Federal Legislation Puts Patients and Doctors Back in Control of Important Health Care Decisions

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Deirdre Middleton, dmiddleton@aoa.org ; 703. 837.1347

Anamarie Rebori Simmons, anamarie.simmons@edelman.com 202.247.7958  

AOA and Georgia Optometric Association-backed 'DOC Access Act' targets health and vision plan abuses; improves quality and access

St. Louis, Missouri - (March 20, 2017) -- An AOA, Georgia Optometric Association, 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.

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-MS), Markwayne Mullin (R-OK), Robert Pittenger (R-NC), and Paul Gosar, DDS (R-AZ). 

"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," says AOA President Andrea P. Thau, O.D. "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."

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 which 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.

·        Non-covered services and materials mandates.

"This is really great news," said Gary Roberts, D.D.S., president of the American Dental Association. "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 said.

Georgia Optometric Association president Ben Casella, O.D. also stated, "We applaud Congressmen Carter and Loebsack for introducing HR 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 non-covered services leads to higher costs and limited access to care. HR 1606 will do well to ensure these companies treat doctors and patients with the fairness they so deserve," Casella added.

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 HR 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," said 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 healthcare system, allowing medical professionals to provide fairer prices to their patients," said 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."