Congress Weighs Overhaul of No Surprises Act

Legislators face pressure to reform an arbitration system overwhelmed by millions of payment disputes.

Updated on Oct. 27, 2026 in Healthcare

Isometric editorial illustration showing a precarious stack of blank, textured white volumes on a slate surface, representing systemic regulatory strain. — Congress is weighing reforms to the No Surprises Act as the volume of medical billing arbitration disputes has surged past projections. AI Illustration. Upload story photo >

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Should the government prioritize standardized payment benchmarks over independent arbitration in healthcare billing disputes?

Congress is considering legislative proposals to amend the No Surprises Act as the volume of medical billing arbitration disputes has far exceeded original government expectations. With over 4 million disputes filed in 2025, policymakers are seeking to address the collapse of the existing dispute resolution process.

Why it matters

The current arbitration system is struggling with a pattern of high awards and a massive volume of filings, leading some insurers to stop paying awards entirely due to unclear enforcement mechanisms. This instability has prompted new legislative action and litigation as stakeholders debate the future of out-of-network care payments.

Arbitrators currently side with healthcare providers in approximately 85% of cases. The No Surprises Act mandates that arbitration awards be paid within 30 days of a decision, yet enforcement remains a significant challenge.

The players

Frank Pallone

He is a U.S. Representative who introduced legislation in October 2026 to replace the arbitration system under the No Surprises Act.

Greg Murphy

He is a U.S. Representative who sponsored a 2024 bill aimed at enforcing 30-day payment windows for arbitration awards.

The details

Legislators are split on how to fix the system, with recent bills proposing either to replace arbitration with a strict payment standard or to enforce payment penalties for insurers. Meanwhile, federal appeals courts remain divided on whether providers can sue to collect on unpaid arbitration awards, necessitating potential Supreme Court intervention.

The No Surprises Act was originally passed into law at the end of 2020.
Rep. Greg Murphy introduced a bill in September 2024 to penalize insurers for missed payments.
There were 4 million arbitration disputes recorded throughout 2025.
Rep. Frank Pallone introduced a bill on October 8, 2026, to overhaul the arbitration system.

Market Landscape

The proposed legislative changes represent a direct response to the operational failures of the No Surprises Act. This shift highlights a widening divide between insurers and providers as they battle for market share within the evolving landscape of out-of-network medical billing.

The ongoing instability in the arbitration process may influence how insurance companies manage out-of-network coverage and billing policies for their members. Patients should monitor their medical bills closely as the legal and legislative outcomes could shift the burden of payment disputes.

The takeaway

The massive discrepancy between estimated and actual arbitration filings highlights the difficulty of managing complex healthcare billing at scale. Providers and insurers must prepare for a period of ongoing uncertainty while courts and legislators determine the future of reimbursement enforcement.