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December 16, 2013

Dr. Richard Soden on What You Need to Know About the Affordable Care Act

Dr. Richard Soden is vice president for clinical affairs at the College and the executive director of the University Eye Center. He is also a recognized authority on health care reform who has lectured widely on the topic over the years. As the Affordable Care Act begins to take effect across the United States, we asked him a few questions about what it will mean for people seeking optometric care.

 

With the Affordable Care Act (also known as “Obamacare” or the ACA) rolling out across the country, give us some of your general impressions about what it means and how much of a landmark this new legislation is for heath care in the United States.

The Affordable Care Act has created the most dramatic change in health care in the United States since the creation of Medicare in 1965. Approximately 30-40 million people who were not previously covered by any health care plan before will be able to receive health care coverage now as a result of this legislation. The emphasis of the new law is placed on primary care and prevention of diseases and eye examinations are one of the core components of this.

The ACA’s major goal is to ensure that all Americans have access to affordable health care and are reasonably able to obtain health insurance coverage. As a result, its primary focus is to provide health insurance coverage to those who have been uninsured and to encourage enrollment in health care coverage plans by offering subsidies (for those who qualify) to purchase coverage.

Despite the initial, and well publicized, issues related to the healthcare.gov website, the ACA has revolutionized health care in this country by creating new models for value-based health care delivery that focuses both on quality and results.

 

One of the major elements of the ACA is the pediatric vision care benefit. Can you explain this benefit for us and discuss any other vision care-related coverage people should be aware of?

With the pediatric vision care benefit, millions of children are gaining health insurance coverage through the age of 18 and will have access to an annual comprehensive eye exam and treatment from an optometrist. This benefit is one of the cornerstones of the ACA and it must be offered by all new small group and individual health insurance plans.

By including the pediatric vision care benefit as part of the law, the ACA is recognizing that regular comprehensive eye exams for children are essential to ensuring visual health and readiness for school.

Although adult vision care is not designated as an essential benefit under the new law, medical eye care services—that is, anything related to the diagnosis and treatment of diseases—will continue to be covered by all health insurance plans.  The millions of adults who are gaining insurance coverage for the first time under the ACA will be able to access optometrists for their medical eye care needs.

 

In what ways will the ACA affect vision insurance plans?

Companies that offer vision care plans will not be allowed to sell these plans directly through the health care exchanges that have been set up by the federal government and the various state governments. Instead, they will need to work with the health insurance companies that offer coverage to patients through these exchanges. Health insurance companies may choose to contract with companies that offer vision plans in order to have them administer a vision care benefit for their customers.

Increased demand for children’s eye care services, thanks to the previously mentioned pediatric vision benefit, will require many health care plans to add optometrists as participating providers starting now and continuing into early 2014.

 

How has the University Eye Center prepared for the implementation of the ACA?

The UEC is already a participating provider on many of the plans that are currently selling through the exchanges and we are working with the insurance companies that we are not currently participating with in order to become participating providers.

We have also worked to ensure that our capacity to see more pediatric patients as well as other patients who will now have insurance coverage is able to meet the expected demand in 2014 and beyond. As we have for decades, the UEC will be able to continue to offer the most comprehensive and cutting-edge eye and vision care to both children and adults now and into the future.