Effects of Supreme Court’s Decision on Health Care Remain to Be Seen


WASHINGTON, D.C.—Yesterday’s momentous Supreme Court ruling upheld the constitutionality and basic provisions of the Patient Protection and Affordable Care Act, affirming its mandate but complicating the federal government’s plan to extend Medicaid coverage to the poorest Americans. As a result of the Court’s 5 to 4 decision, nearly all Americans will be required to obtain health insurance or pay a penalty.

“The Affordable Care Act’s requirement that certain individuals pay a financial penalty for not obtaining health insurance may reasonably be characterized as a tax,” Chief Justice John Roberts wrote in the majority opinion. “Because the Constitution permits such a tax, it is not our role to forbid it, or to pass upon its wisdom or fairness.”

Although the ruling will still face political challenges, many health care organizations said they are moving forward to implement the reforms stipulated by the federal law. In a statement released yesterday, health care giant Kaiser Permanente said, “Today’s Supreme Court decision on the federal health care reform law resolves much of the legal uncertainty over implementation of the law’s provisions. While acknowledging that political uncertainty still remains, in the interest of our members, we plan to continue our extensive reform implementation efforts, which began two years ago when the law first became effective.”

The ruling has broad implications for the delivery of vision care, at both the federal and state levels. The federal government requires states to organize health care exchanges that will offer consumers a choice of health plans. Beginning in 2014, the exchanges will serve primarily individuals buying insurance on their own and small businesses with up to 100 employees, though states can choose to include larger employers in the future. It has yet to be determined how health care organizations will incorporate vision care plans, including standalone plans, into those exchanges, as VMail has reported.

Professional associations were quick to react to the Court’s ruling. The American Optometric Association (AOA) issued a joint statement from its president, Dori Carlson, OD and president-elect Ronald L. Hopping, OD, that said it “anticipates that federal and state-level agencies will now increase efforts to shape state-based health insurance exchanges and implement further provisions of the sweeping new law, including the AOA-backed Harkin Amendment, Stabenow Amendment, and pediatric vision care essential benefit.” AOA’s statement also said it will “continue working to advance pro-access, pro-patient solutions aimed at ensuring that doctors of optometry and their patients are treated fairly under health reform and that policymakers and others fully understand the central role that optometrists play in enhanced care delivery and improved health outcomes.”

David W. Parke II, MD, CEO of the American Academy of Ophthalmology (AAO), said in a statement that the organization “is committed to working with Congress on solutions to expand coverage for the more than 40 million uninsured individuals in the United States, and simultaneously push for key changes in the health care law that protect patients’ access to quality vision care. The Supreme Court’s ruling that the health care law is constitutional is just one chapter in a book that is still being authored. The outcome of the November elections will be another important chapter. Ophthalmology and the medical community look forward to continuing to play a key role in ensuring the highest quality of care for all Americans.”

The National Association of Vision Care Plans (NAVCP) issued a statement saying it believes “the current ACA (Affordable Care Act) model neglects consumer access and choice when it comes to quality managed vision care. Presently, 90 percent of all Americans with vision plans access care through stand-alone plans, yet these are not offered as an option under the current federal guidelines. Regular comprehensive eye exams not only facilitate early detection of eye ailments and degenerative conditions, but also can detect a number of chronic diseases such as diabetes, thus making vision care a critical component of an individual’s health and wellness regimen. NAVCP will continue to promote the value of quality managed vision care whether it is bundled in a comprehensive health plan or offered on a stand-alone basis to ensure consumers maintain the level of access and choice to which they have grown accustomed and rely upon.”

VSP Global, which runs the nation’s largest stand-alone vision plan, said it would continue to advocate the the inclusion of stand-alone plans in state insurance exchanges.“We remain steadfast in our belief that stand-alone vision plans—which cover over 100 million Americans—should have the opportunity to participate directly in the Exchanges, and we will continue to advocate strongly for independent doctors and their patients towards this goal,” said Stuart Thomas, OD, chairman of the board, VSP Global.