Capitol Hill inquires about abusive marketplace tactics in vision, dental coverage

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The push for overseeing fair eye care coverage on Capitol Hill continues with a recent inquiry into abusive marketplace tactics that could be used by specialty plans for vision and dental coverage. Members of the US House of Representatives Committee on Energy and Commerce have requested that a Government Accountability Office (GAO) study be conducted, as stated in a letter written by House representatives Cathy McMorris Rodgers and Brett Guthrie to the United States comptroller general on January 30, 2024.

Rodgers also made statements during a January 31, 2024 US House of Representatives Energy and Commerce Health Subcommittee hearing concerning the consolidation and vertical integration of vision coverage for the past decade.¹

“This has led to the same companies controlling the product of frames and lenses, owning and operating nearly all the laboratories, employing the doctors, and owning independent practices. The result is less transparency and higher cost for treatment,” Rodgers said during the hearing. She continued that the committee is to be informed of the findings after the investigation to help lower the cost of vision care.¹

Specifically, as cited in the study request letter, there are 3 areas of concern for the GAO to investigate. These include an analysis of the concentration of local, regional, state, and national markets and its impact on consumers, prices paid by consumers and health care providers, if vision and dental benefit providers are finding loopholes with payers to evade laws and regulations, and if vision and dental benefit managers are encouraging customers to purchase or utilize services.²

According to data examined by Mark Farrah Associates in 2023, Vision Services Plan Group is the country’s largest vision benefits company, and controls 70% of the market and ensures over 25 million individuals who have vision-only insurance plans.^3,4 The next largest vision insurance company by market share standpoint is Blue Cross Blue Shield with 18%.⁴ The number of Americans fully-insured in vision plans has also increased between 2018 and 2022, rising from about 40 million to over 45 million people.³

The GAO investigative request following on the heels of the US House Committee of Oversight and Accountability’s request for information concerning the Federal Trade Commission’s (FTC) oversight over the vision insurance market. On August 8, 2023, the committee’s chairman James Comer gave the FTC a week to arrange a staff-level briefing on the impacts of insurance plan consolidation.⁵

Additionally, Capitol Hill introduced the Dental and Optometric Care Access Act in March 2023. This act targets anti-doctor and anti-patient policies by prohibiting dental and vision plans from limiting patients’ and doctors’ choice of labs, and price fixing for noncovered services and materials.¹

The American Optometric Association (AOA) also has a history of making moves on Capitol Hill and connecting optometric advocates. AOA backs legislation and regulation in a variety of ways, including utilizing an in-house legal team to combat plan abuses, maintains connections with vision plan companies, and blocks lobbying efforts with the goal of holding vision plan companies accountable.⁶ The organization is also gearing up for its annual AOA on Capitol Hill 2024 event, running from April 14 to 16. The event allows optometry students and affiliate leaders to fly into Washington, DC to attend session, breakouts, and briefings to learn best advocacy strategies and educate lawmakers.¹

"In taking on plan abuses at the national level, we’ve committed our relentless advocacy network, our full grassroots capability, our AOA-PAC clout, our always-on communications platforms and our organizational strength to the job of securing policy change and needed relief for our doctors,” AOA President Ronald Benner said in a news release. “The AOA on Capitol Hill mobilization set for April—which every colleague can join—will bring hundreds of doctors and students to Washington, D.C., in a further push to educate and inform lawmakers about plan-imposed barriers and the bipartisan solutions we want to see enacted.”

References

1. AOA reports Capitol Hill inquiries into plan abuses are expanding. American Optometric Association. News Release. Published February 9, 2024. Accessed February 12, 2024.

2. Rodgers CM, Guthrie B. Congress of the United States House of Representatives Committee on Energy and Commerce. Letter. Published January 30, 2024. Accessed February 12, 2024.

3. Mark Farrah Associates. Highly-concentrated vision insurance market increasing. Published January 12, 2023. Accessed February 12, 2024. https://www.markfarrah.com/mfa-briefs/highly-concentrated-vision-insurance-market-increasing/

4. Guinan S. What are the largest vision insurance companies? ValuePenguin. Article. Updated January 23, 2024. Accessed February 12, 2024.

5. US House investigative committee calls for scrutiny of vision plans. American Optometric Association. News Release. Published August 10, 2023. Accessed February 12, 2024. https://www.aoa.org/news/advocacy/federal-advocacy/us-house-investigative-committee-calls-for-scrutiny-of-vision-plans?sso=y&ct=e950c5892db043e4c7de097467b0a102830962a5a80f09b1340c668d004d7647d34ee11e8508b7c095076434bce528a43f1a0b5cfccf32269e0a2cbc2cb80afe

6. American Optometric Association. AOA and Affiliate Actions to Fight Back and Stand up for Full Reimbursement and Fair Coverage Policies. Published January 2024. Accessed February 12, 2024.