How children benefit from Obamacare

Take-Home

Obamacare’s provision stating vision services for children are essential will help increase the number of young people able to receive check-ups and follow-up care, which are crucial for their well being.

Dr. RepkaBy Rose Schneider, Content Specialist, Ophthalmology Times

Washington, DC-Due to the extensive health-care overhaul that went into affect in October, millions of parents no longer have to avoid getting their child’s vision checked or corrected due to cost concerns.

Because the Affordable Care Act-also known as Obamacare-has designated pediatric vision services as one of 10 essential health benefits, beginning in Jan. 2014, all individual and small groups with 50 or fewer employees have to provide those health plan benefits for children up to 19 years of age.

Come Jan. 2016, coverage will expand to individual and small groups with 100 or fewer employees.

“(The pediatric vision provision) is a great thing,” said Michael X. Repka, MD. “It means that children who have a vision problem will have coverage in any health-care plan . . . (and) it reverses many commercial plans which didn’t cover refractive care.”

The essential services the pediatric vision provision includes are routine comprehensive eye exams and follow-up care. These services were not typically covered previously by insurance plans, said Dr. Repka, medical director for governmental affairs for the American Academy of Ophthalmology (AAO).

“Good vision is key to a child’s physical development, school success and well-being,” Dr. Repka said. “The new (pediatric vision provision) makes it easy for parents to ensure that their children have a healthy start in life and aren’t left behind due to sight problems.”

Before Obamacare

Prior to the health-care overhaul, Campaign for Children’s Health Care conducted a study (“No Shelter from the Storm: America’s Uninsured Children”) and found that more than half of uninsured children have never had a well-child visit, which typically includes a vision screening. The study also found that 1.43 million uninsured children had an unmet vision care need.

“Without coverage, many children make it to the doctor only when something urgent is needed and miss out on the benefits of ongoing well-child care,” the 2006 study stated. “Without adequate preventative care, a child’s health is at risk. Problems that could be prevented or detected early and corrected, can escalate into serious health problems that affect where the child can attend school regularly, participate in physical recreation activities with other children, or develop appropriate social and emotional skills for his or her age.”

Importance

Those statistics alone, Dr. Repka said, are why the vision services provision is so important for a child’s well being.

“How are you going to know if (the child) has a problem?” he said. “Screening lets you know.”

According to AAO, screening is essential in facilitating the early detection and treatment of childhood vision impairments that may not be correctable later in life.

“(Screening) is a quick, efficient, and cost-effective method to identify patients who have indications of a vision problem or a potential vision problem,” AAO stated. “While screening cannot diagnose exactly what is wrong with a child’s eyes, it can indicate whether the child should have a comprehensive eye examination with an ophthalmologist or an optometrist.”

Furthermore, having access to screening is especially important with younger children who may be unable to communicate or recognize a problem, thus going undetected, Dr. Repka said.

“It improves the outcome for them,” he said.

AAO recommends to parents that their children should receive vision screenings at various stages, which can now be a reality for the millions who previously could not afford the price tag without insurance.

Those stages are:

·      All well-child visits from the time they are born until they are 3 years of age.

·      Each year between 3 and 5 years of age.

·      Every 1 to 2 years after age 5.

While Dr. Repka acknowledged there is a risk factor of parents over utilizing the vision screenings now that they are covered, he said the issue is a risk that comes with any insurance benefit.

The pediatric vision provision, he said, is really “a great thing.”

Michael X. Repka, MD

P: 202-737-6662

Dr. Repka has no financial interest in the subject matter.

AAO will be hosting a presentation on the Affordable Care Act and health-care reform during its annual meeting on Monday, Nov. 18 in New Orleans.

(Charts courtesy of Campaign for Children’s Health Care)

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