Employers and consumer groups ask Congress to fix perceived loopholes in No Surprises Act arbitration

# What happened Nearly 70 organizations representing employers, patients and labor unions sent a letter to House and Senate leaders calling for changes to the No Surprises Act's independent dispute resolution (IDR) process. They say the law has prevented millions of surprise bills, but that current IDR procedures are producing higher health care costs for plans and consumers.

# Why the groups are concerned The signatories point to a Georgetown University analysis estimating that IDR-related costs topped $22 billion in 2025. They say the number of cases going to IDR has exceeded federal projections and that payouts to providers are rising at the same time.

The letter highlights two dynamics the groups see as problematic:

• Concentration of cases. A relatively small number of provider organizations and newly emerged IDR intermediaries account for a large share of IDR filings and awards.
• Financial incentives to continue. Because these entities often achieve favorable outcomes and high payouts, the letter argues they have little reason to stop filing large numbers of disputes.

# What the groups are asking Congress to do The letter proposes two primary changes:

• Replace the current baseball-style arbitration with a predictable, transparent benchmarking model. Under benchmarking, payments would be tied to a clear reference (for example, median in-network rates or another market indicator), which the groups say would provide certainty for patients, payers and providers.

• Establish a fair, market-based payment methodology to reduce opportunities for gaming the arbitration system and to prevent excessive reimbursements.

# The groups' framing They describe the No Surprises Act as a major bipartisan consumer protection that successfully prevents direct surprise bills. However, they write that the law's promise of protecting patients while lowering costs has been compromised by how IDR is operating in practice.

# Immediate implications If lawmakers act on the recommendations, the arbitration process would shift toward greater price transparency and predictability for plan budgets. If Congress does not act, the coalition warns that continued IDR patterns could press plan sponsors to adjust benefits, network participation or premiums to manage growing arbitration-related expenses.

# What to watch next