AOA and GOA-backed bill takes aim at anti-patient, anti-competitive abuses by health and vision plans

AOA and GOA-backed bill takes aim at anti-patient, anti-competitive abuses by health and vision plans

An AOA, Georgia Optometric Association (GOA) and American Dental Association (ADA)-backed bill introduced Friday, March 17, in the U.S. House of Representatives would put patients and doctors—rather than health and vision plan executives—back in control of important health care decisions.

This legislation is a strong and necessary step in bringing free market principles back into health care by removing anti-competitive business practices.

The Dental and Optometric Care Access Act, also known as the DOC Access Act, which has been designated as H.R. 1606, seeks to empower doctors and patients in their dealings with plans, eliminate a growing level of anti-competitive practices in health care, and help improve overall quality of patient care.  

This key, pro-patient, pro-access legislation was again championed by U.S. Reps. Buddy Carter (R-Ga.) and Dave Loebsack (D-Iowa). Original co-sponsors of H.R. 1606 include Reps. Bennie Thompson (D-Miss.), Markwayne Mullin (R-Okla.), Robert Pittenger (R-N.C.), and Paul Gosar, DDS (R-Ariz.).   

While 40 states have enacted legislation addressing these exploitations for plans regulated at the state level, a federal effort is now needed to address plans that have been sidestepping these state laws. Among other protections, the DOC Access Act would prohibit federally regulated health, vision and dental plans from:

  • Restrictions on medical plan participation.
  • Limits on a doctor's choice of lab.
  • Noncovered services and materials mandates.

"Millions of Americans rely on local doctors of optometry for their comprehensive eye and vision health care needs, and it is time to put a stop to the barriers vision plans place on the doctor-patient relationship and access to quality care," AOA President Andrea P. Thau, O.D., says.

"The AOA is proud to support the DOC Access Act and commends Reps. Carter and Loebsack for taking this step to ensure that doctors and patients are again at the center of important, personal health care decisions," Dr. Thau adds.  

"This is really great news," says Gary Roberts, D.D.S., president of the ADA. "I want to personally thank Congressmen Carter and Loebsack for introducing this bill. Dental insurance companies must be prohibited from interfering in the doctor-patient relationship by dictating prices for services they don't even cover. While many states have passed similar laws, the Carter-Loebsack legislation would ensure the prohibition applies to federally regulated plans.  

"Again, on behalf of myself and the ADA's 161,000 member dentists, I want to thank Reps. Carter and Loebsack," Dr. Roberts says.  

GOA president Ben Casella, O.D., also states, "We applaud Congressmen Carter and Loebsack for introducing H.R. 1606, an important piece of legislation addressing the unfair and harmful treatment of doctors and patients by vision and dental insurance companies that enjoy limited competition and special legal treatment.  

"The common demands by such companies that doctors charge unusual rates even for noncovered services leads to higher costs and limited access to care. H.R. 1606 will do well to ensure these companies treat doctors and patients with the fairness they so deserve," Dr. Casella adds.

For frustrated and confused patients, these types of plan abuses lead to higher overall costs and limit their access to the doctors of their choice. For doctors—many of whom operate small businesses—the plans dictate and intrude on what they charge for services not covered by the plan; force them to accept damaging terms for supplemental vision plans; and set which labs they can or cannot use to provide needed treatment to patients.  

While vision plans claim to put these restrictive measures in place to benefit patients, a study conducted by Avalon Health Economics demonstrated that the plans' activities really only benefit the plans. The 2016 study conducted by a group of independent health economists found that monopolistic behavior by vision plans "is not the kind that is good for consumers—it's the kind designed to transfer operating margins from providers to plans without benefitting consumers."  

During the last session of Congress, the legislation (formerly H.R. 3323) had very healthy bipartisan support with 65 co-sponsors. The AOA will continue to work with Reps. Carter and Loebsack and the ADA to build new support for H.R. 1606 to make it a priority in Washington D.C. 

"The DOC Access Act is critical to ensure doctors are able to meet patient needs," says Rep. Carter. "By prohibiting insurance providers from forcing doctors to participate in restrictive insurance plans or networks, doctors will be able to charge reasonable fees for the care Americans need. This legislation is a strong and necessary step in bringing free market principles back into health care by removing anti-competitive business practices."  

"I am happy to introduce legislation with my colleague Rep. Buddy Carter that will bring better practices and free market principles back into the health care system, allowing medical professionals to provide fairer prices to their patients," says Rep. Loebsack. "The DOC Access Act also brings fairness to agreements between medical professionals and insurance providers by protecting doctors, dentists and optometrists from anti-competitive business practices."  

Get involved  

As the AOA works to ensure that patients and their local doctors of optometry are again at the heart of their important health care decisions, it's essential that doctors support AOA advocacy efforts.  

In June, AOA will host the profession's largest advocacy event leading up to and during Optometry's Meeting®, June 21-25, in Washington, D.C. Participate in the inaugural AOA+, sponsored by Johnson & Johnson Vision, which will bring together more than 1,500 of the nation's brightest students and new doctors to engage this up-and-coming generation on the importance of professional advocacy.  

Concurrently, AOA on Capitol Hill is optometry's chance for a show of strength as the profession's champions meet with their legislators in a staple of AOA advocacy. To reserve your spot for AOA on Capitol Hill, or to get more information, contact Tess Milliorn in the AOA Washington office at 1.800.365.2219 or tmilliorn@aoa.org.   

Also, doctors can support AOA-PAC, the most effective way to participate in the advocacy process.

March 21, 2017

comments powered by Disqus