Is this you? As a journalist, you can create a free Muck Rack account to customize your profile, list your contact preferences, and upload a portfolio of your best work.
Claim your profile
Articles by Jack Hoadley
The $22 Billion Surprise Inside the No Surprises Act – Jack Hoadley
The $22 Billion Surprise Inside the No Surprises Act – Jack Hoadley Health Affairs September 4, 2026 Jeff Byers and Jack Hoadley Jack Hoadley of Georgetown University breaks down how the No Surprises Act’s dispute resolution process has grown into a $22.4 billion system and what it could mean for healthcare costs and premiums.
States Protect Consumers from Surprise Bills for Ground Ambulances
Blog / February 18, 2026 A fire and EMS ambulance unit drives to a call in the rain in Washington, D.C. Each year, about 3 million people with private insurance rely on ground ambulance transport in emergencies — in circumstances when they typically have no ability to choose a provider.
Balance of Increased Costs for Some Beneficiaries With Protections for Users of Expensive Drugs
The analysis by Cai et al1 asks whether Medicare Part D prescription drug coverage changed after Inflation Reduction Act (IRA) reforms took effect. They found that plan deductibles increased and more plans substituted coinsurance for flat copayments for preferred brand-name drugs. They concluded that beneficiaries who use high-cost drugs clearly benefited from the out-of-pocket maximum.
States Forge Ahead to Protect Consumers, as Advisory Committee Recommends Federal Action on Surprise Ambulance Bills
Blog / September 26, 2024 Nadia Stovicek Research Fellow, Center on Health Insurance Reforms, Health Policy Institute, McCourt School of Public Policy, Georgetown University Jack Hoadley Research Professor Emeritus, Health Policy Institute, McCourt School of Public Policy, Georgetown University Nadia Stovicek Research Fellow, Center on Health Insurance Reforms, Health Policy Institute, McCourt School of Public Policy, Georgetown University Jack Hoadley Research Professor Emeritus, Health...
2023 Data From The Independent Dispute Resolution Process: Select Providers Win Big
This article is the latest in the Health Affairs Forefront series, Provider Prices in the Commercial Sector, featuring analysis and discussion of physician, hospital, and other health care provider prices in the private-sector markets and their contribution to overall spending therein. Additional articles will be published throughout 2024. Readers are encouraged to review the Call for Submissions for this series. We are grateful to Arnold Ventures for their support of this work.
Podcast: The Rise – and Future – of Medicare Advantage w/ Jack Hoadley – RamaOnHealthcare
Podcast: The Rise – and Future – of Medicare Advantage w/ Jack Hoadley Health Affairs May 3, 2024 Jeff Byers, Jack Hoadley Health Affairs’ Jeff Byers interviews Jack Hoadley from Georgetown University about the final rule for the Medicare... Related Articles: 2024-05-03T17:15:37-04:00
Report Shows Dispute Resolution Process in No Surprises Act Favors Providers
For consumers, the goal of the No Surprises Act (NSA) is to avoid financial penalties in the form of surprise bills when they are treated by an out-of-network facility or provider in circumstances where they have no opportunity to receive in-network care. The law appears to be fulfilling that goal — consumers are mostly not receiving costly surprise bills. For insurers, health plans, facilities, and providers, the goal is fair payment.
Expanding the No Surprises Act to Protect Consumers from Surprise Ambulance Bills
Blog / February 15, 2024 Jack Hoadley Research Professor Emeritus, Health Policy Institute, McCourt School of Public Policy, Georgetown University Nadia Stovicek Research Fellow, Center on Health Insurance Reforms, Health Policy Institute, McCourt School of Public Policy, Georgetown University Jack Hoadley Research Professor Emeritus, Health Policy Institute, McCourt School of Public Policy, Georgetown University Nadia Stovicek Research Fellow, Center on Health Insurance Reforms, Health...
Surprise Billing: Volume Of Cases Using Independent Dispute Resolution Continues Higher Than Anticipated
For consumers, the goal of the No Surprises Act (NSA) is to ensure that they are not financially penalized when they are treated by an out-of-network facility or provider in many circumstances where they have no real opportunity to receive care from a facility or provider in their insurance network. For the most part, the law appears to be fulfilling that goal. For other stakeholders—insurers, health plans, facilities, and providers—the story is more complicated.
New No Surprises Act Guidance Builds On Recent Final Rule
On August 19, 2022, the Departments of Health and Human Services (HHS), Labor, and the Treasury issued a new series of frequently asked questions (FAQs) on a range of topics regarding implementation of the No Surprises Act (NSA). Among other topics, the FAQs address the NSA’s application to plans without a network or with a closed network, international pickup by air ambulance companies, emergency services provided in a behavioral health crisis facility, and notices.
Federal Officials Revise Approach To Arbitration Under No Surprises Act
On August 19, 2022, the Departments of Health and Human Services (HHS), Labor, and the Treasury issued a new final rule to further implement the independent dispute resolution (IDR) process under the No Surprises Act (NSA). The final rule was accompanied by a press release, fact sheet, and a status update on the IDR process. Federal officials also released a new series of frequently asked questions on a range of topics that will be summarized in a separate article.
Federal Officials Revise Approach To Arbitration Under No Surprises Act
On August 19, 2022, the Departments of Health and Human Services (HHS), Labor, and the Treasury issued a new final rule to further implement the independent dispute resolution (IDR) process under the No Surprises Act (NSA). The final rule was accompanied by a press release, fact sheet, and a status update on the IDR process. Federal officials also released a new series of frequently asked questions on a range of topics that will be summarized in a separate article.
Recent Guidance To Implement The No Surprises Act
The No Surprises Act protects patients from the most pervasive types of surprise out-of-network bills. The law applies when a patient receives emergency care (including by air ambulances), some post-stabilization services after an emergency, and non-emergency services at in-network facilities (unless a patient consents to treatment by an out-of-network provider).
Banning Surprise Bills, Part 2: Good Faith Estimates, External Review, And More
On September 30, 2021, the Departments of Health and Human Services (HHS), Labor, and the Treasury, alongside the Office of Personnel Management (OPM), issued a new interim final rule to implement additional components of the No Surprises Act (NSA). This rule focuses on the independent dispute resolution (IDR) process, good faith estimates for uninsured individuals, the dispute resolution process for patients and providers, and expanded rights to external review.
Banning Surprise Bills, Part 2: Good Faith Estimates, External Review, And More
On September 30, 2021, the Departments of Health and Human Services (HHS), Labor, and the Treasury, alongside the Office of Personnel Management (OPM), issued a new interim final rule to implement additional components of the No Surprises Act (NSA). This rule focuses on the independent dispute resolution (IDR) process, good faith estimates for uninsured individuals, the dispute resolution process for patients and providers, and expanded rights to external review.
Banning Surprise Bills, Part 1: A New Rule On Independent Dispute Resolution
On September 30, 2021, the Departments of Health and Human Services (HHS), Labor, and the Treasury, alongside the Office of Personnel Management (OPM), issued a new interim final rule to implement additional components of the No Surprises Act (NSA). This rule focuses on the independent dispute resolution (IDR) process, good faith estimates for uninsured individuals, the dispute resolution process for patients and providers, and expanded rights to external review.
Banning Surprise Bills, Part 1: A New Rule On Independent Dispute Resolution
On September 30, 2021, the Departments of Health and Human Services (HHS), Labor, and the Treasury, alongside the Office of Personnel Management (OPM), issued a new interim final rule to implement additional components of the No Surprises Act (NSA). This rule focuses on the independent dispute resolution (IDR) process, good faith estimates for uninsured individuals, the dispute resolution process for patients and providers, and expanded rights to external review.
Proposed Rule On No Surprises Act Focuses On Data Collection And Enforcement
On September 10, 2021, the Departments of Health and Human Services (HHS), Labor, and the Treasury, alongside the Office of Personnel Management (OPM), issued a proposed rule to implement additional components of the No Surprises Act (NSA) and the Consolidated Appropriations Act (CAA). The proposed rule was accompanied by a press release, fact sheet, and report on air ambulances and surprise bills.
Banning Surprise Bills: Biden Administration Issues First Rule On The No Surprises Act
On July 1, 2021—just in time to meet a statutory deadline set by Congress—the Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management (OPM) issued an interim final rule (IFR) to implement key parts of the No Surprises Act (NSA). The NSA—which was adopted as part of a broader legislative package in December 2020 and builds on parts of the Affordable Care Act (ACA)—includes comprehensive new patient protections against surprise medical bills.
Banning Surprise Bills: Biden Administration Issues First Rule On The No Surprises Act
On July 1, 2021—just in time to meet a statutory deadline set by Congress—the Departments of Health and Human Services (HHS), Labor, and Treasury, and the Office of Personnel Management (OPM) issued an interim final rule (IFR) to implement key parts of the No Surprises Act (NSA). The NSA—which was adopted as part of a broader legislative package in December 2020 and builds on parts of the Affordable Care Act (ACA)—includes comprehensive new patient protections against surprise medical bills.
Hybrid Approach to Resolving Payment Disputes Breaks Legislative Stalemates Over Balance Billing, How Will the No Surprises Act Affect These New State Laws?
In December 2020, Congress enacted the No Surprises Act, which is designed to protect all Americans from surprise medical bills from out-of-network providers. But many states did not wait for federal action. Seven states enacted new surprise billing laws in 2020; five of these provide comprehensive protections. These laws raised the total number of states with protections to 33, including 18 with comprehensive protections.
Unpacking The No Surprises Act: An Opportunity To Protect Millions
Update Congress included the No Surprises Act in the omnibus spending bill that was passed and signed into law by President Trump on December 27, 2020. There were some slight changes between the version of the No Surprises Act described below and the final text of the legislation. However, these changes were relatively minor, and this post has been updated to reflect the final enacted legislation.
The Provider Relief Fund: How Well Does it Protect Patients from Surprise Medical Bills for COVID-19 Related Services?
The cost of health care is a critical concern during the current pandemic. People who worry about out-of-pocket costs are more reluctant to seek care. For those with private health insurance, out-of-pocket costs may take the form of deductibles, copayments, or coinsurance. When receiving services from an out-of-network provider, patients may also face balance bills (amounts billed by the out-of-network provider when insurers do not pay their full charges).
States Can Prevent Surprise Bills for Patients Seeking Coronavirus Care
May 1, 2020 Jack Hoadley, Maanasa Kona, Kevin Lucia The ongoing COVID-19 pandemic raises the stakes in the debate over surprise medical bills. Consumers’ fear of incurring medical bills could lead some to avoid testing or treatment. While new federal laws require insurers to waive cost-sharing for COVID-19 testing and the associated medical visit, that protection does not extend to treatment. Nor does it prevent balance billing if a patient is treated by an out-of-network provider or facility.
Update on Federal Surprise Billing Legislation: New Bills Contain Key Differences
February 28, 2020 Jack Hoadley, Beth Fuchs, Kevin Lucia In their latest post for the Commonwealth Fund’s To the Point blog, Jack Hoadley, Beth Fuchs, and Kevin Lucia examine the current status of congressional efforts to protect consumers from surprise medical billing. Four committees have crafted competing proposals.
Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion
Rural Health Policy Project Health Insurance Coverage in Small Towns and Rural America: The Role of Medicaid Expansion September 18, 2018 Jack Hoadley, Joan Alker, Mark Holmes Key Findings The uninsured rate for low-income adults(below 13 percent FPL) has come down since 2008/09 in nearly all states, but small towns and rural areas of states that have expanded Medicaid have seen the sharpest declines.
Stepping into the Breach: How States and Insurers Worked Together to Prevent Bare Counties for 2018
Although Affordable Care Act (ACA) marketplaces were beginning to stabilize in 2017, policy uncertainty stemming from a potential repeal of the law, threats to cost-sharing reduction reimbursements, and questions about enforcement of the individual mandate led many insurers to re-evaluate participation for 2018. In this report, we examine six states that faced the prospect of counties without a single insurer for 2018: Iowa, Nevada, Ohio, Oklahoma, Tennessee, and Washington.
Shielding Children from the Rising Costs of Prescription Drugs
Consider three different drugs that are used by children. Amoxicillin is an inexpensive antibiotic that might be prescribed when a child has an ear infection. Typically, this generic drug would cost between $5 and $15 for a one-time prescription. Antibiotics are the most common type of drug used by children under age 6. EpiPen is a costlier drug used to treat severe allergic reactions, such as those triggered by certain foods or an insect sting or bite.
Small Business Health Insurance and the ACA: Views from the Market 2017
The Affordable Care Act (ACA) ushered in dramatic changes for small employer health plans. Through a review of policy decisions, premium and enrollment trend data, and structured interviews with insurance executives, brokers and small business representatives in six states, researchers reveal a market undergoing a significant evolution.
How Medicaid and CHIP Shield Children from the Rising Costs of Prescription Drugs
Nearly a quarter of U.S. children use at least one prescription drug a month, most commonly treating such conditions as asthma, attention deficit hyperactivity disorder, and infections. Medicaid guarantees that enrolled children who need drugs receive them without any financial barriers, while some in the Children’s Health Insurance Program have a modest copayment.
Medicaid’s Role for Seniors Living in Small Towns and Rural America
Medicaid is a lifeline for millions of older adults (age 65+) who are likely also enrolled in Medicare. Medicaid is the primary payer for long-term services and supports that are not covered by Medicare, paying for more than 50 percent of these costs in 2015.
Rural Health Report
Medicaid is a vital source of health coverage nationwide, but the program’s role is even more pronounced in small towns and rural areas. Medicaid covers a larger share of nonelderly adults and children in rural and small-town areas than in metropolitan areas; this trend is strongest among children.
The Commonwealth Fund
Issue: Privately insured consumers expect that if they pay premiums and use in-network providers, their insurer will cover the cost of medically necessary care beyond their cost-sharing. However, when obtaining care at emergency departments and in-network hospitals, patients treated by an out-of-network provider may receive an unexpected “balance bill” for an amount beyond what the insurer paid.
How Could a New Administration Tackle Affordable Care Act Challenges? Look to Medicare
We’re experiencing another round of bad headlines for the Affordable Care Act (ACA) marketplaces. A government report found that, on average, premiums will rise 25 percent and consumers will have fewer insurance company choices in 2017. Eighty-three insurers will stop offering plans through the marketplaces next year while only 16 insurers will enter; 21 percent of enrollees will only have one insurer to choose from.
The Cost Of A Cure: Revisiting Medicare Part D And Hepatitis C Drugs
Two years ago, soon after the Food & Drug Administration (FDA) approved the first breakthrough treatment for hepatitis C, we wrote about the potential cost of a cure to Medicare Part D and its beneficiaries. For that piece, we used the best available data to estimate the number of people on Medicare who might seek treatment and the impact on Medicare spending.
Medicaid Expansion: Driving Innovation In Behavioral Health Integration
Safety-net providers in states that have accepted the federal funding available for Medicaid expansion under the Affordable Care Act (ACA) are experiencing a positive ripple effect, where increased insurance coverage rates among patients and thus greater financial security for safety-net institutions are translating into better care.
Medicaid Expansion: Driving Innovation In Behavioral Health Integration
Safety-net providers in states that have accepted the federal funding available for Medicaid expansion under the Affordable Care Act (ACA) are experiencing a positive ripple effect, where increased insurance coverage rates among patients and thus greater financial security for safety-net institutions are translating into better care.
The Ripple Effects Of Medicaid Expansion
The 19 states that continue to decline federal funding to offer Medicaid coverage to more uninsured residents are missing out on more than just improvements to their uninsured and uncompensated care rates. In fact, the ability of providers in Medicaid expansion states to deliver care to their most vulnerable patients has notably improved.
Obama's Budget and Surprise Out-of-Network Bills
by Sandy Ahn, Jack Hoadley and Sabrina Corlette of the Center on Health Insurance Reforms, originally posted on Health Affairs Blog, March 22, 2016 President Obama’s final budget proposal was met with little fanfare, but a lot of political opposition. The President, however, put forth one legislative proposal that deserves attention. It is aimed at helping consumers who get stuck with surprise bills from out-of-network health care providers.
President Obama’s Budget Takes State-Level Debates Over Surprise Out-of-Network Bills To National Policymakers
President Obama’s final budget proposal was met with little fanfare, but a lot of political opposition. The President, however, put forth one legislative proposal that deserves attention. It is aimed at helping consumers who get stuck with surprise bills from out-of-network health care providers. Specifically, the proposal would protect patients from having to pay unexpected fees to out-of-network providers for services delivered while they are in an in-network hospital.
Medicare Part D at Ten Years: The 2015 Marketplace and Key Trends, 2006-2015
Medicare Part D at Ten Years: The 2015 Marketplace and Key Trends, 2006-2015 Since 2006, Medicare beneficiaries have had access through Medicare Part D to prescription drug coverage offered by private plans, either stand-alone prescription drug plans (PDPs) or Medicare Advantage prescription drug plans (MA-PD plans). Now in its tenth year, Part D has evolved due to changes in the private plan marketplace and the laws and regulations that govern the program.
Health Affairs Blog: The Cost of A Cure: Medicare’s Role in Treating Hepatitis C
Health Affairs Blog: The Cost of A Cure: Medicare’s Role in Treating Hepatitis C Jun 05, 2014 | Tricia Neuman, Jack Hoadley, and Juliette Cubanski This post now available at the Health Affairs Blog by Tricia Neuman, Jack Hoadley, and Juliette Cubanski discusses Sovaldi (sofosbuvir), an oral drug recently approved by the FDA for the treatment of chronic hepatitis C, and the potential impact of this long-awaited cure on Medicare spending and Part D premiums.
Show More
loading
Actions
Is this you?
As a journalist, you can create a free Muck Rack account to customize your profile, list your contact preferences, and upload a portfolio of your best work.Get in touch with Jack
Contact Jack, search articles and posts on X, monitor coverage, and track replies from one place.
Learn more about Muck Rack