President Trump did what Washington had failed to do for decades: he stood up for patients and put an end to one of the most abusive practices in American healthcare. Surprise medical billing, where families did everything right and still got crushed with massive, out-of-network bills, was a massive scam hiding in plain sight. The No Surprises Act was meant to shut it down, and under President Trump’s leadership, it did exactly that.
Patients are no longer being ambushed with potentially life-shattering bills after emergency care. That is a real achievement.
But passing strong, pro-patient reform is only half the battle in Washington. The other half is stopping entrenched interests from figuring out how to exploit it. And once again, private equity firms – perpetually flush with cash, lawyers, and lobbyists – have found a way to game the system.
While surprise bills may be down, healthcare costs are not. In fact, the No Surprises Act has quietly triggered about $5 billion in new costs in just its first three years. Those costs will be passed on to working Americans through higher premiums and employer costs while wages stay stagnant.
So how did a commonsense patient protection turn into a profit engine for private equity?
The answer lies in a last-minute arbitration scheme buried inside the law: an “Independent Dispute Resolution” (IDR) process that was aggressively pushed by provider groups and backed by private equity money. The IDR process was originally intended to serve as a narrow, last-resort arbitration mechanism to fairly resolve occasional payment disagreements between insurers and providers, without involving patients or driving up overall healthcare costs. But what was sold as a narrow backstop has instead become a weapon.
For years before the law, private equity firms had already turned emergency medicine into a gold mine. They bought up physician staffing companies in areas where patients have no choice and no leverage: emergency rooms, radiology, anesthesiology, and air ambulances. No one price-shops when they’re rushed to the ER. Private equity understood that and built a business model around it.
When surprise billing was finally shut down, those firms didn’t walk away. They simply adapted.
Through the IDR arbitration system, private equity-backed providers now flood the federal process with disputes, far beyond anything regulators anticipated. Instead of the roughly 17,000 cases per year the government expected, nearly 200,000 disputes were filed in just nine months after the system opened.
A small handful of private equity-owned companies dominate these filings. Two firms alone account for more than 40 percent of resolved claims in recent years. And they’re winning about 85 percent of the time.
When they win, they don’t just get paid. They secure reimbursements three to four times higher than normal in-network rates. That money doesn’t come out of thin air. It comes out of the healthcare system, and ultimately, out of the pockets of workers and employers.
Even more troubling, private equity isn’t just profiting on the provider side. Several companies hired by the federal government to act as certified arbitrators are themselves backed by private equity firms. In some cases, those same investment firms also own healthcare providers filing disputes into the system. That’s not a free market. That’s insiders playing both sides of the table. It is completely insane.
President Trump has spent his career calling out this exact caliber of elite abuse. Powerful financial interests are exploiting complexity and hiding behind bureaucracy to shift costs onto ordinary Americans while claiming to act in the public interest.
The No Surprises Act was the right reform. It protected patients just as it was supposed to. But private equity found the loopholes and exploited them to the maximum.
Now the job is to finish what President Trump started: tighten the arbitration process, shut down abusive filings, expose conflicts of interest, and stop Wall Street firms from using healthcare as a cash-extraction scheme.
Protect patients. Lower costs. Drain the healthcare swamp.
Stefano Forte is the President of the New York Young Republican Club and Executive Director of the 1776 Project PAC
