DOC Access Act gains Senate companion

As a result of the tireless advocacy of the AOA and its affiliates, the bipartisan Dental and Optometric Care Access (DOC Access) Act now has a new Senate companion.

With more support than ever, the DOC Access Act (H.R.1385) was reintroduced on March 7 in the U.S. House by Reps. Buddy Carter, R-Ga., and Yvette Clarke, D-N.Y. And on May 3, Sens. Joe Manchin, D-W.V., and Kevin Cramer, R-N.D., introduced S. 1424. AOA priority legislation, the DOC Access Act has made steady progress through Congress since its original introduction in 2015. 

“Every West Virginian and American deserves access to quality, affordable health care, including dental and vision care. Our bipartisan DOC Access Act would help put health care choices in the hands of patients and doctors themselves, instead of insurance companies. This legislation would provide more options and expand access to patient care, while also allowing for more flexibility in treatment options for doctors, especially those operating their own practices as small businesses. Similar laws already exist in 44 states, including West Virginia, and the DOC Access Act would apply these laws to federally regulated dental and vision plans. I urge my colleagues on both sides of the aisle to support this bipartisan, commonsense legislation to give patients and doctors greater control over their health care decisions,” Sen. Manchin said in a news release.

“Our doctors need more autonomy within our health care system, whether it’s selecting the best materials and lab services for their patient, or by increasing fairness in doctor-insurer agreements,” said Sen. Cramer. “Our bipartisan legislation looks to protect consumers and allow doctors to provide high-quality care to their patients.”

Each year, tens of millions of Americans rely on local doctors of optometry for their comprehensive vision and eye health care needs. Many patients are covered for this essential care through a combination of health plan and supplemental vision plan. Special legal treatment for and a lack of competition among vision plans has led to costly mandates being forced on patients and their doctors—higher prices and less access to care for patients while doctors face the tough choice of providing needed care to neighbors or keeping their practices viable.

The AOA has a multi-armed strategy to combat these abuses at the federal, state and local level. The reintroduction of this bill, along with its growing support, means optometry’s advocates are making significant headway.

“Family eye doctors across West Virginia and around the country support Sen. Manchin as he takes on the VBMs and other health industry middlemen who exploit loopholes, spread confusion and undermine the quality care patients need and deserve,” added AOA President Ronald L. Benner, O.D. “By introducing the bipartisan Dental and Optometric Care Access Act and committing to fix a rigged system, Sen. Manchin and the other health policy leaders in Congress he’s rallying are working hard for essential care access and choice solutions and full, immediate restoration of patient-doctor decision-making.”

Curbing vision, health plan policies that restrict care

The DOC Access Act complements state-level vision and dental plan laws enacted in 45 states by disallowing detrimental policies by ERISA and other federally regulated vision, dental and health plans. However, a federal effort is now needed as roughly one-third of patients in any given state now have a vision and/or dental plan that is federally regulated and not complying with these state laws.

The DOC Access Act would prohibit plans from: 

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

Additionally, the bill would limit plan-doctor agreements to two years unless otherwise indicated by the doctor and includes a strong enforcement provision that encourages state and federal regulators to work together to put a stop to harmful plan abuses.

“Let’s be frank: health care is unreasonably expensive and bogged down by confusing red tape,” 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. The DOC Access Act is a strong and necessary step in bringing free market principles back into health care and start putting patients before profits.”

Rep. Clarke adds, “Every year, millions of American families go to their local doctor of optometry for their vision and eye health care needs. Unfortunately, special legal treatment for and a lack of competition among vision plans has led to higher prices and less access to care for patients while doctors face the difficult choice of providing needed care to folks in their community or keeping their practices viable. The DOC Access Act aims to combat this issue by putting the power back in the hands of the patients and their doctors to control their own important health care decisions. I’m proud to join my colleagues across the aisle to help preserve access to care and help create a fairer market into our nation’s health care industry.”

More support than ever

The DOC Access Act is expected to be a larger focus for lawmakers as a growing chorus of patient advocacy groups are increasingly calling on Congress to address the harms of health care consolidation and vertical integration, including in the vision plan market.

Patients Rising, a leading patient advocacy organization speaking out on behalf of tens of millions of patients nationwide, issued a new call for Congress to put a stop to increasingly harmful vision benefit manager abuses. A video posted to the organization’s website pulls back the curtain on the broken vision plan market and explains how the abuses are hurting patients and their doctors, including by limiting choice, raising prices and forcing independent eye doctors out of business. The group is urging lawmakers to act now to fix the market before it completely collapses and has committed more than 110,000 members of its advocate network to ramping up the fight against vision benefit manager abuses. The AOA is proud to have a new patient advocacy group get behind the movement to stop vision benefit manager abuses and advance the DOC Access Act.

Last year, the Hispanic Leadership Fund cast its support behind the DOC Access Act, noting that insurers “manipulate the free market” with policies that amount to “scheme[s] set up to benefit insurance companies.” Weeks later, the Southern Christian Leadership Global Policy Initiative noted its support in a letter to Rep. Yvette Clarke, D-N.Y., where the civil rights advocate underscored that unraveling “some of the power and dominance that the vertically integrated vision plan behemoths have amassed over the years” could help boost access to eye and vision care “while ensuring that our families aren’t priced out of getting the high-quality vision correction [they] deserve.” Americans for LimitTed Government has also weighed in urging lawmakers to act as has Patients Over Profits, among others.

Fighting back against abuses

The payer community is lagging behind in recognizing optometry’s essential and expanding role in health care and post-COVID-19 care delivery challenges, especially regarding spiking inflation and increased costs connected to updated health and safety protocols. 

The AOA is confronting executives with major plans and payers and actively pressing for expanded recognition of optometry and reimbursement updates. Together with state associations, the AOA is identifying plan policies that devalue optometric care and is insisting on corrective action: 

• Menacing “clawback” audits
• Systematic downcoding
• Disregarding increases set by state Medicaid agencies

Support optometry’s advocates

The AOA and its partners will be working overtime this year to ensure that Congress steps up to stop vision plan abuses—and you can be part of this action:

• Visit AOA’s Action Center to urge your House and Senate members to co-sponsor H.R. 1385 or text “DOC” to 1.855.465.5124.
• Make plans to attend Optometry’s Meeting®/AOA on Capitol Hill June 21-24 in Washington, D.C., and join thousands of other advocates fighting for patients and the profession. Registration for Optometry’s Meeting is open now, and registration for AOA on Capitol Hill will open soon; stay tuned for updates from the AOA.