Former Trump administration officials told Breitbart News how President Donald Trump can further his affordability platform by ending a Biden-era loophole and lowering health insurance premiums.
“By acting to fix the issues with the No Surprises Act that Democrats created, President Trump would be ending the kind of waste, fraud, and abuse that this administration is working every day to root out and address. And this will lower healthcare costs. This should be a top priority,” a former Trump White House official told Breitbart News.
In his first term in office, President Donald Trump signed the landmark No Surprises Act (NSA), a bill designed to end the scourge of surprise medical bills. Before the legislation was signed into law, patients often got slapped with unexpected medical bills for using out-of-network services. When they used out-of-network services, patients often bore the brunt of the cost of the bill when there was a dispute between the health insurer and the healthcare provider.
The law was such a smashing success that the NSA prevented 10.1 million surprise medical bills in the first nine months of 2023, according to a survey from AHIP and the Blue Cross Blue Shield Association.
The law made progress on ending surprise medical bills; however, advocates say that there is room to end a Biden-era loophole in the independent dispute resolution (IDR) process that would lower healthcare premiums and prevent some healthcare providers from bilking the IDR process. The independent dispute resolution process is the mechanism by which insurers and providers and a third-party arbiter choose what they believe is the fair reimbursement for the healthcare service rendered to the patient.
The NSA uses a “baseball-style arbitration,” where the arbiter chooses either the provider’s or the insurer’s amount with no other option, as well as a “loser pays” approach to the IDR fees.
Insurers and providers blame the other side for unfairly benefiting from the IDR process. But government data says that the IDR process often disproportionately benefits healthcare providers over insurers.
Government data has revealed that providers win 88 percent of cases and are often awarded three or four times above comparable in-network rates when they win, according to Centers for Medicare & Medicaid Services (CMS) data. The data found that providers prompted 81 percent of the disputes.
Many healthcare providers have reportedly gotten rich by bilking the IDR process. The New York Times detailed how one plastic surgeon with offices in New York and Florida is making $440,000 per breast reduction surgery, thanks to the IDR loophole.
HHS in February 2026 found that the number of IDR disputes was “substantially higher” than originally projected. In 2022, the government estimated that there would be 17,000 IDR disputes. In 2023, there were 209,286 disputes, or roughly 12 times the figure that was projected just one year prior. It also found that median payment determinations were notably higher than in the Health Care Cost Institute (HCCI) claims database.
New York found that the IDR process led to a nearly “10 percent increase in premium rates this year.”
The exploitation of the loophole in the IDR process comes at a time when Americans’ health insurance premiums are skyrocketing. In 2026, employer-sponsored premiums are projected to increase by nine percent. This means that the annual family share of premiums could increase by $617.
Employers, workers, patients, and consumers in a February 2026 letter asked Treasury Secretary Scott Bessent, HHS Secretary Robert F. Kennedy Jr., and the Department of Labor (DOL) secretary to address the “at least $5 billion in wasteful spending” that occurs due to the IDR process.
They wrote that the IDR process is “undermining affordability and weakening protections for the millions of Americans who rely on job-based health insurance.” They also warned that the IDR process is being abused to raise costs for patients, plan sponsors, health plans, and the broader healthcare system.
As a result, former Trump administration officials have urged the Trump administration to fix the rule that was first implemented by the Biden administration in 2023. Former Trump senior officials argued that the Biden administration bungled the implementation of the IDR rule, leading to many of the issues that the healthcare system now faces.
Now, reports find that the Health and Human Services (HHS) Department is meeting with industry groups across the spectrum to address the IDR rule.
“President Trump and Dr. Oz know health care affordability is one of the most important issues facing working Americans. A few predatory doctors and hospital systems making millions at the expense of everyone else isn’t fair and is driving up premiums,” West Cuthbert, the former Associate Deputy Secretary of HHS and Chief of Staff to Deputy Secretary Jim O’Neil, told Breitbart News.
“Fixing the loopholes created by the Biden Administration is a great way to lower costs for all Americans and is in line with this administration’s efforts to curb waste, fraud, and abuse.”
President Trump has promised to “lower healthcare prices for all Americans and truly make healthcare affordable again,” and by ending the IDR loophole, he may just make health care a little greater.
“While Democrats lie and say that Republicans want to increase healthcare costs — it was actually the Biden administration who oversaw the loopholes that are helping cause families’ premiums to skyrocket. President Trump should act fast to fix it and bring relief to American families now,” a former senior Trump administration official told Breitbart News.
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