The No Surprises Act is tied to an 18% decline in out-of-pocket spending among adults with direct purchase private health insurance, according to a BMJ study published Aug. 27.
The analysis was conducted by researchers from Harvard University and Mass General Brigham and compared 18 states that gained NSA protections with 6 control states that had protections in place pre-NSA. The study population included more than 17,000 adults ages 19 to 64 with direct purchase private insurance drawn from 2019 to 2024. Spending amounts were inflation-adjusted to 2023 dollars.
Five notes:
1. There was an 18% decline in out-of-pocket costs in states with newly gained NSA protections versus states that already had comprehensive protections, with $567 saved per family.
2. In states that gained NSA protections, family out-of-pocket spending fell from $3,674 to $2,922. In control states, it decreased from $2,704 to $2,550.
3. The NSA did not significantly change premium spending or high-burden medical spending.
4. The results were consistent across sociodemographic subgroups, including sex, race/ethnicity, poverty status, education and employment). Sensitivity checks, including an expanded control group (adding 15 states with partial protections) and an analysis that added Medicaid beneficiaries, were broadly supportive of the results.
5. A separate study published Aug. 25 in Health Affairs found that the independent dispute resolution process created under the NSA has generated at least $5 billion in costs since its launch in 2022, largely due to high dispute volumes and provider wins. The high administrative costs will likely lead to higher overall health costs and consumer premiums in the future, according to the researchers.
