Why Vision Care Should Be Included In Obamacare’s ‘Essential Health Benefits’

Under President Obama’s landmark health reform law, states will institute — either on their own or with the help of the federal government — insurance exchanges that will act as virtual marketplaces where Americans can purchase health coverage. Plans on these exchanges must include benefits across ten broad “essential health benefit” categories, including preventative care, maternity care services, and prescription drug coverage. But experts are now saying that states should go beyond the federal standard and designate vision care as an essential health benefit, too.

According to Kaiser Health News, while states mandate vision benefits for children, adults are largely left to fend for themselves, perpetuating a system in which otherwise insured adults decide to forgo vision care rather than pay for crucial treatments out-of-pocket:

[R]esearchers found that more than 40 percent of people in their study lacked vision insurance. They also looked at a subgroup of about 12 percent of people in the study who reporting having glaucoma, macular degeneration, or cataracts — the three leading causes of vision loss in the U.S. About 40 percent of that group also did not have vision insurance. Yet nearly 90 percent of both groups had health insurance.

Dr. Sudha Xirasagar, who oversaw the study, said she was particularly surprised to see such a high number of people without vision insurance, particularly those with serious eye conditions.


“Lack of vision insurance impedes eye care,” Xirasagar said, which “may irrevocably affect vision.”

The researchers also found that people with vision insurance were more likely to have seen an eye doctor within the past year and were less likely to report having difficulty seeing and reading.

“You would think that people who have glaucoma and macular degeneration should be worried about their eyes and should be going and getting [care] regardless of whether they have vision insurance or not. But they don’t, which is a bad thing,” said Xirasagar.

The American Academy of Ophthamology estimates that by age 80, more than half of all Americans have cataracts, accounting for $6.8 billion in annual health spending. And as lawmakers in Washington consider raising the Medicare eligibility age to 67, more and more seniors may have to rely on Obamacare’s insurance exchanges for their care — furthering the case for vision benefits as an essential need.