The Skinny Solution Gained Weight
How narrow networks were sold to employers as savings, and why the bill came back as arbitration
A joint policy paper from the Emergency Air Rescue Alliance and Action for Health
By M. Dylan McClelland, Senior Advisor, Emergency Air Rescue Alliance, and Christopher G. Sheeron, President, Action for Health.
October 2026
Narrow networks promise lower costs. But what happens when patients need emergency care outside those networks, and the price of resolving the resulting payment disputes falls back on employers?
This joint paper examines how network design, initial payments and administrator fees can shift costs rather than eliminate them. It argues that policymakers and employers should look beyond the headline savings and examine the incentives behind the bill.
Three takeaways
Emergency patients cannot shop for a network. Time-sensitive care, including emergency air medical transport, requires a system that protects access when patients have no practical choice.
Reported savings may not tell the whole story. The paper examines how percentage-of-savings fees and later arbitration awards can create costs that employers did not anticipate.
Accountability starts with transparency. The authors call for closer scrutiny of administrator contracts, payment practices and the full cost of resolving disputes.
Why this matters for emergency air medical care
A payment system should support access to care when every second counts. This paper places emergency air medical services within the wider debate about network adequacy, employer costs and the No Surprises Act.
