Congress passed the No Surprises Act on December 27, 2020, creating arbitration to keep patients out of billing fights between doctors and insurers. Reporting in October 2026 found the costs landing on employers and public plans: Clark County, Nevada teachers' arbitration fees rose from 7% to 25% of what the plan paid for emergency care, San Antonio is $40 million over budget, and New York state employees face a 10% premium hike. Arbitrators pick higher-priced doctor bids 85% of the time. Pallone now proposes eliminating arbitration and paying doctors at median in-network rates; Murphy and Cassidy say bills are coming.