S-1716-119
Read twice and referred to the Committee on Health, Education, Labor, and Pensions.
Sponsored by Kevin Cramer (R-ND)
What it does
This bill would amend the Public Health Service Act to set two new rules for vision plans. First, it would cap the initial term of any agreement between a vision plan and an optometrist at two years, with renewals allowed in two-year increments only if the optometrist affirmatively accepts each extension. Second, it would prohibit vision plans from restricting which laboratories, suppliers, or sources an optometrist may use when providing eyewear or other vision services to covered patients. The bill also establishes a federal-state enforcement framework, requiring the Secretary of HHS to annually notify states of their enforcement authority and to step in with federal enforcement if a state declines or fails to respond.
Who benefits
Optometrists (doctors of optometry) who currently operate under long-term or auto-renewing vision plan contracts they cannot easily exit, and who may be restricted to specific labs or suppliers. Independent optical laboratories and smaller or regional suppliers who may currently be excluded by plan-mandated lab restrictions. Patients who may gain access to a wider range of lens and eyewear products if their optometrist is free to choose among suppliers. New or independent optical suppliers seeking to compete with large, plan-affiliated labs.
Who is hurt
Large vision insurance plans (such as VSP, EyeMed, and Spectera) that currently use long-term contracts and lab-exclusivity arrangements as part of their business model. Plan-affiliated or in-network optical laboratories that benefit from mandatory referral arrangements. Employers and plan sponsors who may face higher administrative costs or premium adjustments if plan networks are restructured. States that currently regulate vision plans differently may face compliance complexity under the federal-state enforcement notification process.
Supporters argue
Supporters argue that dominant vision plans use long-term contracts and mandatory lab restrictions to lock optometrists into arrangements that limit professional independence and steer patients toward plan-affiliated labs regardless of quality or cost. They contend that freeing optometrists to choose their own labs and suppliers would increase competition among optical laboratories, potentially improving product quality and reducing costs, while giving patients access to a broader range of eyewear options. They further argue that two-year contract caps with affirmative renewal requirements restore basic bargaining fairness to a market where individual optometrists have little leverage against large national vision plans.
Opponents argue
Opponents argue that vision plan lab networks exist to ensure quality control, standardized pricing, and coordinated care — and that eliminating lab restrictions could fragment supply chains, raise administrative costs, and ultimately increase premiums for enrollees. They contend that two-year contract caps with mandatory affirmative renewal requirements would create significant administrative burdens for plans and providers alike, potentially destabilizing network arrangements that currently keep vision benefits affordable. They further argue that the federal government is intervening in a market that states already regulate, and that the bill's enforcement notification mechanism adds bureaucratic complexity without clear evidence that existing state oversight is inadequate.
Constitutional context
Congress regulates health insurance markets under the Commerce Clause (Art. I, §8, cl. 3) and the Taxing and Spending Clause. The bill amends the Public Health Service Act, a well-established exercise of Commerce Clause authority over interstate insurance markets. No active constitutional tension is implicated, though post-Loper Bright (2024), any HHS regulations implementing the bill's enforcement notification mechanism would face independent judicial review rather than automatic deference.
Checks and balances
Congress gains authority to set contract and supplier-choice standards for vision plans; HHS implements the annual state-notification and enforcement mechanism; states retain primary enforcement authority and exclusive jurisdiction where state law directly governs vision insurance issuers, with federal enforcement as a backstop.
Historical precedent
The Federal Trade Commission and several states have previously examined optometry market restrictions — including lab mandates — as potential antitrust concerns, but no directly analogous federal statute governing vision plan contract terms and lab-choice restrictions has been enacted.