When Protections Work but Processes Stall: Evaluating the No Surprises Act's Implementation Record

The No Surprises Act aimed to accomplish two objectives: protect consumers from surprise medical bills and contain health care costs. While the statute has successfully accomplished its first aim, implementation of the independent dispute resolution (IDR) process-the process within the law intended to settle payment disputes and contain costs-has been wrought with litigation and rulemaking challenges. As a result, implementation has led to unintended consequences that may inadvertently add to, rather than reduce, health care costs. This article provides insights on the successes and challenges of rulemaking, and offers suggestions on how to insulate future policies from legal challenges and issues in implementation.