Rep. Frank Pallone (D-NJ), one of the architects of the landmark No Surprises Act, is now calling for a major overhaul of the very system he helped create. His new bill, the Lower Premiums, Faster Payments Act, would eliminate the law's Independent Dispute Resolution (IDR) arbitration process and replace it with market-based benchmarks based on median in-network rates—with payments required within 30 days of a filed claim.

Pallone says the NSA largely succeeded in shielding patients from surprise medical bills, but a "few bad actors—largely backed by private equity" have exploited the arbitration system, creating backlogs, delaying payments, and driving up premiums. Arbitration firms have overwhelmingly sided with providers, and a flood of disputes—many aided by third-party vendors—has frustrated payers and employers alike.

By the Numbers:

• $22.4 billion — total IDR system costs through end of 2025, far exceeding Congressional projections
• 30 days — required payment window under the proposed new system
• Providers have won the vast majority of arbitration rulings, with payers pushing back via targeted policies and lobbying campaigns

Why it matters: If Pallone's party retakes the House, he's in line to chair the Energy and Commerce Committee—giving his bill a real shot at advancing. The outcome could reshape how out-of-network billing disputes are settled, with major implications for providers, insurers, and patients' premiums.