When President Donald Trump finished his first term in 2020, he signed the law to protect Americans from the shocking medical bill. “This has to be over,” Trump said. “We’re going to hold insurance companies and hospitals fully accountable.”
But widespread push to significantly reduce government spending by the president led by billionaire Elon Musk is undermining the federal agency responsible for implementing the No Surprise Act.
About 15% of people working at the Federal Consumer Information and Insurance Monitoring Center (CCIIO) were fired two weeks ago, according to Jeff Grant, former assistant director of the agency.
And while the full impact of the cuts is still focused, the cuts are threatening work at agencies that are already working hard to run an already overgrown system to resolve very large bills from out-of-network healthcare providers.
“It’s a hot mess,” Grant said of cutting back on his job in an interview with KFF Health News. “Chaos put everyone in the tail spin.”
The cuts that affected 82 federal agency employees also risk delaying key new rules designed to speed up the process of adjuring disputes over the shocking bill between health plans and healthcare providers.
Grant, the best career manager at CCIIO, retired from the government after 41 years. He blasted the layoffs as “a tragic mistake” in a strong-worded letter to the acting HR manager, criticizing him for cutting jobs regardless of employee qualifications or agency needs.
Health insurers also raised concerns about maintaining agency work on the surprising bill.
A spokesman for the Federal Centers for Medicare and Medicaid Services, which oversees CCIIO, said federal agencies are doing so. “CMS is working on implementing the No Surprise Act and the agency continues to carry out its important work,” said Katherine Howden.
CCIIO, a small part of the federal health agency, has accused health insurance plans of ensuring that they meet the standards created by the Affordable Care Act of 2010 and established by the law to protect patients.
After Congress passed the No Surprise Act in 2020, the office assumed additional responsibility for setting up and managing the complex processes to protect patients from surprise bills.
The job was supported by Democrats and Republicans who were accepted to talk of patients who were hit by huge bills from emergency physicians, anesthesiologists and other providers who were not involved in the patient’s insurance network, even if the patient received care at a network hospital.
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“We’re going to surprise medical bills,” Trump promised on the 2020 campaign trail. “The days of tearing patients are over.”
The law has mostly banned healthcare providers from chasing patients over the surprising bill. The ban is not directly affected by recent job cuts ordered by the government efficiency of masks.
However, CCIIO was working to streamline the systems established by the No Surprise Act to resolve differences between health plans and health providers over out-of-network bills. This important protection was introduced to prevent patients from being arrested in the middle of a claim dispute.
The system, known as independent conflict resolution, or IDR, is flooded with hundreds of thousands of cases. A recent analysis published in Journal Health Affairs shows that over 650,000 new disputes were filed in 2023.
“The North Surprise Act protects millions of Americans from receiving surprising medical expenses,” said Jennifer Jones, who directs legislative policy for the Blue Cross Blue Shield Association, an insurance trade group. “But the issue concerns the independent conflict resolution process,” she added. “Payment costs are increasing for patients and employers.”
What’s also overwhelming is a consumer reporting system designed to allow patients to file complaints if they feel unfairly targeted by the Surprise Bill.
Under former President Joe Biden, CCIIO was working on new rules to make conflict resolution more efficient, experts said it would make a difference.
“If this rule is final and works as intended, it should help more network billing be resolved,” said Jack Hordley, an emeritus professor of research at Georgetown University who studied Surprise Medical Billing.
However, the new rules did not end before Biden resigned. And the senior official overseeing the work left his job in January. The recent cuts have collided with the remaining CCIIO staff working on the No Surprise Act, according to other sources familiar with Grant and layoffs.
Grant said senior CCIIO staff were able to shift some employees and got permission to remind them of some of the 82 people. However, he said there is no guarantee that they all hope to return to the reduced agency.
What’s even more concerning, Grant said, is the deep cuts that the White House told federal agencies to prepare by March 13th.
“These cuts were pretty bad,” Grant said. “What happens next will become even more important.”
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KFF Health News is a national newsroom that produces detailed journalism on health issues. Along with policy analysis and voting, KFF Health News is one of KFF’s three major operating programs. KFF is a donated non-profit organization that provides the country with information on health issues.
