No Surprises, New Problems: The Unfinished Business of Healthcare Billing Reform

Healthcare expenses are a growing mountain on the backs of American consumers. To make matters worse, it is not always clear what patients might be billed for. This unfortunate reality has given rise to “surprise billing”, where patients receive unexpected out-of-network charges after receiving care. In this paper, I describe the origins of this phenomenon, especially as it pertains to the creation of insurance networks. I analyze state and federal policies implemented to address surprise billing, with specific attention directed towards the recent No Surprises Act and a thorough evaluation of its successes and shortcomings. By incorporating perspectives from both federal committees and advocacy groups, I argue that the breadth of the No Surprises Act must be widened, and that revision is necessary for its key regulatory mechanism of arbitration to improve the affordability and transparency of healthcare.