giant
leap to eliminate one access point and be guaranteed that another access point
will replace it?
“I have heard from doctors all across the country
about the issue of patient access in the health care reform model, and I know
it’s important that they continue to see their patients connected with
stand-alone vision plans,” he continued. “HHS is still evaluating how
stand-alone plans will be incorporated into the exchange structure, and we must
continue to stay engaged in this discussion.” – by Nancy Hemphill,
ELS
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