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Newly Introduced Federal Legislation Puts Doctors and Patients Back in Control of Important Health Care Decisions

AOA-backed “DOC Access Act” targets health and vision plan abuses; improves quality and access for millions of patients.

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(PRESS RELEASE) WASHINGTON – A bi-partisan bill backed by the American Optometric Association (AOA) and the American Dental Association (ADA) was recently introduced in the U.S. House of Representatives to counter abusive practices in the federally regulated vision and dental coverage markets, and ensure patients and doctors – as opposed to insurance and plan executives – are at the center of important health care decision-making.

“The DOC Access Act seeks to completely ban, at the Federal level, anti-doctor and anti-patient policies of vision plans,” said Barbara L. Horn, O.D., AOA president. “The AOA is proud to join with the American Dental Association in supporting this legislation and in thanking Reps. Loebsack, Carter and all of the other original co-sponsors for their decisive leadership.”

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Introduced by Rep. Dave Loebsack (D-IA) on July 15th, H.R. 3762, or the Dental and Optometric Care Access (DOC Access) Act, already enjoys support from seven cosponsors, building upon the overwhelming support generated in the 115th Congress with 105 U.S. House Republicans and Democrats. The bill would eliminate plan mandates being forced on patients and their doctors that ultimately result in higher prices and less access to care. In effect, the legislation would complement state-level vision plan laws by disallowing detrimental policies by ERISA and other federally regulated vision and health plans, namely:

  • Limits on a doctor’s choice of lab
  • Mandates on noncovered services and materials

Each year, millions of Americans rely on local doctors of optometry for their comprehensive vision and eye health care needs. While many patients have coverage for medical eye care through a health plan, roughly 200 million Americans have supplemental preventive eye exam and materials (glasses/contact lenses) benefits through a vision plan.

Unfortunately, special legal treatment (vision plans often aren’t regulated like health insurers) and a lack of competition in the market. Currently, a small number of national, vertically—integrated plans monopolize markets in a large majority of communities. In fact, the two most dominant vision plans provide coverage to roughly two-thirds of Americans with this coverage, which means plans can dictate how doctors furnish services thereby limiting patient choice.

A 2016 study by Avalon Health Economics conducted by a group of independent health economists found that this kind of monopsony behavior exhibited by vision plans harms consumers. Avalon concluded that “such mandates have another effect – they lead to higher overall costs for these consumers and, especially, for consumers without vision plans as doctors are forced to compensate for the transfer of operating margins from doctors to the plans.”

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Already, 42 states have enacted legislation addressing these and other plan abuses; however, roughly one-third of plans operating in any given state can sidestep these laws because they are federally regulated. Moreover, some of these states only provide protections from one of dental or vision plans but not both.

AOA’s member doctors of optometry and students are encouraged to urge their U.S. House members to co-sponsor the bill. Visit AOA’s Online Legislative Action Center for more information on supporting optometry’s priority issues.

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