The Surprising State of the No Surprises Act – Independent Dispute Resolution Reform

When signed into law in 2020, the No Surprises Act (NSA) was designed to lower costs for patients and employers by addressing the issue of surprise medical bills. Unfortunately, the implementation of the law has proven to be the opposite of what employers, and Congress, expected.

Today, the NSA’s independent dispute resolution (IDR) process has actually increased costs as employers are seeing a flood of claims coming through reflecting a system that is heavily tilted in favor of providers.

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Why do employers care?

  • The No Surprises Act IDR process is inflating health care costs, and providers are abusing the arbitration loophole. 
  • Providers are winning more than 85% of arbitration cases, and health plans absorb IDR losses directly. This ultimately increases premiums and health care costs for employees. 

Advocacy Activity

  • On July 10, 2026, ERIC and employers groups sent a letter to the House Ways and Means Committee opposing the No Surprises Act Enforcement Act (H.R. 4710/S. 2420), which will exacerbate the affordability crisis.

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