3 days, 5 priority issues, 300 Hill meetings and 700 of optometry's advocates

Coming off a difficult, pandemic-riddled year that saw the AOA’s advocacy log significant wins for the profession, optometry’s advocates redoubled their focus on no less crucial issues currently before Congress.

Virtual AOA on Capitol Hill, May 23-25, the AOA’s single-largest annual advocacy event and centerpiece of optometry’s federal advocacy efforts brought together over 700 registered doctors, paraoptometrics, students and industry leaders to champion five crucial areas of legislation and advocacy that could immediately affect optometry practices. With Congressional offices still closed for the foreseeable future due to the public health emergency, advocates once again convened virtually at a consequential time for the 117th Congress.

Notwithstanding stark divisions on Capitol Hill, optometry’s advocates found receptive ears and a bipartisan consensus on the profession’s issues in well over 300 meetings scheduled with members of Congress and their staffs. Although 2020’s federal advocacy importantly solidified around securing optometry’s access to COVID-19 relief and recovery measures—with the AOA helping optometry access more than $2.1 billion in federal funds—Virtual AOA on Capitol Hill returned this year to its central message about the essentialness of eye and vision health care services that doctors of optometry provide Americans.

“Against all odds, we didn’t merely survive the pandemic, but we are coming out stronger than we have ever been before,” Dr. Reynolds said. “But we still have a lot of work to do. There are so many different agendas and so many who fight against us, yet we work year-round to make sure we are at the table, to reinforce the essential role doctors, students and staff play in health care and to address our concerns and needs.”

Closing contact lens prescription verification loopholes

Popular with roughly 45 million Americans, contact lenses are a safe and effective vision-correction option when worn and cared for properly. However, poor-fitting or improperly used contact lenses can result in serious eye and vision harm, which is why the U.S. Food and Drug Administration regulates these as Class II and III medical devices that require an eye doctor’s prescription and oversight. Both the FDA and Centers for Disease Control and Prevention (CDC) advise consumers that contact lenses are not “one size fits all” and that regular, comprehensive eye examinations are necessary for ensuring optimal health.

Despite these concerns, online contact lens sellers continue their push to deregulate the contact lens market and remove necessary physician oversight of these medical devices. Such is the case, online sellers commonly sidestep requirements in the Fairness to Contact Lens Consumers Act (FCLCA) and Contact Lens Rule to sell lenses without valid prescriptions or to substitute brands not originally prescribed by patients’ doctors. However, the AOA and many in Congress agree that closing these loopholes is a priority.

Legislation introduced in both the U.S. House and Senate, H.R. 3353 / S. 1784, the Contact Lens Prescription Verification Modernization Act, would go far in resolving some of these concerns by overhauling a broken prescription verification system that retailers game to lure consumers. This bipartisan measure would not only prohibit prescription verification via automated “robocalls” and establish a paper trail by requiring online sellers to use direct communication to confirm prescription accuracy, but also require sellers to establish a HIPAA-compliant portal for allowing patients to upload their own prescriptions.

“Increasingly, online sellers are using disruptive and unreliable prescription verification robocalls that too often lead to patients receiving contact lenses not prescribed by their eye doctor,” noted Denise Roddy, O.D., AOA Federal Relations Committee (FRC) member.

While federal regulators interpreted the FCLCA to permit the use of robocalls, these automated calls are often unintelligible, do not include all the necessary information for confirmation and do not allow for two-way communication with the provider. So, too, online sellers use robocalls to take advantage of the “passive verification” provision of the law to gain automatic verification of contact lens prescriptions.

Building upon legislative groundwork set in the 116th Congress with an earlier iteration of the bill that quickly garnered 74 bipartisan cosponsors before the session closed, optometry’s advocates championed the familiar issue on Capitol Hill this week but not without staunch opposition.

Even as advocates prepared for Virtual AOA on Capitol Hill, a conservative political outlet, The Federalist, published an article that openly asked why the U.S. has not deregulated the contact lens market as in Europe. However, the article is just the latest attempt to muddy a conversation about the central issue of patient safety—and optometry’s advocates refuse to yield. 

• Visit AOA’s Action Center to urge your House and Senate members to co-sponsor H.R. 3353 / S. 1784, or text “robocall” to 855.465.5124.

 Curb health, vision plan policies that restrict care

To increasingly take the fight to health and vision plans, the AOA and optometry’s advocates built upon the successful repeal of the insurer anti-trust exemption in late 2020 and encouraged congressional support of the AOA’s and American Dental Association’s Dental and Optometric Care (DOC) Access Act.

Introduced in the House and Senate, the bipartisan H.R. 3461 / S. 1793 complements state-level vision and dental plan laws on the books in 44 states by disallowing detrimental policies by ERISA and other federally regulated vision, dental and health plans: namely, limiting doctors’ choice of labs and mandating noncovered services and materials. Additionally, the bill would limit plan-doctor agreements to two years—unless otherwise indicated by the doctor—and includes a private right of action that allows doctors to take offending plans directly to court.

While many patients have coverage for medical eye care through a health plan, roughly 200 million Americans have supplemental, preventive eye exam and materials benefits through a vision plan. However, the two most dominant vision plans provide coverage to roughly two-thirds of Americans, thereby creating a circumstance where there is little competition in the market with these vertically integrated plans. Such is the case, these plans can impose policies in provider contracts that aren’t in the doctor’s best interest and often blow back on patients.

In fact, an Avalon Health Economics report found that vision plans’ monopsony market behavior is designed to transfer operating margins from providers to plans without benefit to consumers. In turn, the report says, “such mandates have another effect—they lead to higher overall costs for these consumers and, especially, for consumers without vision plans as doctors are forced to compensate for the transfer of operating margins from doctors to the plans.”

Reintroduction of this priority legislation comes months after Congress approved the Competitive Health Insurance Reform Act (CHIRA) that amended the McCarran-Ferguson Act to repeal the federal anti-trust exemption for health, vision and dental insurance companies, in turn exposing these companies to federal antitrust scrutiny for the “business of health insurance.” The CHIRA should address some competition issues engrained in the insurance market and is likely to hone federal agencies’ attention on health insurance transactions, “such as network provider contracts, division of markets, cooperative negotiation by providers and/or insurers, or information sharing among competitors.”

Optometry’s advocates emphasized how some vision and health plans contribute to competition issues, creating a stagnate reimbursement environment and levying unnecessarily detrimental polices on optometry practices.

“The vision plan market is broken and, without congressional action, patients and practices will continue to suffer,” noted Karoline Munson, O.D., AOA FRC member.

Visit AOA’s Action Center to urge your House and Senate members to co-sponsor H.R. 3461 / S. 1793, or text “DOC” to 855.465.5124.

Expanding access to needed optometric care

Additionally, optometry’s advocates championed several patient access issues on the Hill this week, ranging from a new Medicare vision benefit to securing full federal enforcement of the provider non-discrimination law, and ensuring comprehensive practice standards for veterans’ care.

Currently, Congress is considering an expansion of traditional Medicare benefits to add coverage for vision, hearing and dental. Although a proposed expansion of Medicare vision benefits began in earnest in 2020, the AOA warned that initial measure did not adequately address seniors’ care. Now, optometry’s advocates are continuing that work to educate lawmakers about essential components of successful benefit design, making clear that it must be directly administered by Medicare and not subcontracted to vision plan administrators, and that predatory eyeglass and contact lens sellers must be kept from taking advantage of unsuspecting seniors.

“The AOA will continue fighting for our rightful seat at the table as Congress over the next few weeks and months considers the creation of a new refraction and materials benefit under traditional Medicare,” noted Deanna Alexander, O.D., AOA FRC member.” We know that our combined advocacy will be key to getting this potential benefit right, especially considering that some insurers and other payers are already trying gain control of it, impose enforced restrictions on the professional judgment and authority of doctors, and segment vision from overall patient health."

Separately, advocates appealed for strict enforcement of the decade-old provider nondiscrimination law, also known as the Harkin Law, after a recent Congressional action forced the matter once again.

Signed into law as part of the Consolidated Appropriations Act of 2021, the No Surprises Act protects patients against surprise medical billing but also includes a provision calling on key federal agencies to issue rules to fully implement Section 2706(a) of the Public Health Service Act (PHSA), also known as the Harkin Law, by Jan. 1, 2022. Originally included as part of the Affordable Care Act as AOA’s key victory in the 2010 battle over health care reform, this PHSA section aims to address insurers’ suppressing subscriber utilization by limiting patient access to covered services provided by entire categories of providers, including doctors of optometry, providing care within the bounds of their state scope of practice.

While AOA has successfully pushed plans to comply with Section 2706(a), this nondiscrimination law has never been fully enforced by federal regulators, who have instead favored a “hands-off” approach. However, increasing examples of access restrictions makes it clear vigorous enforcement is needed now more than ever—and optometry’s advocates worked to grow support to do just that.

“The AOA fought for this law to help combat growing instances of health plans refusing to credential doctors of optometry or treating doctors of optometry differently than ophthalmologists when providing same care,” Dr. Alexander noted. “But, with continued discrimination, Congress and the AOA are simply not going to wait around anymore for regulators who have continued to drag their feet. We and lawmakers are not going to stop until this law fully works as originally intended.”

Lastly, optometry’s advocates worked to ensure anticipated Department of Veterans Affairs (VA) national practice standards fully recognize the care that doctors of optometry provide and that veterans deserve.

In 2020, the VA issued two key policies aimed at boosting veteran access to needed care by urging its facilities to better utilize the range of care doctors of optometry are trained and licensed to provide, as well as by removing an agency directive that for 15 years had prevented veterans from accessing VA doctors of optometry for therapeutic laser eye care already recognized in seven states so far.

Now, the VA is working to develop national practice standards in conjunction with the Department of Defense to help implement a new, joint EHR system. Optometry’s advocates appealed to lawmakers, helping ensure these new standards recognize optometry’s contemporary laser procedures as Medicare, Medicaid, the Indian Health Service and all other major payers already do.

“Nearly 1,000 doctors of optometry and more than 200 residents each year provide nearly 70% of all veteran eye and vision care,” noted Marrie Read, O.D., AOA FRC member. “With optometry playing the outsized role that it does in caring for America’s veterans, it is all the more critical that the VA keeps moving in the right direction and ensures that these new national practice standards recognize the full range of care that doctors of optometry are trained to provide and to which our veterans desperately need greater access.”

Virtually quick takeaways

The AOA recognized two of optometry’s champions on Capitol Hill with AOA Health Care Leadership Awards, related to their tireless efforts to advance eye health and vision care: 

• John Boozman, O.D., R-Ark.
• James Clyburn, D-S.C.

Sunday’s opening session featured a discussion about the current political climate in Washington, D.C., by keynote speakers Anna Palmer and Jake Sherman. The founders of Punchbowl News, an online political news daily, and best-selling New York Times authors were the former co-authors of the top-rated POLITICO Playbook franchise. Specifically, the duo of policy wonks addressed their top-5 political questions of 2021 thus far; namely, what happens to the infrastructure bill; what else might happen this Congress; is partisanship as bad as it seems; who takes the House in the 2022 midterms; and, what comes of a Senate majority? So, what is happening on the Hill? 

• In referencing Democrats’ unified control of Congress and the presidency because of the 2020 General Election and a raft of key issues and re-elections coming up, Sherman noted: “We’re in the middle of what is probably the most significant and most consequential period of legislating in, I can’t remember—probably in our reporting careers.”
• Given the high stakes involved this Congress, Palmer added that advocates might expect a return to normalcy regarding in-person visits with members of Congress in the next couple of months; however, elements of the COVID-19 pivot will likely remain: “The virtual world isn’t ending anytime soon. I actually think that now that members of Congress and their staffs have been doing these for quite a while, there’s a sense that a lot of the members won’t do away with these [virtual meetings] completely.”

To hear Palmer’s and Sherman’s answers to their top-5 questions, access AOA’s EyeLearn Professional Development Hub and watch the keynote presentation from the opening session.

Additionally, industry professional development and government affairs representatives—from Johnson & Johnson Vision, Essilor of America and CooperVision—participated in a panel discussion on effective advocacy engagement strategies to help prepare optometry’s advocates for their Hill meetings over the coming days.

Keep optometry’s momentum going

Virtual AOA on Capitol Hill laid a formidable foundation for optometry’s priorities going forward, but effective advocacy requires persistence and commitment. Help keep the momentum up and get involved today to support optometry’s advocates. Here’s how: 

• Visit AOA’s Action Center to learn more about these and other priority federal issues and contact your members of Congress to urge their support of these impactful bills.

Become an AOA-PAC investor, one of the easiest and most effective ways to make an impact in the AOA’s ongoing advocacy efforts. Consider donating to AOA-PAC to