These letters to the WaPo Editors are well stated: "The No Surprises Act is supposed to protect patients. Here’s how it hurts providers. Reforming the No Surprise Act and AI standards, in readers' eyes. October 22, 2026 at 4:29 p.m. EDT Yesterday at 4:29 p.m. EDT Jackson Hammond and Brian Blase’s Oct. 18 op-ed, “A $17 billion surprise bill for Americans,” argued the No Surprises Act’s arbitration system is driving up health care costs, but they missed the root cause driving disputes. I am a practicing emergency physician, and I’ve never met a colleague who said they view arbitration as a business model. But it becomes necessary when insurers terminate network contracts to make lowball payment offers to physicians who treat patients in emergencies, regardless of their ability to pay. The op-ed, which detailed the new Paragon Health Institute analysis, argued that independent arbitrators side with providers in roughly 85 percent of disputes. But that statistic deserves context. In one study, which was backed by the Americans for Fair Health Care coalition, insurers’ qualifying payment amounts were set at $0 in more than 20,000 disputes, and in almost 1,000 others, they were set at less than $1. Meanwhile, more than 20 percent of the time, insurers delayed paying arbitration awards or failed to participate, leaving physicians waiting to be paid for care they had already provided. Paragon argues that physicians use arbitration to demand higher rates. My organization, TeamHealth, has seen awards below what insurers paid for the same services in 2019. Health care systems would rather work under fair, stable in-network agreements, but persistent underpayments make it harder to recruit and retain clinicians and negotiate sustainable contracts, contributing to narrower networks and reduced access to emergency care. Congress should preserve the No Surprises Act’s patient protections, require insurers to comply with arbitration decisions and address the payment practices that make arbitration necessary. Jody Crane, Richmond The writer is the chief medical officer for TeamHealth." Letter #2: "Every single day in America, someone experiences a life-threatening event that requires an air ambulance to keep them alive and get them to a hospital that can provide the appropriate level of care. Teams of dedicated medics, nurses and pilots are on duty 24/7 to respond to emergencies. But these services are critically undervalued by health insurance companies. As important as the No Surprises Act is for protecting patients, it lacks the enforcement mechanisms needed to ensure emergency care providers are reimbursed. Unfortunately, a growing number of payers are refusing to pay the outstanding claims that independent arbitrators have determined they owe — decisions which are legally binding and must be paid within 30 days. To date, insurers owe my company, PHI Health, more than $50 million in unpaid independent dispute resolution awards for emergency care already delivered. This enormous burden has forced us to suspend operations at one base in rural California and threatens the future of air ambulance services. Insurers’ failure to respect the law could eventually leave many communities without air medical services, a situation Congress hardly intended. The No Surprises Act needs more teeth to ensure that insurance companies follow the law and that claims owed are paid promptly. Paul Julander, Tempe The writer is co-president of PHI Health."

Rep. Pallone (D-NJ) has issued his new bill to reform the #NoSurprisesAct and let me count my top 3-4 reasons why it is a trainwreck for physicians and hospitals (and wait until you see #4): 1. IDR would be eliminated in favor federal rate setting at the "qualifying payment amount" (QPA or initial payment determined by the health plan). There is no recognition here that the federal district and appellate courts (TMA I, II, III and IV plus 2 appellate court decisions, so 6-0 for the TMA) have found issues with the administration of the QPA and recently that the QPA rules should be void and have no legal effect due to health plans' inclusion of ghost rates and other QPA manipulations (TMA III US Court of Appeals for the Fifth Circuit, Aug. '26). The Rep. includes the CPI-U adjustment in his bill which is laughable as the current law requires it and few if any plans actually comply with the requirement. One reason--no real audits of the QPA (see #4 below). Why? The current CPI-U is +28% from a 2019 baseline. 2. No other factors would be considered in final payment--just blatant federal rate setting. NSA requires acuity of the Pt, prior contract rates, qualifications of the clinicians and one can use the Transparency in Coverage (TiC) data which shows market rates among other factors for the IDRE to consider--none of that for Mr. Pallone. Ask your colleagues in CA and MI how they like state based rate setting for applicable OON claims? 3. Another laughable provision--payment w/in 30 days but no interest or penalties--and yes that is in the current NSA. As I have cited so many times here, the data is overwhelming that the plans are in systemic non-compliance with payment. Why would they comply in the future without enforcement, penalties or interest? 4. My favorite--no judicial review of the QPA. The plans have the ultimate and unquestionable power to set the QPA and never be questioned by any physician or hospital in court. Oh, CMS can audit and that's true today. 4+ years ago CMS announced they were conducting over 20 audits, one has been announced in that time and the plan was out of compliance with setting the QPA. To the physician and supporting community--time to get ready to become active again to preserve and enhance the NSA. If that bill above becomes law, independent practice as we know will largely cease for groups actually accepting insurance and patient access to care will greatly suffer. democrats-energycommerce.hou…

The House is planning to return next week. HR 4710 (the bill referenced below) could be on the docket for "mark up" by the Ways and Means health sub-committee. Congress Is Returning. Act Now on the No Surprises Act Enforcement Act. votervoice.net/Shares/BpzzuA…