Practice Management

OPINION: How the Health Care Debate May Impact Pediatric Vision Care

The finger puppets Dr. Shin sometimes uses with her young patients. Dr. Shin says, regardless of what happens to Obamacare’s pediatric benefit, ODs must make an effort to better serve families with children.

By Lisa Shin, OD

March 22, 2017

The first months of the Trump administration are bringing much debate and some clarity to the future course of health care reform. What this means to optometry is still unfolding.

In recent weeks, House Republicans unveiled a legislative draft of the American Health Care Act (AHCA) that is designed to replace the Affordable Care Act (ACA). Analysts declared that, if passed, the measure would create new winners and losers, favoring the wealthy and hurting lower-income Americans. Objections to the bill were voiced by the AMA and AARP. Several hospital groups said that it would create “tremendous instability” for children, the elderly and the disabled. Conservative critics have called the bill “Obamacare-lite,” replacing subsidies for tax credits, and the individual mandate requiring insurance with higher fees for those who let their insurance lapse. —ROB Editors.

How might the GOP’s repeal-and-replace plan affect optometry? And what can we do about it?

One area of concern to me is pediatric care. The American Health Care Act preserves Obamacare’s essential benefits for the insurance market, but sunsets this requirement for Medicaid recipients. The AHCA would allow states to determine which essential benefits would be covered for their Medicaid recipients. It is possible that Senate Republicans will lobby to remove the essential benefits requirement, including pediatric vision, for both the insurance market and Medicaid. While this will be disappointing to ODs, we must remember that the utilization and awareness of the pediatric benefit has been extremely low. Generally, we have not seen a surge in pediatric eye exams as a result of this coverage.

Even so, ODs that want to see the pediatric benefit included in their state’s Medicaid, should make their voices heard. It is likely that the AHCA will give more control over Medicaid to the states. This means that ODs can play an important advisory role at the local level.

We must not rely on insurers, or the government, to build our pediatric base. Instead, we must aggressively promote ourselves, build trust and gain referrals.

Recently, I gained a referral source through a local learning and educational development (LED) specialist. I informed her about my comprehensive eye examinations that include evaluation for binocular vision disorders. I explained my partnership with HTS, an online, computerized vision therapy program, to treat learning-related vision problems. I have reached out to pediatricians and school nurses. I also discovered that our state’s Lion’s Club not only has an excellent visual screening program in the public schools, but also has an assistance program for needy families. In my area, with the appropriate referral and paperwork, they will pay up to $100 for a children’s eye examination, and $75 for eyewear materials.

Also, I am building my pediatric practice by presenting options for myopia control with every myopic child. Parents are increasingly worried about their child’s nearsightedness. I have found that they are open and quite receptive to this conversation. I share how I wished my OD had given this option to me, as a 13-year-old.  My Paragon Corneal Refractive Therapy (CRT)  lenses have become a valuable asset. I also utilize my multifocal, center-D soft contact lenses. This specialty takes practice and commitment. I show videos on CRT in the waiting room.

I also talk to parents about blue light protection for their kids’ eyes, which means a conversation about spectacle lenses, as well as nutrition.

In addition, I make sure that my office is “kid-friendly” with plenty of games, toys and books. I have mastered the art of retinoscopy: a necessary skill for every pediatric practice. I play cartoons and use finger puppets as fixation targets. During my eye exams with parents, I emphasize the importance of early detection, intervention and treatment of visual problems in children.

I am continually amazed at how many times I am asked: “How soon should I bring my child in for their eye exam?”

For More About the Essential Pediatric Vision Benefit

The AOA Cites the Success of the Pediatric Vision Benefit

AOA: What is Covered

Primary Care Optometry News


How are you building a practice that weathers the political storms, and which includes outreach to families with children? What conversations are you having with parents and children to differentiate your practice from competitors?   



Lisa Shin, OD
, is the owner of Los Alamos Family Eyecare, P.C. in Los Alamos, N.M. To contact:








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