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No. 5: Victory! 22-year battle for Medicare parity succeeds

May 7, 2013

Editor’s Note: To commemorate 50 years of groundbreaking news in optometry, we are publishing the Top 10 AOA News stories as selected by our readers from all five decades. Please share your commentary and personal stories on the site as well (http://connect.aoa.org). The AOA News ran the following article on Nov. 1, 1986.

An event that optometry has been hoping to proclaim for 20 years finally happened last month when Congress approved and the president signed legislation ensuring optometric patient equity under Medicare.

The Medicare provision was contained in the reconciliation package for the 1987 federal budget. President Reagan signed the budget package Oct. 21, and the Medicare provision will become effective April 1, 1987.

The measure allows payment for vision care services performed by optometrists, if the services are among those already covered by Medicare when furnished by a medical doctor, and if the optometrist is authorized by state law to provide the services.

The stunning victory, which AOA President David W. Ferris, O.D., has termed “the greatest legislative achievement in the history of optometry,” caps a 20-year effort by the AOA. Since Medicare was enacted in 1965, the AOA has campaigned for optometrists to be recognized as vision care providers under the system, which provides health care to 30 million Americans.

A special section inside this issue of the AOA News examines the Medicare provision, what it means and the effort behind the passage of the measure. Also included are interviews with Dr. Ferris and the measure’s two Congressional sponsors, and reflections of several optometrists who have been involved in the long struggle to obtain Medicare parity.

Supposedly ‘dead’ Medicare issue becomes AOA’s ‘greatest legislative achievement’

Six months after organized ophthalmology declared optometric parity under Medicare a dead issue for the rest of the 99th Congress the American Optometric Association has claimed its greatest-ever legislative victory.

AOA’s 20-year battle for full reimbursement under Medicare ended in this stunning victory when Congress passed its 1987 budget reconciliation bill, signed by President Reagan on Oct. 21 (PL 99-509).

Included in the bill is the long-sought change in Medicare allowing payment for vision care services performed by optometrists, if the services are among those already covered by Medicare when furnished by a medical doctor, and if the optometrist is authorized by state law to provide the services.

The new provision—the so-called Mikulski amendment, named after its author, Rep. Barbara Mikulski, D-Md.—will take effect April 1, 1987.

“This is the greatest legislative achievement in the history of optometry and the American Optometric Association,” said AOA President David W. Ferris, O.D.

“It firmly establishes optometry as a primary health care provider, and provides optometrists with an opportunity to recapture the older-adult patient base which has been eroding over the years as a result of Medicare discrimination. All AOA members can be proud of their national organization for this stunning victory on behalf of the profession and elderly patients.”

Dr. Ferris, who played a key role in the bill’s passage by testifying several times before Congressional committees, emphasized that the new provision will provide relief to many Medicare patients who until now have been forced to leave their practitioner of choice, pay out-of-pocket for services or forego care altogether.

“This will be a major benefit to these patients by increasing access and competition,” Dr. Ferris said, adding that the provision enjoyed the strong support of many senior citizens organizations, including the 20-million-member American Association of Retired Persons.

Passage of the Mikulski amendment culminated over three years of efforts by Mikulski and colleague Rep. Bob Whitaker, R-Kan., a former optometrist, to solve the Medicare issue.

The two were successful last year in having the provision included in the 1986 budget reconciliation measure, only to have it removed at the last minute along with other items because of veto threats by the Administration. At that point the American Academy of Ophthalmology and others in Washington declared the provision would not resurface because of pressure on Congress to adopt a 1987 reconciliation measure that met the spending targets set by the Gramm-Rudman deficit reduction law.

According to Dr. Ferris, AOA’s Washington staff and consultants rejected this conventional assessment and predicted correctly that the fear of Gramm-Rudman automatic budget cuts would have exactly the opposite effect.

“Our Washington representatives were convinced that widespread support for this provision still existed, and that ultimately the Administration would have to accept a 1987 package that included some minor spending provisions if it met the Gramm-Rudman targets and avoided automatic cuts,” said Dr. Ferris. “Much of the credit for keeping this provision alive and seeing it through goes to them for having the foresight to read the situation correctly and the lobbying strength to get the job done.”

Within weeks after being dropped from last year’s reconciliation measure, the Mikulski amendment was reintroduced by a number of key members of the House, including Reps. Pete Stark, D-Calif., chairman of the Ways and Means Health Subcommittee; John Duncan, R-Tenn., ranking Republican on Ways and Means; and Henry Waxman, D-Calif., chairman of the Energy and Commerce Health Subcommittee.

In July, the Energy and Commerce Committee approved the provision as part of its reconciliation package. Also approved by Energy and Commerce were substantial cuts in the fees paid for cataract surgery, a significant development, according to Harvey Hanlen, O.D., chairman of the AOA Federal Relations Committee.

“This served to put organized ophthalmology on the defensive, force them to fight two major battles at once, and undercut their argument that optometric coverage was a wasteful expansion,” Dr. Hanlen said.

Although it would take the House until September to approve a reconciliation package, there was more good news for AOA in August when the House Republicans drafted an alternative package that sought to achieve more savings, but retained the vision care provision. While the package was ultimately not offered, the message on vision care was clean—House Republicans supported this provision and agreed that Gramm-Rudman targets could be met without dropping it.

After returning from the August recess period, the House and Senate approved different versions of reconciliation; among the differences, the Senate did not include the vision care language. In late September, conference began meeting to work out a final agreement acceptable to both bodies and the Administration.

Several weeks of negotiations and many late night sessions finally produced a consensus agreement which met the deficit targets and included the optometric provision. Key players in protecting the House position on vision care were Republicans Whittaker and Duncan and Democrats Stark and Waxman.

There were still some anxious moments as a last-minute dispute on a provision to expand the Aid To Families With Dependent Children program held up final action, but once this issue was resolved, both bodies passed the conference agreement overwhelmingly on Oct. 17.

Four days later President Reagan signed the bill into law, and optometry’s 20-year dream became reality.

“So much went into this effort. It really was a team victory,” Dr. Ferris said. “The Federal Relations Committee kept on top of the issue all the way, our Keyperson program did a great job of making back home contacts, and our Washington office and representatives provided an outstanding professional effort.”

Dr. Hanlen echoed Dr. Ferris’ comments. “This has been AOA’s No. 1 priority for years, and the Federal Relations Committee wants to thank everyone who helped us make it over the top,” he said.

Both Drs. Ferris and Hanlen emphasized the same kind of effort would be needed to work out the details of optometric reimbursement with the Health Care Financing Administration and provide members with guidelines for dealing with the program and patients.

“The Federal Relations Committee has already started to work in this area, and working together with the Third Party Committee we are committed to making the transition from only aphakic care as smooth as possible,” Dr. Hanlen said.

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