What the paper is
Paragon Health Institute published Fixing the No Surprises Act: Scaling Back and Reforming the Federal Arbitration System on September 14, 2026. The paper is authored by Jackson Hammond and Katherine Hall.
The authors analyze federal IDR public-use files and other sources, then argue that dispute volume, prevailing-party results, and award levels support substantial changes to the arbitration framework.
Findings reported by the authors
Paragon reports that federal IDR initiations reached 2.56 million in 2025 and that providers prevailed in 86.4% of disputed line items. The paper also reports that the median 2025 award was nearly four times the qualifying payment amount and approximately 5.5 times the Medicare rate for the same services.
Those figures are presented as Paragon's analysis of CMS public-use files and related data. Readers can review the authors' methods and the underlying federal reports through the source links on this page.
Recommendations for elective services
Paragon recommends eliminating the federal IDR process for elective services after establishing meaningful advance notice, patient consent, and price information through Advanced Explanations of Benefits.
The paper proposes allowing balance billing in that setting only when patients receive advance disclosure and affirmatively consent. This is the authors' proposed framework, not the rule currently governing elective services.
Recommendations for emergency services
The paper recommends keeping the prohibition on surprise balance billing for emergency care. It then presents two possible paths: eliminate federal IDR for those disputes and rely on other resolution mechanisms, or retain a substantially revised emergency-services IDR process.
The suggested reforms include limits on awards, changes to arbitrator compensation, prompt-payment provisions, standardized training, written decisions, and stronger oversight.
Frequently asked questions
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Sources and scope
This page summarizes the cited paper without adding a firm policy position. It is general information, not legal advice.