If anyone asks you what will be happening to vision care and eyewear sales once the Affordable Care Act (ACA) begins to go into effect in 2014, you can join a very large crowd of seriously knowledgeable people and answer what they all do, which is: Gee. I. Don’t. Exactly. Know.

Because, trust me, the record number of attendees of managed vision care executives, optical retailers, large ECP groups and other health care experts who were at the NASHO/NAVCP Specialty Healthcare Summit in San Diego last month, were, to a person, confounded about making major proclamations about the future managed care scenario. The informative sessions throughout the meeting shared many stories, a great deal of statistics and finely-honed expertise about the U.S. health care delivery system and where things appear to stand now.

But while the topics at the meeting touched on such things as the current status of public and private health exchanges, market trends, technological innovations and more, there remained a few overwhelming questions, which colored everyone’s view. Those questions— just how many people will move (voluntarily or involuntarily) from one insurance plan to another, how many will flood a “new” system of national plans, public state exchanges and private exchanges, create a huge wild card right now.

It is very tricky to predict that movement—of the tens of millions of previously uninsured coming into the U.S. system plus the millions of underinsured perhaps moving within the system plus the millions of people who are currently covered with insurance via small and mid-size employers and may not be in the future plus the millions of Americans who are currently adequately covered but may face rate increases in 2014. All of these variables are keeping the insurance cost/delivery plates spinning, and vision care is just one of those plates.

In a presentation by Milliman actuary Daniel Henry, which acknowledged that vision plan coverage has been growing, he referenced the implementation of pediatric vision care as one of the defined essential health benefits in the ACA. He concluded that in the near term, it would still be subject to “administrative complexity.”

And that’s before or at the same time (depending on who you talk to) the structure of the plan delivery systems, their provider panels and the role of the three Os in vision care, is hammered out. Be prepared for changes. Managed vision care doesn’t seem to be first in the line to go through these shifts; but the maneuvering has begun. “Administrative complexity,” indeed. ■

maxelrad@jobson.com