New Policy Paper Unpacks the Nexus of Health Plan Design, Third-Party Administrators, and Federal IDR
JOINT PRESS STATEMENT · OCTOBER 20, 2026
Analysis sheds new light on how narrow insurance networks were sold to employers as savings, resulting in Independent Dispute Resolution claims
Read the policy paper (PDF) · Download the press statement (PDF)
WASHINGTON and TAMPA, Fla. — As national debate over the No Surprises Act heats up again, the Emergency Air Rescue Alliance and Action for Health released today a new policy paper analyzing why this law’s federal arbitration volume is a consequence of plan design rather than provider abuse. It is written for plan sponsors, as well as policymakers in Washington now being sold a concocted story about why healthcare costs are rising.
The policy paper, titled “The Skinny Solution Gained Weight,” emphasizes the fact that the No Surprises Act’s IDR process is not a story about providers discovering a loophole or flooding the arbitration system. Rather, it is the predictable output of health plan design that was sold to employers as savings, priced to reward friction, and built on the assumption that patients would stay inside a network that no longer includes the physicians who treat them.
“Big health insurers sell employers narrow networks as savings,” stated M. Dylan McClelland, senior advisor to the Emergency Air Rescue Alliance. “What they leave out is that their administrators collect a percentage of every dollar they shave off a claim, so the lower the first payment, the bigger the fee. That is not cost containment. It is a business model built on underpayment, and the employer gets the bill.”
McClelland continued, “The company that designed the network, set the payment, and billed the fee walks away with none of the risk. The patient never chose any of this, and the employer never saw it coming. As a former chief enforcement counsel for California’s health plan regulator, the nation’s largest, I know the difference between a dispute and a design defect.”
According to Christopher Sheeron, president of Action for Health, “Employers are now being counted by the health insurance lobby as members of its camp. Even the strictest diet shows this shouldn’t be the case. As third-party administrators, health plans are underpaying federal arbitration disputes. What’s worse, plans are falling short of their duty to these employers by not showing up to IDR cases. Almost 25% of IDR determinations last year resulted in default, meaning health plans didn’t even bother to respond or participate. When an impartial referee, in this case the independent arbitrator, rules against a health plan more than eight times in ten, the problem isn’t the referee. IDR was designed as baseball arbitration. Yet in more than one in five cases, someone didn't even take the mound. You don't blame the umpire when your pitcher won't throw strikes or doesn't show up."
Employers and providers are not on opposite sides of this current debate. They are both downstream of health plans’ intentional design. Reform that begins by asking what the initial payment in federal IDR should have been will do more for employer affordability than any congressional proposal to benchmark IDR payments or eliminate IDR altogether. Fanning the notion that providers are abusing the bipartisan process that Congress created six years ago should have no place on legislators’ menu.
Explore the paper and its key takeaways →
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About
The Emergency Air Rescue Alliance (EARA) is a coalition working to protect access to emergency air medical care for every American. The Alliance brings patients, air medical professionals, providers, and advocates together to advance fair payment and dependable access to care.
Action for Health is a national nonprofit advocacy organization working to ensure fair outcomes for critical healthcare issues. In all its work, the organization educates policymakers, the media, and concerned citizens about policies, laws, and regulations that are important to patients.
