Capitol Hill inquiries into plan abuses are expanding

Leaders of a second powerful congressional committee launched an inquiry into reports provided by doctors of optometry, dentists and patient advocates of abusive marketplace power and tactics used by specialty plans covering vision and dental benefits. 

In a Jan. 30 message to Congress’ investigative arm, the Government Accountability Office (GAO), Reps. Cathy McMorris Rodgers, R-Wash., and Brett Guthrie, R-Ky., detailed a series of urgent concerns and questions about the tactics of vision and dental plans that they want answered. The two lawmakers chair, respectively, a U.S. House committee and subcommittee with direct jurisdiction over health coverage issues. 

At the direction of the two lawmakers, the GAO is now tasked with fully evaluating and promptly reporting back to Congress on “how vision and dental benefit manager consolidation, market concentration, and acquisitions of small and other independent health care practices may impact consumers—including through the prices paid by consumers, and health care providers.” 

This latest investigative action by Reps. Rodgers and Guthrie builds on an earlier vision benefit manager (VBM) probe underway since August, led by Rep. James Comer, R-Ky., chair of the U.S. House Committee on Oversight and Accountability. 

⏩ How AOA-backed legislation would prevent plan abuses optometrists face.

In opening remarks to a Jan. 31 House Energy and Commerce Health Subcommittee hearing on the growing cost of health care, Rep. Rodgers expressed dismay over ballooning health care costs incurred by American families “through ever-increasing insurance premiums,” tax dollars and the effect on wages due to employers’ health care expenses. In citing examples of elevated costs for patients and employers, Rep. Rodgers directly called out vision plans. 

“One such example is with vision insurance, an area that has seen significant consolidation and vertical integration for over a decade,” Rep. Rodgers says. “This has led to the same companies controlling the production of frames and lenses, owning and operating nearly all the laboratories, employing the doctors and owning the independent practices. The result is less transparency and higher cost of treatment.”  

Ronald L. Benner, O.D., AOA president, noted that the AOA is fighting back in the policy advocacy arena against plan policies designed to work against doctors and patients, and as a result, optometry is seeing growing support in both the House and Senate. 

"In taking on plan abuses at the national level, we’ve committed our relentless advocacy network, our full grassroots capability, our AOA-PAC clout, our always-on communications platforms and our organizational strength to the job of securing policy change and needed relief for our doctors,” Dr. Benner says. “The AOA on Capitol Hill mobilization set for April—which every colleague can join—will bring hundreds of doctors and students to Washington, D.C., in a further push to educate and inform lawmakers about plan-imposed barriers and the bipartisan solutions we want to see enacted.” 

How the Dental and Optometric Care Access Act will help optometrists 

Even prior to these federal probes, VBMs faced bipartisan, bicameral legislation designed to crack down on anti-doctor and anti-patient policies affecting the marketplace. The Dental and Optometric Care (DOC) Access Act, H.R. 1385/S. 1424, would complement state-level vision and dental plan laws enacted in the majority of states by disallowing detrimental policies by ERISA and other federally regulated vision, health and dental plans.  

Specifically, the DOC Access Act would prohibit plans from: 

• Limiting patients’ and doctors’ choice of labs. 
• Price fixing for noncovered services and materials. 

As nearly one-third of patients in any given state have a vision or dental plan that is federally regulated, the DOC Access Act would represent a significant step toward curbing these plan policies. Jointly backed by the AOA and American Dental Association, the DOC Access Act also enjoys the support of more than two dozen patient and consumer advocacy groups, including Patients Rising, the Hispanic Leadership Fund and the Southern Christian Leadership Global Policy Initiative. 

📺 WATCH: Patient Rising’s video on stopping vision benefit managers’ abuses. 

Tens of millions of Americans rely on their local doctors of optometry for their comprehensive eye health and vision needs, and even despite historic advancements in optometry’s scope and level of care provided, plans haven’t sufficiently advanced alongside the profession. Toward that end, the AOA and affiliates continue a multi-pronged approach to achieving reimbursement and coverage fairness. 

Read more about optometry’s advocates’ approach to fighting back against plan abuses.  

Experiencing difficulties with a health or vision plan? Report these challenges to the AOA Third Party Center at stopplanabuses@aoa.org.