New Research Reveals How NSA is Affecting Providers, Consumers

As Congress again turns its focus to budget concerns, healthcare might be on the backburner for a while. However, two new studies examining the No Surprises Act (NSA) published in the last couple weeks showed the financial impact the law has had on the healthcare system – from consumers to providers to plans.

First up is a study from Harvard University and Mass General that found “significant decreases” in out-of-pocket spending for adults in states that enacted new protections under the NSA. Researchers found that the NSA prevented more than 10,000 surprise bills during just the first three quarters of 2023, and that consumer complaints about surprise bills dropped off notably as well.

This resulted in an estimated $567 reduction in out-of-pocket spending for Americans, which was a greater impact than even the Medicaid expansion and the Inflation Reduction Act. The study did note, however, that premium spending was not impacted by NSA.

Experts had considered the possibility that the law’s independent dispute resolution (IDR) process could impact premiums and healthcare costs through the negotiation process. But the federal government has released data indicating that cases won by providers result in higher payments – and providers win about 85 percent of IDR cases, per the latest data.

Interestingly, the study also suggested that the NSA actually increased healthcare utilization, keeping healthcare costs stagnant, and did not have a particular impact on what it calls high-burden medical spending that leads to medical debt. Researchers suggested that addressing some of the gaps in the NSA, including coverage of ground ambulance services – which, as frequent listeners to Monitor Mondays have heard me talk about many times, were intentionally left out of the NSA – as well as expanding knowledge about the NSA protections to all Americans could be helpful.

A report in HealthAffairs examined a different angle of the NSA: the hard numbers surrounding the IDR process. It’s no secret that the sheer number of IDR disputes initiated under the NSA has surprised just about everyone. Federal agencies had initially estimated the IDR process would address about 17,000 disputes annually, but from mid-2022 to May 2025, a total of 3,324,051 disputes were filed.

This exceedingly high volume has led to delays in the process – at one point the average time for a decision was 96 days instead of the statutory 30 days.

The report also found that the IDR process has incurred almost $5 billion in total costs from things like administrative fees and plan/provider costs to manage disputes. Experts cited in the article expressed that while costs only affect IDR-specific claims right now, this could eventually impact the healthcare system’s overall costs, if claim volume and outcomes continue at current levels.

The authors suggest potential solutions to address this, including changes to the IDR portal that could assist in weeding out ineligible cases that are slowing down IDR arbitrators. They also suggest more transparency among these arbitrators to help outside observers understand the process and results.

Both of these studies report on realities that plans and providers both are already seeing. While many can agree that the NSA has been successful in reducing consumers’ out-of-pocket costs associated with surprise bills, I think they can also agree that the IDR process isn’t perfect.

Both Congress and the states continue to examine the process, and of course there are still several open court cases on the IDR process we continue to track – so keep your eyes peeled for some changes that could alter the NSA landscape.