The Congressional Budget Office (CBO) is calling for more research into the No Surprises Act to evaluate the law’s effect on healthcare prices and network participation, amid growing concerns that it “might not have the effects that CBO anticipated.”
The No Surprises Act was signed into law on Dec. 27, 2020, to protect patients from surprise billing. It prohibits certain out-of-network providers from balance billing patients unless the patient is notified of their network status—and requires independent dispute resolutions (IDR) between payers and providers for out-of-network charges.
The agency originally estimated the legislation would reduce in- and out-of-network prices, in turn reducing premiums insurers charge by roughly 1%. CBO notes that projected estimated savings were partially offset by several factors, including increased spending by insurers on newly covered out-of-network care, greater healthcare services utilization and administrative costs.
“Although prices for some services that had high rates of surprise billing before the law's enactment have declined (after adjusting them for inflation), several published reports indicate that providers are winning more than eight in 10 IDR cases and are being awarded payments that are much higher than expected, particularly in certain geographic areas,” the agency said.
Providers' frequent arbitration victories and the high volume of filed disputes have frustrated payers, who have rolled out targeted policies and launched lobbying campaigns in an effort to clamp down on what they describe as a broken system.
The CBO, meanwhile, is seeking more information on the law’s impact on healthcare prices, network participation, ownership structures, arbitrators’ decision-making processes and incentives and how healthcare markets can “continue to evolve” in the face of the law.
While an August 2024 analysis found the law protected patients from more than 10 million surprise medical bills, the arbitration process is proving costly.
An August 2025 study from Georgetown University researchers found the IDR system cost $5 billion to manage—$2.24 billion of which were additional payments from plans to providers.
The U.S. Centers for Medicare & Medicaid Services (CMS) finalized a rule in late May aiming to overhaul the law’s protocols. The rule would reduce administrative fees on disputes from $115 to $15 and allow for multiple claims to be resolved in a batch—in effect lowering the barrier for more likely-to-succeed dispute filings from providers.
CMS said that there are plans to launch a centralized platform for monitoring disputes that progress to the IDR phase, dubbed IDR Gateway.