No Surprises Act Implementation Challenges: Roundtable Discussion on Volume, Costs, and Outcomes, Plus Future Reforms

Session Submission Type: Late-Breaking Roundtable

Abstract

The No Surprises Act was a part of the 2021 Consolidated Appropriations Act, and its main provisions ban surprise balance bills for out-of-network emergency, ancillary, and air ambulance services and establish an Independent Dispute Resolution process for out-of-network health care providers and insurers to resolve payment disputes. This federal law was passed with bipartisan support and initially hailed as a victory for consumer protection. Yet in recent months, nearly five years after the law’s passage, members of Congress from the U.S. Senate Committee on Health, Education, Labor, and Pensions and the U.S. House Committee on Ways and Means have issued letters to the Secretaries of the Departments of Health and Human Services, Labor, and the Treasury urging rulemaking reforms.

The No Surprises Act seems to be protecting patients from balance bills and has lowered out-of-network payments for emergency, ancillary, and air ambulance services. Yet the volume of cases brought to Independent Dispute Resolution and the costs of the process far exceed the initial expectations of regulators. Recent analyses by researchers at Georgetown University indicate that the costs of the Independent Dispute Resolution process reached $5 billion over its first three years. The roundtable will debate the pros and cons of the No Surprises Act’s implementation so far, and how the policy may or may not be achieving its intended goals. The future of Independent Dispute Resolution implementation will also be discussed, including the revised rulemaking proposed by regulators in 2024 and the Speakers’ own views on potential improvements.

This roundtable includes experts with extensive qualitative and quantitative research on the No Surprises Act Independent Dispute Resolution implementation, and diverse economic and policy perspectives. Speakers include Petra Rasmussen, a policy researcher at RAND, who has led ASPE-sponsored research on the No Surprises Act implementation since 2022; Kennah Watts, a research fellow at the Center of Health Insurance Reforms at Georgetown University’s McCourt School of Public Policy, who has published numerous influential analyses of independent Dispute Resolution outcomes and administrative costs; and Erin Duffy, an assistant professor at the University of Southern California Price School of Public Policy and scholar at the Schaeffer Center for Health Policy and Economics, who has authored several qualitative and quantitative studies on the implementation of the No Surprises Act. The panel will be moderated by Adam Biener, an associate professor of economics at Lafayette College, who has studied the magnitudes of surprise bills and the impacts of the No Surprises Act.

Policy Area

• Health Policy

Secondary Policy Area

• Politics, Media, and the Policy Process

Moderator

• Adam Ira Biener, Lafayette College

Organizer

• Erin Duffy, University of Southern California

Speakers

• Erin Duffy, University of Southern California

• Kennah Watts, Georgetown University