Critical moment: AOA mobilizes for VBM reform

With a critical congressional window approaching, nearly 35 leading AOA doctor advocates answered the AOA's call and traveled to Washington, D.C., for a targeted push to advance federal Vision Benefit Middlemen (VBM) reform. 

The AOA Federal Keypersons mobilized for direct lawmaker advocacy with nearly every member of the House Energy and Commerce Committee, urging leaders to advance bipartisan reforms to the increasingly costly, controlling and care-limiting abuses of VBMs. 

The rapid mobilization comes as the AOA continues to press for action as Energy and Commerce leaders move closer toward advancing VBM reform. The committee has so far secured a Government Accountability Office report on the abusive VBM market and began consideration of VBM reform language at the July Health Subcommittee hearing and then again at a full committee hearing, with promises of further action in the coming weeks. 

"When there is an opportunity to move meaningful reform forward for our patients and profession, optometry shows up," says AOA President Teri K. Geist, O.D. "Advocates from across the country answered the call and came to Washington at a crucial moment to make sure lawmakers heard directly from doctors about why VBM reform matters for practices and for patient care. This is what sustained advocacy looks like, and we will keep pushing until patients and doctors have the choices they deserve." 

AOA keypersons push targeted federal VBM reforms 

The advocacy focused on provisions championed by Reps. Buddy Carter, R-Ga., and Yvette Clarke, D-N.Y., that ban VBM lab monopolies, close a federal loophole claimed by abusive VBMs, and require VBM-doctor contracting fairness. 

Offered in June 2026 by Reps. Buddy Carter, R-Ga., and Yvette Clark, D-N.Y., the Carter-Clarke Amendment draws from the widely supported DOC Access Act (H.R. 1521) and mirrors provisions in the Senate's bipartisan Vision Lab Choice Act (S. 1716). The targeted reforms complement VBM laws enacted in nearly 25 states while addressing federally regulated plans that state reforms cannot reach. 

The reforms would: 

• Ban lab monopolies: Prohibits insurance and VBM plans from requiring doctors or patients to exclusively use optical laboratories owned by the insurer. 
• Close loopholes claimed by abusive VBMs: While many states have enacted and are actively strengthening access laws, federally regulated plans (like ERISA) use harmful loopholes. This legislation will fully enforce lab choice at the federal level. 
• Require contracting fairness: Reforms the contracting process to ensure full flexibility and choice for patients and doctors. 

Together, the reforms would push vertically integrated VBMs to compete for business rather than rely on mandates directing patients and doctors into affiliated supply chains. 

Patient advocates unite behind bipartisan reforms to bring transparency, competition and choice to vision care 

The AOA's push has support beyond optometry. 

Dozens of leading national patient organizations, including the National Consumers League and Patients Rising, have urged Congress to advance the Carter-Clarke reforms, citing concerns about consolidation and vertical integration in the vision benefit market and their effects on competition, provider independence and consumer choice. The organizations called the proposal a "thoughtful, bipartisan effort" focused on commonsense reforms. 

Their support reinforces the fundamental issue at stake: patients should have greater choice and doctors should be able to make decisions based on what works best for their patients, rather than being locked into a VBM's affiliated supply chain. 

The bipartisan reforms would promote transparent competition and patient choice in one of the most concentrated segments of the health care market, helping ensure that vision care decisions are driven by the needs of patients and their doctors. 

$12.5 million returned to doctors from AOA reimbursement, coverage fairness advocacy 

The Capitol Hill push is one part of the AOA's broader effort to challenge unfair payer and vision plan practices on behalf of doctors and patients. 

AOA reimbursement and coverage advocacy has returned more than $12.5 million to doctors across the country and helped stop downcoding programs implemented by Aetna and Humana. 

For doctors, those interventions matter. Fighting an improperly denied or reduced claim costs practices time and money that could otherwise be spent caring for patients. In fact, the average cost of fighting a single claim is $43.83, while 97% of denied dollars are eventually paid—evidence that many claims should have been paid from the start. By combining federal and state legislative advocacy with direct payer intervention, the AOA is working to address unfair practices both systemically and when they affect individual practices. 

If you experience payer issues, contact stopplanabuses@aoa.org to enlist AOA support on your behalf.