{"id":5995,"date":"2026-08-01T10:42:54","date_gmt":"2026-08-01T10:42:54","guid":{"rendered":"https:\/\/nextcitydigest.com\/?p=5995"},"modified":"2026-08-01T10:42:54","modified_gmt":"2026-08-01T10:42:54","slug":"jarvis-the-no-surprises-act-needs-a-dose-of-sunlight","status":"publish","type":"post","link":"https:\/\/nextcitydigest.com\/?p=5995","title":{"rendered":"Jarvis: The No Surprises Act needs a dose of sunlight"},"content":{"rendered":"
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The Trump administration recently said it wants to \u201cclean up\u201d the No Surprises Act, the law that ended surprise billing for medical emergencies but opened up the healthcare system to exploitation. Now, a law that does a lot of good for individual patients could wind up raising costs for everyone.<\/p>\n

Read more Horoscopes August 1, 2026: Jason Momoa, expand your interests and to learn something new<\/a><\/p>\n

To understand what went so wrong, policymakers need a better grip on the players and processes that have caused a well-intended law to go so far off course. As is so often the case, sunlight could be the best disinfectant.<\/p>\n

To be clear, the principle behind the No Surprises Act is a good one. People experiencing health emergencies shouldn\u2019t be stuck with surprise bills because someone on their care team isn\u2019t covered by their insurance. And that used to be common: Before the law, about one in five Americans who had visited an emergency room later received an unexpected bill from an out-of-network provider. Those bills could leave even well-insured patients with thousands of dollars in out-of-pocket costs.<\/p>\n

Patients no longer are on the hook for such bills, which is a win. But the law, which directs providers and insurers to settle payment disputes between themselves, has created a new problem. When an out-of-network provider and an insurer can\u2019t agree on a payment, the law calls for an arbitrator to be brought in to settle the matter. And as I recently explained, the system seems ripe for exploitation.<\/p>\n

First, the system has been overwhelmed with disputes \u2014 millions more than government officials had anticipated. And the vast majority of disputes are being won by providers, who are getting payouts that can far exceed the industry standard. In 2025, they received six times the rate insurers pay for in-network services on average, according to a\u00a0Wall Street Journal\u00a0analysis.<\/p>\n

A spokesman for the\u00a0Centers for Medicare and Medicaid Services\u00a0recently told the\u00a0New York Times\u00a0that the law \u201cis being gamed to get higher prices, and CMS is actively working to clean it up.\u201d<\/p>\n

Federal officials have yet to outline what that would entail. But there are a few obvious places to start.<\/p>\n

Opaque rules<\/h4>\n

Their first stop should be the arbitration firms that decide whether a doctor\u2019s or insurer\u2019s proposed payment is fair. Nobody can explain why physicians are overwhelmingly winning these disputes \u2014 especially when they are asking for payments that are so far outside the norm.<\/p>\n

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The law had laid out guidelines for arbitration firms, which must be certified by the government. It originally called for these independent judges to benchmark payments against the rate insurers typically paid for similar services in an area. But provider groups challenged that practice in court \u2014 and won.<\/p>\n

Read more Dear Abby: Should I ask my friend for her side of this disturbing story?<\/a><\/p>\n

That\u2019s left arbitrators using a process that\u2019s frustratingly opaque to outsiders. \u201cA better sense of what happens under the hood, and how they\u2019re reaching their judgment\u201d would help everyone understand where things are going wrong, says\u00a0Zach Cooper, a health economist at\u00a0Yale University.<\/p>\n

More transparency around the ownership structures of the arbitrators is also needed. Although firms aren\u2019t supposed to be connected to an insurer or provider, those relationships can be murky.\u00a0The Private Equity Stakeholder Project\u00a0found that at least five of the 16 arbitration firms accredited by the\u00a0Centers for Medicare and Medicaid Services\u00a0are backed by private equity \u2014 some by more than one investment firm. The PESP also found at least one instance of a private equity firm owning both an arbitrator and a provider group that initiated disputes under the law. Identifying these potential conflicts of interest is paramount.<\/p>\n

Malign actors<\/h4>\n

And scrutiny shouldn\u2019t stop with the arbitrators. Of the millions of claims being filed, the majority are being brought by a small number of physician groups, many of which are owned by private equity firms. It\u2019s not surprising that private equity might take advantage of this system \u2014 after all, private equity-backed physician staffing firms previously profited from charging consumers for emergency services not covered by their insurance.<\/p>\n

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Those firms have the financial wherewithal to navigate the dispute system, says\u00a0Kennah Watts, a research fellow at Georgetown University\u2019s Center on Health Insurance Reforms. Smaller, independent physician groups might not be able to afford to sit on a bill for months while the arbitration process unfolds, let alone be on the hook for the arbitration firm\u2019s fees if they lose, she explains.<\/p>\n

Now, though, billing firms are popping up to draw more providers into these payment disputes. Where health economists see a policy gone far awry, these middlemen see, as one put it in a recent webinar to potential clients, \u201ca big, underutilized opportunity\u201d for doctors. They offer to streamline the process of filing claims, tout their success at securing higher payouts for providers, and typically only take a cut if they win a dispute.<\/p>\n

The proliferation of these businesses should shock no one, Cooper says. After all, before the No Surprises Act, consultants had emerged to help out-of-network physicians recover payments from patients. \u201cIf there are profits to be had, it\u2019s going to create incentives for malign actors to take advantage of the law,\u201d he says. \u201cThis is why it\u2019s so critically important to get a better sense of what the arbitrators are doing, how they\u2019re thinking about the rulings, and what outcomes they get.\u201d<\/p>\n

Identifying and closing loopholes in the law wouldn\u2019t just be good for patients and the healthcare system \u2014 ideally, it would prevent vulnerabilities from being carried into future laws. The No Surprises Act doesn\u2019t cover every aspect of emergency care, and emergency care isn\u2019t the only situation where patients are sidelined by unexpected bills. As lawmakers try to bring more transparency into the healthcare system, they should learn from this experience.<\/p>\n

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry.\u00a0\u00a92026 Bloomberg. Distributed by Tribune Content Agency.<\/em><\/p>\n

Read more Harriette Cole: Am I expecting too much from my not-boyfriend?<\/a><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

How a well-intended plan to protect patients from unexpected ER charges turned into a cash cow for middlemen<\/p>\n","protected":false},"author":1,"featured_media":5994,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8],"tags":[],"class_list":["post-5995","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-opinion"],"yoast_head":"\nJarvis: The No Surprises Act needs a dose of sunlight - Next City Digest<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/nextcitydigest.com\/?p=5995\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jarvis: The No Surprises Act needs a dose of sunlight - Next City Digest\" \/>\n<meta property=\"og:description\" content=\"How a well-intended plan to protect patients from unexpected ER charges turned into a cash cow for middlemen\" \/>\n<meta property=\"og:url\" content=\"https:\/\/nextcitydigest.com\/?p=5995\" \/>\n<meta property=\"og:site_name\" content=\"Next City Digest\" \/>\n<meta property=\"article:published_time\" content=\"2026-08-01T10:42:54+00:00\" \/>\n<meta name=\"author\" content=\"admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995\"},\"author\":{\"name\":\"admin\",\"@id\":\"https:\\\/\\\/nextcitydigest.com\\\/#\\\/schema\\\/person\\\/13065d40d633843429ac57d4e5c06f9b\"},\"headline\":\"Jarvis: The No Surprises Act needs a dose of sunlight\",\"datePublished\":\"2026-08-01T10:42:54+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995\"},\"wordCount\":1034,\"commentCount\":0,\"image\":{\"@id\":\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/nextcitydigest.com\\\/wp-content\\\/uploads\\\/2026\\\/08\\\/ddb52b1250b7a171bfa6607e280eebec-scaled.webp\",\"articleSection\":[\"Opinion\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995\",\"url\":\"https:\\\/\\\/nextcitydigest.com\\\/?p=5995\",\"name\":\"Jarvis: The No Surprises Act needs a dose of sunlight - 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