The Congressional Budget Office is requesting more research on the No Surprises Act.
In a June 15 website post, CBO called for research relying on more recent data, as claims data for existing studies end in 2023, while arbitration patterns were just beginning to emerge. CBO also hopes to solidify whether price and network trends are related to NSA, isolated from other factors. Other recommended research includes quantitative or qualitative insights on arbitrators’ decision making and possible incentives, as well as healthcare market evolution in the wake of the law.
CBO said it previously expected NSA, designed to protect patients from unanticipated medical bills if they get care from out-of-network facilities or providers during emergencies, to contribute to commercial plan premium reductions of 1%. Due to lower federal subsidies, federal deficits could fall by $17 billion from 2021 to 2030. However, the agency is now questioning whether those projections will take hold.
The agency acknowledged how data points to the NSA protecting patients from unexpected bills. Out-of-network claims and patient cost sharing have dipped since the law’s enactment.
But independent dispute resolution cases have surpassed projections, along with many of their awards. There were 3.4 million disputes filed from 2022 through part of 2025, far above the roughly 22,000 projected per year. Awards often exceed 400% of Medicare rates. With providers winning more than 80% of cases, arbitration could enable them to threaten remaining out of network, giving them leverage in contract negotiations and affecting premiums.
In 2023 and 2024, five organizations accounted for almost 60% of IDR filings. Many cases were backed by private equity or revenue-cycle management firms and concentrated in certain markets. Insurers have pushed back against this dynamic. For example, after a California federal judge dismissed an Elevance Health subsidiary’s challenge of claims management company HaloMD in April, the insurer appealed.
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