2022 No Surprises Act Reduced Patient Out-of-Pocket Spending
TUESDAY, Sept. 9, 2025 -- The U.S. No Surprises Act (NSA) reduced patients’ out-of-pocket spending for medical care, according to a study published online Aug. 27 in The BMJ.
Michael Liu, M.D., from Beth Israel Deaconess Medical Center in Boston, and colleagues estimated changes in U.S. health care spending after implementation of the NSA in 2022 among adults with direct-purchase private insurance. The analysis included 17,351 privately insured adults (aged 19 to 64 years), with 8,204 residing in the 18 intervention states that gained surprise billing protections after the NSA and 9,147 residing in the six control states that already had protections in place.
The researchers found that after implementation of the NSA, out-of-pocket spending showed a decline among privately insured adults in intervention states (from $3,674 to $2,922; relative percentage change, −16.5 percent). There was no decline among privately insured adults in control states ($2,704 to $2,550; relative percentage change, 1.9 percent). There was also a significant differential reduction in out-of-pocket spending among privately insured adults in intervention states versus control states after the NSA (relative percentage change, −18.0 percent; absolute change, −$567). There were no differential changes between the groups for either premium spending (absolute change, $93) or high-burden medical spending (absolute percentage point change, −1.0 percent) between the two groups. Findings persisted across sociodemographic characteristics including sex, race/ethnicity, poverty status, education level, and employment status.
"Our findings have important implications for patients and should inform ongoing policy efforts to prevent financial toxicity and address the health care affordability crisis in the United States," senior author Rishi Wadhera, M.D., also from the Beth Israel Deaconess Medical Center, said in a statement.
Several authors disclosed ties to relevant organizations.
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Disclaimer: Statistical data in medical articles provide general trends and do not pertain to individuals. Individual factors can vary greatly. Always seek personalized medical advice for individual healthcare decisions.
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