U.S. House investigative committee calls for scrutiny of vision plans

August 10, 2023
Amid the AOA’s push for the bipartisan Dental and Optometric Care Access Act, a congressional panel authorized to investigate “any matter at any time” goes public with vision plan concerns and demands for oversight of industry consolidation and vertical integration.
Magnifying Glass

A highly concentrated vision plan market raises concerns about the effects on American consumers, including higher costs, per a newly launched Capitol Hill probe of regulators’ role in overseeing the vision care market. 

On Aug. 8, U.S. House Committee on Oversight and Accountability Chair James Comer, R-Ky., issued a request for information from the Federal Trade Commission (FTC) to conduct oversight of the agency’s role in preventing unfair and harmful marketplace practices, especially considering consolidation in the vision insurance market. The investigative committee’s probe tracks with ongoing inquiries into harm being caused by increasing market power and business practices of large pharmacy benefit managers.

⏩ See how AOA-backed legislation would prevent plan abuses that optometrists face.

“Several vision insurers have also sought to vertically consolidate, creating their own brick-and-mortar retail stores providing favorable copays and pricing to steer consumers to their stores and away from their competitors. Additionally, many of these insurers own lens and frame manufacturers enabling them to mark up prices by as much as 1,000 percent,” reads Rep. Comer’s letter to FTC Chair Lina Khan.

In setting a one-week deadline for information he’s seeking, Comer notes “the Committee on Oversight and Accountability is the principal oversight committee of the U.S. House of Representatives and has broad authority to investigate, ‘any matter at any time.’”

Prior to the committee probe, vision benefit managers (VBMs) were already the focus of bipartisan legislation in the House and Senate designed to crack down on anti-doctor and anti-patient policies. The approach is strongly backed by the AOA, the American Dental Association, Patients Rising and more than two dozen patient and consumer advocacy groups.

“Throughout this year, and especially during June’s AOA on Capitol Hill mega-conference, AOA doctors have been in close touch with U.S. senators and House members to build support for DOC Access legislation and a crack down on plan abuses,” says AOA President Ronald L. Benner, O.D. “We see increasing interest in the issues we’re raising and aim to continue to advocate for full accountability for plans and fair treatment for our patients and our profession.”

Go deeper: The Dental and Optometric Care Access Act

The AOA’s redoubled push for reimbursement and coverage fairness is a multi-armed strategy that also includes the reintroduction of the federal Dental and Optometric Care (DOC) Access Act, H.R. 1385/S. 1424. Complementing state-level vision and dental plan laws enacted in 45 states, the DOC Access Act would disallow detrimental policies by ERISA and other federally regulated vision, dental and health 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 policies. Such is the case, the DOC Access Act is jointly backed by the American Dental Association (ADA), whose ERISA Special Committee Chair Randall Markarian, DMD, addressed the AOA’s House of Delegates on the bill during Optometry’s Meeting® in Washington, D.C. Dr. Markarian spoke to the parallels between dental and vision coverage with market consolidation of insurers, and the need to work together in reforming laws, such as ERISA, that might impede doctors’ ability to practice independently.

Concurrently, over 650 doctors of optometry and students championed optometry’s priority issues, such as the DOC Access Act, across more than 430 individual meetings with members of Congress during AOA on Capitol Hill at Optometry’s Meeting. The effect is that the DOC Access Act is garnering more congressional attention than ever, bolstered by patient advocacy groups joining the AOA’s and ADA’s call to correct the vision/dental plan market.

As members of Congress return to their home states and districts during Congress’ August recess through Sept. 12, optometry’s advocates can help build support for the DOC Access Act by encouraging their lawmakers to co-sponsor H.R. 1385/S. 1424.

AOA, affiliates challenge vision plans

Tens of millions of Americans rely on their local doctors of optometry for their comprehensive eye health and vision care needs, and even despite historic advancements in optometry’s scope and level of care provided, plans haven’t sufficiently advanced alongside the profession. In fact, compounded by increased costs and new challenges to care delivery—be it supply chain disruptions to staffing issues—plans’ stagnant pay scales and anticompetitive policies have put doctors of optometry in a difficult place.

The AOA and affiliates understand this dynamic and are advocating for an equitable system that fairly values optometric care; here’s how:

  • Countered model language proposed by NAVCP. The AOA worked to stop NAVCP-developed model language from being introduced at the National Council of Insurance Legislators earlier this year.
  • Initiated direct dialogue with plan CEOs. Focused on benefits coordination, resolution of barriers to care delivery and other member complaints, these AOA meetings keep up a constant refrain for the profession.
  • Supported updating state laws. In addition to Texas and Nevada, Illinois and Georgia enacted vision plan laws this year with more affiliates looking to their statehouse advocacy for solutions.
  • Built alliances with physician and patient organizations. In addition to the ADA, the AOA allied with the Patients Rising advocacy organization to help bolster calls for Congress to cease increasingly harmful VBM abuses.

What’s more, the AOA continues to review and monitor such plan mandates and challenges alongside anti-trust experts, as well as provide enhanced transparency behind these actions with the AOA’s Health and Vision Plan Action Report.

If you or your practice experience difficulties with health or vision plans, please report these issues to the AOA Third Party Center at stopplanabuses@aoa.org.

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