Congress Can Stand Up to Predatory Vision Insurers
If there’s one durable truth about America’s healthcare system, it’s that patients lose when insurance companies win. Major insurers have posted record profits in recent years and grown more powerful while patients have a harder time finding care and pay more out of their own pocket when they do. While often overlooked, the vision insurance industry is ground zero for insurers manipulating prices and choices at the expense of patients. Those patients deserve a fair system that allows them to get the services they need at an affordable price, which is why Congress must step up on their behalf.
The typical vision plan covers only basic services and often requires a significant out-of-pocket expense for necessities like frames. Many vision policyholders will tell you their plan is hardly a great value – and that’s likely without realizing that these policies are designed to turn their vision care into a profit machine for insurance companies. Nearly two-thirds of the country’s vision plans are offered by two large, vertically integrated insurers. Those insurers don’t just dominate the coverage market. They also manufacture lenses and own labs, vision care centers, and many of the most recognizable frame manufacturers. They dominate every corner of vision care in the United States.
That dominance gives them the power to dictate prices to doctors, demand doctors use certain labs and sell products that yield higher profits, and cut costs even when they can’t afford it. The big insurers can even set prices paid by patients who don’t belong to those plans. As a result, patients have fewer choices and, instead of working with their doctor to make decisions about their care, end up getting the products and services that best benefit their insurance company.
This system amounts to institutionalized coercion. It robs patients of options, drives up costs, and threatens their access to vision care. Avalon Health Economics, an independent researcher, found that these practices are nothing more than a way for insurers to “[transfer] operating margins from providers to plans without benefiting consumers.” Insurers’ manipulation particularly hurts those who are least likely to be able to afford the consequences: the uninsured. “Those without vision insurance and those with an alternate vision plan may face higher overall prices as margins are squeezed and costs shifted,” Avalon said.
The Dental and Optometric Care (DOC) Access Act was introduced in the last session of Congress as a solution to this problem and is expected to be introduced again this year. Lawmakers should not pass on the opportunity to act upon it this time around and take a strong stand for affordable, accessible care. This bipartisan bill would prohibit vision insurers – and dental insurers, which operate in a similar fashion – from price fixing and protect patients from their aggressive behavior. It takes medical decision-making away from insurers by allowing doctors to choose the labs that best fit patient needs. The bill also prohibits insurers from dictating network agreements longer than two years, preventing them from strong-arming doctors into unfavorable terms that ultimately fall on the backs of patients.
It's time for Congress to unwind the coercive and manipulative practices insurers are using to maximize profits at the expense of patients. Insurance should exist to provide patients with coverage for the care they need. Nearly every state in the country – 44 of them and counting – has some form of this law on the books, demonstrating a widespread recognition of the problem and the political appetite to address it. However, these laws only apply to plans regulated by their respective states. Nearly a third of vision and dental plans are regulated by the federal government. The DOC Access Act would help millions of patients who lack protection from heavy-handed, profit-seeking insurers.
It's an unfortunate reality that opportunities to truly make a difference for patients are few and far between in Congress. The DOC Access Act represents a real opportunity that lawmakers shouldn’t pass up this time around. Patients can’t afford an insurance industry that continues to consolidate power while they pay more for less.
Sean Shaw is the Chairman of People over Profits, a non-profit organization dedicated to standing against corporate influence and fighting for the rights of everyday people. He is the former Insurance Consumer Advocate for the State of Florida.
