The brazen murder of Brian Thompson, CEO of UnitedHealthcare sparked social media scorn for his company and the U.S. health insurance industry that serves as the guardian of the nation’s $4.5 trillion health care system.
Trying to file an insurance claim with UnitedHealthcare, one of the nation’s largest insurance companies, is a “humiliating and dreadful task,” one commenter wrote. “I suppose (the murderer) could be a disgruntled policyholder.”
Another poster complained: “CEOs make money by withholding care. I feel bad for his family, but I can’t say I’m surprised. »
Although social media is often filled with hate and “good riddance” after a high-profile murder, and there have been cases of violence against people involved in health care before, the reaction this time has been different, experts said.
The Midtown Manhattan killing sparked a wave of public anger toward an industry the public often knows only through impersonal delays and denials of needed health care, said Wendell Potter, a former executive at CIGNA became a whistleblower against the health insurance sector.
“I’ve heard for years about people being very frustrated with denials or delays in care, and this was an opportunity for people to express their anger at someone they had just recently to know. suddenly,” Potter said.
“It’s unfortunately misplaced anger,” he continued. “The system is rigged against Americans who need care, people who have health insurance, and much of that is due to the role Wall Street plays in our health care system. »
Why are people so angry at the health insurance industry?
Thompson’s death also sparked a reaction outpouring of vitriol on social media toward health insurers, grievances about 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 the motive. Authorities found three bullet casings on which the words are written “deny”, “defend” and “depose”, several media reported. The words evoke the title of a book critical of the insurance sector published in 2010.: “Delaying Denial to Defend: Why Insurance Companies Won’t Pay Claims and What You Can Do About It.”
Before President Obama’s 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 ill. a costly disease such as cancer.
Such “cancellations” are now no longer permitted, except when a person commits fraud or intentionally misrepresents the facts. The 2010 health law requires insurers to spend a minimum of 80 to 85 percent of their premiums on medical care, or to provide discounts to customers when they fail to meet those thresholds.
But other problems remain for consumers. Denied claims and difficulty finding a provider through networking are among the most common problems faced by Americans who say they have had difficulty using their health insurance, according to a report. 2023 survey from KFF, a health policy nonprofit.
Health insurance issues can be complex and confusing to navigate, leading people to delay getting care and “could have very long-term adverse health consequences,” said Ashley Kirzinger, director of survey methodology at KFF. “We know it causes a lot of anxiety for people,” she said.
Others argue that the private health insurance industry is a function of the design of the American health care system.
“Insurers get criticized for a lot of things that are actually decided at a much higher level,” said Loren Adler, associate director of the Center on Health Policy at the Brookings Institution. “The way the United States has set up our health care system, it appoints insurers to make the unpopular decisions to deny certain care, get prior authorization, and try to control costs. And no one I like 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 laboratories to obtain insurer authorization before approving medical care.
But the lawsuits and congressional reports provide some clues about the insurer’s business practices.
In October, a Senate committee report found that UnitedHealthcare’s post-acute care refusal rate “increased from 10.9% in 2020, to 16.3% in 2021, and to 22.7% in 2022.”
Nearly a dozen people were arrested in July outside UnitedHealthcare headquarters in Minnetonka, Minnesota, while “protesting the company’s systemic practice of refusing to authorize and pay for care,” according to THE Popular Action Institute. The organization offered its condolences on the death of Thompson in a statement.
A 2023 trial filed against United Healthcare, its parent company UnitedHealth Group and its subsidiary NaviHealth claimed the insurance giant used artificial intelligence to deny claims from seniors enrolled in private Medicare plans. The lawsuit claimed that seniors lacked access to skilled nursing and rehabilitation centers and that the insurer used AI to make “rigid and unrealistic” decisions about what it took for seniors to patients recover from serious illnesses.
When the lawsuit was filed UnitedHealth said USA TODAY that NaviHealth’s AI program is not used to determine coverage. The case is ongoing.
Claim denials or delays are two strategies 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 results in November, the insurer paid higher claims than Wall Street had expected and warned of government payment cuts for plans private Medicare and low reimbursement from the public Medicaid program. After the insurer lowered its financial performance forecast for next year, the company’s stock price fell 8%.
“From an investor perspective, the company was paying too much for care and it was punished,” Potter said.
Healthcare workers face attacks and workplace violence
Beyond the anger directed at insurance companies, Thompson’s death is the latest in a series of violent attacks and threats against health care workers, including doctors, nurses and health care executives. ‘industry.
Research has found that healthcare workers are approximately five times more likely to be victims of workplace violence than employees in other sectors and their risk of being victims of gun violence increases. Meanwhile, healthcare companies have spent hundreds of thousands of dollars to protect senior executives while threats against them have also increased.
Unlike mass shootings where the perpetrator does not personally know the victims, attacks in health care settings are usually intentional, targeted, and often involve grudges related to medical or surgical outcomes, research has found.
“The risk of workplace violence constitutes a serious occupational hazard for nurses and other healthcare workers,” a recent National Nurses United study found. “The countless acts of assault, battery, assault and threats of violence that regularly take place in health care settings demonstrate a frightening trend of increasing violence faced by health care workers across the country.
According to a study conducted by Maine Medical Center Researchers published in 2019.
Chris Pierson, CEO of security firm BlackCloak, said he has seen executives at Fortune 500 pharmaceutical companies become crush victims after raising drug prices, as well as its own healthcare clients physically confronted by people who tried to hold them accountable for their company’s decisions.
Although violence is rare, consumer troubles with insurance companies are common.
According to the KFF survey, half of people who reported problems with their health insurance were unable to receive recommended care, saw their health deteriorate, or paid more than expected, all as a direct result of their problems.
Although most people, especially those in good health, say they are satisfied with their own insurance provider, “people are much more negative about the health insurance industry as a whole,” said Kirzinger.
“With health care costs rising, there is a lot of debate about who is responsible for this and what is not covered,” she said.
Contributor: Christopher Cann, USA TODAY; Reuters