STATEMENT: U.S. PIRG reacts to first court decision relating to No Surprises Act

Advocates say the court failed to follow the intent and language of the law

U.S. PIRG

WASHINGTON —  As Americans receiving bills for recent medical appointments exercise their financial protection rights under the federal No Surprises Act, they may not benefit fully from the new law’s protections. A U.S. district court has struck down parts of the rules implementing the new law, which bans most surprise medical bills, resulting in a weakening of the cost controls in the arbitration system used to settle payment disputes between out-of-network providers and insurers.

In response to the ruling, Patricia Kelmar, U.S. PIRG’s Health Care Campaigns director, made the following statement:

“The stated rationales for this decision imply that the court failed to consider either the text of the No Surprises Act or Congressional intent. Congress intended not only to protect individual patients from having to pay surprise medical bills, but also to solve the problem of high costs that out-of-network charges add to our health system. The court’s decision in Texas Medical Association v. The United States Department of Health and Human Services, et al. ignored the weight of the evidence supporting the need for an arbitration system that keeps overall health care costs down. This decision destroys the careful structuring of the arbitration system under the new law, which is likely to result in out-sized payments to out-of-network providers at the expense of all insured Americans. 

“Since the court nullified important guardrails in the provider-insurer arbitration system, it’s far more likely we’ll all pay higher premiums. Will our extra dollars guarantee better medical care? Of course not. But arbiters won’t have constraints on the amounts they award providers, and someone will have to pay. 

“Providers may promise to “do no harm” but clearly the thing they care about keeping healthy is their revenue stream. After fighting against patients — and losing — in the halls of Congress and again during the executive branch’s rule-making process, they finally found a sympathetic ear in one federal district court. We commend the Biden administration and Congress for standing firmly on the side of Americans to protect patients from high health care costs by implementing strong rules against surprise bills. 

“This setback ‘tis but a scratch. Right is on our side, as is popular opinion. One misguided court decision will not stop all the American patients who are happy to pay a reasonable price for their health, but are sick to their stomachs because of the profit-driven interests of private equity-owned providers.” 

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