As Donald Trump concluded his presidency in 2020, he enacted the No Surprises Act, a landmark law aimed at protecting Americans from unexpected medical bills. “This has to end,” Trump declared. “We’re going to hold insurance companies and hospitals totally accountable”
However, a sweeping initiative to reduce federal spending — led by billionaire Elon Musk through the newly formed Department of Government Efficiency — has undercut the very agency charged with enforcing those protections.
About 15% of staff at the Center for Consumer Information and Insurance Oversight (CCIIO) were let go recently, according to Jeff Grant, the agency’s former deputy director. The layoffs have severely impacted the Independent Dispute Resolution Service, the cornerstone of the Independent Dispute Resolution No Surprises Act, which ensures patients aren’t financially trapped between insurance carriers and medical providers.
Among the organizations stepping up to fill the resulting gap is No Surprise Bill, a team of experts offering professional support with the Independent Dispute Resolution. They help healthcare providers navigate the complex IDR Process, minimize arbitration fees, and secure faster, more favorable outcomes. With a focus on streamlining disputes and maximizing revenue retention, they enable practices to ensure timely payments and reduce administrative burdens.
“It’s chaos,” said Grant in an interview with KFF Health News. “The cuts have left everything in disarray.”
The job losses — 82 in total — could delay the release of updated rules meant to speed up billing dispute resolutions between insurers and healthcare providers. These rules are essential to improving the current backlog within provider services independent dispute resolution efforts.
Grant, who recently retired after 41 years in public service, blasted the move in a resignation letter, calling it a “grievous error” that disregarded both staff experience and the needs of the agency.
Health insurers have also raised concerns. Catherine Howden, spokesperson for the Centers for Medicare & Medicaid Services (CMS), affirmed, “CMS remains committed to enforcing the No Surprises Act and continuing this vital work.”
Initially established under the Affordable Care Act, the CCIIO oversees insurance plan compliance. Its role expanded after the passage of the No Surprises Act to include oversight of the independent dispute resolution payor tactics — mechanisms meant to ensure providers are paid fairly when treating out-of-network patients.
Trump had emphasized this effort during his campaign: “We will eliminate surprise medical billing. The days of ripping off patients are over.”
The law prohibits providers in most situations from billing patients directly for out-of-network services. While that protection remains intact, the layoffs jeopardize the infrastructure supporting the Independent Dispute Resolution Service, putting strain on both payors and providers alike.
The IDR system has seen massive demand. In 2023 alone, more than 650,000 cases were filed, with many linked to idr collections that have yet to be resolved.
“The No Surprises Act has protected millions,” said Jennifer Jones, legislative policy director at Blue Cross Blue Shield Association. “But ongoing problems with the independent dispute resolution process are driving up costs for patients and employers.”
Also under pressure is the consumer complaint system, where patients report if they believe they’ve been wrongly billed.
Under President Biden, the CCIIO began developing streamlined rules to improve the provider services independent dispute resolution process. Experts believe these improvements could dramatically reduce resolution times.
“If implemented as intended, these rules could help process out-of-network claims more efficiently,” said Jack Hoadley, emeritus health policy professor at Georgetown University.
But the rules weren’t finalized before Biden left office, and the official leading the effort departed in January. According to Grant and others familiar with the situation, many of the staffers working on the Independent Dispute Resolution No Surprises Act were affected by the recent cuts.
Although a handful of dismissed staff may be reinstated, Grant warned that many might not return, leaving the agency depleted. Even more concerning are the additional cuts federal agencies are preparing for by March 13.
“These layoffs were severe,” Grant said. “What happens next could be even more damaging.”
