A Wake-Up Call: The UnitedHealthcare CEO Assassination and the Public's Demand for Reform

The recent assassination of UnitedHealthcare CEO Brian Thompson has sent shockwaves through the healthcare and insurance industries. Luigi Mangione, the alleged CEO killer, currently faces state and federal charges with 20 total counts including first degree murder and  murder as an act of terrorism. Mangione, a valedictorian and Ivy-League grad, pleaded not guilty, and though his next court appearance is not until February 21st, the actions and motives of the killer have reignited discussions about the role of big insurance companies, their practices, and their impact on the American people. 

One significant issue that has come into focus is the high denial rates for insurance claims, most notably from UnitedHealthcare, the company of which the victim was the CEO. This controversy displays the slippery slope between the profit-driven motives of big health insurance companies and the needs of individuals who depend on them for healthcare.

Why do health insurances deny claims and how do they justify it? 

Big insurance companies deny claims as a calculated strategy to maximize profits, employing several different tactics to reduce their payouts and cash in on their premiums. Treatment might not be covered by the policy or a person can easily miss one little document of the mountains of paperwork needed. Additionally, companies argue treatments aren’t “medically necessary”, an ambiguous term that is difficult to fight back and appeal against. Moreover, once these claims get rejected, the appeal process is just as, and can be even more strenuous. The convoluted puzzle of making an appeal results in a fraction of denied claimants to even attempt to appeal and only half of the appeals actually succeeding. Overall, insurers prioritize their financial bottom line over patient care,  manipulating the system and leaving patients to shoulder the financial and health consequences. 

Health Insurance Denial Rates: A Shadow of Transparency

UnitedHealthcare is the largest health insurer in the United States and has faced criticism for having the nation's high denial rates for insurance claims. The image below is

a graphic that was circling around social media shortly after the death of Thompson, exhibiting his company UnitedHealthcare to have the highest claim denial rate at 32 percent. This alleged statistic put UnitedHealthcare under fire on social media and was seen as a plausible reason why Luigi targeted their CEO. However, the federal government does not force these private health insurers to make comprehensive and transparent data on claim denials. This makes it virtually impossible to verify denial rates, allowing these health insurance companies to not be exposed for their denial rates. 

What this Lack of transparency leads to:

This lack of transparency of claim denial rates allows insurance companies like UnitedHealthcare to operate without significant and legitimate public accountability. Without reliable and publicly accessible data on claim denials, consumers are completely left in the dark about the true extent of the issue. Insurers are enabled to deny claims at any rate they want with minimal fear of reputational damage or regulatory repercussions, as there is no concrete evidence to hold them accountable. As a result, many individuals may face significant financial and medical hardship. A denied claim could mean paying out-of-pocket, having delays in treatment, or having a complete inability to access necessary care.

What is the future of Healthcare and Health Insurance Under Trump?

 With Donald Trump defeating Kamala Harris in the 2024 election, the tides of how health insurance will be handled will turn with Trump in office. Through Trump’s 2024 campaign, it was unclear how Trump would handle the healthcare system–most notably regarding the Affordable Care Act(ACA). The ACA, put into place under President Obama’s term, had three primary goals: To make affordable health insurance available to more people, to expand Medicaid, and to support new medical care methods to lower the costs of healthcare. Despite this, the U.S. has the highest per capita healthcare spending in the world and has consistently outpaced inflation, regardless of Biden’s enhanced premium subsidies for purchasing health insurance. Without these subsidies with Trump in office, Americans could be forced to pay an even steeper price tag for health insurance. Moreover, the uninsured rate in the U.S. could rise drastically with only 4 states and D.C. actually requiring health insurance. However, nothing is for certain with Trump only having ‘concepts of plan’ for the future healthcare system and nothing constructive regarding healthcare in his first 100 day plan.

What Should the Path Forward Look Like?

1. Transparency in Claim Denials and Claim Denial Rates: Federal mandates requiring insurers to publicly disclose their claim denial data. This way, the people have a clear understanding of what could possibly get them denied and how often that is.

2. Improved Appeal Processes: A more streamlined and user-friendly for challenging denied claims(In 2021, consumers appealed less than 0.2% of denied in-network claims!)

3. Regulation of Profit Margins: Keeping and enforcing strict limits on administrative   profits. Under the ACA, insurers must spend at least 80% of their revenue from premiums on healthcare and the other 20% goes to administrative overhead. Is it sustainable for that 80% to increase? Who knows what will happen under Trump. 

The assassination of Brian Thompson was a violent reminder of the public's mounting frustration with the American healthcare system. As Trump embarks on his second term, the direction of healthcare policy remains uncertain. However, the public's call for better accountability and fairness in this broken U.S. healthcare system is louder than ever. It is imperative for policymakers at all levels of government to prioritize meaningful reforms(while holding onto successful legislation) that put patients’ needs and the American majority first.