Vision and Dental and Healthcare Oh My!

Earlier this week the house passed a healthcare reform bill. It is a 2,000 plus page document and I remain unsure that our representatives have actually read all of it. I have not read the bill in it’s entirety (good thing I’m not your representative), but I have been alerted to a huge change that voters everywhere must be aware of and take action on.

Now.

With the new heathcare plan, vision and dental plans for children would be separate than that of adults. Let me explain to you why this should have you on the phone, emailing or snail mailing your local congressperson.

Insurance companies take large groups of people and split the risk between them. If you work for a multinational corporation then your “group” is likely to be tens of thousands of people. The insurance companies use actuary tables to find the average cost per person, then they add a little so that their shareholders are paid back on their investments. The nations largest vision and dental providers are not for profit, and I’m not convinced that this should change. Currently my family enjoys vision and dental care. With the new plan, my children would be moved to their own vision and dental plans and 26,000 small businesses would be negatively impacted as well.

The new healthcare plan would create separate pools for children’s vision and dental insurance. I’m unclear what benefits would be offered to the kids with the new plan, but right now when you visit the dentist in addition to monitoring the health of your teeth and gums your dentist is the first person would would detect cancers in the mouth, lips or throat.

When my kids go to the pediatrician for their annual exam they read from an eye chart. They cover one eye and that’s pretty much the extent of it. If eye exams are rolled into medical I worry that kids will lose the proper eye exam they need each year.

Because my son was diagnosed with strabismus and ambloypia while still an infant, he has had an exorbitant number of eye exams. In addition to reading from a chart (don’t get me started on the early years…. they were tough) the eyes are dilated. With a dilated pupil and a skilled optometrist the eye provides physicians with an opportunity to see bloodflow and assess vascular health without being invasive.

One of the side effects of the obesity epidemic is a dramatic rise in type two diabetes. A thorough eye exam can give as much as a seven year advance warning to the onset of type two diabetes. With an advance warning people can change their food and exercise habits, and increase both their lifespan and their quality of life.

After my miserable day spent trying to get my son the H1N1 Vaccine in a county clinic setting, I saw the need for reform firsthand. To say that the level of care was substandard is a gross understatement.

I don’t have a solution. I wish I did, but I’m a Mom and a Housewife, not a lawmaker, not a healthcare worker nor a student of public health.

I can tell you this. Taking children and separating their dental and vision care from the parents (and this is mandatory folks!) is not an acceptable piece of this legislation.

It is critically important that you call or write your congressperson immediately and ask them why children would have separate policies. Ask your congressperson what vision care will remain. Ask them what dental care will remain in place? Tell your congressperson that our children deserve the diagnostics of a comprehensive annual vision exam, a complete exam performed by a physician that we choose. Tell your congressperson that our children deserve full dental examinations in dentist’s offices, and that this is about more than cavities and reading glasses.

Please contact your congressperson and explain to them that making an insurance group comprised solely of children is a terrible plan and that healthcare isn’t just about responding to illness. It should be about health.

If you don’t care about kids (I know I didn’t care that much before I had them) you should care because your wallet tells you to. An unhealthy nation is a poor one.

Click here to look up your local congressperson.

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Comments 11

  1. Pediatricians (and schools) cannot detect eye problems in children. They all said my sons vision was normal. We took him to an eye specialist when he was 6 and discovered he had one lazy eye. It’s only treatable until the child turns 9 and we lost valuable time.

  2. Thank you for sharing this. I am all for healthcare reform but as a constituent, it is so hard to follow what is actually going to change and our representatives are not keeping us informed in a way that is understandable to the public.
    I would also be interested to know what will be covered under hearing health for children. Did you know that 1 in 300 children is affected by some sort of hearing loss and hearing aids are NOT covered by most insurance companies? With today’s digital technology 2 hearing aids cost around $6000, not to mention the earmolds ($180) that need to be replaced every few months for growing ears. My 7-year old daughter, who was born with severe hearing impairment, is on her second pair of hearing aids already because like any delicate piece of technology, they need to be replaced every few years. Not one penny of these expenses were covered by our health insurance. It’s simply outrageous.

  3. Great post! This is another example of the devil being in the details. The potential loss of things like vision and dental care is not being talked about by the mainstream media and we need to remind our representatives that we actually LIKE these plans and would like to keep them!

  4. I’m sorry, I don’t understand. Here is the exact language from H.R. 3962, which provides benefits to children that adults won’t be eligible for under a basic plan. (Bearing in mind that this is a BASIC plan, and not a premium plan). As I read it, adults might not have access to standard oral and vision care, but children WILL. What part of the below is objectionable?

    H.R.3962
    Affordable Health Care for America Act (Engrossed as Agreed to or Passed by House)

    SEC. 222. ESSENTIAL BENEFITS PACKAGE DEFINED.

    (a) In General- In this division, the term `essential benefits package’ means health benefits coverage, consistent with standards adopted under section 224, to ensure the provision of quality health care and financial security, that–
    (1) provides payment for the items and services described in subsection (b) in accordance with generally accepted standards of medical or other appropriate clinical or professional practice;
    (2) limits cost-sharing for such covered health care items and services in accordance with such benefit standards, consistent with subsection (c);
    (3) does not impose any annual or lifetime limit on the coverage of covered health care items and services;
    (4) complies with section 215(a) (relating to network adequacy); and
    (5) is equivalent in its scope of benefits, as certified by Office of the Actuary of the Centers for Medicare & Medicaid Services, to the average prevailing employer-sponsored coverage in Y1.

    In order to carry out paragraph (5), the Secretary of Labor shall conduct a survey of employer-sponsored coverage to determine the benefits typically covered by employers, including multiemployer plans, and provide a report on such survey to the Health Benefits Advisory Committee and to the Secretary of Health and Human Services.

    (b) Minimum Services To Be Covered- Subject to subsection (d), the items and services described in this subsection are the following:
    (1) Hospitalization.
    (2) Outpatient hospital and outpatient clinic services, including emergency department services.
    (3) Professional services of physicians and other health professionals.
    (4) Such services, equipment, and supplies incident to the services of a physician’s or a health professional’s delivery of care in institutional settings, physician offices, patients’ homes or place of residence, or other settings, as appropriate.
    (5) Prescription drugs.
    (6) Rehabilitative and habilitative services.
    (7) Mental health and substance use disorder services, including behavioral health treatments.
    (8) Preventive services, including those services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention.
    (9) Maternity care.
    (10) Well-baby and well-child care and oral health, vision, and hearing services, equipment, and supplies for children under 21 years of age.
    (11) Durable medical equipment, prosthetics, orthotics and related supplies.

    (c) Requirements Relating to Cost-Sharing and Minimum Actuarial Value-
    (1) NO COST-SHARING FOR PREVENTIVE SERVICES- There shall be no cost-sharing under the essential benefits package for–
    (A) preventive items and services recommended with a grade of A or B by the Task Force on Clinical Preventive Services and those vaccines recommended for use by the Director of the Centers for Disease Control and Prevention; or
    (B) well-baby and well-child care.

    ACTUARIAL AND ABORTION STUFF HERE OMITTED FOR PURPOSES OF THIS POST ONLY

    (f) Report Regarding Inclusion of Oral Health Care in Essential Benefits Package- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report containing the results of a study determining the need and cost of providing accessible and affordable oral health care to adults as part of the essential benefits package.

    http://thomas.loc.gov/cgi-bin/query/F?c111:2:./temp/~c111KDFczC:e140367:

    The way I read this, I might not have oral or vision (I do, some don’t, but under the plan approved by the House, all CHILDREN will. Period, as part of the basic plan). That’s bad how???

  5. I don’t think Jessica is saying that children WOULDN’T be covered or that requiring them to be covered is not desirable. What I believe she is saying is that because these pediatric benefits have to be provided by a “qualified health plan,” those not-for-profit dental and vision insurers won’t be eligible to offer those pediatric benefits under this section of the bill because to do so they would have to offer ALL of those essential benefits listed above. If a vision plan or say a dental plan, such as Delta Dental (the largest one?), does not also provide hospital coverage, mental health services, maternity care and other services (things they do not cover now because they specialize in one area), they would also not be able to provide those pediatric dental services for which they are, one would have to argue, the experts at providing. Picture this: Imagine if you could buy fruits and vegetables for you and your husband at the local farmers’ market but by law you HAD to buy your child’s fruits and vegetables at Wal-Mart? You’d think that was crazy, right?

    So, if you and your family currently had Delta for your dental coverage, under this bill your child would be forced to get those benefits from a “qualified health plan” (i.e., a big insurance company!) regardless of whether you wanted to keep your current coverage for your child through Delta. It would cause disruptionand limit choice.

    Mind you, the section of the bill you’ve been so kind to post here is but one page of a 2,031 page bill and, as such, just posting this section takes this out of the context of the larger bill. Either way, it just demonstrates how expansive this legislation really is – biting off more than Congress or the American public can chew at one time. Why aren’t they approaching this in a more step-by-step fashion, as opposed to going whole hog? Glad they are requiring that kids be covered but they shouldn’t be so heavy-handed in the approach.

  6. Thanks for the great post on such a hot topic! I had the same take on this that Caroline did. My understanding was that this portion of the bill was designed to ensure that no child gets left behind in health care. Should a parent decide to opt out of coverage (for whatever reasons), they would still be mandated to provide coverage for their children.

    Nonetheless, I will definitely hit Lundgren with an email and ask him to break it down in lay women’s terms! It’s important understand this one.

  7. And I think that a lot of people might have medical insurance for their children, but might not provide separate dental, vision, hearing coverage, because of the additional cost for coverage for dependents under an employment plan. Having all of that included in the actual health plan is very appealing to me for her.

  8. I’m not sure I understand the problem. We don’t have any separate vision or dental coverage, but all of my daughter’s ophthalmologist’s appointments, including surgery at an Eye Institute (rather than a general hospital) were covered. Just because she’s covered by a general health insurance, doesn’t mean that special doctors aren’t covered.

    I do absolutely agree with you that we can’t rely on pediatricians to detect dental or visual or hearing problems. And that dental, visual and hearing services must be covered.

  9. I am missing the problem as well. Here in Canada, we don’t have vision or dental as a part of the provincial health plan. That kind of insurance exists through employers only. But children are covered for dental, eye exams and for vaccinations through the province. This is to ensure that all kids get the basics regardless of whatever insurance their parents employers might or might not provide.

    If I was going to worry about the plan, I might worry more about the fact that being a women is seen by our congressmen as a pre-existing condition and that much of what the average women needs might be left on the Senate floor as the Republicans and Blue-dogs are allergic to the idea that women have “girl parts” that need maintenance. If they have their way, everything between our navels and our knees are going to fall outside what is covered.

  10. In full disclosure, I must first mention that I work for a vision insurance company. However, I am also a mom, and I’m concerned about this issue. Here’s how I see it:

    If a medical plan is required to provide my children with vision and dental coverage, my choice of doctors could potentially be limited. There are no guarantees the medical plan will add my local eye doctor or dentist to their network. President Obama said I would not have to change my doctors, and it’s important to me that I have this choice.

    There’s also nothing in the current legislation that mentions the level of coverage. Preventive care and early detection are a critical part of the care I believe my children deserve. I think it would be a huge step backwards in our healthcare system if coverage moved away from this. Medical care has a history of focusing on treatment versus prevention. What if the medical plans choose to cover vision screenings instead of comprehensive eye exams? There’s a big difference in the two and there’s nothing in the legislation to prevent this from happening.

    Finally, I have first-hand experience using my medical coverage for an eye exam. For a brief period of time, I didn’t have a vision benefit. I knew it was important for my children to get eye exams every year, and I was told my medical insurance would cover the exam.

    I ran into problems before I could even get in the door. I was repeatedly questioned why my children needed an eye exam if I had no indication there was anything wrong with them. Only after realizing my husband was a patient (medical issue) did they finally allow me to make an appointment. Afterwards, it was an absolute nightmare trying to get my medical insurance to pay for the eye exams. In fact, they never did. The doctor tried billing them for six months. The insurance company would not approve the eye exams since my children didn’t wear glasses and had no eye condition. There was no consideration whatsoever for preventive care.

    If eye problems aren’t detected early, permanent damage can occur. If children can’t see clearly in school, their learning can be impacted. What I can’t understand is why I was the only one who seemed concerned about this.

    When I finally got my vision insurance back, I had a much greater appreciation for the care my family now receives. I don’t want to see that end.

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