President Donald Trump speaks on the Nationwide Prayer Breakfast on the Capitol in Washington, Feb. 6, 2025.
Evan Vucci/AP
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Evan Vucci/AP
As President Donald Trump wrapped up his first time period in 2020, he signed laws to guard Individuals from shock medical payments. “This should finish,” Trump mentioned. “We will maintain insurance coverage corporations and hospitals completely accountable.”
However the president’s wide-ranging push to slash authorities spending, led by billionaire Elon Musk, is weakening the federal workplace charged with implementing the No Surprises Act.
Some 15% of these working on the federal Middle for Shopper Data and Insurance coverage Oversight, or CCIIO, have been fired two weeks in the past, in line with the company’s former deputy director in control of operations, Jeff Grant.
And whereas the complete influence of the cutbacks remains to be coming into focus, the retrenchment is threatening work at an company already laboring to run an overstretched system for resolving typically very giant payments from out-of-network medical suppliers.
“It is a sizzling mess,” Grant mentioned of the job cuts in an interview with KFF Well being Information. “The chaos has put everybody in a tailspin.”
The cuts, which affected 82 of the greater than 600 staff within the federal workplace, additionally danger delaying vital new guidelines designed to hurry the method of adjudicating disputes over shock payments between well being plans and medical suppliers.
Grant, who was the highest profession official at CCIIO, retired final week after 41 years in authorities. He blasted the layoffs as a “grievous error” in a strongly worded letter to the appearing human assets director, criticizing him for chopping jobs with out regard for the {qualifications} of staff or the wants of the company.
Well being insurers have additionally raised issues about sustaining the company’s work on shock payments.
Spokespeople for the Division of Well being and Human Providers, led by Robert F. Kennedy Jr., didn’t reply to questions concerning the job cuts.
The CCIIO, a small a part of the federal well being company, was created by the 2010 Inexpensive Care Act and charged with guaranteeing that medical insurance plans meet requirements established by the regulation to guard sufferers.
After Congress handed the No Surprises Act in 2020, the workplace assumed extra duty for establishing and administering the complicated course of for shielding sufferers from shock payments.
The work drew help from Democrats and Republicans, who’d been inundated with tales of sufferers hit by enormous payments from emergency physicians, anesthesiologists, and different suppliers who weren’t in sufferers’ insurance coverage networks, even when sufferers acquired care at in-network hospitals.
“We are going to finish shock medical billing,” Trump promised on the marketing campaign path in 2020. “The times of ripping off sufferers are over.”
The regulation barred medical suppliers most often from pursuing sufferers over shock payments. This prohibition will not be immediately affected by the current job cuts ordered by Musk’s Division of Authorities Effectivity, created by Trump by way of an government order.
However the CCIIO had been working to streamline a system established by the No Surprises Act to resolve disagreements between well being plans and medical suppliers over out-of-network payments. This key safety was put in place so sufferers wouldn’t be caught in the midst of billing disputes.
The system, often called unbiased dispute decision, or IDR, has been inundated with lots of of hundreds of circumstances. In 2023, greater than 650,000 new disputes have been filed, in line with a current evaluation printed within the journal Well being Affairs.
“The No Surprises Act has protected tens of millions of Individuals from receiving shock medical payments,” mentioned Jennifer Jones, who directs legislative coverage on the Blue Cross Blue Protect Affiliation, an insurance coverage commerce group. “However points with the unbiased dispute decision course of,” she added, “are driving up prices for sufferers and employers.”
Additionally overwhelmed has been a shopper reporting system designed to permit sufferers to lodge complaints in the event that they really feel they’ve been unfairly focused with a shock invoice.
Beneath former President Joe Biden, the CCIIO had been engaged on new guidelines to make dispute decision extra environment friendly, which consultants mentioned would make a distinction.
“If this rule turns into closing and works in addition to supposed, it ought to assist extra out-of-network claims get resolved,” mentioned Jack Hoadley, an emeritus analysis professor at Georgetown College, who has studied shock medical billing.
However the brand new guidelines weren’t completed earlier than Biden left workplace. And the senior official overseeing this work left his job in January. The current cuts hit the remaining CCIIO staffers engaged on the No Surprises Act, in line with Grant and different sources accustomed to the layoffs, who requested to not be recognized out of worry {of professional} retaliation.
Grant mentioned senior CCIIO officers have been since capable of shift some staff round and bought permission to recall a number of the 82 folks let go. However he mentioned there isn’t any assure that each one of them will need to come again to the diminished company.
Much more regarding, Grant mentioned, are deeper cuts that the White Home has instructed federal companies to arrange for by March 13.
“These cuts have been fairly unhealthy,” Grant mentioned. “What occurs subsequent can be much more vital.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is without doubt one of the core working applications at KFF.
