Neutral policy analysis · not marketing · not legal advice
Estimating the cost of IDR: a balanced look at the Georgetown analysis
One widely cited estimate anchors much of the 'IDR is expensive' narrative. It is rigorous, and it rests on a now-contested input.
As of 2026-08-11 · 6 min read · Keyword: IDR cost estimate
The estimate
Researchers associated with Georgetown's Center on Health Insurance Reforms, publishing in Health Affairs, produced an influential estimate of the cost of the IDR process. The analysis is methodologically careful and is frequently cited in the policy debate.
The caveat that changes everything
Contested-but-credible
The estimate rests on a QPA benchmark that the Fifth Circuit, in TMA III (Aug 11, 2026), held was calculated unlawfully. A rigorous estimate built on a now-disputed input should be cited as contested, not as settled fact.
For that reason, this site does not repeat headline dollar figures from cost estimates as if they were verified. We link the analysis, note its benchmark dependency, and let readers weigh it.
The provider rebuttal
Provider-side commentators argue that estimates built on a depressed QPA overstate the cost attributable to IDR and understate the effect of underpayment. That rebuttal is itself an interested-party position; we present it as such, alongside the payer-side framing, without endorsing either.
Sources & evidence tiers
- ContestedGeorgetown CHIR / Health Affairs IDR cost analysis, Rigorous but rests on a QPA benchmark held unlawful in TMA III.
- VerifiedFifth Circuit en banc TMA III decision, Aug 11, 2026
- AdvocacyProvider-side and payer-side responses
Figures are cited as of 2026-08-11 and reflect data available at that time. The IDR data environment moves quickly; verify current rules and figures with CMS and counsel.