A federal law intended to protect healthcare consumers from surprise medical bills appears to have had some unfortunate side effects. The New York Times reports (Sarah Kliff and Margot Sanger-Katz, “A $440,000 Breast Reduction: How Doctors Cashed In on a Consumer Protection Law,” New York Times, April 22, 2026):
“The No Surprises Act was designed to eliminate surprise medical bills, for patients who showed up in the emergency room and were treated by a doctor who didn’t take their insurance.
“It bars those out-of-network doctors from billing patients directly. Instead, they can plead their case to a government-approved arbitrator. If they win, the patient’s insurer has to pay their desired amount.
“By all accounts, the law is successfully protecting patients against bills from doctors they never chose. But it has also generated an expensive unanticipated consequence: Doctors have flooded the arbitration system with millions of claims. Most are winning, often collecting fees hundreds of times higher than what they could negotiate with insurers directly or what they could have earned from patients before the law passed.”
Physicians aren’t the only ones being seen to profit from the new law. The Times article notes:
“The arbitrators are doing well too. The fees they earn for deciding cases, which range from $425 to $1,150 per case, have added up. They earned $885 million from 2022 to 2024.”
The doctors themselves may not be the ones benefiting in all cases Again from the Times:
“The money does not always end up with the doctors but instead can go to the owners of their practices. The Times interviewed two physicians who show up repeatedly in public data files. Both said they were salaried workers and uninvolved in the claims filed under their names.
“The government has hired 15 firms, some boutique vendors and others large contractors, to arbitrate billing disputes. Doctors and insurers can select a firm if they agree, or be randomly assigned one if they do not.
“Health policy experts have been surprised to see such lopsided results that favor doctors. Some argue that because the arbitrators are paid per case, they may have an incentive to render decisions that keep doctors coming back.”
Attempts to address these issues have thus far been unsuccessful. The Times notes that:
“In late 2023, the Biden administration proposed changes to the arbitration system, including more scrutiny of ineligible claims. The Trump administration has not yet put into place those reforms.
“Only one bill has been introduced in Congress to change arbitration, and it would increase penalties on insurers that fail to pay doctors quickly after cases are concluded.
“Seeing little movement in Washington, health plans have turned to the courts. They have filed at least 20 lawsuits against doctors and the companies they use to submit claims.
“But this month judges in California and Florida dismissed two such cases, finding that Congress did not intend for judges to review the arbitration awards.”
Breaking News
- Surprise Medical Billing Law Creates Windfall For Medical Practices, Physicians April 23, 2026A federal law intended to protect healthcare consumers from surprise medical bills appears to have had some unfortunate side effects. The New York Times reports (Sarah Kliff and Margot Sanger-Katz, “A $440,000 Breast Reduction: How Doctors Cashed In on a Consumer Protection Law,” New York Times, April 22, 2026): “The No Surprises Act was designed to ...
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- European Health Forum Gastein 2025 September 30-October 3 September 9, 2025Both in-person and virtual registration is still open for the European Health Forum Gastein 2025, which is being held September 30 through October 3 in Bad Hofgastein, Austria. The theme for this year’s forum is “Rethinking solidarity in health: Healing Europe´s fractured social contract.” There are fees for in-person attendance. Virtual attendance is free of charge. ...
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- WHO Releases World Health Report 2025 May 15, 2025May 15, 2025 The WHO released its World Health Report 2025 on May 15, 2025. According to the WHO: “An estimated 1.4 billion more people were living healthier by the end of 2024, surpassing the 1 billion target. The progress in healthier lives was driven by reduction in tobacco use, improved air quality and better access ...
- WHO: Nursing workforce grows but disparities in access persist May 15, 2025May 15, 2025 A new report issued May 12 by the World Health Organization finds that “1 in 7 nurses worldwide – and 23% in high-income countries – are foreign-born, highlighting reliance on international migration.” The WHO reports that: “The global nursing workforce has grown from 27.9 million in 2018 to 29.8 million in 2023, but wide disparities in ...
- WHO: Health inequities are shortening lives by decades May 15, 2025May 15, 2025 A new report issued May 6th by the World Health Organization finds that “underlying causes of ill health often stem from factors beyond the health sector, such as lack of quality housing, education and job opportunities.” According to the WHO, the new World report on social determinants of health equity shows that “such determinants can ...
- Medical Debt in Collections in the US May 1, 2025August 6, 2021 On July 20, JAMA published an article on medical debt in collections in the US entitled “Medical Debt in the US, 2009-2020.” The researchers found: “In this retrospective analysis of credit reports for a nationally representative 10% panel of individuals, an estimated 17.8% of individuals in the US had medical debt in collections in ...
- Healthcare in the US Compared to Other High-Income Countries May 1, 2025August 6, 2021 On August 4, the Commonwealth Fund issued a new report entitled Mirror, Mirror 2021: Reflecting Poorly / Health Care in the US Compared to Other High-Income Countries. The report compares health care systems in eleven nations: the United States, Canada, Switzerland, France, Sweden, New Zealand, Germany, the United Kingdom, Australia, the Netherlands, and Norway. The ...
- Gallup: 11% of US Adults Unable to Afford or Access Quality Healthcare April 2, 2025April 2, 2025 Eleven percent of US adults are unable to afford or access quality healthcare, according to new research by Gallup and West Health. According to Gallup (“In U.S., Inability to Pay for Care, Medicine Hits New High,” April 2, 2025, last accessed April 2, 2025): “The most notable increases since 2021 have occurred among Hispanic adults ...
- Healthcare Policies in US States: The Washington Cares Fund March 6, 2025March 6, 2025 The Washington Cares Fund is a long-term care insurance program operated by the state of Washington. According to the WA Cares Fund website (accessed March 6, 2025), “All working Washingtonians contribute a small percentage of their income into the fund. Then when you need care, you can access your earned benefit of $36,500 ...
- US Healthcare Spending Hits $4.9 Trillion December 18, 2024December 18, 2024 US healthcare spending continues to grow. According to an article in the journal Health Affairs (Anne B. Martin, Micah Hartman, Benjamin Washington, Aaron Catlin, and The National Health Expenditure Accounts Team, National Health Expenditures In 2023: Faster Growth As Insurance Coverage And Utilization Increased, Health Affairs (2024), doi.org/10.1377/hlthaff.2024.01375): “National health care spending reached $4.9 trillion in 2023 (or ...
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- Nearly One Fourth of Working Age Adults Underinsured, New Report Shows November 22, 2024November 22, 2024 The Commonwealth Fund on November 21, 2024 released a new report on insurance coverage in the US. According to The State of Health Insurance Coverage in the U.S.: “• More than half (56%) of U.S. working-age adults were insured all year with coverage adequate to ensure affordable access to care. But there are soft ...
- World Health Systems Facts is @HealthSystemsFacts.bsky.social November 14, 2024November 14, 2024 World Health Systems Facts now has an account on the social media platform BlueSky, we’re @HealthSystemsFacts.bsky.social. Give us a follow! Health System OverviewHealth System RankingsHealth System OutcomesHealth ExpendituresHealth System FinancingCoverage and AccessCosts for ConsumersHealth System Resources and UtilizationPreventive Healthcare Healthcare WorkersHealthcare Workforce Education and TrainingLong-Term Services and SupportsHealth Information and Communications TechnologiesPharmaceuticalsPeople With DisabilitiesAgingSocial Determinants ...
- Nonprofit Hospitals and Charity Care November 7, 2024November 7, 2024 Two new reports throw light on the level of charity care actually provided by nonprofit hospitals in the US. As noted in US Nonprofit Hospitals Have Widely Varying Criteria To Decide Who Qualifies For Free And Discounted Charity Care (Luke Messac, Alexander T. Janke, Lisa Herrup Rogers, Imani Fonfield, Jared Walker, Elijah Rushbanks, Nora V. Becker, and Ge Bai, US Nonprofit ...
- Doximity Releases 2024 Physician Compensation Report October 16, 2024October 16, 2024 The physician networking, communications, and staffing company Doximity has released its 2024 Physician Compensation Report. According to Doximity, “Doximity found that after several years of modest or declining growth, the average pay for doctors increased nearly 6% in 2023, rebounding from a decline of 2.4% in 2022.” The report noted that “In 2023, the gender ...
- Commonwealth Fund Releases Newest Installment of its Mirror Mirror Series of National Health System Comparisons September 21, 2024September 21, 2024 The Commonwealth Fund has released the newest installment of its Mirror Mirror series, which compares various national health systems with the US. According to Mirror, Mirror 2024: A Portrait of the Failing U.S. Health System: “Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between ...
- Baker Institute Report Examines Hospital Prices, Costs, and Profits September 11, 2024Rice University’s Baker Institute for Public Policy has issued a new report on hospital finances. The report, entitled Prices Versus Costs: Unpacking Rising US Hospital Profits, compares “the commercial operating costs, net patient revenue from commercial patients, and commercial operating profits of hospitals with different price levels to examine if higher prices are charged to ...
- Healthcare in the US Becoming Less Affordable July 23, 2024July 23, 2024 The ability of Americans to access affordable healthcare has declined in recent years, according to a new report by Gallup and the nonprofit West Health. According to the report, entitled Tracking Healthcare Affordability and Value: The West Health-Gallup Healthcare Affordability Index and Healthcare Value Index: “Cost security among U.S. adults has dipped to its lowest ...
- NY Times Investigative Series on Pharmacy Benefit Managers and High Prescription Drug Costs June 21, 2024June 21, 2024 The New York Times has begun a new series about how pharmacy benefit managers prioritize their own interests at the expense of patients, employers, and the public. Part one, entitled “The Opaque Industry Secretly Inflating Prices for Prescription Drugs,” was published June 21, 2024. According to the Times: “The three largest pharmacy benefit managers, ...
- Journalism Organizations Plan Webinar Series on Business of Healthcare February 14, 2024February 14, 2024 The Association of Health Care Journalists and Investigative Reporters & Editors, with the support of the NIHCM Foundation, are hosting a series of free webinars for journalists on the business of healthcare. The series is entitled “Follow the Money: The Business of Health Care.” The first webinar, “Using HospitalFinances.org and other tools to tell money stories,” ...
- US Healthcare Spending in 2022: $4.5 Trillion January 2, 2024January 2, 2024 According to the federal Centers for Medicare and Medicaid Service (accessed January 2, 2024): “US health care spending grew 4.1 percent to reach $4.5 trillion in 2022, faster than the increase of 3.2 percent in 2021 but much slower than the rate of 10.6 percent in 2020. The growth in 2022 reflected strong ...
- Baker Institute: More Texans Insured Thanks To The ACA November 23, 2023November 23, 2023 Rice University’s Baker Institute for Public Policy reports that more Texans have health insurance coverage now thanks to the Affordable Care Act. According to the Institute’s November 14 issue brief, entitled Looking at the Numbers: 10 Years of Data on the Affordable Care Act Reveal Benefits for Texans: “When the ACA was enacted in ...
- Update: Medicare Drug Price Negotiations Moving Forward October 19, 2023Negotiations between the federal government and the manufacturers of ten prescription drugs over prices for the Medicare program are moving forward. The American Hospital Association reported on Oct. 3, 2023 (“CMS: Makers of selected drugs agree to participate in Medicare price negotiation”): “The companies that make the first 10 Medicare Part D drugs selected to participate ...
- Medicare and Medicare Advantage October 15, 2023Medicare is a complicated system that mixes public and private insurance providers. As reported by the Scripps News Service on Oct. 21, 2022 (“Why Is Medicare So Complicated?”): “By the government’s last count in 2021, 64 million adults were enrolled in Medicare. But that doesn’t mean it’s simple to navigate. The Medicare maze is growing more ...
- Medicare Open Enrollment Season Runs October 15 – December 7 October 15, 2023Open enrollment season for Medicare is October 15 through December 7. According to the federal Centers for Medicare and Medicaid Services (last accessed Oct. 15, 2023): “Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. October 15 to December 7 is when all ...
- List of Drugs For Which Medicare Will Negotiate Prices Announced September 1, 2023September 1, 2023 On August 30, 2023, Kaiser Health News reported (“5 Things to Know About the New Drug Pricing Negotiations”): “The Biden administration has picked the first 10 high-priced prescription drugs subject to federal price negotiations, taking a swipe at the powerful pharmaceutical industry. It marks a major turning point in a long-fought battle to control ...
- Learning From Others June 14, 2023June 14, 2023 Professor Aaron E. Carroll, MD, MS, is the Chief Health Officer of Indiana University. In a guest essay comparing the US health care system with the systems of five other nations that was published June 13, 2023 in the New York Times (“I Studied Five Countries’ Health Care Systems. We Need to Get ...
- Practice Consolidation and Access to Quality Care May 14, 2023May 14, 2023 The New York Times reports on a growing trend among healthcare organizations in the US, the impact of which may be of concern for patients and taxpayers. The Times reported on May 8, 2023 (“Corporate Giants Buy Up Primary Care Practices at Rapid Pace”) that: “CVS Health, with its sprawling pharmacy business and ownership ...
- Medicaid Re-Enrollment Begins Again April 1, 2023US states are restarting yearly Medicaid and Children’s Health Insurance Program (CHIP) eligibility reviews. The Kaiser Family Foundation reported on February 22, 2023 (“10 Things to Know About the Unwinding of the Medicaid Continuous Enrollment Provision”): “Primarily due to the continuous enrollment provision, Medicaid enrollment has grown substantially compared to before the pandemic and the uninsured rate has dropped. ...
- The Existential Threat of Greed in US Health Care February 7, 2023February 7, 2023 The journal JAMA published a Viewpoint on Jan. 30, 2023 by Donald Berwick, MD, MPP, entitled Salve Lucrum: The Existential Threat of Greed in US Health Care. In it, Dr. Berwick contends: “Profit may have its place in motivating innovation and higher quality in health care, as in any industry. But kleptocapitalist behaviors that raise ...
- Oregon Becomes First US State To Guarantee Its Residents Access To Affordable Healthcare January 20, 2023January 20, 2023 In the November 2022 general election, Oregon voters narrowly approved Oregon Measure 111, the Right to Healthcare Amendment. The measure amended the state constitution, adding a guarantee of access to affordable healthcare for all Oregon residents. According to Ballotpedia, last accessed Jan. 20, 2023: “Ballot title “The ballot title was as follows:“Amends Constitution: State must ...
- Massive Savings Possible In US Health System October 21, 2021October 21, 2021 The management consulting firm McKinsey & Company has issued a new report estimating that administrative changes and efficiencies could save the US health system more than a quarter trillion dollars. As noted in a Viewpoint article published in JAMA on October 20: “The analysis dissected profit and loss statements of individual health care organizations, estimated ...
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World Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems and policies in the US and sixteen other OECD member nations.
Page last updated April 23, 2026 by Doug McVay, Editor.