UnitedHealth Helped Write the Rules. Then It Started Losing.
There is something almost impressive about the audacity of what Wendell Potter has documented.
UnitedHealth helped provide the research that shaped the political case for the No Surprises Act, a landmark federal law designed to protect patients from devastating out-of-network medical bills. The company apparently believed the resulting policy would give insurers greater leverage over doctors and hospitals. Then the law took effect, providers began winning payment disputes before neutral arbiters, and one of the largest healthcare corporations in America discovered that the system it had helped bring into existence was no longer producing the outcomes it expected.
Now UnitedHealth says the system needs to be reformed.
Potter, the former insurance executive turned whistleblower and healthcare journalist, recently documented this extraordinary sequence in Health Care un-covered, connecting UnitedHealth’s role in influential academic research with the passage of the No Surprises Act, the company’s subsequent experience in arbitration, and the insurance industry’s growing campaign to change how those disputes are resolved. The details matter because this is not simply a story about corporate hypocrisy. It is a case study in how power moves through American healthcare, often invisibly, from corporate data and academic research to media coverage, lobbying campaigns, federal legislation, regulatory policy, and eventually the bills that arrive in our mailboxes.
The Research Behind the Law Was Not as Independent as It Looked
The No Surprises Act addressed a very real and deeply abusive problem. Before the law took effect in 2022, patients could do everything they were supposed to do, choose an in-network hospital, carry insurance, ask the right questions, and still receive an enormous bill because an anesthesiologist, radiologist, emergency physician, or other clinician involved in their care happened to be outside their insurance network.
Congress eventually acted, prohibiting many forms of surprise balance billing and creating an Independent Dispute Resolution process to settle payment fights between insurers and providers. The basic premise was straightforward and important: Whatever argument happened over the money, the patient should no longer be trapped in the middle of it.
But Potter’s reporting illuminates the machinery operating behind the policy debate that helped produce the law. Influential research led by Yale health economist Zack Cooper helped define the national conversation around surprise billing and was cited as Congress built the case for federal intervention. The research focused considerable attention on physician staffing companies and their role in driving out-of-network charges, helping establish a public narrative in which providers were frequently cast as the principal source of the problem.
What was largely invisible to the public was UnitedHealthcare’s role behind that research. According to internal emails obtained through litigation and previously reported by The Intercept, the underlying claims data had been provided by UnitedHealthcare under an arrangement that kept the insurer’s involvement out of the published research and much of the resulting media coverage. Potter reports that UnitedHealthcare executives were briefed on the researchers’ progress, suggested edits, and operated under a data-use agreement that gave the company the ability to object to publication. One UnitedHealth executive even suggested policy language that ultimately appeared in the research.
None of this automatically means that every conclusion reached by the researchers was false, nor does it erase the very real abuses that existed in surprise medical billing. But it raises a far more consequential question about how evidence becomes accepted truth in American healthcare. When a corporation with a direct financial stake in a policy outcome supplies the data, participates behind the scenes in the research process, and remains largely invisible while that research influences media coverage and federal legislation, the public deserves to understand the full chain of influence.
Patients do not have anything remotely comparable. Individual Americans do not maintain research departments, lobbying operations, public affairs firms, trade associations, proprietary national datasets, investor relations teams, and armies of attorneys capable of operating simultaneously across academia, government, media, regulation, and the courts. Large healthcare corporations do, and their influence does not always arrive in Washington wearing a corporate logo. Sometimes it arrives as academic research, sometimes as an industry survey, sometimes as an op-ed, and sometimes as a coalition organized around the language of affordability and consumer protection.
That distinction matters because the person reading the resulting headline has almost no way of seeing the machinery behind it.
Then UnitedHealth Started Losing
The No Surprises Act did more than prohibit certain surprise medical bills. It had to answer the inevitable question left behind once patients were removed from the payment dispute: If the patient is no longer responsible for an excessive out-of-network bill, how much should the insurer actually pay the provider?
That is where Independent Dispute Resolution comes in. When an insurer and an out-of-network provider cannot agree on reimbursement, a neutral arbiter can choose between their competing offers. The patient remains outside the financial crossfire, which is precisely the point.
The problem for UnitedHealth is that providers have been winning many of those disputes.
On a July 2026 earnings call, UnitedHealth executive Dan Kueter told Wall Street analysts that the IDR process associated with the No Surprises Act was being “exploited” by certain providers and blamed the law for contributing approximately one percentage point to the company’s medical cost trend. He cited insurance industry estimates suggesting that many disputes entering arbitration were ineligible and argued that some awards were dramatically higher than Medicare reimbursement rates. The implication was clear: The arbitration process was producing unacceptable results and therefore needed to change.
But there is another explanation for why neutral arbiters might repeatedly rule against insurers, and it is considerably less flattering to the insurance industry. The insurers may simply be offering providers too little.
That possibility becomes harder to dismiss when viewed alongside what has already happened in court. In 2021, a Nevada jury ruled against UnitedHealth in a dispute involving TeamHealth affiliates over reimbursement practices. After hearing weeks of testimony, the jury found the company liable for unfair reimbursement practices and concluded that it had acted with “oppression, fraud and malice,” ultimately awarding $60 million in punitive damages. Testimony also described a UnitedHealth savings program in which clinicians could receive a fraction of their billed charges while the company collected administrative fees tied to the difference between the original charge and what was ultimately paid.
More recently, Potter points to a series of insurer lawsuits challenging arbitration outcomes that have run into trouble in federal courts. In one July 2026 decision involving Blue Cross Blue Shield of Georgia, a federal judge rejected claims alleging a vast scheme by providers to manipulate the arbitration process and instead wrote that it was “highly plausible” that the insurer itself had consistently submitted low offers in an effort to maximize profits. Other insurer lawsuits involving similar theories have also been dismissed, although additional cases remain pending.
This is what makes UnitedHealth’s current position so extraordinary. The company supported the intellectual and political movement toward a surprise-billing law because it expected that law to constrain providers and give insurers additional leverage over payment. Congress passed the law. The law established a process for resolving disputes. Providers began using that process and frequently winning. Now the industry is increasingly arguing that the very mechanism producing those unfavorable decisions is being abused.
There may indeed be problems with the arbitration system that deserve examination. No payment mechanism involving hundreds of billions of healthcare dollars should be considered beyond scrutiny. But when one of the largest and most financially powerful participants in that system begins demanding reform immediately after neutral decision-makers repeatedly rule against its financial interests, policymakers should be extraordinarily careful about accepting the company’s diagnosis of the problem.
The Business Model Is Working Exactly as Designed
The argument that UnitedHealth needs relief from an unsustainable payment system would be easier to accept if the company were struggling financially under the burden of medical costs. Its latest results tell a very different story.
According to the second-quarter 2026 results highlighted by Potter, UnitedHealth reported approximately $8 billion in earnings from operations, up from roughly $5.15 billion during the same quarter a year earlier, an increase of about 55%. The company’s stock had risen more than 32% since the beginning of the year. At the same time, UnitedHealth had shed more than 1.5 million U.S. health plan enrollees and was spending a smaller percentage of premium revenue paying medical claims than it had during the comparable period a year earlier.
Those numbers should be considered alongside the constant national conversation about healthcare affordability. Americans are routinely told that healthcare costs too much because patients consume too much care, hospitals charge too much, doctors demand too much, prescription drugs cost too much, and the population is getting older and sicker. Employers are told that premiums must rise because medical costs are increasing. Patients are told that deductibles, narrower networks, prior authorization, utilization management, and increasingly elaborate administrative barriers are necessary to keep the entire system affordable.
Meanwhile, one of the largest healthcare conglomerates in American history can generate billions of dollars in quarterly operating earnings while telling investors that one obstacle to controlling future medical costs is an arbitration system in which independent decision-makers sometimes conclude that the company has not offered healthcare providers enough money.
From the perspective of shareholders, there is little evidence here of a broken business model. The uncomfortable question is whether the model works precisely because so much of what Americans experience as dysfunction is economically productive for someone else.
The Patient Experiences the Consequences, Not the Machinery
Most people encounter American healthcare one transaction at a time. Someone receives a denied claim, an incomprehensible bill, a prior authorization request, a medication that suddenly disappears from a formulary, or a notice that a longtime physician is no longer considered in network. Someone spends hours on the phone trying to correct an obvious mistake, files an appeal to obtain treatment their doctor already prescribed, or discovers that the explanation of benefits is not actually an explanation of anything.
Because we experience these events individually, we are encouraged to understand them as individual problems. We assume there has been an administrative error, a coding mistake, a misunderstanding, or an unfortunate exception to an otherwise functional system. We rarely see the institutional architecture behind the experience because patients encounter the consequences at the very end of an enormously complex chain of corporate, financial, political, and regulatory decisions.
That information imbalance is one of the central reasons I wrote We the Patients: Understanding, Navigating, and Surviving America’s Healthcare Nightmare. The healthcare industry’s greatest advantage over ordinary Americans is not simply that it has more money. It is that the industry understands the machinery because it helped build much of it, while the rest of us are expected to navigate that machinery only after we become sick.
Patients are asked to participate in a healthcare economy whose rules are negotiated in rooms they will never enter, informed by research whose financial relationships they may never see, interpreted by regulators they will never meet, and influenced by organizations whose names often reveal very little about the commercial interests behind them. When those rules produce an unfavorable outcome for a powerful corporation, that corporation has the resources to lobby Congress, petition regulators, finance research, organize coalitions, publish opinion pieces, file lawsuits, and construct a new public narrative explaining why the rules themselves need to change.
When the same thing happens to a patient, the patient gets an 800 number and a hold queue.
That disparity is not incidental to the American healthcare system. It is one of its defining characteristics.
The Real Question Is Who Gets to Write the Next Rule
None of this means the No Surprises Act should be treated as untouchable. Protecting patients from surprise medical bills was necessary and long overdue, but no federal law is perfect, no arbitration system is immune from abuse, and providers are not automatically virtuous simply because insurers are powerful. Every participant in a system involving this much money deserves scrutiny, and legitimate evidence of fraud, manipulation, excessive billing, or improper arbitration claims should be investigated wherever it occurs.
The same standard, however, must apply to the corporations asking Washington to change the rules.
When an industry participant helps supply and shape influential research used to justify federal legislation, expects to benefit financially from the resulting policy, and then seeks to alter the enforcement mechanism after outcomes begin moving against its interests, policymakers should examine every proposed reform with extraordinary skepticism. The relevant question is not whether UnitedHealth is winning or losing enough arbitrations. The relevant question is whether the law continues to protect patients while insurers and providers fight over how healthcare dollars are divided.
That distinction is essential because patients have already spent decades serving as human collateral in financial battles among healthcare corporations. The No Surprises Act was supposed to remove patients from one of those battles, not merely create another opportunity for the most powerful participants to rewrite the rules once they became dissatisfied with the outcome.
Potter’s reporting ultimately reveals something much larger than a fight over medical billing arbitration. The American healthcare system is not simply a collection of hospitals, doctors, insurers, pharmaceutical companies, employers, regulators, and patients awkwardly bumping into one another. It is a political economy in which institutions with enormous financial resources can influence the research used to define a problem, the public narrative surrounding that problem, the legislation designed to solve it, and the subsequent campaign to change that legislation when the results no longer serve their interests.
That is why transparency matters, why independent journalism matters, and why patients need something more powerful than another pamphlet teaching them how to become better healthcare consumers. If corporations can organize to influence the rules governing our healthcare system, the people whose bodies, families, finances, and lives are governed by those rules must learn to organize as well.
That is what the Year of the Patient should mean. It should not be another healthcare slogan attached to a conference banner or corporate marketing campaign. It should mean recognizing that patients are not merely consumers passing through a marketplace. They are citizens living under a healthcare system whose policies have consequences as profound as almost anything government does.
The system has counted for decades on patients experiencing its failures privately and fighting its institutions individually. The next era of healthcare accountability begins when those individual experiences become collective knowledge, collective pressure, and eventually collective political power.
The sick shall inherit the ballot.
And perhaps the most important question raised by this entire story is one millions of Americans already know how to answer: Have you ever fought an insurance company, eventually won the appeal, gotten the treatment covered, or had the bill corrected, only to realize afterward that making you fight that hard may have been part of the system all along?
