Exchanges may be where rift resolves

St. Louis-An open forum here last month with representatives of VSP Global and the AOA did not bring the sides any closer to hammering out their differences about how stand-alone vision plans should participate in state health insurance exchanges, but it did give them a chance to explain their positions to a wide optometric audience.

At the forum where VSP principals invited AOA leaders to share their views, about 100 optometrists, most who identified themselves as members of both groups, listened and asked questions during the 90-minute web simulcast. VSP said another 500 ODs representing as many as 32 states viewed the event live online.

The Patient Protection and Affordable Care Act (ACA) requires each state to set up a health insurance exchange by 2014. The law specifically designates pediatric vision care as an essential health benefit, and in December the Department of Health and Human Services issued guidelines that define that vision care benefit as a comprehensive eye exam and follow- up care offered through qualified health plans. This would mean that Spectera and Davis Vision, which are owned by health plans, could provide access to eye care directly in the exchanges while VSP and EyeMed would have to partner with health plans that do not offer vision coverage.

The AOA advocated for the provision to allow vision plans to participate in state exchanges by partnering with qualified health plans. VSP and the national Association of Vision Care Plans have taken the opposite position-that stand-alone vision plans should also be allowed to participate directly in the exchanges. Four state optometric associations-Maryland, Hawaii, Arizona, and California-and the Optometric Society of the District of Columbia have broken with the AOA in advocating for stand-alone vision plans. However, the AOA noted that dozens of state associations, including Ohio and Michigan, which voted last month, support the AOA.

Robert Jarrell III, OD, chair of the AOA State Government Relations Center Executive Committee, explained the AOA's position at the forum. "There's a common misconception that establishment of state insurance exchanges will take patients away from our practices, and this is simply not true. The insurance exchanges will have no effect on the coverage of 270 million Americans who are covered by their current plans, standalone vision plans included."

Dan Mannen, OD, FAAO, director of VSP Global board of directors, countered with its position. "Until we have absolute assurance that all optometrists will be able to participate in all medical plans, just like our medical colleagues, we absolutely have to protect our current access to patients and fight for medical equality," he said.

Lack of trust in health plans

Medical plans will "determine who gets to play on the panel; it will be they who determine what procedures will be done by whom, and it will be they who determine who gets paid what," Dr. Mannen said. "We certainly don't want to trust health-care plans that routinely discriminate against optometry."

VSP representatives expressed concern about how the exchanges would achieve parity and access. Dr. Mannen pointed out that the Harkin Amendment in the ACA, which bars health insurers from discriminating against ODs, does not guarantee full participation and payment parity for all optometrists.

The AOA noted that it advocated for the Harkin amendment, named for Sen. Tom Harkin (D-IA), and helped turn back the American Medical Association's efforts to strip it from the legislation and, more recently, repeal it.

One audience member asked about a compromise between the two organizations, but the panel had no clear answers.

"I don't think that either side has to compromise," Dr. Jerrell said. "At some point we have to decide where each of our positions is in this. Who are we going to be an advocate for?"