{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T01:26:00Z","timestamp":1777857960172,"version":"3.51.4"},"reference-count":42,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T00:00:00Z","timestamp":1666396800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["International Journal of Social Determinants of Health and Health Services"],"published-print":{"date-parts":[[2023,1]]},"abstract":"<jats:p>Hailed as a major reform, the No Surprises Act (NSA) is a profoundly conservative law that aims neither to reform design of insurance, to regulate fees, nor to limit health care spending. The NSA mitigates a perverse but narrow problem: unpredictable and uncontrollable high out-of-pocket bills for individuals who are unable to receive care within their insurance network. However, the NSA neglects to address the broader high medical costs, limited choice of caregivers, and the resulting insecurity and unfairness that characterize American health care. It allows caregivers to extract high payments and insurers to restrict choice of caregivers. Insurers can continue to employ ineffective cost controls that generate unpredictable high out-of-pocket costs for patients\u2014and high levels of denial of payments to doctors and hospitals. The law amputated the most politically and visibly gangrenous consequences of unregulated private insurance in the United States in ways that enable business as usual in private health insurance to persist, subject to unnecessarily complex arbitration rules that magnify administrative waste.<\/jats:p>","DOI":"10.1177\/00207314221125141","type":"journal-article","created":{"date-parts":[[2022,10,23]],"date-time":"2022-10-23T00:16:26Z","timestamp":1666484186000},"page":"63-68","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["The No Surprises Act: A Conservative Band-Aid to Protect Business as Usual"],"prefix":"10.1177","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0415-7131","authenticated-orcid":false,"given":"Marc A.","family":"Rodwin","sequence":"first","affiliation":[{"name":"Suffolk University Law School, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Sager","sequence":"additional","affiliation":[{"name":"Boston University School of Public Health, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,10,22]]},"reference":[{"key":"bibr1-00207314221125141","unstructured":"American Hospital Association, Hospital Statistics, 2000, 2010, and 2020 editions, Table\u00a03, Chicago: AHA."},{"key":"bibr2-00207314221125141","unstructured":"Adler L, Fiedler M, Ginsburg PB, et al. State approaches to mitigating surprise out-of-network billing. USC-Brookings Schaeffer Initiative for Health Policy. https:\/\/www.brookings.edu\/research\/state-approaches-to-mitigating-surprise-out-of-network-billing\/. Accessed June 25, 2021."},{"issue":"6","key":"bibr3-00207314221125141","doi-asserted-by":"crossref","first-page":"1032","DOI":"10.1377\/hlthaff.2019.01776","volume":"39","author":"Song Z","year":"2020","journal-title":"Health Aff"},{"key":"bibr4-00207314221125141","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20200601.723677"},{"key":"bibr5-00207314221125141","unstructured":"Stasha S. How many Americans are uninsured. Policy Advice. https:\/\/policyadvice.net\/insurance\/insights\/how-many-uninsured-americans\/."},{"key":"bibr6-00207314221125141","unstructured":"Finegold K, Conmy A, Chu RC, Bosworth A, Sommers BD. Trends in the U.S. uninsured population, 2010\u20132020. U.S. Dept. of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation. February 11, 2021."},{"key":"bibr7-00207314221125141","unstructured":"Rosenthal E. Who\u2019s profiting from your outrageous medical bills. New York Times, February 14, 2020. https:\/\/www.nytimes.com\/2020\/02\/14\/opinion\/sunday\/surprise-medical-billing.html."},{"key":"bibr8-00207314221125141","unstructured":"Kaiser Health News.\n                      Bill of the Month\n                      . https:\/\/khn.org\/news\/tag\/bill-of-the-month\/ (last visited Jan. 9, 2022)."},{"key":"bibr9-00207314221125141","unstructured":"An $80\u2005000 surprise bill points to a loophole in a new law to protect patients. https:\/\/www.npr.org\/sections\/health-shots\/2022\/02\/23\/1082405759\/an-80-000-surprise-bill-points-to-a-loophole-in-a-new-law-to-protect-patients."},{"key":"bibr10-00207314221125141","unstructured":"Kliff, He went to an in-network emergency room. 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Center on Budget and Policy Priorities, October. 2009 Oct 13;13. https:\/\/www.cbpp.org\/sites\/default\/files\/atoms\/files\/10-13-09health2.pdf."},{"key":"bibr16-00207314221125141","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.0970"},{"key":"bibr17-00207314221125141","unstructured":"Pollitz K, Rae M, Claxton G, Cox C, Levitt L. An examination of surprise medical bills and proposals to protect consumers from them. Peterson-KFF Health System Tracker. February 10, 2020. https:\/\/www.healthsystemtracker.org\/brief\/an-examination-of-surprise-medical-bills-and-proposals-to-protect-consumers-from-them-3\/."},{"key":"bibr18-00207314221125141","unstructured":"Carpenter E, Sloan C. 2018. Health plans with more restrictive provider networks continue to dominate the exchange market. Avalere. December 4, 2018. https:\/\/avalere.com\/press-releases\/health-plans-with-more-restrictive-provider-networks-continue-to-dominate-the-exchange-market."},{"issue":"10","key":"bibr19-00207314221125141","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1377\/hlthaff.2016.0693","volume":"35","author":"Daniel P","year":"2016","journal-title":"Health Aff"},{"key":"bibr20-00207314221125141","unstructured":"NORC at the University of Chicago. New survey reveals 57% of Americans have been surprised by a medical bill. August 30, 2018. https:\/\/www.norc.org\/NewsEventsPublications\/PressReleases\/Pages\/new-survey-reveals-57-percent-of-americans-have-been-surprised-by-a-medical-bill.aspx."},{"issue":"2","key":"bibr21-00207314221125141","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1016\/j.amj.2008.11.001","volume":"28","author":"Scarano RM","year":"2009","journal-title":"Air Med J"},{"key":"bibr22-00207314221125141","doi-asserted-by":"publisher","DOI":"10.1377\/forefront.20191016.235396"},{"key":"bibr23-00207314221125141","unstructured":"H.R.133\u2014Consolidated Appropriations Act 2021. https:\/\/www.congress.gov\/bill\/116th-congress\/house-bill\/133\/text."},{"key":"bibr24-00207314221125141","unstructured":"Kaiser Family Foundation. Surprise medical bills: new protections for consumers take effect in 2022. 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