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’ll 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 Heart for Shopper Info and Insurance coverage Oversight, or CCIIO, have been fired two weeks in the past, based on the company’s former deputy director in control of operations, Jeff Grant.
And whereas the total affect 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 massive payments from out-of-network medical suppliers.
“It is a scorching 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 workers within the federal workplace, additionally threat delaying important 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 sources director, criticizing him for slicing jobs with out regard for the {qualifications} of workers or the wants of the company.
Well being insurers have additionally raised considerations 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 Reasonably priced Care Act and charged with making certain that medical insurance plans meet requirements established by the legislation to guard sufferers.
After Congress handed the No Surprises Act in 2020, the workplace assumed further accountability for organising and administering the advanced 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 large 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 legislation barred medical suppliers normally from pursuing sufferers over shock payments. This prohibition shouldn’t be straight affected by the latest job cuts ordered by Musk’s Division of Authorities Effectivity, created by Trump via an govt 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 impartial dispute decision, or IDR, has been inundated with lots of of 1000’s of circumstances. In 2023, greater than 650,000 new disputes have been filed, based on a latest evaluation revealed within the journal Well being Affairs.
“The No Surprises Act has protected hundreds of thousands 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 impartial 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.
Below 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 remaining 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 latest cuts hit the remaining CCIIO staffers engaged on the No Surprises Act, based on Grant and different sources conversant in the layoffs, who requested to not be recognized out of worry {of professional} retaliation.
Grant mentioned senior CCIIO officers have been since in a position to shift some workers round and acquired permission to recall a few of the 82 folks let go. However he mentioned there isn’t any assure that each one of them will wish to come again to the diminished company.
Much more regarding, Grant mentioned, are deeper cuts that the White Home has instructed federal businesses to organize for by March 13.
“These cuts have been fairly dangerous,” Grant mentioned. “What occurs subsequent will probably be much more necessary.”
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF.
