Shocking response to UnitedHealth CEO's killing spotlights Americans' outrage at insurance system

The killing of the CEO of UnitedHealthcare sparked a shocking backlash against insurers and their practices, raising questions about propriety while increasing pressure on the incoming Trump administration and Congress to overhaul the industry.

Police think the gunman targeted the executive, Brian Thompson, outside a midtown Manhattan hotel because of his role in the insurance industry.

Shell casings found at the scene reportedly had the words  “deny,” “defend” and “depose” written on them, a reference to tactics insurers use to refuse medical claims and enhance profits. Online commentators were unusually reluctant to condemn the killer, reflecting a deep-simmering — if not shocking — loathing of the industry.

“No one here is the judge of who deserves to live or die. That’s the job of the AI algorithm the insurance company designed to maximize profits on your health and no one else,” several people wrote on X.

Others posted videos describing their struggles with gaining coverage for medical issues. 

They were upset about prior authorization, in which an insurer must approve surgeries or procedures before they can occur; the increasing rate of denied claims to protect profits; and the lack of coverage for breakthrough drugs for conditions such as Alzheimer’s disease and obesity.

Gallup released a survey Friday that says opinions of the U.S. health care system and coverage had fallen to their lowest point in decades.

Just 28% say coverage is excellent or good, or 4 points lower than the average since 2001 and well below the high point of 41% in 2012. 

The poll was conducted before the UnitedHealthcare shooting but reflected long-standing gripes about the industry.

Two-thirds of Americans said health insurers deserve a “lot of blame” for high health care costs, while only 4% said they deserve no blame at all, according to a KFF poll in February.

A separate KFF survey from 2023 found that most Americans like their own health plan, but a majority had an issue with their insurance, such as falling out of network or seeing their claims denied.

The words reportedly on the shooter’s shell casings were similar to the mantra that describes insurer tactics and was part of the title of a 2010 book by Rutgers University law professor Jay Feinman: “Delay, Deny, Defend: Why Insurance Companies Don't Pay Claims and What You Can Do About It.”

The professor declined to comment for this article about the post-shooting outrage toward insurers.

The debate around insurance practices is reaching a boil as a new Congress and administration take shape in Washington.

Some members of Congress, notably Sen. Bernard Sanders of Vermont, have called for a government-run, single-payer system of health insurance. They argue that private insurers cannot be trusted to put patients’ needs ahead of profits.

“Trump has suggested that Canada become the 51st state in our union. Does that mean that we can adopt the Canadian health care system and guarantee health care to all, lower the cost of prescription drugs, and spend 50% less per capita on health care? I'm all for it,” Mr. Sanders, an independent who describes himself as a democratic socialist, wrote on X the day before the shooting.

The incoming Trump team hasn’t proposed sweeping changes to the insurance industry, but analysts believe the GOP administration might curb Medicaid benefits for the poor or Affordable Care Act benefits, especially because lawmakers need ways to extend tax cuts that were approved in Mr. Trump’s first term.

Mr. Trump took cuts to Medicare coverage for older adults off the table, putting the focus on the other programs.

He permitted work requirements to rein in the federal-state Medicaid program.

And while a repeal of "Obamacare" is unlikely, the GOP might allow supersized subsidies in the program to expire after 2025 to pay for Mr. Trump’s tax pledges.

“Once the trade-offs in changes to the ACA and Medicaid become clear — federal spending vs. health coverage and affordability — the contours of the political debate will also become clearer,” Larry Levitt, the executive vice president for health policy at KFF, wrote in a recent piece for the JAMA Health Forum.

The debate around insurance coverage is fraught and delicate — and will be more so, given the cold-blooded killing in midtown Manhattan.

One day after the killing, BlueCross Blue Shield said it would no longer cover the full duration of surgeries in Connecticut, New York and Missouri, only to reverse its decision.

“We pushed Anthem to reverse course on their decision to strip anesthesia coverage away from New Yorkers and today they will be announcing a full reversal of this misguided policy,” New York Gov. Kathy Hochul, a Democrat, said on social media. “Don’t mess with the health and well-being of New Yorkers — not on my watch.”

Online commentators couldn’t help but wonder if the reversal was due to the threatening atmosphere around insurers rather than gubernatorial intervention.

By contrast, health organizations offered condolences to Mr. Thompson's family.

“Emphasizing that a simplified health care experience was optimal, he valued the importance of meeting consumer needs while sustaining positive, trustworthy relationships with providers,” said Craig A. Kennedy, president and CEO of Medicaid Health Plans of America. “And in advocating for the nation’s health care delivery system to work for everyone, he helped ensure that vulnerable, underserved populations have access to quality, affordable, and effective health care.”

Following the shooting, UnitedHealthcare said it was “deeply saddened and shocked at the passing of our dear friend and colleague Brian Thompson.”

“Brian was a highly respected colleague and friend to all who worked with him,” the insurer said. “We are working closely with the New York Police Department and ask for your patience and understanding during this difficult time. Our hearts go out to Brian’s family and all who were close to him.”