As part of a group practice in metropolitan Detroit, Mich?l Garin, OD, sees many patients who work for the Big Three automakers.
As part of a group practice in metropolitan Detroit, Michael Garin, OD, sees many patients who work for the Big Three automakers. On the job, however, Dr. Garin is at a disadvantage-he is the only optometrist in the practice, while there are three ophthalmologists.
So, when patients present with medical eye problems, Dr. Garin must bill them privately or refer them to one of the practice's three ophthalmologists.
Plans that discriminate
Dr. Garin's patients are among the 70-plus million individuals covered by ERISA plans-plans "that can and do discriminate against optometry," said Randolph Brooks, OD, president, American Optometric Association (AOA).
That will change, however, with passage of the Patient Protection and Affordable Care Act (PPACA), the nation's $940 billion health-care overhaul bill. The legislation, which is expected to provide health insurance coverage to 32 million uninsured Americans, also contains the first federal provider non-discrimination standard that targets ERISA plans.
That's part of the AOA's overall goal: greater access for patients.
"Immediately after the 2008 elections, when health-care reform was just beginning to take shape, the AOA made clear two urgent priorities in health-care reform," Dr. Brooks said. "One, expand patient access to doctors of optometry by making provider non-discrimination safeguards a key element of reform. Two, make eye health and vision care a great priority within health care."
Following is what the legislation likely will do for optometry and what issues must still be addressed.
The U.S. House of Representatives gave final approval to the PPACA on March 21, and President Obama signed it 2 days later. One week later, he signed the Health Care and Education Reconciliation Act of 2010, known as the "reconciliation bill."
PPACA will extend health insurance coverage through state-based health insurance exchanges, re-shape Medicare and other federal health programs, and impose new requirements on health insurance. The act also will expand Medicaid eligibility, subsidize insurance premiums, and offer incentives for businesses to provide health-care benefits.
Section 2706, an amendment sponsored by Sen. Tom Harkin (D-IA) and backed by the AOA, prohibits plans, including ERISA-type plans, from discriminating against any provider, such as optometrists, who are acting within the scope of their licensure. This represents the first major change since ERISA became law in 1974, Dr. Brooks said.
A historic advance
ERISA sets minimum standards for pension and health plans in private industry to provide protection for individuals in these plans. ERISA, however, pre-empts state laws and does not allow state insurance departments authority over employers' self-funded plans. That means ERISA plans are not bound by state laws that would prevent discrimination against optometrists.
"Approval of the Harkin Amendment is a tremendous victory for optometry," Dr. Brooks said. "It will likely prove to be one of the most historic advances in patient access to optometric care since the 1986 recognition of optometrists as physicians under Medicare."
That's good news to Dr. Garin. "It will make it a lot easier to treat patients I already see for their eye-care needs," he said.