Congress should revisit the No Surprises Act: a new estimate suggests the law has added roughly $17 billion to health care costs, with spillover effects that can reach premiums, employer spending and, ultimately, patients' access and affordability. For clinicians, that means a patient-protection law that ended many surprise bills may also be reshaping payment rates and practice economics in ways that affect care delivery.

The Move

• The No Surprises Act was designed to protect patients from unexpected out-of-network bills, especially in emergency care and facility-based specialties.

• Critics now argue the law's payment dispute process has inflated reimbursement benchmarks and added an estimated $17 billion in systemwide costs.

• The core policy question for Congress is whether the law's arbitration structure is overpaying some out-of-network claims relative to what lawmakers intended.

Why it Matters for Care

• Higher payment expectations can feed into higher premiums and cost sharing, which can make it harder for patients to afford medications, follow-up visits and elective care.

• Clinicians in emergency medicine, anesthesiology, radiology and other hospital-based fields may feel the effects most directly because those specialties were central to surprise billing disputes.

• Health systems and physician groups may also adjust contracting strategies, staffing and site-of-care decisions based on how lucrative out-of-network dispute awards remain.

Between the Lines

• The law solved a politically potent consumer problem, but payment design always creates winners and losers.

• If arbitration outcomes consistently land above in-network rates, providers and investors have an incentive to stay out of network or use the dispute process aggressively.

• That can weaken insurers' leverage in negotiations and push up commercial spending even as patients are shielded from the bill at the point of care.

What to Watch

• Whether Congress reopens the No Surprises Act and targets the independent dispute resolution process.

• How federal agencies refine implementation rules and whether new data clarify which specialties, markets or claim types are driving the added costs.

• Whether employers, insurers and physician groups make the issue part of a broader 2025 health cost and election debate.

Source: RealClearHealth