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Will Obama ‘vision’ be truly affordable or accessible in 2018?
Our patients deserve the best refractive and refractive cataract technology that is available today.
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In March 2010, the Patient Protection and Affordable Care Act, also known as Obamacare, became a federal mandate in health insurance reform, requiring health insurance for all. As we enter 2018, both premium surgeons and our patients want to know what to expect regarding the priority of vision and surgical/medical eye care services as compared with other health care needs, such as hearing, dental, podiatry, dermatology and cardiology.
In 2017, we learned that Obama-care was about making health care accessible and not truly affordable. Most of my surgical patients had and still have extremely high deductibles and out-of-pocket expenses after their deductibles are met. Drug co-pays are exorbitant if the drugs are even covered in the first place. The pressure for premium surgeons to move eye drops to generic products for better coverage was a bait-and-switch tactic, with pricing no different from brand products in the end. Most manufacturers did provide coupon co-pay cards that made brand products more affordable than generics pushed by the insurance carriers, especially for commercially covered patients before Medicare age.
Unfortunately, a domino effect could take place into 2018 in which the Affordable Care Act remains unaffordable to most of our patients with continued high deductibles, co-insurance premiums and co-payments. With these latter issues, premium practices like my own continue to have challenges just collecting the deductible portion for a refractive cataract procedure, making the sale to any upgrade to femtosecond laser, premium IOLs, astigmatism management and/or intraoperative aberrometry nearly impossible. Can advanced technology, which we as premium surgeons have become accustomed to, still be provided in this “unaffordable” setting?
Not to be too pessimistic going into the New Year, but I plan to bring what I did in 2017 and more to my patients — the newest and most advanced refractive and refractive cataract technologies available, such as Streamline IV IntelliAxis-L lenticular toric marking for toric IOLs with the Lensar femtosecond laser platform; the Light Adjustable Lens (RxLAL, RxSight); small incision lenticular extraction for astigmatism management (Carl Zeiss Meditec); and scleral Er:YAG laser treatments for presbyopia (Ace Vision Group), just to name a few exciting developments.
Do baby boomers, Generation X and millennials want to spend more money for refractive procedures and advances such as presbyopic corneal inlays (Kamra, AcuFocus; Raindrop, ReVision Optics) and topography-guided laser vision correction (WaveLight, Alcon) in this setting of accessibility but not true affordability? Those who have retired have essentially fixed incomes and expenses unless their 401(k)s and other savings can come to their rescue. Those still working have the advantages of flex spending and health saving accounts as pretax monies available to pay for such procedures not covered by the health insurance system.
Do credit worthiness and credit access, such as Alphaeon and/or Care-Credit, provide any further safe haven for our premium patients to afford and pay for all these great technologies in 2018?
In the end, I am hopeful 2018 can bring an end to the classic Obamacare picture as we know it from a premium surgeon perspective of accessibility vs. true affordability. Our patients deserve better and deserve all the great technology we can provide them in the refractive and refractive cataract world as we share with them daily.
- For more information:
- Mitchell A. Jackson, MD, can be reached at Jacksoneye, 300 N. Milwaukee Ave., Suite L, Lake Villa, IL 60046; email: mjlaserdoc@msn.com.
Disclosure: Jackson reports he is a consultant for Lensar and ReVision Optics and a shareholder in RxSight and Ace Vision Group.