The Affordable Care Act (ACA) requires vision coverage for all children, but that could change next month when the Supreme Court hears arguments in King v. Burwell, a case that challenges the legality of a key component of the law: tax credits to people who purchase health insurance on the federal exchange.
A Supreme Court ruling against the tax credits (expected by July 4) could set off what the Rand Corporation called a “death spiral” for the law. Major overhaul of the ACA—if not outright repeal—becomes all the more likely, according to Jeff Anderson, executive director of the 2017 Project, a think tank promoting a conservative alternative to the act.
“The politics here are going to be exceedingly volatile,” says Nicholas Bagley, a University of Michigan law professor who’s written frequently about the legal machinations of the ACA.
Dismantling the law could mean a “huge mess” for vision care coverage of children in lower- to middle-income families, says Julian Roberts, executive director of the National Association of Vision Care Plans (NAVCP).
Another potential fallout from a ruling against the ACA: the revival of an argument in eye care between vision plans and the AOA (and American Academy of Ophthalmology). These groups have differed on how people should be able to purchase children’s vision coverage on the state and federal exchanges. Physicians’ groups prevailed in getting language into the ACA that limits the exchanges to only sell vision plans that are bundled with health insurance, while Vision Service Plan (VSP) and the NAVCP sought to let the exchanges sell vision coverage separately from health insurance—so-called standalone vision plans.
ACA’s Impact on Eye Care
As the second year of mandated coverage begins, the impact the ACA has had on optometric office visits is still in question. No data have quantified how many more children gained vision coverage.
“Do more children have vision care due to the exchanges? Probably so,” Mr. Roberts says. “The issue is whether they’re utilizing it.”
AOA President-elect Steven A. Loomis, OD, says early evidence shows that they are. “Optometrists will continue to see a boost from the ACA’s pediatric benefit,” said Dr. Loomis in an email. “Many ODs have seen an uptick in pediatric patients.” How many depends on how far along a state is with ACA implementation, he noted.
Vision Council’s 2014 Economic Situation Study, released last May, reported the ACA “had not had too much of an immediate impact” on the optical industry, and its long-term impact on the eyewear industry was “in doubt.”
Back when the ACA was being drafted, the vision carriers had warned that bundling vision plans with health insurance for children would result in a lack of awareness about eye exams. Last year, the AOA’s American Eye-Q Survey found that two-thirds of people surveyed did not know ACA covered children’s eye examinations.
Dr. Loomis pointed to two key ACA components that should drive more patients into optometrists’ offices: any-willing-provider provisions, known as the Harkin law, which prompted Ford Motor Corporation to include optometry in its coverage for medical eye care; and incentives for accountable care organizations (ACOs, which are provider panels that coordinate care for selected groups of Medicare patients) to seek out optometrists to join their networks. “The AOA views ACOs as a model of care ODs should learn more about,” Dr. Loomis said.That is, if all those pieces of the ACA survive the year.