A coalition of 67 employer, patient and labor groups, led by Families USA, has written to congressional leaders asking them to replace the No Surprises Act's arbitration process with a transparent benchmarking system, arguing that a small number of provider organizations and IDR intermediaries are exploiting the current process in ways that are pushing self-funded plan costs, and ultimately premiums, higher.

The letter targets the law's independent dispute resolution (IDR) process specifically, a "baseball-style" system in which arbitrators must pick one side's proposed payment rather than set a rate themselves. Research from Georgetown University's Center on Health Insurance Reforms puts total IDR-related costs at $22.4 billion through 2025, up from roughly $5 billion through 2024, a jump the coalition attributes partly to "flooding" from a concentrated group of repeat filers.

That concentration is not abstract. Private equity firm Leonard Green and Partners holds stakes in a certified IDR entity's parent company while separately owning an anesthesia group that itself initiates IDR disputes, and HaloMD, a firm built specifically around filing disputes on providers' behalf, has registered federal lobbyists. Providers won more than 80% of federal arbitration cases as of mid-2026, according to a University of Pennsylvania panel, well above the more balanced win rates some state-level systems have produced.

The coalition's proposed fix, benchmarking disputed payments to Medicare rates or median in-network rates, would move the system closer to what the Congressional Budget Office originally scored when the law passed in 2020, when it assumed a benchmark-anchored process would pull prices down roughly 1% rather than the provider-favorable arbitration system that emerged in practice.

Congress is already engaging with the issue separately: the House Energy and Commerce Committee has sent formal information requests to arbitration firms about their NSA compliance, ahead of any legislative response to this specific letter.

For brokers and self-funded plan sponsors, the letter is worth tracking as a live legislative signal rather than a one-off statement: a shift toward benchmarking would represent a structural change to exactly the cost driver that has been feeding into stop-loss renewal pressure, and any bill that emerges from this push is worth flagging to clients well before it reaches a floor vote.