Americans are sharing stories of heartbreaking insurance denials – ones that led to worse illness and death – in the aftermath of the killing of Brian Thompson, CEO of the mega-insurer United Healthcare.
A rise in practices such as prior authorizations and automated denials of coverage have made it more difficult for Americans to access healthcare, and changes are urgently needed to reform practices like these and restore trust in the health system, experts said.
“Obviously it is morally reprehensible to murder someone, and vigilante justice is not justice. But I am not particularly surprised by the forceful expressions of anger toward the American health insurance system,” said Miranda Yaver, assistant professor of health policy and management at the University of Pittsburgh.
“When you have your life turned upside down because you can’t get a test for something that is really bothersome, or you can’t get a medication that would actually solve your issues, it creates a lot of frustration and anger and loss of trust.”
The killing in early December “has become a flashpoint for discussions about corporate power, bringing to the surface the public’s frustration with the industry,” said Anthony Grasso, assistant professor of political science at Rutgers University Camden. “There’s very little accountability.”
When Dianna H’s daughter was born in December 2016, doctors detected heart and lung issues in the baby, who spent eight days in the neonatal intensive care unit.
Doctors wanted to give her shots to protect against RSV (respiratory syncytial virus), an infection that can be deadly in children under two – even among babies with no preexisting conditions.
But her baby didn’t qualify because she wasn’t born premature or with specific conditions, Dianna said.
Two weeks later, the newborn became sick with RSV and went into respiratory failure, Dianna said. She was taken by ambulance to an intensive care unit three hours away.
“We almost lost her several times,” Dianna said.
Patients entangled in insurance denials describe frustration and helpless anger over the sense that they have little recourse or means to hold companies to task.
“I’d be lying if I didn’t get a small amount of pleasure out of knowing the insurance company had to pay hundreds of thousands of dollars because they made the choice to not spend a few thousand on a preventative,” Dianna said.
It’s a small consolation, she said, but it’s the closest she comes to feeling like the insurer bore responsibility for a dangerous policy.
She’s followed the response to the Thompson killing closely and said that while “it’s not something I would do,” she can “understand how somebody would be driven to do it”.
She has also struggled with a spinal injury that, had she been able to receive preventative care, might not have required extensive surgery. After seeing X-rays of a spinal fusion that Luigi Mangione, the suspect in the Thompson murder, had posted online, Dianna said: “As soon as I saw that, I said: ‘I get it.’ Inadequate healthcare, pain, feeling lost and disrespected and disregarded, is dehumanizing, and as a result, you do inhumane things.”
Less than a third (31%) of Americans said they have a positive view of the healthcare system, compared with 51% who said the same in 2020, according to a Gallup poll released last week.
Cost and access to care are among the most urgent health problems in the country, respondents said, with people citing those problems much more than health issues such as cancer or infectious diseases. About 79% of people said they were dissatisfied with the cost of care in the US.
While healthcare spending has risen by 67% in the past decade, the earnings of UnitedHealth Group, Elevance and Cigna have shot up by 262% in the same time. These rates once tracked closely together until markedly diverging in 2016.
Healthcare coverage has reached its lowest approval since Gallup started tracking the issue in 2001. The dip in satisfaction comes alongside a rise in coverage denials.
Humana, Cigna and United Healthcare have all been the recipients of class action lawsuits over their use of new AI tools to process and deny claims.
One lawsuit alleged that 90% of United Healthcare’s initial AI denials were reversed upon appeal, “an astonishing number”, Yaver said.
California recently enacted legislation with bipartisan support to regulate automated tools like these, requiring physician oversight based on a patient’s records.
Nationally, an act to speed up decisions about coverage for seniors on Medicare passed the US House of Representatives in September 2022 and was recently reintroduced in the US Senate.
“Even if we’re not reducing the extent of denials, we can at least mitigate some of these delays,” Yaver said.
Without “a large-scale reimagining of the American healthcare system, just making it easier for people to navigate is something that could help to repair what’s been broken”, she said.
Another area that could be reformed is the Employee Retirement Income Security Act (ERISA), which keeps workers on certain employer-sponsored plans from suing insurers for damages or even attorney’s fees at times. Yaver said it creates “accountability problems because there isn’t a major penalty, there isn’t really a cost to wrongful denials”.
Even when insurers lose lawsuits over denied care or face fines for breaking regulations, any costs incurred can be handed down to customers by increasing the cost of premiums.
“A lot of the things we do have to hold executives accountable are just absorbed as the cost of business,” Grasso said, adding “that some enhanced punishment of corporate executives and corporate wrongdoing, harms, and misconduct would be beneficial”.
There are also fundamental differences in how Americans understand and respond to harmful behavior, Grasso said.
“When someone’s shot on the street, we define that as a crime – we’ve got to punish that act of violence,” Grasso said. “But when we look at harms caused by corporate decision-making, such as the denial of lifesaving medical care, we typically don’t think of that as violence.”
But this shooting, and the outpouring of responses, is changing that understanding, he said.
“It is violence,” Dianna said of insurers denying lifesaving care. “It’s administrative violence.”
After her battle with RSV, Dianna’s daughter recovered, and she’s now a happy, energetic eight-year-old. Still, those early days linger in her mother’s memory with every cough, every sneeze.
There’s now a new, highly effective shot to protect against RSV, and it’s recommended for all newborns, not just preemies with certain health conditions. And there are RSV vaccines for pregnant people and the elderly.
Dianna hopes they make a difference – and that medications like these aren’t snarled up in insurance denials.
“Hopefully … nobody has to go through what we went through ever again,” she said.
