EDITORIAL: “Surprise medical billing” arbitration has become a costly farce, and Republicans should fix it

One of the most frustrating parts of working on health policy in the Congress was watching a well-intentioned law blow up in ways nobody intended.

On paper, the idea always sounded great. Then the law met the real world.

The No Surprises Act is a perfect example.

Congress was right to stop patients from getting hammered with surprise medical bills after emergency care. Who could defend someone receiving a massive bill from an out-of-network anesthesiologist they never chose?

The problem is that the solution has produced a different kind of surprise.

Instead of patients receiving unexpected bills in the mail, Americans are now paying for a massive arbitration system that has become a gold rush for a handful of providers, private equity-backed physician groups, lawyers, and arbitrators.

The arbitration process Congress created to resolve payment disputes has exploded far beyond anything lawmakers envisioned. Federal officials originally projected roughly 17,000 arbitration disputes a year. This year, there have already been millions of filings, and nearly 1.4 million were filed in just the first five months of 2026. Healthcare providers received almost $15 billion in arbitration awards in 2025 alone, more than triple the previous year’s total.

The Washington Reporter has criticized health insurers, including for their campaign to extend enhanced ACA subsidies. But on this issue, they’re absolutely right. Surprise billing arbitration has become a costly farce.

The Wall Street Journal editorial board highlighted just how absurd the system has become. A process expected to handle only a few thousand disputes has instead become a sprawling industry, with providers, lawyers, and arbitration firms all making enormous sums while the costs are quietly passed on to everyone else through higher premiums.

Every inflated arbitration award eventually shows up in higher insurance premiums, higher deductibles, and higher costs for employers providing coverage. The surprise bill was spread across millions of working families who have no idea they’re paying it.

This is terrible policy and it’s also terrible politics.

Every poll shows affordability remains one of the biggest issues facing voters. Republicans promised to lower costs for working families. Every unnecessary dollar flowing through this bloated arbitration racket moves the country in the opposite direction.

The costs are spread across virtually every insured American, while the benefits are concentrated among a relatively small group getting extraordinarily wealthy from exploiting a loophole Congress never intended. Voters don’t spend their evenings studying the mechanics of “independent dispute resolution.” They just know their health insurance keeps getting more expensive.

The good news is that this is fixable.

Congress doesn’t need to weaken the patient protections in the No Surprises Act. But lawmakers should reform the arbitration process so it functions as a backstop instead of a billion-dollar business model.The Coalition Against Surprise Medical Billing has a number of good policy ideas.  

There isn’t much legislative time left before the election. That makes this all the more urgent. Reform is opposed primarily by those profiting from the current system. Everyone else would benefit from restoring some common sense.

Republicans should make fixing this costly farce a priority.