A law aimed at making healthcare more affordable may actually be driving up premiums, according to a new Georgetown University study.
Researchers found that the No Surprises Act, a law addressing the issue of surprise medical billing situations for care received out-of-network, has driven up arbitration costs between doctors and insurers, hitting $22.4 billion in 2025.
And the study found evidence that those costs are a reason for employers and insurers to raise premiums. The findings were shared on Wednesday in Health Affairs.
“We actually think our estimate is conservative,” said Jack Hoadley, one of the authors of the study and a professor at the university’s McCourt School of Public Policy.
The Independent Dispute Resolution (IDR) process brings in a neutral third party to consider the best payment when an insurer and provider cannot reach an agreement. The arbiter then asks both sides to submit proposals with supporting documentation, and then that same arbiter selects the winning proposal while weighing several factors. The losing party also pays additional fees. In 2025, the median provider award was 445% higher than averages paid by in-network insurers to providers.
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Researchers also noted that costs have not primarily been driven by providers the bill was intended to target, such as air ambulance services. Instead, surgeons and neurologists made up most disputes, and awards decided by arbiters in those negotiations seem to have no limit.
“The time may, in fact, be ripe to revisit [the law] to realize the law's original cost containment goals without jeopardizing the consumer protections that are really the main reason this law got passed in the first place,” he said.
Despite high costs, researchers noted that the law is technically working. According to the study, providers won approximately 85% of disputes in 2025. But researchers warn those costs are likely to weigh on insurance premiums of everyday Americans.
The study follows a call to action by the nonpartisan Congressional Budget Office over the summer, which noted that the law “might not have the effects” experts anticipated.
