Our Take
The CBO admitting miscalculation on a flagship healthcare law signals payers may have overestimated its price-control power, and forces a reckoning on what happens next.
Why it matters
Payers and regulators have relied on the No Surprises Act to curb out-of-network billing shock. If the law's actual effects fall short of initial projections, the entire cost-containment strategy needs revision, and patients could face continued surprise bills.
Do this week
Benefits leaders: audit your surprise-bill claims data from 2022 onward against baseline 2020 figures to validate what the No Surprises Act actually prevented in your plan.
CBO seeks new data on No Surprises Act outcomes
The Congressional Budget Office has petitioned for additional research into the effects of the No Surprises Act, the 2020 law designed to protect patients from surprise medical bills. In its request, the CBO acknowledged that the law "might not have the effects that CBO anticipated" (per Healthcare Dive). The agency is now asking for deeper investigation into how the statute has influenced healthcare prices and related market trends.
The No Surprises Act, enacted in 2020, required insurers and providers to limit out-of-network charges to in-network rates in most emergency and certain non-emergency settings. It also established independent dispute resolution (IDR) processes to resolve billing conflicts between payers and providers when rate disagreements occur.
This request represents a formal acknowledgment that initial CBO modeling may have overestimated the law's cost-control reach or speed of implementation. The agency is now seeking empirical data to understand actual compliance, dispute resolution outcomes, and market-wide pricing effects since the law took effect.
Payers face revision risk on cost-savings projections
Healthcare payers have cited the No Surprises Act as a major tool for controlling out-of-network costs and reducing patient financial exposure. If the CBO's assessment is correct—that the law's real-world effects fall short of projections—then payers may need to revise their financial models and cost-containment strategies.
The timing is significant. Four years into implementation, the law's actual impact on claim patterns, provider disputes, and premium trends should be measurable. A CBO acknowledgment of divergence between forecast and reality suggests that either compliance is incomplete, provider workarounds are common, or market dynamics have offset expected savings in ways not anticipated during the law's design.
For regulators and plan sponsors, this is a signal to shift focus from assumption-based planning to actual performance monitoring and potentially to secondary policy interventions if gaps remain.
What to do with incomplete cost control
Plan sponsors should not assume the No Surprises Act is delivering expected savings without direct measurement. Request detailed claim-level data from payers showing surprise billing rates, IDR dispute counts, and out-of-network utilization trends before and after 2020. Compare these against your plan's projected savings assumptions. If the law is underperforming, design supplemental network controls, such as tighter prior authorization on out-of-network referrals or higher patient incentives for in-network care. Engage your third-party administrator now to quantify the actual impact on your plan's surprise-bill exposure.