Employer community strongly opposes NSA Enforcement Act, urges focus on affordability

Group letter warns: ill-advised surprised billing measure ‘will only incentivize more abuse of an increasingly broken system’

WASHINGTON, DC – With the U.S. House of Representatives House Ways and Means Committee poised to fast-track the No Surprises Act Enforcement Act (H.R. 4710) the American Benefits Council and 57 other employers and employer organizations came out in strong opposition to the measure.

As rising health care costs are placing a large burden on employers and working families, misuse of the independent dispute resolution (IDR) process under the No Surprises Act is fueling higher health care costs and deepening the affordability crisis. The No Surprises Act Enforcement Act would merely impose additional penalties on payers (including for ineligible claims) without fixing the fundamental flaws of the IDR system.

As the letter says, “the profit-driven use of the IDR process by certain provider groups and middlemen is causing health care costs to spiral even higher, and employers, working families, patients and consumers are paying the price. Congress should be focused on advancing policies that improve health care affordability by fixing the broken IDR system rather than misguided legislation like the No Surprises Act Enforcement Act, which will only exacerbate the affordability crisis.”

The letter cites several recent examples of increasingly high payment determinations that are raising health care costs, including:

• A recent New York Times article, A $440,000 Breast Reduction: How Doctors Cashed In on a Consumer Protection Law, highlights the impact of the misaligned incentives in a broken system: 
  • a neurosurgery practice outside of Philadelphia went to arbitration after the health plan Highmark offered its standard payment of $2,660 for a diagnostic procedure to measure blood flow to the brain. An arbitrator awarded it $333,000 instead.
  • a New Jersey anesthesiologist was awarded $14,560 in 2025 for an X-ray-guided steroid injection.
• Another recent New York Times article included the example of a surgical assistant in Dallas who was awarded $50,456 through arbitration for a prostate removal operation while the surgeon, who accepted the patient’s insurance, was paid $1,843.

The letter concludes the NSA Enforcement Act will “compound and accelerate the health care affordability crisis by layering a new penalty, paid by plans — and ultimately by employees and their families — on top of a fundamentally flawed IDR structure. Moreover, the bill would extend penalties for late payments to the vast number of ineligible claims that should never have been awarded in the first place.”

For these reasons, the American Benefits Council will continue to urge Congress to reject the No Surprises Act Enforcement Act and focus its efforts on advancing policies that will instead make health care more affordable for employers as well as employees and their families.

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