With affordability top of mind for voters and policymakers heading into the midterm elections, Paragon Health Institute’s Brian Blase and Jackson Hammond make the case in a new Washington Post op-ed that tackling the “unintended consequences of the No Surprises Act’s arbitration system,” known as independent dispute resolution (IDR), should be a top priority for congressional leaders. Given that arbitration’s “price tag is likely to grow and could add hundreds, if not thousands, of dollars to health insurance premiums,” addressing the cost of IDR has become mission-critical to improving healthcare affordability for millions of Americans.
Key highlights (emphasis added):
- “With less than a month before the midterms, Republican and Democratic candidates both say affordability is a priority. They could start by addressing the unintended consequences of the No Surprises Act’s arbitration system.”
- “A new Paragon Health Institute analysis found that the [IDR] process is broken. Providers win roughly 85 percent of the time, and awards are typically far above market prices. In 2025, the median award was four times the median in-network rate. This has led to extreme discrepancies, such as when an in-network Manhattan surgeon made $12,767 for performing plastic surgery, while his out-of-network assistant received $210,000.”
- “Providers have little to lose by seeking arbitration… Arbitrators make more money the more disputes they resolve, and because providers file over 99 percent of disputes, they are functionally arbitrators’ clients. A high provider win rate makes an arbitrator look more attractive to providers. Our research shows a strong positive correlation between arbitrators’ dispute volumes and their decisions in favor of providers.”
- “As providers learned that they almost always win, they began submitting increasingly high offers. American families ultimately finance excessive awards through higher premiums.”
- “But the bigger problem may occur outside arbitration: High awards give providers leverage to demand higher in-network rates from insurers. Providers can now credibly threaten to remain out of network, where arbitration may pay them far more, unless insurers agree to inflated prices. This is a government-created distortion that raises healthcare costs for families.”
- “Private equity firms have swept into this space, building business models around keeping providers out of network and securing high payouts through arbitration. Private-equity-backed Radiology Partners has become one of the arbitration system’s heaviest users, winning 93 percent of its cases in 2025 and receiving median awards nearly five times insurers’ median in-network rates.”
- “Elected officials can fix this problem and still protect patients from surprise bills. Congress should remove elective services from arbitration and require more transparency in pricing for certain procedures.”
- “Those deciding whether cases are eligible get paid only when a dispute actually resolves — an obvious incentive to allow disputes that are otherwise ineligible for procedural or jurisdictional reasons to proceed. Arbitrators should be paid for eligibility determinations, regardless of the outcome.”
- “Dysfunctional government policies are a major reason healthcare is unaffordable for many Americans, but special interests often block needed reforms. Fortunately, there is bipartisan support for reexamining the No Surprises Act, giving Congress a chance to fix the mess it created.”
Paragon is one of many organizations urging Congress to prioritize IDR reforms this year. Congress must close IDR loopholes and address the extreme awards that are driving up costs for millions of Americans. Read the full op-ed here, Paragon’s original report here, and learn more here.
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