California Optometric Association, American Optometric Association differ on state exchanges

Sacramento, CA-The tug-of-war over how vision plans will participate in state health exchanges got a little tighter last month when the California Optometric Association (COA) voted to stand with VSP Vision Care and all but defy the American Optometric Association's (AOA's) position on the issue.

The crux of the matter is how people can purchase vision insurance once the state insurance exchanges come online in 2014.

The Affordable Care Act mandates that vision plans participate in the exchanges only by contracting with health plans, a provision the AOA and American Academy of Ophthalmology advocated when the law was being drafted. That is, vision plans may not "stand alone" from health plans. People who buy vision insurance in the exchanges may do so only if they also buy health insurance.

By comparison, insurance exchange customers would be allowed to purchase dental plans without the concomitant health insurance. That is because dental plans, with the support of the American Dental Association, may participate in the exchanges as stand-alone plans.

Therein lies the rub. The COA House of Delegates passed a resolution stating their support for the inclusion of stand-alone vision plans in California's Insurance Exchange.

"Stand-alone plans provide access for patients to continue seeing their optometrist[s] 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," said COA President Movses D'Janbatian, OD. "We will continue to work with these plans to ensure doctors don't lose their patients."

In the land of VSP

Of course, California is also home to VSP, the largest U.S. vision plan. VSP Board Chairman Tim Jankowski, OD, FAAO, applauded the vote. "Speaking as a 35-year member of the COA, I am pleased the COA and COA House of Delegates have overwhelmingly reaffirmed the critical role that stand-alone plans have in providing access to patients for optometry as the health-care landscape continues to change," he said. "VSP and the COA are committed to working together to develop programs that support full medical integration for optometrists."

Days before the COA vote, former Congressman and present Washington State Insurance Commissioner Mike Kreidler, OD, issued an open letter to "Dear Fellow Optometrists" to oppose any move to include stand-alone vision plans in the exchanges. The AOA distributed the letter to eye care media.

AOA President Dori Carlson, OD, acknowledged VSP's power in its home state. "We recognize that VSP has a uniquely high penetration in the vision care market in California, and they were successful in messaging that they were not being allowed into the new insurance exchanges, and thus threatened the business models of California optometrists," Dr. Carlson said in a statement.

She maintained, however, that "stand-alone vision plans" might participate in the exchanges "if they simply contract with a qualified health plan."

Business as usual?

Dr. Carlson also noted that the market for stand-alone plans outside the state insurance exchanges would continue as is. "The other misconception that has been fueled by some stand-alone plans is that the current 'book of business' is at risk when the exchanges come into effect on January 1, 2014," she said. "That is not true." The exchanges are designed to cover people who do not now have health insurance, she said.

Nationally, the National Association of Vision Care Plans, which represents 17 such plans in the United States, has been working to get the ban on stand-alone vision plans repealed. In California, lawmakers will be finalizing key elements of the state's insurance exchange in the coming months.