CEO shooting highlights growing frustration with US healthcare system
The brazen killing of UnitedHealthcare CEO Brian Thompson has unleashed social media scorn at his company and a U.S. health insurance industry that serves as gatekeeper to the nation’s $4.5 trillion health care system.
Trying to file an insurance claim at UnitedHealthcare, among the nation’s largest insurance companies, is a “humiliating and godawful slog,” one commenter wrote. “Guessing this (shooter) might be a disgruntled policy holder.”
Another poster complained, “CEOs are making money hand over fist- by DENYING care. I feel terrible for his family, but can’t say I’m surprised.”
Although social media is often filled with hatred and “good riddances” after a high-profile murder, and there have been instances of violence against people involved in health care before, the reaction this time felt different, experts said.
The Midtown Manhattan killing tapped a groundswell of public anger over an industry the public often only knows through impersonal delays and denials to needed health care, said Wendell Potter, a former CIGNA executive who became a whistleblower against the health insurance industry.
“I’ve been hearing for years now from people who have been so frustrated because of denials or delays of care, and this was an opportunity for people to vent and to take out their anger against someone who just became known to them all of a sudden,” Potter said.
“It’s sadly misplaced anger,” he continued. “The system is rigged against Americans who need care, people who have health insurance, and it is largely because of the role that Wall Street plays in our health care system.”
Why are people so angry at the health insurance industry?
Thompson’s death also elicited an outpouring of vitriol on social media toward health insurers, grievances over denied claims and complaints about perceived greed in the industry.
Investigators are still working to identify and locate the shooter who killed Thompson as well as determine a motive. Officials found three bullet casings inscribed with the words “deny,” “defend” and “depose,” multiple news outlets reported. The words evoke the title of a book critical of the insurance industry published in 2010: “Delay Deny Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.”
Before President Obama’s signature Affordable Care Act took effect last decade, health insurers often denied or limited coverage based on a person’s medical history and retroactively canceled plans when a person became sick with a costly disease such as cancer.
Such “rescissions” are not allowed now except when a person commits fraud or intentionally misrepresents facts. The 2010 health law mandated insurers spend a minimum of 80% to 85% of premiums on medical care, or rebate customers when they fail to meet those thresholds.
But other consumer aggravations remain. Denied claims and trouble finding a provider in network work are among the most common reportedly problems faced by Americans that say they’ve had trouble using their health insurance, according to a 2023 poll from KFF, a health policy nonprofit.
Problems with health insurance can be complex and confusing to navigate, which leads people to put off getting care and “could lead to very long term and detrimental health impacts,” said Ashley Kirzinger, director of survey methodology at KFF. “We know that it causes a lot of anxiety for people,” she said.
Others say the private health insurance industry is a function of the design of the United States health care system.
“Insurers get maligned for a lot of things that are really decided at a much higher level,” said Loren Adler, associate director of Center on Health Policy at the Brookings Institution. “The way the U.S. set up our health system, it designates insurers to make the unpopular decisions on denying some care, having prior authorization and trying to control costs. And no one likes cost control.”
What is UnitedHealthcare’s record on claim denials?
UnitedHealthcare does not publicly report how often it denies claims or requires doctors, hospitals or labs to get the insurer’s authorization before approving medical care.
But lawsuits and Congressional reports provide some clues to the insurer’s business practices
In October, a Senate panel report found UnitedHealthcare’s denial rate for post-acute care “surged from 10.9 percent in 2020, to 16.3 percent in 2021, to 22.7 percent in 2022.”
Almost a dozen people were arrested in July outside UnitedHealthcare’s headquarters in Minnetonka, Minnesota, while “protesting the company’s systemic practice of refusing to authorize and pay for care,” according to the People’s Action Institute. The organization offered condolences for Thompson’s death in a statement.
A 2023 lawsuit filed against United Healthcare, its parent company UnitedHealth Group and subsidiary NaviHealth claimed the insurance giant used artificial intelligence to deny claims for seniors enrolled in private Medicare plans. The lawsuit claimed seniors were denied access to skilled nursing and rehab centers and the insurer used AI to make “rigid and unrealistic” determinations about what it takes for patients to recover from serious illnesses.
When the lawsuit was filed UnitedHealth told USA TODAY that NaviHealth’s AI program isn’t used to make coverage determinations. The case is ongoing.
Claim denials or delays are both strategies that health insurance companies employ to limit the amount they pay in medical claims due to pressure from Wall Street, Potter said.
When UnitedHealthcare’s parent company, UnitedHealth Group, reported quarterly earnings in November, the insurer paid more in claims than Wall Street expected and warned of government payment cuts for private Medicare plans and low reimbursement from state Medicaid program. After the insurer lowered its forecast on financial performance for the next year, the company’s stock price dipped 8%.
“From the investors’ point view, the company was paying too much for care, and the company was punished,” Potter said.
Health care workers face on-the-job attacks, violence
Beyond anger directed at insurance companies, Thompson’s death is the latest in a number of violent attacks and threats against health care workers, including doctors and nurses, and industry executives.
Research has found health care workers are about five times more likely to experience workplace violence than employees in other industries and their risk of becoming gun violence victims is rising. Meanwhile, health care companies have shelled out hundreds of thousands of dollars to protect top executives as threats against them also rose.
Unlike mass shootings where the perpetrator doesn’t personally know the victims, attacks in health care settings are usually purposeful, targeted and often involve grudges related to medical or surgical outcomes, research has found.
“The risk of workplace violence is a serious occupational hazard for nurses and other health care workers,” a recent study by National Nurses United found. “Countless acts of assault, battery, aggression, and threats of violence that routinely take place in health care settings demonstrate a frightening trend of increasing violence faced by health care workers throughout the country.”
Holding a grudge against a physician for health outcomes is the motive in about 20% of fatal shootings involving health care workers, according to a study by Maine Medical Center researchers published in 2019.
Chris Pierson, CEO of security firm BlackCloak, said he’s seen executives of Fortune 500 pharmaceutical companies become victims of swatting after raising drug prices as well as his own clients in the health care industry physically confronted by people attempting to hold them accountable for their company’s decisions.
While violence is rare, consumer aggravation with insurance companies is routine.
Half of the people who reported issues using their health insurance either couldn’t receive recommended care, experienced a decline in their health or paid more than expected all as a direct result of their problems, the KFF poll found.
Though most people, particularly those in good health, say they’re happy with their own insurance provider, “people are much more negative about the health insurance industry writ large,” Kirzinger said.
“With the increase in costs of health care, there’s a lot of discussion of who’s to blame for that and what’s not getting covered,” she said.
Contributing: Christopher Cann, USA TODAY; Reuters
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