Why the Affordable Care Act Does Not Cover Vision

“Healthcare.gov will reopen for business on Nov. 15, welcoming millions of Americans to an insurance marketplace that offers medical plans and dental coverage. No one will be shopping for separate eye-care plans, an exclusion that roils companies that sell vision insurance. Even though they aren’t getting new customers, vision insurers still have to pay the Affordable Care Act’s tax on health insurance providers. Why did vision get left out of Obamacare?” asks Business Week. “The answer reveals a lot about the rabbit hole of bureaucracy and political gridlock that’s responsible for so much of American public policy in 2014. Vision plans were originally intended to be part of the exchanges when the ACA was being drafted, says Rob Lynch, chief executive of VSP Global, a vision plan that covers eye care for 67 million Americans. Lawmakers became concerned about how subsidies to help people afford coverage would be split among medical, dental, and visual providers, so glasses got left out. But eye-care plans remained subject to the tax on health insurers. When VSP paid the fee last week, the levy amounted to $25 million. In a letter to the Internal Revenue Service along with the payment, VSP’s general counsel said the company intends to seek a refund.” Read more.

Exchanges Remain as a Portion of Obamacare Is Delayed

"In a significant setback for President Obama’s signature domestic initiative, the administration on Tuesday abruptly announced a one-year delay, until 2015, in his health care law’s mandate that larger employers provide coverage for their workers or pay penalties," writes the New York Times. The post added: "While the postponement technically does not affect other central provisions of the law — in particular those establishing health insurance marketplaces in the states, known as exchanges, where uninsured Americans can shop for policies — it threatens to throw into disarray the administration’s effort to put those provisions into effect by Jan. 1." Starting next year, individuals without employer-based health insurance will have to purchase insurance or face the penalties. Read more.

The Impact of the Affordable Care Act

If you want to get an idea of the impact of the Affordable Care Act, you might want to read a series being published by the New York Times. "To follow how the historic law is playing out, The New York Times will look periodically at its impact in Louisville, a city of 600,000 that embodies both the triumphs and the shortcomings of the medical system in the United States." Read more.

EyeMed Says New Approach Makes Business Easier for ECPs

EyeMed Vision Care is implementing an updated business model that will keep it simple for eye care professionals to do business with the company and improve exam reimbursements. The model was tested with more than 150 independent provider locations and is designed to support provider practice growth, simplify administration, and deliver a wide choice of products and labs, according to a company spokesperson. The model was designed over the past two years with input from more than 2,000 independent providers collected through focus groups, beta tests, and a pilot program of more than 150 different provider locations. Read more to find out about the benefit details.

VSP Tells California to Use Colorado Model for Stand Alones

“VSP Vision Care has advice for board members from Covered California when they meet Thursday to decide how and when to offer stand-alone vision and other supplemental benefits in the new health insurance marketplace: look at Colorado.” That’s the report from the Sacramento Business Journal. “Last week, Connect for Health Colorado voted to provide direct access to stand-alone vision plans for consumers via a link during the health insurance enrollment process that starts Oct. 1. Like other states — including California — Colorado hit a stumbling block in March when new federal rules narrowed the way supplemental plans can be offered in exchanges. These products can be offered by separate state programs that share resources and infrastructure with a state-based exchange, but federal subsidies can’t be used for non-essential benefits — nor can exchange administrative fees support them.” For more details, read more.

States Limit Access to Health Care

“With only a few months remaining before Americans will start buying coverage through the new state insurance exchanges under President Obama’s health care law, it is becoming clear that the millions of people purchasing policies in the exchanges will find that their choices vary sharply, depending on where they live,” according to a New York Times post.”States like California, Colorado and Maryland have attracted an array of insurers. But options for people in other states may be limited to an already dominant local Blue Cross plan and a few newcomers with little or no track record in providing individual coverage, including the two dozen new carriers across the country created under the Affordable Care Act.”Read more.

White House Touting the Affordable Care Act

You want to get a jump on how the Affordable Care Act could affect you as an optician, as a citizen?  Read the following from The White House Blog (yes, that white house on Pennsylvania Ave.): “And every health insurance plan in the Marketplace will cover a standard set of essential health benefits that includes, among other benefits, hospital stays, prescription drug coverage, preventive services, oral and vision care for kids. Open enrollment begins October 1, 2013. Get ready now for the Marketplace by signing up for e-mails and text messages for updates and information at <https://signup.healthcare.gov/>. In June, the site will be unveiling the new Marketplace. You’ll be able to learn everything you need to know about the Marketplace, including how it works, the benefits of health insurance, how to choose a plan based on your needs and lifestyle, and more. Then in the fall, you can use this site to enroll in a plan from home, or from any place you can access the Web.” Read more.

Final Rules for the Affordable Care Act

"The Obama administration issued a final rule on Wednesday defining 'essential health benefits' that must be offered by most health insurance plans next year, and it said that 32 million people would gain access to coverage of mental health care as a result," according to a New York Times post. "Under the rule, health plans must provide benefits that have not always been provided by commercial insurers. For example, insurers must cover dental care and vision services for children, as well as 'habilitative services' to help people with disabilities keep or improve their skills." Read more.

PPACA Should Include Vision Care, Say Experts

"As states set up their exchanges under the federal health law, they should consider including adult vision benefits, according to the authors of a new study showing that people without such coverage are less likely to seek care," reports Kaiser Health News. "Although the federal health law mandates vision coverage for children, the same requirement does not apply to adults. States themselves can require certain insurance benefits. And researchers from the Arnold School of Public Health at the University of South Carolina suggest strong reasons for doing so. In their study, published Monday in the Archives of Ophthalmology, the researchers found that more than 40 percent of people in their study lacked vision insurance. They also looked at a subgroup of about 12 percent of people in the study who reporting having glaucoma, macular degeneration, or cataracts — the three leading causes of vision loss in the U.S. About 40 percent of that group also did not have vision insurance. Yet nearly 90 percent of both groups had health insurance." Read more.

Insurance Marketplaces under Affordable Care Act (PPACA) Approved in 6 States

"The Obama administration gave conditional approval on Monday to health insurance marketplaces being set up by six states led by Democratic governors eager to carry out President Obama’s health care overhaul," says a New York Times post. "The six are Colorado, Connecticut, Maryland, Massachusetts, Oregon and Washington. At the same time, the administration rejected pleas from other states that want to carry out a partial expansion of Medicaid, to cover fewer people than the president and Congress originally intended. Some states want to expand Medicaid to cover childless adults with incomes up to the poverty level, $19,090 for a family of three." Read more.

Some States Struggle Setting Up Insurance Exchanges

"The days since President Obama won re-election have been marked by tension and angst in Republican-led states like Iowa, where Gov. Terry Branstad has waited until the last minute to decide whether to create a crucial tool for people to get medical coverage under Mr. Obama’s health care law," according to the New York Times. "'There has been a total blackout of information,' said State Senator Jack Hatch, a Democrat who vented his frustration at a news conference here this week. 'We’re behind schedule, we’re at a disadvantage, and I don’t know what our governor’s plan is to reposition Iowa.' States are supposed to tell the Obama administration by Friday whether they want to create their own health insurance exchange — a deadline that many had bet might never come to pass, choosing to sit on their hands for months in the hope that Mitt Romney would win the presidency and the health care law would be repealed." Read more.