Recent developments have cast uncertainty over the future health of the No Surprises Act, a law designed to protect patients from unexpected medical bills. Despite President Donald Trump's previous commitment to eliminating surprise medical billing, the federal office responsible for enforcing the law—the Center for Consumer Information and Insurance Oversight (CCIIO)—has seen significant budget cuts. This reduction in staffing raises concerns about the agency’s ability to oversee compliance and effectively regulate disputes between healthcare providers and insurers.
At the same time, new data from the U.S. Department of Health and Human Services reveals that healthcare providers are winning the majority of reimbursement disputes under the No Surprises Act's Independent Dispute Resolution (IDR) process. In the first six months of 2024, providers prevailed in approximately 84% of cases, suggesting that insurers have been undervaluing medical care in out-of-network claims. Emergency department and radiology cases made up the majority of disputes, with Aetna, Anthem, Cigna, and UnitedHealthcare involved in roughly 65% of the claims.
While the IDR process has seen improvements—reducing the number of ineligible disputes from 22% in 2023 to 18% in 2024—the increasing caseload underscores the necessity of strong enforcement mechanisms. Without adequate staffing and resources at CCIIO, insurers may find loopholes to underpay providers, ultimately undermining the law’s intent.
The No Surprises Act was a landmark step toward shielding patients from financial hardship due to unexpected medical costs. However, enforcement remains critical. Weakening oversight could tip the scales in favor of insurers and erode the protections that patients and providers have fought hard to secure. As the battle over surprise billing continues, policymakers must ensure that the law remains intact and that those responsible for enforcing it have the necessary support to uphold its promises.
