Broad Payer & Consumer Coalition Urges Congress to Close Loopholes in No Surprises Act That Inflate Health Costs - Families USA Skip to Main Content
09.10.2026 / Press Release

Broad Payer & Consumer Coalition Urges Congress to Close Loopholes in No Surprises Act That Inflate Health Costs

Two new issue briefs highlight the abuse of the appeals process by private equity and corporations, and also successful solutions at the state level that suggest a federal fix

WASHINGTON, D.C. – Today, as Congress comes back into session next week, a broad range of 67 consumer, labor, and employer organizations, led by the patient advocacy group Families USA, sent a joint letter urging Congress to take urgent action to control costs by fixing loopholes in the No Surprises Act. Bolstering the case for Congressional action, two new issue briefs from Families USA find that a handful of private equity-backed firms and corporate middlemen are driving a surge of appeals, systematically exploiting the law’s arbitration process to get inflated payments that are ultimately passed on to consumers through higher premiums. The federal government projected that the No Surprises Act’s arbitration system would handle roughly 17,000 payment disputes a year, but in 2025, it processed 2.6 million.

  • “Congress Must Act to Safeguard the No Surprises Act from Industry Gaming” highlights CMS data that shows corporate-backed provider groups won 87% of arbitration disputes in 2025, at rates three to ten times the median in-network rate. The brief also identifies a built-in conflict of interest: arbitration entities, which earned more than $1.2 billion in fees last year paid by the losing party, have a financial incentive for providers to continue to win and continue to file. The paper urges Congress to establish a fixed payment benchmark for out-of-network services, close conflicts of interest in the arbitration system, and expand consumer protections to prevent further gaming of the statute by the industry.
  • “States Spotlight Promising Fixes to the No Surprises Act” presents new data that several states have successfully implemented solutions to surprise medical bills without such abuses. In diverse states like California, Ohio, and Virginia, state policies have put in place guardrails and guidelines, including a firm, evidence-based price benchmark to determine appropriate out-of-network payments. The result is a process that is not overwhelmed or skewed to inflated payments. In Virginia, for example, providers won just 45% of disputes compared to 85% federally during the same time period.

“The No Surprises Act delivered important patient protections from unexpected medical bills that can threaten families’ financial security — but we need to plug some loopholes. Some private equity firms and providers have abused the appeals process to inflate their payments and health care costs for everyone,” said Anthony Wright, Executive Director of Families USA. “Congress didn’t set out to build a system that private equity firms could turn into a profit engine. Several states have successfully solved surprise medical bills and shown these issues are not inevitable. A fixed, evidence-based payment benchmark would close that loophole, to pay providers fairly while not inflating health prices.”

Families USA will continue advocating for policies that protect consumers from surprise medical bills while promoting a fair and sustainable health care system that strengthens accountability, improves transparency, and ensures the health system works as intended for patients, purchasers, and taxpayers.