I use a similar graph when discussing the NSA. When insurers say that the NSA is driving costs, look at this graph. It’s a near straight line change from 2000. The spike after 2020 is the COVID utilization spike. If anything, it’s actually slightly slowing here in 2026. NSA is a convenient scapegoat for insurers who want complete pricing control but it’s not the driver of healthcare premium or cost increases no matter what you hear.

I just don’t get it. While people may disagree on how the law is enacted and what it does, it is still the law. If I don’t agree with my tax return, can I just refuse to pay it and have nothing happen? If I don’t agree with a speeding ticket, can I just ignore it and have no consequences? The Technical Assistance released by the federal government explicitly states that even if the insurer disagrees with the outcome and wants to dispute the eligibility of a claim, they MUST pay the amount in arbitration to the physician within 30 days. That’s not an optional component. And yet insurers feel they can be judge and jury and I don’t blame them given that our government refuses to hold them accountable and enforce penalties for nonpayment. We need the No Surprises Act Enforcement Act at this point and we need CMS/DOL/Treasury to use every lever available to enforce payment. Billion dollar companies shouldn’t be able to choose which laws they want to adhere to and ignore the ones they don’t. The insurers are openly admitting they aren’t paying, asking employers to participate in their scheme, and laughing all the way to the bank as enforcement never occurs.