ST. LOUIS—The leaders of two major vision care organizations, VSP Global and the American Optometric Association, faced off here last night in a dramatic debate about optometry’s role in managed vision care. The Healthcare Reform Open Forum held at the St. Louis Airport Marriott Hotel last night focused on whether stand-alone vision plans should or should not be permitted to directly participate in the insurance exchanges being established as a result of the Patient Protection and Affordable Care Act (ACA). Formatted like a presidential debate, with opening and closing statements framing a series of questions posed by live audience members as well as virtual attendees viewing a simulcast, the forum featured a panel of three representatives of the American Optometric Association and an equal number of VSP Global executives.

While both organizations had the opportunity to reiterate views in a public arena that they’ve previously expressed through various other media, no real conclusions were drawn nor next steps laid out. Still, the drama of the two organizations facing off had the optical industry abuzz. Over 100 optometric leaders from 32 states attended the event in person, and more than 500 individuals watched the event live, online. The forum was also popular in social media with nearly 200 tweets using the hashtag #hcrOpenForum, equating to over 138,000 impressions. VMail was on-site at the forum.

Both VSP’s and the AOA’s positions remain the same as they were before the meeting. While VSP feels strongly “that stand-alone vision plans being excluded from insurance exchanges poses a great risk to optometry and the access doctors have to their patients,” the “AOA supports the inclusion of vision plans in the exchanges via contracting with qualified health plans.” Ultimately, VSP argues that not allowing stand-alone vision plans to participate in the exchanges will severely limit optometrists’ access to patients, while the AOA remains staunchly in support of having vision coverage bundled within qualified health plans to ensure that optometrists receive parity with all other medical professionals. While VSP agrees that this is a worthy but idealistic goal that is not based on current practice, its representatives feel that the AOA has not put together a plan to reach this goal.


Representing AOA were Stephen Montaquila, OD, chair, AOA Third Party Center Executive Committee; Robert L. Jarrell, OD, chair, AOA State Government Relations Center Executive Committee; and Roger Jordan, OD, chair, AOA Federal Relations Committee.

Representing VSP were Rob Lynch, CEO; Tim Jankowski, OD, FAAO, immediate past chair of the board of directors; and Dan Mannen, OD, FAAO, director of the board of the directors.

Both sides offered strong arguments supporting their opinions regarding how vision coverage should be offered through the state health insurance exchanges.

“While this unprecedented change to healthcare delivery certainly represents challenges to optometry, it also represents great opportunity to take the next step in showing how optometry is the primary eyecare provider in the healthcare system. Optometrists must be allowed to participate by fully integrating our care as part of the patient’s overall healthcare and working closely with the rest of the health care team. We must eliminate barriers that isolate optometric care from the rest of healthcare. Further, it is imperative that we are able to provide our patients with the full range of services in an integrated and coordinated manner,” said Montaquila, representing the AOA’s position.

“We’re here to talk about healthcare reform, but what we need to be talking about is access to patients,” said Mannen, in support of VSP and stand-alone plans. “The number one priority for optometry has got to be access to patients, and that’s why state associations and major organizations have supported stand-alone vision plans.”


Over the past few months, a growing number of state optometric associations have passed resolutions supporting the inclusion of stand-alone vision plans. Arizona is the latest state optometric association to do so, with a unanimous vote last week by both its board and its membership resolving to support stand-alone vision plans in its state health insurance exchange. This follows similar resolutions already passed by the optometric associations of California, Hawaii and the District of Columbia. One state, Maryland, has already legislated the inclusion of stand-alone vision plans in its health insurance exchanges.

In addition, both Transitions Optical and Carl Zeiss Vision have also made announcements about this issue. According to a statement from Transitions, “To help ensure continuity of care between eyecare professionals and their patients, we support inclusion of all vision plans in the current healthcare reform debate.” Carl Zeiss Vision’s release stated, “We believe that preserving broad coverage choices for patients, employers and eyecare practices are an important component in the healthcare reform legislation in order to maintain regular, frequent access to eye exams that is essential to visual health.”

Publicly opposing the direct participation of stand-alone vision plans in the state insurance exchanges, in addition to the AOA, is Washington State insurance commissioner Mike Kreidler, OD, MPH, FAAO, who released a statement in February opposing the inclusion of stand-alone vision plans the same week the AOA sent a letter to its members formatted to debunk a series of what it refers to as “myths” related to stand-alone vision plans. More recently, this month the optometric association of the state of Michigan voted “No” to allowing segregated stand-alone plans to restrict the benefit to limited vision services severed entirely from the patients’ comprehensive health coverage.

It became clear at last night’s forum that both sides maintain their differences—VSP fully in support of allowing stand-alone vision plans to participate directly in the state health insurance exchanges and AOA preferring instead that vision care be bundled with qualified health plans…yet not articulating a clear plan on how to reach that goal.

“As I see it, access is the number one priority for optometry,” said VSP’s Mannen. “Access means opportunity, and we need to maximize, not minimize, those opportunities.” Mannen went on to talk about the risk of putting “the fox in charge of the hen house” in reference to medical plans controlling optometry’s future.

After the forum, Stuart Thomas, OD, chairman of the board, VSP Global, told VMail, “We still feel strongly that access to patients is paramount, ensuring that access by including stand-alone vision plans in the exchanges. The AOA has still not articulated a plan, and until that plan is clearly articulated, it makes no sense not to include stand-alone vision plans. We will continue to have discussions with the AOA around this important issue. Hopefully, we will be able to come to a conclusion and work together.”

Also following the forum, Joe Ellis, OD, past president of the Kentucky Optometric Association and the American Optometric Association, called on vision plan executives to work with optometric leaders to lock in the profession’s recent legislative and regulatory victories, including the new designation of pediatric vision care as essential and the Harkin patient access targeting discriminatory ERISA plans. In a video message to members, Ellis urged optometrists to build on the success of last month’s AOA Advocacy “Super” Meeting, which brought more than 700 optometrists and optometry students to the nation’s capital seeking to build new support for the AOA’s patient access agenda and join with the AOA and state associations in speaking with one voice on Capitol Hill and in statehouses.

Video of the complete Healthcare Reform Open Forum will be posted within 24 hours on both the AOA website and the VSP Proves It website.

John Sailer
js ailer@jobson.com