CBO Seeks Research on the Unintended Effects of the No Surprises Act
On June 15, 2026, the Congressional Budget Office (CBO) issued a call for research, requesting data on the impact of the No Surprises Act (NSA) on healthcare prices and network participation. Specifically, the CBO seeks data that address the following questions:
Are price trends causally related to the NSA? They are seeking evidence on whether changes in prices or network participation vary with the independent dispute resolution (IDR) system used.
What alternative benchmarks are being used? The CBO seeks information on quantitative or qualitative research into arbitrators' decision-making processes and the incentives they face.
Who is participating in the process? The CBO believes that early evidence indicates that large organizations dominate arbitration activity, potentially disadvantaging smaller providers and encouraging consolidation.
What is the NSA?
The NSA, enacted on December 7, 2020, as part of the Consolidated Appropriations Act of 2021, was created to protect patients from unexpected, large “balance bills” for out-of-network care. While it applies broadly to patients covered by group and individual health plans, the law primarily affects emergency care, anesthesiology, radiology, and air ambulance services. The NSA banned balance billing and established the IDR process in 2022. Providers and payors must resolve disputes through binding arbitration rather than billing patients.
Why is the CBO requesting this research?
There is a general consensus that the NSA is protecting patients from surprise bills, but debate remains over whether the arbitration process is increasing healthcare prices. Some early data indicated that it was reducing service prices, while others believe there is evidence that premiums are increasing due to the size of arbitration awards, which incentivize physicians to stay out of the network.
Position of stakeholders?
Payors complain that providers win most cases and receive payments significantly higher than standard network rates. In contrast, physicians complain about the administrative backlog of complaints, insurer nonpayment, and a lack of transparency in arbitration. Since 2022, numerous lawsuits have been filed, and advocacy efforts have sought to reform the process.
On September 28, 2026, the final rule for the No Surprises Act (NSA) was released. The rule focused on improving the implementation of the NSA-established independent dispute resolution (IDR) process. The Biden Administration first proposed the rule in 2023. Notably, the final rule lacked enforcement provisions. Providers have raised concerns that they are not being paid, or are not fully paid, after an arbitration decision is finalized.
Congress is working to address the enforcement gap through the bipartisan, bicameral No Surprises Enforcement Act, introduced on July 23, 2025.
What’s next?
The law will continue to evolve through action by the Trump Administration and Congress, as well as through advocacy by stakeholders. Data collected by the CBO could help inform future efforts related to this law.
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For more information and questions, please contact:
Sheila Madhani
Madhani Healthcare Consulting
Email: smadhani@madhani-health.com
Tel: (202) 679-2977