The No Surprises Act could be a shock to the U.S. health care system

The 2022 bipartisan fix

When the No Surprises Act took effect in 2022, it represented one of the rare moments of bipartisan problem-solving in recent U.S. health care politics. The law targeted a specific, painful experience: insured patients who, often after emergency care, would receive bills from out-of-network providers embedded in their treatment. According to Lisa Jarvis writing in Bloomberg, the law "took that problem out of patients' hands, requiring insurers and out-of-network doctors to settle on a fair payment." The intent was simple — stop the financial bleeding for patients who had done everything right and still ended up with ruinous debt.

The law's structure is worth understanding. Rather than letting patients fight individual billing battles, the No Surprises Act shifts the dispute to a back-end process between insurers and providers, leaving patients out of the negotiation entirely. That design choice is precisely what made the legislation politically viable across the aisle. It also created the conditions for the current problems, because any back-end dispute mechanism can be optimized by whichever side has more resources and expertise.

A $12,000 broken ankle

Jarvis illustrates the issue with a vivid example: a person rushed to the hospital with a broken ankle requiring emergency surgery, only to later receive a $12,000 bill because one provider was out of network. Before the act, "that happened all the time, even to people with generous coverage," she notes — and in fact, this exact scenario happened to her editor. The anecdote grounds the policy in lived experience, making clear that the No Surprises Act addressed a real and recurring crisis, not a theoretical one.

That kind of story was, in effect, the political fuel behind the law. Insured Americans who kept up their premiums and used in-network facilities were being clobbered by bills they had no realistic ability to dispute at the moment of care. The bipartisan outrage that produced the 2022 legislation came directly from how visible and how visceral those stories were, and it explains why the law survived attempts to weaken it.

The arbitration system pressure

Now, however, the protection that spared millions of Americans from unexpected medical costs may itself be driving up overall health care spending. Jarvis reports that flaws in the arbitration system meant to mediate disputes between insurers and out-of-network doctors are inflating health care costs and insurance premiums. The bipartisan solution, in other words, may be producing its own unintended consequences.

The article does not detail which specific flaws are doing the damage, but the underlying concern is familiar to anyone who has watched regulatory design meet behavioral adaptation: when one side of a market can repeatedly game the dispute-resolution mechanism, back-end costs migrate into higher premiums and broader medical inflation. For U.S. consumers, the practical effect is that the protection from individual surprise bills may be offset by the gradual rise in what they pay for coverage itself. The story frames the law as a rare success in patient protection whose mechanical implementation is undermining its broader fiscal goals — a tension that will need legislative or regulatory attention if premiums are to stabilize.