Al Cleinman's Blog

VSP Moves to Mail Order Eyewear - Providers are Out, Out, Out!

Dateline:  Sometime in the not too distant future:   In an effort to continue it's growth against competition from the likes of Highmark and EyeMed, and to further reduce employer costs for eyecare/eyewear plans, VSP announced that it was going "direct to consumer" with the sale and delivery of eyewear. 

"We now control over 50 million patients (that's 1 in every 6 Americans) and have the purchasing and technology clout to deliver unprecidented savings to our employer groups and individual subscribers," said a VSP spokesperson.  "We have the resources and technology to eliminate the middleman and, in the case of eyewear, the Optometrist Provider is simply not necessary," he said. 

The announcement above is bogus and is this author's creative endeavor. 

Ask yourself an important question.  Can the above happen?  What's to prevent it?    Eyewear is now sold daily through a host of internet providers and estimates indicate that the delivery system currently controls as much as 10% of all eyewear/sunwear volume.  What's to stop VSP from harnessing the technology that they know so well?   Further, VSP has your patient list and controls a significant portion of many Provider's business now.  Unless en masse, Providers simply won't be able to drop VSP in a defensive move, since, for many, VSP represents the lion's share of their business.  Providers will be left with just the medical/refractive side. 

VSP has all the assets it needs to take the Provider out of the loop on eyewear; as well as, perhaps, a compelling competitive reason (and advantage) to do so.  With Marchon (frames), VSP Labs (lenses) and Eyefinity/Officemate (internet and computing technology), direct delivery to consumers appears a logical next step.  Why not?  VSP is already selling consumers directly (see June 15th post).  VSP certainly demonstrates little care for the economic health of its Providers.  There's little to prevent them from eliminating the Provider entirely from the eyewear delivery system. 

Sorry, Providers, you're just not needed!  Will you join the ranks of stock brokers and travel agents?  Will the internet do you in?  What can you do, now, to prevent this eventuality (think "patient experience")?

Think losing your eyewear business isn't logical or possible? Take a look at what's going on in the pharmacy world.

http://money.cnn.com/2009/06/16/smallbusiness/small_pharmacies_fight_for_suivival.smb/index.htm

Providers - Send a Thank You to VSP

In a recent press release, VSP proudly announced that the "individual vision plan" they launched two years ago has now gained more than 25,000 members; that's about one patient for every VSP provider.

 The release went on to say that, according a recent survey, 16 percent of respondents "invested in individual vision care benefits due to unemployment or forced reduced hours, causing them to lose access to vision care." (author's emphasis)

Further, VSP informed us that "of the individual-plan members who are employed, more than 50 percent said they do not have vision coverage at work." (author's emphasis)

Gary Brooks, president of VSP Vision Care, went on to note in the release that VSP’s individual plan has seen “a large uptick in 2009.” Brooks said VSP attributes that increase to the plan’s personalized service and  affordability (author's emphasis).

Hm-mm.  I wasn't aware that VSP provided personalized service and affordability.  If I understand correctly, VSP provides NOTHING but administrative and marketing services.  Is it not VSP's providers who deliver these attributes which VSP so proudly calls their own?  Is it not these providers who are taking it in the shorts while VSP is walking away with profit adequate to fund tens of millions in excessive management benefits and perks annually; near $billion acquisitions and global expansion efforts? 

And with 25,000 providers within minutes of virtually everyone; with the likes of WalMart, Shopko, Lenscrafters, Pearle, etc; since when do consumers lack access to vision care? 

VSP Providers should send a letter of thanks to VSP.

*    Thank you for reaching into our patient files and re-selling our services at deep discount to individuals who would otherwise likely have been willing to pay U&C. 

*    Thank you for recognizing that we have no individual marketing capability; that we're lost without you. 

*    Thank you because, as just lowly optometrists, we know that we can only survive by selling all of our services at a deep discount. 

*    Thank you, for showing us that the only way to develop a successful brand is to position ourselves as the proverbial "Monty Hall"...let's make a deal with everyone. 

*    And while we're at it, Thank You VSP for unilaterally cutting our contact lens and second-pair reimbursements/allowances so that our margins continue to erode, further reducing our ability to invest in the services that you describe to YOUR customers as "personalized." 

When will Providers rise up and finally say "we're sick and tired of someone else controlling our destiny and we're not going to take this anymore?"

VSP Study Supports Significant Increase in Provider Reimbursements

In a recent press release, VSP announced the results of a study that indicates that annual eye exams save companies nearly $3 billion each year.  That's great and very logical.  And I trust that VSP will be making the study available to all it's Providers for use in their individual marketing efforts.

These results certainly appear to be very compelling and I applaud the study.  Great job VSP (I really mean it)!

Reading the Study from a different direction, the results are also reason why VSP should be able to convince employers to increase their investment in vision care for their employees and, as a result, bring Provider reimbursements to a realistic level. 

But one doesn't really have to look to VSP's customers (employers) for rationale for improvement in reimbursements.  While VSP's 2008 Audited Financials (reflecting the impact of the Marchon acquisition) don't yet appear to be available through my source, here's a copy of their 2007 Auditor's Report for your viewing pleasure (Download VSP 2007 Financials).  As this report shows, for 2006 and 2007,VSP had net income (after reserves for taxes) of over $100 million each year!  That's after paying  their employees what can only be viewed as ludicrous benefits and outlandish salaries. 

So let's assume for a moment that 50% of that income is reasonably available for distribution to the Providers whom VSP purportedly serves.  After all, reserving $50million in capital each year (VSP has a net worth in excess of $1billion and cash/securities as of 12/31/07 of almost $800 million) should be adequate to fund capital investments and their required statutory reserves of about $15million. 

The result would be a distribution of about $2,000 per Provider each year.  Not great, but it helps.

But now, since VSP has proven that employers save about $3billion a year through annual eye exams, it seems safe to say that employers would be thrilled to save, say, only $2.5 billion.  After all, that's a huge return on their premium investment and a compelling bottom line improvement.  That would give VSP the ability to improve reimbursements by, let's say, about $20,000 per Provider per year.  Now that's real money and would finally bring Provider reimbursements in line with increasing costs.

I know that VSP would say "that's ridiculous, it's a cold, cruel world out there and we have to compete."  That's logical, after all, VSP is the "high cost producer" in the "managed vision" world.  VSP premiums are higher than most other plans.  Unfortunately, what none of the plans seem to get is that Providers require margins to continue to invest in people, facilities and technology to deliver the very health benefits that the VSP Study proves are of such value.  And that, without quality Providers, all these managed care businesses are worthless..can't operate...nada...vaporized...or...as my grandfather would say..."kaput." 

Hmmm, I wonder when Providers will finally say "we're sick and tired of being treated like dog dirt and we're not going to take this anymore?"  What would the result be of a unilateral "strike" during which all optometrists simply refused to accept any vision care plans?  What would happen if optometrists simply told plan participants, "I'm sorry, Mrs. Jones, your insurance is not reimbursing us at a level at which we can continue to provide the quality care that you expect from us.  So, we've decided to participate in a national boycott for the next week to send a message to these plans and to your employer that we can't deliver what you expect us to deliver without adequate reimbursements.  I'm sure that you can understand this...our plight is the same as if your employer reduced your hourly wage by 50%."   

Perhaps, only then, will the likes of VSP, EyeMed, Spectera and Davis and the employer groups whom they represent (they sure as heck don't represent Providers) stand up and take notice? 

 

 

 

VSP - The Rabbi and the Beggar

In a recent letter to VSP providers, VSP says:

a) It's a competitive market (duh!)

b) They've lost some business to "retail friendly plans" (read EyeMed)

c) To compete, they're dictating some changesin reimbursements (ie: you're going to suffer)

VSP's solution is to increase the discount on 2nd pair sales for eyewear purchases on the same day as an exam from 20% to 30%; Move more contacts to tiered pricing; and eliminate the $2 case fee and the patient supplied frame fee.

Oh...the good news is that they did promise to allow you to provide in-office finishing for select programs beginning in early 2010 (no details).  Perhaps VSP is reading my blog:)

What VSP is really saying here is that, because they want their premium income to rise and they're challenged to sell against a price competitor, Providers are, once again, going to take it in the shorts. 

What's interesting is that these changes appear to have little impact on VSP premium pricing.  They're modifications that will be perceived by employers and consumers as enhancements but which seemingly carry little cost toVSP...they come from the Provider. 

VSP, if you're really worried about competition, why not simply reduce your employer 401k contribution from an outrageous 15% of payroll to the more standard 3%.  Based on just that action, my simple math indicates that you could roll back premiums to employers by about 2%.  Then, add in the $75,000 company cars for management and all the other outrageous benefits that you give your employees and I'll bet you could roll back premiums by as much as 5% WITHOUT TAKING A DIME FROM YOUR UNDERPAID AND UNAPPRECIATED PROVIDERS. 

This reminds me of the scene from Fiddler on the Roof in which the beggar is shouting "alms for the poor" and the rabbi hands him one Kopeck.  The beggar says, in response, "but Rabbi, last week you gave me two Kopecks"  The rabbi retorts "I had a bad week"...to which the beggar responds, "so you had a bad week, why should I suffer!"

VSP, it's time for you to suffer along with your Providers.  Tighten your belt, just as you have continually forced belt-tightening on your Providers.  It's time to share in the pain instead of operating like Fat Cats and living off the largesse of your Providers.

VSP's Provider Network to Include Chains and Private Opticians?

A fellow blogger sent me the following question:

 

What do you hear about VSP opening up their plans to chains and other "types" of practices who they previously didn't offer the ability to be a provider for their insurance?

I hear they are still not going to allow an independent optician to be part of their network.

 

VSP is faced with some significant competition from EyeMed, which certainly includes chain retailers in the form of Lenscrafters and Pearle.  So, VSP might feel compelled to add some kind of provider alternative to combat EyeMed's promoted advantage (Mr. Employer Group - "our Lenscrafter's relationship provides your employees with 7 day a week service access and the pricing advantages of Lenscrafters").  So, we might see VSP making an attempt to combat that "advantage." 

 

As for adding private opticians to their provider network, I think that anything along those lines is pure conjecture and, perhaps, wishful thinking on the part of opticians. What purpose would it serve?  Certainly, it would appear that there's little benefit on the insurance side and, indeed, such a move represents additional cost to VSP. In my opinion, as it relates to the insurance side, VSP doesn't need more "independent" providers.

 

On the Marchon side, one would guess that they thought this situation through prior to the acquistion and feel they're going to add more opportunitywith the VSP association then they'll lose because of pushback from non-VSP customers frozen out of the Provider Network.  That said, one has to believe that Marchon's focus, and perhaps even VSP's, is largely international. That was a significant stated objective with the acquisition.  One can assume that the addition of Claudio Gottardias Marchon's COO only supports that focus. 

 

On the lab side, it would appear beneficial for VSP to open its doors to opticians...but why would opticians follow (there's lots of good labs and price competition is fierce)and would the resulting push-back from their current provider network be worth it? And then one must consider that non-examining opticians (vs. optician/O.D. combinations) are not much of a market for Officemate products.

 

In the US, VSP already "owns" 55 million consumers.  That's what has driven their business in the past. Now, with the loss of their non-profit status and their acquisition of Marchon, one must question who VSP is today.  Are they a provider of patients to their private O.D. network?  Are they a supplier of frames and lenses?  Are they an integrated retailer?  Until they answer this question with their actions, we'll have a hard time predicting their moves.

Perhaps, the real question is: Does VSP care enough about its existing provider base to be loyal to them at the expense of Marchon market share? Can they serve multiple masters?

 

Let's see.

 

 

Managed Care Math

Here's an interesting depiction that might explain the ongoing struggle over profit margins in the managed care environment.  Perhaps, what ECPs are faced with, is a misunderstanding over basic math.

Download Managed Care Math

SIGN UP NOW FOR MORE MANAGED CARE...MILLIONS OF LIVES ARE YOURS FOR THE ASKING.

According to an industry release, a new managed vision care company, ExcelVision, is opening its doors and will be soon recruiting providers.  The firm’s claim to fame is that they are opening the doors to all three O’s (now that's interesting) and “hope to reach 20,000 providers by this time next year.”

 

According to the release, after more than a year of planning, ExcelVision is getting underway in the first quarter of this year, and providing its first vision services in early March. “ExcelVision has developed a high-quality, fully insured vision plan with a national footprint, with policy filings in 50 states,” ExcelVision’s chief executive officer, Joe Zambito is quoted as saying “Our distribution partners represent a membership base of more than 11 million lives.”

I have but one question.  WHY THE #$@&% DO WE NEED ANOTHER MANAGED CARE VISION COMPANY?

 

My guess is that the vast majority of prospective providers will agree with me.  And before you begin salivating over the “membership base of 11 million lives” one might translate the wording of the comments as "we have talked with a bunch of associations or unions who might be interested in our services if we can find providers."  This writer doesn't believe for a minute that they've a firm contract for anything.  Having cut my teeth in the managed vision care arena in the mid 1980’s, I understand this language when I see it.

 

The solution? 

 

Stop them cold in their tracks. 

 

Don’t sign up.   

 

These plans are all alike.  They announce that they’ve got all these lives and that becoming a provider is a ticket to all this volume.  Then they sign up providers who are anxious for volume and buy their double-speak.  They then go to the buyers of services (associations, employers, unions, etc.) and sell the provider panel. 

 

No provider panel.  No sale. 

 

Your question is simple.  Will I have a chance at these lives if I don’t sign up.  Given that you’ve got the likes of VSP, EyeMed, Spectera and Davis out pounding the pavement anxious to sell your services at a deep discount, the odds of these lives going unserved are slim and none.  They'll end up with one of the plans you already know...and the devil you know is better then the devil you don't know.  

 

It’s time to take a stand. 

A Conversation with VSP's Chief Financial Officer...and some observations.

I came across this interview of VSP's CFO.  It's interesting reading and provides some insight into the thinking of your largest customer (for those readers who are private practice optometrists).  Some observations:

a) It's interesting to note that VSP describes themselves as a "provider."  Funny, I thought they were an insurance company.  Not once did the interviewee describe how VSP works with providers.  This supports my theory that VSP believes that they own you.

b) Note the discussion about how important their financial control system is.  Take a lesson from that...invest in yours.  Margins are eroding and those of you who receive timely and accurate financial information will be rewarded.

c) Note the discussion about how their financial control system allowed them to identify unprofitable products and eliminate them. Do you have the same ability?  Further, I wonder if they anayze the profit impact of their products on their providers...doubtful.

d) Note that VSP is seeing huge claim volume, and blame it on folks using their benefits before they lose their job.  This confirms an observation that I communicated last fall.  Eyecare and eyewear will see (and is seeing) strong demand among the independent providers due to Flex Plan spending (at year end) and benefit demand closer to eligibility.  In years past, when consumers had more confidence, they likely didn't use their eyecare benefits immediately as they became eligible. With jobs threatened, this is happening.  The inverse of this is the possibility that demand will deteriorate later this year.

What other lessons can you derive from this post?

VSP’s CFO Discusses Budgeting in Uncertain Times

Steve Player February 12th, 2009

Among the different subjects touched upon in our upcoming Business Finance interview with Patricia Cochran, CFO of Vision Service Plan, we thought Patricia’s comments surrounding budgeting and forecasting may hold special interest to finance professionals at large. Here’s a short excerpt:

Steve Player: Tell me a little bit about what VSP does, for those of our readers who may not know which eye care plan they’re actually using.

Patricia Cochran: VSP stands for Vision Service Plan. We provide eye care as an employee benefit. We’ve been in business a long time — since 1955. We are the largest provider of this service, covering over 55 million people throughout the United States, which means that about one out of every six people has our vision coverage.

We primarily sell it through employers as well as associations. We also have an individual plan so people can buy it directly. We provide eye exams, eyeglasses, and contact lenses if patients need vision correction.

SP: My introduction to VSP was through the company’s activity-based management program. What were you aiming to achieve when you set up activity-based costing, and what role does it play today?

Cochran: In my earlier years working here, I kept hearing from my colleagues in management, “If only we understood our costs!” They wanted to know what it cost to do a particular piece of work, and they couldn’t decipher it through the traditional accounting that we were doing for them. I thought there had to be a way to get that understanding to them. When I first started the activity-based cost program, I thought, “This is something that they will understand, versus natural classification of expense or department reports.”

At this point the management teams in our organization know so much about their costs — they can’t escape! Before it was a mystery; now it’s no longer a mystery. They understand how much it takes to do the work they’re doing, and whether it’s creating value.

Activity-based costing has been very helpful for us. We’ve dropped some products that really weren’t profitable. As much as we wanted to hang on to them, the facts were the facts, and so we dropped them. It’s definitely been a value-add.

SP: Have you made any major changes in planning and budgeting, or do you have a fairly traditional budget?

Cochran: I’d say we’re still doing traditional budgeting. One thing I’ll add, though, is that the budget isn’t static, because we can adapt to various business changes.

We do the budget in a condensed timeframe; we give people about six weeks.

SP: So you’re not a six-months-process type of organization …

Cochran: No, we get that thing done! And then, on an ongoing basis every month, our business leadership team — the four company presidents, the CEO, the CFO, and the VP of HR — gets together, and if there are any changes that need to be made, we talk about those as a group. Do we need to increase an activity? Do we need to make a strategic investment in a business or a product line? The budget isn’t set in stone, and it does evolve during the year, but there are some pretty substantial discussions among the top leadership team before any changes are made.

SP: How far out do you forecast?

Cochran: We do a pretty good job of forecasting for the next two years. We try to do some forecasts out five years, but I’d say those are pretty big guesses.

SP: How does VSP deal with the kind of volatility we’ve seen since the back half of 2008? I assume some of your customers have been laying people off, so they have fewer employees for their health programs to cover. How does that impact you?

Cochran: We’ve been impacted from two standpoints. One, as you mentioned, is that unemployment is not our friend. The second thing is that when people are nervous about losing their jobs, they use their benefits at an extraordinary level. They’re thinking, “I’d better use it today, because who knows whether I’ll have it tomorrow.” So we’ve seen a real spike in utilization. In all the time I’ve been here, I’ve never seen a utilization pattern like this last year.

Our seven-executive budget oversight committee is where we think this through. Obviously, we want to safeguard our employee base; our talent pool is our future. With that as an underlying premise, we looked at our discretionary spending areas — some of which are nice to have, some of which are part of our culture here — and we thought about them in tiers: If we need to start paring back because of shrinking enrollment, what’s our first tier? What are our second and third tiers? So we’re ready to execute if we have to.

VSP's Court Case - Revisited

By now, you're aware that the Supreme Court turned down VSP's request to hear their appeal about the revocation of their non-profit status by the IRS.  What follows is a great assessment of the crux of this case and, although written before the case was rejected, provides some good insight into the issue.  The next question is...what will VSP do in response and will this impact anything?

 

Vision Service Plan v. U.S. may answer the question: What is charity?

 

• By Bruce D. Collins

Published in the 2/1/2009 Issue of Inside Counsel.

The public is used to hearing about the Supreme Court’s rulings on things like the rights of the accused or the First Amendment, and they assume other subjects get similarly regular attention. But we lawyers know it’s a big deal when the court rules on an issue in our practice areas. I daresay every legal specialist can identify at least one issue important to his or her practice that has been hanging around for years waiting for dispositive treatment by the high court.

Because the stakes can be high on which way the court rules, much energy is put into getting the right set of facts for your side in the certiorari chain. Both defendants and plaintiffs alike know they will probably get only one bite of the apple so they want the case the court hears to be "just right."

But the court does not always oblige us in its choice of cases. They must pick from real cases and controversies, not from idealized test cases with perfect facts. Thus it is that the non-profit, tax-exempt world awaits whether the court will decide to hear Vision Service Plan v. U.S.

The case could answer the fundamental question: "What is a charity?" In 2003, the IRS revoked Vision Service Plan’s 40-year-old tax-exempt status as a social welfare organization because the nation’s largest provider of insurance for eyeglasses and contacts provided benefits only to its members and subscribers. The IRS and the 9th Circuit called that an impermissible "private" benefit rather than a permissible "community" benefit. The difference between the two means a lot to the $1 trillion non-profit health care industry, especially the non-profit HMOs.

The crux of the case is that the IRS got two federal judges to agree that VSP was run more like a for-profit business than a non-profit business and that it did not provide charity aid to a larger community. The courts pointed to several aspects of VSP’s operations as being too uncharitable, including, unfortunately, the high salaries and bonuses of its executives.

And this is the problem with this case as a test case on the fundamental meaning of "charity." It is possible the non-profit sector could be punished for the same reason the big three auto executives got so much heat for flying into Washington, D.C., on their private jets to ask Congress for a taxpayer bailout. Regardless of the merits of the auto industry’s argument, the public and politicians focused their ire on the private jets to the near exclusion of everything else. It is no wonder the car guys went back to Detroit empty-handed after their first visit to Capitol Hill.

Similarly, the district court judge zeroed in on the "luxury company cars" VSP provided its chief officers and executives as evidence VSP acted more like a for-profit company than not. He noted the company offered its executives "high salaries and other forms of compensation" more akin to for-profits. The top executive, for example, received $1.3 million in 2004. One of those other forms of compensation included "bonuses that are taken directly from … net earnings."

The judge thought they looked too much like stock dividends that for-profit executives would enjoy. He wrote that one year VSP paid $19 million in broker commissions, which was more than it spent on charity work that year. Tsk. Tsk. Finally, the judge said VSP’s 2003 surplus of "more than $300 million" sounded more like ordinary commercial activity than it did aiding the poor.

You see the problem. VSP’s lawyer, Kenneth Starr (of Monicagate fame), has argued that the IRS acted rashly in revoking VSP’s tax exemption. But the frou frou of luxury cars and huge salaries and bonuses could well tip the balance against that argument no matter how well it is articulated. With that in mind, if this case goes to the Supreme Court, the VSP executives should consider driving to D.C. in a plain American-made sedan.

Bruce D. Collins is the corporate vice president and general counsel of C-SPAN, based in Washington, D.C.

Should VSP Retain Non-Profit...Tax Free...Status?

The following post on another blog is typical of the PR effort that VSP appears to be making.  I suggest that it's a PR effort because, of the dozen or so that I've read like this, they all seem to be saying the same thing and using the same words. 

It appears to me that this is a simple question.  Does the structure of VSP, given its foray into for-profit businesses, warrant tax-free status.  The vast majority of their revenue comes from for-profit businesses (employers) and the vast majority of their expenses go to for-profit businesses (providers).  So why shouldn't they contribute to the tax needs of the country.  While I'm all for tax-free status to legitimate charities...I fail to see the societal benefit of such status in this case, unless its to fund the 15% 401-K grant and other significant benefits and salaries of VSP employees and officers.  There's no doubt that VSP is a good corporate citizen...but at who's expense? 

What do you think?  If you think VSP should retain tax-free status, post your comments below. 

_________________________________________________________________________

The Supreme Court will soon have the opportunity to decide whether to hear a case that could have tremendous impact on the ability of private, nonprofit charities to provide health care and other services to the poor. The case involves the Internal Revenue Service's decision to strip Vision Service Plan (VSP) - a California-based nonprofit which provides vision-care insurance to 55 million Americans - of its tax-exempt status. VSP is fighting the IRS' decision five years ago to revoke its (501(c)(4) status as a tax-exempt social-welfare organization - one it had held since 1960.

The high court will decide by Jan. 9 whether to hear the lawsuit VSP filed to overturn the IRS decision. If VSP loses, the result could be very damaging to a wide array of private, nonprofit organizations.

The VSP case illustrates how bureaucrats in the executive branch quietly expand their power to rewrite federal laws enacted by Congress with the acquiescence of the federal judiciary. In 1960, VSP became a 501(c)(4) tax-exempt organization. In 1986, Congress amended the law to take tax-exempt status away from providers of "commercial-type" insurance - a change that was aimed at Blue Cross insurers, who were tax-exempt even though they operated in much the same way as for-profit companies. But the 1986 amendment contained "safe harbor" language that was understood at the time to preserve the tax-exempt status of most nonprofit health maintenance organizations, and VSP's exemption was not challenged by the IRS until 1999, when the firm expanded from regional to national operations. The IRS opened an inquiry into VSP's tax-exempt status that year, and in 2002 it announced that effective Jan. 1, 2003, the company would lose its tax exemption.

VSP began paying taxes in 2003, but filed suit in an effort to overturn the IRS ruling and get the tax money back. In December 2005, a U.S. District Court judge in Sacramento ruled in favor of the IRS, holding that the company was ineligible for 501(c)(4) status because it was operated in a manner similar to for-profit organizations. But the ruling did not address the 1986 amendment. It was appealed to the U.S. Court of Appeals for the Ninth Circuit, which in January affirmed it in a short (three-paragraph-long) ruling that also did not address the 1986 measure. Congress - which could clarify the situation - has failed to act, abdicating the issue, at least for now, to the federal courts.

These misinterpretations of federal law could have devastating results for people served by VSP and other HMOs. VSP General Counsel Thomas Fessler told The Washington Times that since 1997 his organization has donated more than $90 million worth of free health care to poor children through a program called "Sight for Students." Three national charities that are partners in the program with VSP - Prevent Blindness America, the National Council of La Raza and the National Association of School Nurses - signed an amicus brief warning that the IRS decision threatens to "divert to the federal treasury funds from the Sight for Students program" - thereby jeopardizing health care for poor children.

The Supreme Court should hear the Vision Service Plan case.