The murder of Brian Thompson, the UnitedHealthcare executive, in late 2024 unearthed a torrent of public outrage against the health insurance industry. And since then, Americans’ anger has solidified into deep mistrust of the companies.
Much of the current dissatisfaction stems from rising economic concerns: More and more people cannot afford the increasing costs of insurance premiums and medical bills.
Consumers are directing their ire at behemoths like UnitedHealth Group, which owns UnitedHealthcare and a host of related businesses, including Optum Rx, the major pharmacy benefit manager, and sprawling networks of doctors. CVS Health, which owns the major insurer Aetna, a chain of drugstores and CVS Caremark; and Cigna, which operates Express Scripts and a big insurer, have also drawn criticism.
“There’s a tremendous backlash against corporate medicine at this point,” said Jeff Goldsmith, a health care industry analyst. Not only has the public’s antipathy been sustained, he added: “If anything, it has broadened out.”
Luigi Mangione, the defendant accused of killing Mr. Thompson, had no direct dealings with UnitedHealthcare, according to the authorities and the company. But insurers’ practices were a focus of complaints in Mr. Mangione’s writings that resonated with the public.
On Friday, Mr. Mangione admitted to killing Mr. Thompson as he pleaded guilty in federal court to charges of interstate stalking resulting in death, and stalking through use of interstate facilities resulting in death. Both charges carry a maximum sentence of life imprisonment.
Federal and state lawmakers have called for breaking up UnitedHealth Group and other major companies that now control decisions all along the route to medical care by insuring patients, employing their provider and dispensing their drugs.
Insurers have also been slammed by both Republicans and Democrats for the companies’ inability to contain soaring medical costs at congressional hearings in this midterm election year. In poll after poll and month to month, lawmakers have been reminded that Americans have listed health care costs as a top concern.
The companies have tried to shift the blame, countering that hospitals and pharmaceutical companies were responsible for high prices. “The cost of health insurance is driven by the cost of health care,” Stephen J. Hemsley, the chief executive of UnitedHealth, told lawmakers in January.
Insurers, though, and other corporations were shocked by Mr. Thompson’s assassination in Midtown Manhattan. Companies pulled executive photos from their websites, assigned additional security crews to their management teams and limited public meetings.
But while many insurance executives were startled by the ugliness of the discourse, others understood it to be a clear sign to the overall health sector.
“It’s a moment of reckoning for the health care industry, more broadly,” Dr. Sachin H. Jain, the chief executive of SCAN Group and SCAN Health Plan, said at the time. “We’ve unmasked a sentiment that things need to change.”
Nearly 70 percent of insured adults surveyed this year described the process of seeking approval from an insurer before they could get care as burdensome, according to KFF, a nonprofit health research group.
Trust in insurers has declined modestly since 2024, according to an analysis of membership satisfaction by JD Power. Only 30 percent of commercial plan members described their insurer as a trusted partner in their health and wellness. Instead, people found that the companies focused on managing costs rather than helping them navigate the health care system.
In the immediate aftermath of Mr. Thompson’s killing, the industry, including UnitedHealth’s chief executive at the time, Andrew Witty, pledged to do better. “We know the health system does not work as well as it should,” Mr. Witty said, “and we understand people’s frustrations with it.” Many companies vowed to listen more closely to their customers and to make getting a claim approved much less cumbersome.
The next year, the industry and UnitedHealth promised to reduce the need for prior approval for a medical test or treatment, and to speed up decision-making when an insurer did require authorization before care.
The companies say they already have eliminated millions of requests for authorization. UnitedHealth said it would reduce the number of treatments requiring prior approval by 30 percent in 2026, and the company has also said it would exempt rural hospitals and pediatric patients from most approval requirements. Optum Rx also said fewer medications would need review.
But doctors and patients say there is little hard evidence that the companies’ moves have removed the roadblocks to get care. And a government watchdog recently singled out major insurers like UnitedHealthcare for denials of care for people enrolled in private Medicare plans.
A KFF analysis released this week offered mixed reviews: While the majority of requests for procedures were approved, a large number of denials were overturned, raising concerns about the process. The report also found a wide variation among the insurers.
“This new data confirms that the vast majority of prior authorization requests are approved and responded to in less than one day, faster than federal standards,” said Chris Bond, a spokesman for AHIP, an industry trade group, in a statement. “Health plans continue to make steady progress on industrywide actions to standardize and simplify prior authorization and deliver real-time responses for most electronic prior authorization requests in 2027.”
Under particular scrutiny, UnitedHealth has sought to demonstrate a commitment to accountability. The company said it had created a board committee for public responsibility and conducted numerous reviews of its businesses, according to its most recent earnings release. This year, it invited a group of reporters to its headquarters, where it offered presentations about its efforts to improve its responses to customer complaints.
Americans are also reeling from fresh concerns about the high cost of coverage and rising out-of-pocket costs that have left many unable to pay for care.
Many experts and insurers have largely blamed the decision by congressional Republicans to end extra subsidies under the Affordable Care Act for the double-digit decrease in enrollment. An estimated three million people have dropped coverage, with millions more expected in the coming years.
The nation’s big hospitals are already attributing declining coverage to a surge in unpaid medical bills and emergency room visits by the uninsured.
But even those with coverage, including insurance provided by an employer, are having trouble paying for care. Fewer than half of American adults say they can consistently afford health care, according to a recent study from the West Health-Gallup Center on Healthcare in America, a partnership between Gallup and West Health, a group of nonprofits focused on health care costs.
There is little relief in sight. Health plans are forecasting higher costs for 2027, and many individuals will encounter both higher premiums and larger deductibles. Health care costs are a top issue for voters, and insurance companies are likely to remain a political target for both Democrats and Republicans in the coming weeks.
