News from the AOA's Blog

The Obama administration released hundreds of pages of proposed regulations in July seeking to put in place more of the provisions of the 2010 health care overhaul law, officially known as the “Affordable Care Act.” 

The AOA, which is as fully engaged in tracking the law’s implementation process as it was when the legislation was being developed on Capitol Hill, is especially interested in the new guidelines for states to observe as they establish their own health insurance marketplace, or “exchange,” through which the uninsured and employees of small businesses can purchase health coverage.   

The Affordable Care Act calls for the creation of an individual and small business exchange or a combination of the two in each state that would achieve federal certification by January 1, 2013. For any state choosing not to create an exchange, the federal government will step-in and set up an exchange on behalf of that state.

Throughout the two-year period health care legislation was under consideration on Capitol Hill, there was considerable support for federal preemption and the possible expansion of ERISA-type health plans.  However, the AOA worked to ensure that state patient access and provider choice laws would be protected under the state exchange system.  

Although the just-proposed regulations would seem to confirm that state patient access and provider choice laws would be protected, the AOA is taking nothing for granted as it examines every word and readies detailed comments it will submit to the government in response within 60 days.   

“In the national health care overhaul battles in Washington, a top priority for us from the very beginning was to safeguard all existing and even future state laws aimed at assuring patient access to optometrists,” said AOA Executive Director Barry J. Barresi, O.D., Ph.D. 

“Like the underlying legislation, the just-released proposed regulations respect our profession’s hard-won access gains from coast-to-coast.  With more regulations in development and soon to be released, there remains much to do to expand patient access to optometric care and to make eye health the priority it must be,” Dr. Barresi added.

According to U.S. Department of Health and Human Services (HHS), under the provisions of the Affordable Care Act, a health insurance exchange is a mechanism for organizing the health insurance marketplace to help consumers and small businesses shop for coverage in a way that permits easy comparison of available plan options based on price, benefits and services, and quality. 

The White House has said that the new exchanges will make it easier for individuals and small businesses to compare health plans, get answers to questions, find out if they are eligible for federal health programs or qualify tax credits for private health insurance, and enroll in a health plan that meets their needs.

Overall, the administration’s plan seeks to set minimal standards for states, openly welcomes state innovation in the development of exchanges, and leaves many of the operational specifics up to the state.

But, while the draft plan is intended to lessen the burden on states, AOA knows that the overall flexibility afforded to states could potentially provide a new opportunity for health insurers to limit patient access to optometric care.

One of the areas of flexibility and potential concern in the proposed rule is the standard for network adequacy. In general, network adequacy establishes the standards by which health plans operating in the exchanges must meet to ensure that there is an adequate provider network to supply the services for which plan consumers are paying.

Without strong patient access safeguards in place, the AOA is concerned that health insurers could limit the number of providers on their panels or even limit the types of providers on the panel.

This type of outright health plan discrimination was why AOA fought for the approval of the first-ever federal standard of provider non-discrimination (Harkin Amendment) and will need to fight even harder to ensure that hard-won patient protections also apply to exchange health plans.

The AOA began preparing for the implementation phase of the health care overhaul and the new exchange system immediately after the legislation was signed into law by President Obama in March 2010. 

Since then, the AOA has been sharing information and ideas aimed at expanding access to optometric care, part of an organization-wide mobilization aimed at helping ODs thrive and succeed in the era of the national health care overhaul. 

Last October, the AOA sponsored a gathering of advocacy and third-party leaders from every affiliate to provide an advance briefing on the Affordable Care Act implementation process.   A follow-up meeting will be held in Washington, D.C. in April. 

For information on this important topic or to learn how you can become more involved in the fight for patients and the future of the profession, please contact the AOA Washington Office at 800-365-2219 or by email at: ImpactWashingtonDC@aoa.org.

For more information on the formation of state-based health insurance exchanges, HHS offers information on health insurance exchanges, including fact sheets, on its Health care Web site: (www.healthcare.gov/exchanges). 

“Optometry and the private health insurance provisions of the Patient Protection and Affordable Care Act,” an extensive article outlining the health plans to be offered through state health insurances, appeared in the June edition of Optometry: Journal of the American Optometric Association. 

The article can be accessed online through the Optometry Web site (www.optometryjaoa.com).