Industry Titans’ Warning To Congress: Do What We Say Or Health Insurance Premiums Go Up

Some of America’s largest companies are warning Congress that a law shielding patients from surprise medical bills is about to spike their health insurance premiums.

The ERISA Industry Committee, whose board includes executives from ExxonMobil, Lockheed Martin, PepsiCo and Walmart, says that unless Congress stems the huge fees they’re bearing from the 2020 No Surprises Act, businesses will have to pass more of the cost on to their employees. The committee hopes that message resonates at a time when Americans frustrated with the cost of living are thinking about taking it out on incumbents seeking reelection.

“To the extent that Congress actually gives a damn about how much you pay for health insurance, here’s the test,” said James Gelfand, a former counsel to Republican senators who’s now chief executive of the committee. The committee represents large employers that self-fund their health plans instead of contracting with insurance companies.

The committee has ramped up its lobbying this week, releasing a report Thursday on the No Surprises Act’s impact on businesses and hosting two briefings on Capitol Hill to call for reforms.

In 2020, lawmakers from both parties came together to protect patients from unexpected medical bills during emergencies. Their goal was to prevent patients treated by out-of-network doctors from being charged out-of-network rates in unavoidable cases. President Donald Trump signed the law as part of a year-end funding package.

The law created a system in which doctors dissatisfied with insurance payments could appeal to an independent arbitrator to decide whether they’re owed more. Patients are held harmless.

The system triggered a surge of disputes lawmakers didn’t anticipate. A recent Georgetown University report found doctors, some backed by private equity firms and contractors hired to make the claims, initiated 2.6 million disputes last year, far above the 22,000 annual claims Congress expected. Arbitration costs surpassed $16 billion last year, more than triple the spending in 2024. In some cases, doctors have won judgments far above the typical costs for their services.

For example, a plastic surgery practice was awarded $440,000 for a breast-reduction surgery that normally costs no more than $25,000, according to an April New York Times report. In another case, an out-of-network surgical assistant won $210,000 for a surgery to feminize the face of a transgender woman, while the in-network surgeon earned $12,767, the Times reported. The surgeon and assistant are married.

At the same time, doctors say insurers often refuse to pay, and physician lawmakers on Capitol Hill, such as Rep. Greg Murphy (R-N.C.), the co-chair of the GOP Doctors Caucus, are more sympathetic to the doctors’ plight than to the insurers’.

“Insurers are spinning a disingenuous narrative that providers are driving up costs under the [No Surprises Act] and fooling Employers. In reality, employers should be livid the payers are not participating in the process in good faith,” Murphy said in a statement.

Patrick Velliky, chief external affairs officer at HaloMD, a Dallas-area firm that doctors hire to file disputes, blamed insurers' “willful non-compliance” for problems. He added that initial estimates for the number of disputes relied on poor methodology. HaloMD registered to lobby last year and supports legislation proposed by Murphy to penalize insurers that fail to pay. The House Ways and Means Committee has used Murphy’s bill as a foundation for revisions to the No Surprises Act.

Richard Heller, senior vice president of health policy at Radiology Partners, another large filer of disputes, said that high dollar awards are “rare” and argued that doctors are often under-reimbursed for services, as most No Surprises Act claims are settled without arbitration.

A recent Centers for Medicare and Medicaid Services report found that between January 2022 and December 2025, doctors and insurers filed 14,799 complaints related to the No Surprises Act. The number of complaints about doctors was more than three times that of complaints about insurers.

Insurers complained that doctors file claims related to nonemergency services at in-network facilities and failed to provide good-faith estimates for the cost of services.

Doctors charged that insurers failed to comply with pricing requirements and don’t pay on time.

Both House and Senate committees that shepherded the law and now oversee its implementation are considering next steps. This week, Senate Health, Education, Labor and Pensions Committee Chair Bill Cassidy (R-La.), who is a doctor, convened roundtables to gather ideas from the interested parties.

Employers are making a hard push, Gelfand said, because the system Congress created is “blowing holes in budgets. It's making employers have to make sacrifices that are hurting employees.”

One unnamed employer in Thursday’s ERISA Industry Committee report spent more than $6 million in dispute payments in the first half of this year, almost double what it spent last year. Another employer said judgments were more than quadruple the original billed value of claims this year, estimating disputes will make up 5% to 6% of its health care spending.

In June, the Congressional Budget Office, which advises lawmakers on the cost of legislation, called for new research on the law, acknowledging it “might not have the effects” the agency had initially anticipated.

Insurers and employers partly blame a lack of guardrails on disputes for the higher cost of health care. The cost of providing health benefits for the 165.6 million Americans who receive coverage through an employer is expected to rise 8.5% next year, its steepest hike in nearly a quarter of a century, according to the consulting firm Mercer, adding to the list of growing expenses for U.S. businesses.

“Policy action is needed to end the indefensible and well-documented provider-driven abuse of the No Surprise[s] Act that is causing billions of dollars in wasteful health care spending and driving up premiums for consumers and employers," said Chris Bond, a spokesperson at AHIP, the trade group for insurers.

Willie Underwood, president of the American Medical Association, the trade group for doctors, said the law works to protect patients but acknowledged the need for stronger enforcement.

“The law can work better with stronger enforcement. That enforcement should be focused on genuine misconduct, not penalize physicians when health plans withhold critical eligibility information or refuse to participate in the mandatory open negotiations process,” he said in a statement.

Under the No Surprises Act arbitration system, doctors and payers — usually insurance companies — each submit an offer and the arbitrator must choose one. Doctors have prevailed nearly 90% of the time.

Calls to reform the law have drawn in some of the largest lobbies in Washington, setting up an expensive policy battle among doctors, insurers, and employers spanning U.S. industry. In addition to the ERISA Industry Committee, Lockheed Martin, the National Retail Federation and the Chamber of Commerce have recently reported lobbying on surprise billing issues.

The influential Paragon Health Institute, a conservative think tank, has also weighed in, releasing a report this week warning the No Surprises Act’s dispute system is “increasingly an alternative payment system rather than a backstop for unusual out-of-network disputes.”

“It's one of these fundamental clashes of incentives in health care between providers and hospitals, who ultimately are always looking for new ways to grow their revenue, and then insurers,” said Riley Kruse, a director at Baron Public Affairs, a consultancy group. The firm found that doctor groups including HaloMD, Team Health and Radiology Partners, which were responsible for more than three-quarters of disputes last year, spent $1.9 million lobbying in the first half of 2026, up from approximately $750,000 in 2025.

Josh Hopson, a spokesperson for TeamHealth, said it seeks an average incremental payment of about $350 in the arbitration process and blames “insurer underpayment, not a preference for arbitration” for pursuing the dispute process.

“What is often lost in the rhetoric about the No Surprises Act is that the process is working — patients are protected from surprise medical bills.”

The ERISA Industry Committee is calling on Congress to order arbitrators to abide by market-rate calculations for price benchmarks, known as a qualifying paying amount, in determining what doctors are paid. The American Medical Association opposes this proposal, and HaloMD has called this a “non-starter,” arguing the previous benchmark system gives insurers too much leeway. The 5th Circuit Court of Appeals ruled in August that the No Surprises Act methodology for rates allowed insurers to keep rates artificially low and banned the practice.

Murphy is also opposed, arguing that tying reimbursement to the benchmark rate was never intent of the law because “Congress knew that insurers can manipulate it in their favor.”

Employers have also called on Congress to establish a small appeals process to challenge arbitration decisions and to investigate doctors who file large numbers of cases. They’re eyeing a year-end spending bill, which Congress is likely to pass during a post-election lame-duck session, as a vehicle to amend the law.

Cassidy sponsored the law in 2020 and is keen to revise it before he leaves Congress at the end of the year.

Some attendees at his first stakeholder roundtable this week expected a heated debate, but instead got a three-hour tête-à-tête between providers, insurers and employers, according to three people familiar with the discussions who were granted anonymity to speak candidly.

“The employers and physicians had a colloquy that was productive,” one of the people said. “We need to return to some type of more accurate reflection of market [prices].”

That colloquy focused on the way benchmark rates for medical services are currently calculated, which doctors mostly support, according to the three people. In the meeting, physicians suggested the government should let these rates play out, a provider in attendance, granted anonymity to speak candidly, said.

Participants in the roundtable discussed a range of potential changes to the law, but there was no clear consensus. Most agreed on two main complaints: the dispute system allows too many ineligible claims and fails to encourage prompt payouts.

While Cassidy wants to move quickly, his committee is still far from introducing a bill. The committee will hold another roundtable with senators next week to explore solutions. Two House committees, Ways and Means and Energy and Commerce, are also brainstorming legislative fixes.