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The law meant to shield patients from unexpected medical bills is now fueling higher premiums and narrower insurance networks. A surge in arbitration disputes — with providers winning ~85% of cases and often receiving payouts far above in-network rates — has insurers, employers, and patient groups demanding reform. But a divided Congress and entrenched provider-insurer tensions make a quick fix unlikely.
The No Surprises Act (NSA), passed in 2020 to protect patients from shock medical bills, is generating some serious unintended consequences. A flood of arbitration disputes — over 5 million since 2022 — has providers winning roughly 85% of cases and walking away with payouts well above typical in-network rates. A new NBER working paper warns this is nudging providers to stay out of insurer networks, while insurers facing more arbitration are hiking premiums. A coalition of 67 patient and employer groups is now urging Congress to act.
The blame game is fierce. Insurers say providers — especially private-equity-backed practices — are gaming the system with inflated claims. Providers fire back that insurers routinely lowball offers, forcing disputes in the first place. Meanwhile, a Trump administration rule aimed at streamlining arbitration may actually increase dispute volumes by lowering filing fees and expanding "batching" of claims.
By the Numbers:
Why it matters: Without reform, dispute volumes will keep climbing, pushing up premiums for everyday Americans — the very people the law was designed to protect.
