Killing of insurance CEO reveals simmering anger at US health system
The “brazen and targeted” murder of health insurance executive Brian Thompson, CEO of UnitedHealthcare, outside a New York hotel this week has shocked the nation. The crime has also revealed a deep-seated anger toward the trillion-dollar insurance industry.
While the phrase “prior authorization” might not typically evoke strong emotions, it was at the heart of a protest this past July. Over 100 people gathered outside UnitedHealthcare’s Minnesota headquarters to voice their opposition to the company’s policies and patient claim denials.
“Prior authorization” refers to the process by which insurance companies review proposed treatments before agreeing to pay for them.
The protest led to the arrest of eleven individuals who blocked a road. Police records show they traveled from states such as Maine, New York, Texas, and West Virginia to participate in the rally organized by the People’s Action Institute.
Unai Montes-Irueste, media strategy director for the Chicago-based advocacy group, explained that many of the protesters had personal experiences with claim denials and other healthcare system challenges.
“They are denied care, then they have to go through an appeals process that’s incredibly difficult to win,” he told the BBC.
The growing frustration many Americans feel about the healthcare system—a complex web of for-profit and not-for-profit providers, insurance giants, and government programs—came to the forefront following Thompson’s apparent targeted killing in New York City.
Thompson led UnitedHealthcare, the largest insurer in the US, and was part of the health services provider UnitedHealth Group. While police are still searching for the suspected killer and the motive remains unclear, authorities found messages on shell casings at the scene. The words “deny,” “defend,” and “depose” were written on them, which investigators believe might refer to strategies that critics accuse insurance companies of using to avoid payouts and boost profits.
A look at Thompson’s LinkedIn reveals many people upset over claim denials. One woman commented on a post Thompson made about his company’s efforts to make drugs more affordable: “I have stage 4 metastatic lung cancer,” she wrote. “We’ve just left [UnitedHealthcare] because of all the denials for my meds. Every month there is a different reason for the denial.”
Thompson’s wife, Paulette, told NBC that her husband had received threats in the past. “There had been some threats,” she said. “Basically, I don’t know, a lack of [medical] coverage? I don’t know details. I just know that he said there were some people that had been threatening him.”
Philip Klein, a security expert who previously provided protection for Thompson, expressed surprise that the executive was not provided with security for his trip to New York. Klein, who runs Klein Investigations in Texas, noted that rising frustration with high costs in multiple industries often leads to threats against corporate leaders.
“There’s lot of anger in the United States of America right now,” Mr Klein said.
“Companies need to wake up and realise that their executives could be hunted down anywhere.”
Mr Klein says he’s been inundated with calls since Thompson was killed. Top US firms typically spend millions of dollars on personal security for high-level executives.
In the wake of the shooting, a number of politicians and industry officials expressed shock and sympathy.
Michael Tuffin, president of insurance industry organistion Ahip, said he was “heartbroken and horrified by the loss of my friend Brian Thompson”.
“He was a devoted father, a good friend to many and a refreshingly candid colleague and leader.”
In a statement, UnitedHealth Group said it had received many messages of support from “patients, consumers, health care professionals, associations, government officials and other caring people”.
But online many people, including UnitedHealthcare customers and users of other insurance services, reacted differently.
Those reactions ranged from acerbic jokes (one common quip was “thoughts and prior authorisations”, a play on the phrase “thoughts and prayers”) to commentary on the number of insurance claims rejected by UnitedHealthcare and other firms.
At the extreme end, critics of the industry pointedly said they had no pity for Thompson. Some even celebrated his death.
The online anger seemed to bridge the political divide.
Animosity was expressed from avowed socialists to right-wing activists suspicious of the so-called “deep state” and corporate power. It also came from ordinary people sharing stories about insurance firms denying their claims for medical treatments.
Mr Montes-Irueste of People’s Action said he was shocked by the news of the killing.
He said his group campaigned in a “nonviolent, democratic” way – but he added he understood the bitterness online.
“We have a balkanised and broken healthcare system, which is why there are very strong feelings being expressed right now by folks who are experiencing that broken system in various different ways,” he said.
Mr Tuffin, head of the health insurance trade association, condemned any threats made against his colleagues, describing them as “mission-driven professionals working to make coverage and care as affordable as possible”.
The posts underlined the deep frustration many Americans feel towards health insurers and the system in general.
“The system is incredibly complicated,” said Sara Collins, a senior scholar at The Commonwealth Fund, a healthcare research foundation.
“Just navigating and understanding how you get covered can be challenging for people,” she said. “And everything might seem fine until you get sick and need your plan.”
Recent Commonwealth Fund research found that 45% of insured working-age adults were charged for something they thought should have been free or covered by insurance, and less than half of those who reported suspected billing errors challenged them. And 17% of respondents said their insurer denied coverage for care that was recommended by their doctor.
Not only is the US health system complicated, it’s expensive, and huge costs can often fall directly on individuals.
Prices are negotiated between providers and insurers, Ms Collins says, meaning that what’s charged to patients or insurance companies often bears little resemblance to the actual costs of providing medical services.
“We find high rates of people saying that their healthcare costs are unaffordable, across all insurance types, even (government-funded) Medicaid and Medicare,” she said.
“People accumulate medical debt because they can’t pay their bills. This is unique to the United States. We truly have a medical debt crisis.”
A survey by researchers at health policy foundation KFF found that around two-thirds of Americans said insurance companies deserve “a lot” of blame for high healthcare costs. Most insured adults, 81%, still rated their health insurance as “excellent” or “good”.
Christine Eibner, a senior economist at the nonprofit think tank the RAND Corporation, said that in recent years insurers have been increasingly issuing denials for treatment coverage and making use of prior authorisations to decline coverage.
She said premiums are about $25,000 (£19,600) per family.
“On top of that, people face out-of-pocket costs, which could easily be in the thousands of dollars,” she said.
UnitedHealthcare and other insurance providers have faced lawsuits, media investigations and government probes over their practices.
Last year, UnitedHealthcare settled a lawsuit brought by a chronically ill college student whose story was covered by news site ProPublica, which says he was saddled with $800,000 of medical bills when his doctor-prescribed drugs were denied.
The company is currently fighting a class-action lawsuit that claims it uses artificial intelligence to end treatments early.
