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When Protections Work but Processes Stall: Evaluating the No Surprises Act's Implementation Record.
Kennah Watts1, Jack Hoadley1, Kevin Lucia1
1Georgetown University.
Journal of Health Politics, Policy and Law
|June 5, 2026
Summary
The No Surprises Act protects patients from surprise medical bills but faces challenges in its independent dispute resolution (IDR) process, potentially increasing healthcare costs. Policy solutions are needed to address implementation issues and legal challenges.
Area of Science:
- Health Policy
- Healthcare Economics
- Medical Law
Background:
- The No Surprises Act was enacted to protect consumers from unexpected medical expenses and control healthcare spending.
- A key component, the independent dispute resolution (IDR) process, aims to resolve payment disputes between providers and payers.
- However, the implementation of the IDR process has encountered significant legal and regulatory hurdles.
Purpose of the Study:
- To evaluate the effectiveness of the No Surprises Act in achieving its dual objectives.
- To analyze the challenges and unintended consequences arising from the implementation of the IDR process.
- To propose recommendations for improving future healthcare policy implementation and mitigating legal challenges.
Main Methods:
- Review of legislative intent and statutory provisions of the No Surprises Act.
- Analysis of litigation and rulemaking challenges associated with the independent dispute resolution (IDR) process.
- Examination of potential economic impacts and unintended consequences on healthcare costs.
Main Results:
- The No Surprises Act has successfully protected consumers from surprise medical bills.
- Implementation of the IDR process has been hindered by extensive litigation and rulemaking difficulties.
- These challenges may lead to increased, rather than decreased, healthcare costs due to implementation issues.
Conclusions:
- While consumer protection goals are being met, the cost-containment objective is threatened by IDR process implementation failures.
- Future healthcare policies require robust strategies to prevent legal challenges and ensure smooth implementation.
- Addressing the current challenges is crucial for the No Surprises Act to fully achieve its intended economic benefits.
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