Health groups urge Congress to fix costly surprise billing arbitration
A coalition of 67 health care and advocacy groups has sent a letter to congressional leaders calling for changes to the No Surprises Act's arbitration process, which they say has become a financial burden. The baseball-style arbitration system, intended as a rare fallback, is now frequently used and has led to providers receiving payouts averaging over six times local in-network rates. Lawmakers on key committees are exploring reforms, including a Senate roundtable and House inquiries into arbitration firm practices.
The letter, sent to the top four congressional leaders, highlights that the arbitration mechanism has become a default rather than a rare exception. Providers prevail in most disputes, securing payouts averaging more than six times the local in-network rate. These payments totaled $15 billion in 2025 alone, contributing to higher premiums for employers and employees.
In response, Senate HELP Chair Bill Cassidy plans a roundtable, while Rep. Frank Pallone Jr. is probing arbitration firm practices. House Ways and Means Republicans are also examining rising costs. The coalition advocates replacing the current system with a benchmark tied to Medicare or median in-network rates—a proposal rejected during the original law's creation. With the House entering recess until after the election, legislative action is limited to the lame-duck session.
The arbitration cost surge could indirectly raise health insurance premiums for millions of Americans, as employers pass on higher costs. This may strain household budgets and employer finances. The proposed shift to benchmarking could alter provider reimbursement incentives, potentially affecting network participation and patient access. If Congress fails to act, the financial burden may persist, but the ongoing legislative attention suggests a possible resolution that could stabilize costs, though the outcome remains uncertain.