On October 9, 2026, Energy and Commerce Committee Ranking Member Rep. Frank Pallone (D-NJ) introduced the Lower Premiums, Faster Payments Act. The legislation would replace the federal Independent Dispute Resolution (IDR) process for services furnished on or after January 1, 2028. The new benchmarking process would pay providers at the median in-network rate for their services, adjusted for geography, even if they are out-of-network. The bill is still in development and is already drawing significant opposition from physician organizations, setting up for a broader conversation in Congress on whether to reform the existing IDR process and, if so, how to do it. We expect continued discussions on this issue in the next Congress as it has garnered bipartisan attention.   

How does the current IDR method work? 

Under the current IDR method, insurers and providers each propose a rate for a given out-of-network service; then, an arbitrator chooses one of the suggested figures after considering the Qualifying Payment Amount (QPA) and other relevant data. Beginning in 2028, the bill would eliminate this “baseball style” arbitration, replacing it with a “benchmarking” system where plans pay providers an in-network payment rate based on an insurer’s median contracted QPA as of Jan. 31, 2019, even if the provider is out-of-network. It would also adjust the payment amount annually to the Consumer Price Index, so reimbursement rises along with inflation, and require that payments be issued within 30 days of the claim being filed. In a statement, Rep. Pallone asserts that the bill “will replace the broken arbitration system with a fair and timely payment process that lowers people’s health insurance premiums.  

What problem is the Lower Premiums, Faster Payments Act trying to solve?
The bipartisan No Surprises Act (NSA), which Rep. Pallone helped author, protects patients from certain surprise bills. The Act created the IDR process to resolve payment disputes between payers and providers for out-of-network services. Think of it as a referee deciding between two different rates. In the IDR process, payers and providers are supposed to negotiate the rate of an out-of-network service with the arbiter or mediator, making the final decision. In announcing the new legislation, Rep. Pallone argued that a small number of organizations, many backed by private equity firms, drive a disproportionate share of IDR cases and that the process is rising costs. This creates backlogs, delays payments and increases costs. His office reported that about 67% of the 2.5 million disputes submitted in 2025 were submitted by just 10 provider groups.  

Why is the proposed bill facing criticism? 

Rep. Pallone’s bill has already drawn opposition from The American Society of Anaesthesiologists (ASA), American College of Emergency Physicians (ACEP) and American College of Radiology (ACR). In an October 8th joint statement, they cautioned that the elimination of the IDR process would remove a safeguard against unreasonably low insurer payments and give insurers more influence over out-of-network reimbursement. They also characterized the legislation as premature because recent federal operational changes have not been fully implemented. Physician groups instead recommend improving the NSA through targeted policymaking that reduces bad actors. 

The group’s September analysis submitted to Congress shows how insurer practices — including unreasonably low initial payments, flawed QPAs and failures to participate in IDR — have contributed to the significant backlog of disputes. Their report cited federal data showing insurers failed to participate and lost by default on 25% of IDR line items in 2025, offered $1 or less on 8% of line items, and, excluding defaults, submitted offers at or below the QPA for nearly 40% of items.  

While Pallone is the first to release a major NSA reform proposal, legislation is not expected to move until next Congress. Other Committees are still considering reform options. The House Ways & Means Committee is taking a more bipartisan approach with Republican and Democratic Committee staff conducting joint meetings with stakeholders, and the Senate HELP Committee holding private roundtables with providers, insurers and IDREs. The Trump Administration is also working on regulatory and subregulaotry updates to the NSA, which they currently intend to promulgate before the end of the year. Regardless of the election outcome, this will be an energetic policy space that is intended to have an impact on commercial reimbursement.

Topics: Congress, Payment Policy