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Issue of stand-alone vision plans in state exchanges continues to be debated
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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
For more information:
- The American Optometric Association can be reached at www.aoa.org.
- The California Optometric Association can be reached at www.coavision.org.
- The Hawaii Optometric Association can be reached at www.hawaiioptometry.org.
- The Maryland Optometric Association can be reached at maryland.aoa.org.
- VSP Vision Care can be reached at www.VSP.com.