Getty ImagesThe “brazen and targeted” killing of health insurance executive Brian Thompson and the CEO of UnitedHealthcare outside a New York hotel this week has shocked America. The reaction to the crime also revealed widespread anger against a trillion-dollar industry.
“Prior authorization” doesn't sound like a phrase that would generate much emotion.
But on a hot day last July, more than 100 people gathered outside UnitedHealthcare's headquarters in Minnesota to protest the insurer's policies and denial of patient claims.
“Prior authorization” allows companies to review proposed treatments before agreeing to pay for them.
11 people were arrested for blocking the road during the protest.
Police records indicate they came from all over the country, including Maine, New York, Texas and West Virginia, to attend the rally organized by the People's Action Institute.
Unai Montes Eroeste, director of media strategy for the Chicago-based advocacy group, said protesters have personal experience with claims denials and other problems in the health care system.
“They are denied care and then have to go through an appeals process that is very difficult to win,” he told the BBC.
The latent anger that many Americans feel toward the health care system — a dizzying array of providers, for-profit and non-profit companies, insurance giants, and government programs — has exploded into the open in the wake of Thompson's apparent targeted killing in New York City. Wednesday.
Thompson was CEO of UnitedHealthcare, the insurance unit of health provider UnitedHealth Group. The company is the largest insurance company in the United States.
Police are still searching for the suspected killer, whose motives are unknown, but authorities revealed messages written on shell casings found at the scene.
The words “deny,” “defend” and “deposit” were discovered on the insurance covers, which investigators believe may refer to tactics critics say insurance companies use to avoid payouts and boost profits.
A scroll through Thompson's LinkedIn history reveals that many were angry about the dismissed claims.
One woman responded to a post in which the CEO boasted about his company's work in making drugs more affordable.
“I have stage 4 metastatic lung cancer,” she wrote. “We just left (UnitedHealthCare) because of all my medication denials. Every month there's a different reason for the denial.”
Thompson's wife told NBC that he had received threatening messages before.
“There were some threats,” Paulette Thompson said. “Basically, I don't know, lack of (medical) coverage? I don't know the details.”
“I just know he said there were some people who were threatening him.”
Frustration with high costs across a range of industries inevitably leads to threats against company leaders, a security expert says.
Philip Klein, who runs Texas-based Klein Investigations, which protected Thompson when he gave a speech in the early 2000s, says he's surprised the CEO didn't have security for his trip to New York City.
“There is a lot of anger in the United States of America right now,” Klein said.
“Companies need to wake up and realize that their CEOs can be pursued anywhere.”
Mr. Klein says he has received an influx of calls since Thompson's murder. Major American corporations typically spend millions of dollars on the personal security of high-level executives.
UnitedHealthcareIn the wake of the shooting, a number of politicians and industry officials expressed shock and sympathy.
Michael Tovin, president of insurance industry organization Ahip, said he was “heartbroken and horrified by the loss of my friend Brian Thompson”.
“He was a devoted father, a good friend to many, and an outspoken and entertaining colleague and leader.”
UnitedHealth Group said in a statement that it had received many messages of support from “patients, consumers, healthcare professionals, associations, government officials and other people who provide care.”
But the reaction of many people online, including UnitedHealthcare customers and users of other insurance services, was different.
These reactions ranged from snarky jokes (one popular joke was “thoughts and advance authorizations,” a play on the phrase “thoughts and advances”) to commentary on the number of insurance claims denied by UnitedHealthcare and other companies.
In the end, industry critics made it clear they had no pity for Thompson. Some even celebrated his death.
Online outrage appears to be bridging the political divide.
Hostility has been expressed from avowed socialists to right-wing activists skeptical of the so-called “deep state” and corporate power. It also came from everyday people sharing stories of insurance companies denying their claims for medical treatment.
Montes Eroeste of the Popular Action Organization said he was shocked by the news of the killing.
He said his group campaigned in a “democratic and non-violent” manner, but added that he understood the bitterness people felt online.
“We have a divided and broken health care system, and that's why there are very strong sentiments being expressed right now by people who are experiencing this broken system in many different ways,” he said.
Mr. Toffin, president of the Health Insurance Trade Association, condemned any threats against his colleagues, calling them “professionals with a mission who work to make coverage and care as affordable as possible.”
Getty ImagesThe posts highlighted the deep frustration many Americans feel with health insurance companies and the system in general.
“The system is incredibly complex,” said Sarah Collins, a senior scholar at the Commonwealth Fund, a health care think tank.
“Just navigating and understanding how you get coverage can be challenging for people,” she said. “And everything may seem fine until you get sick and need your plan.”
Recent research by the Commonwealth Fund found that 45% of insured working-age adults were charged for something they thought should have been free or covered by insurance, and that less than half of those who reported suspected billing errors challenged them. 17% of respondents said their insurance company refused to cover care recommended by their doctor.
The health system in the United States is not only complex, it is expensive, and high costs often fall squarely on individuals.
Prices are negotiated between providers and insurers, Collins says, which means that what patients or insurers are charged often bears little resemblance to the actual costs of providing medical services.
“We find high rates of people saying their health care costs are unaffordable, across all types of insurance, even Medicaid and Medicare (government-funded),” she said.
“People are accumulating medical debt because they can't pay their bills. This is unique to the United States. We really have a medical debt crisis.”
A study by researchers at the KFF Health Policy Foundation found that about two-thirds of Americans said insurance companies deserve “a lot” of the blame for rising health care costs. Most insured adults, 81%, still rate their health insurance as “excellent” or “good.”
In recent years, insurers have increasingly issued denials of coverage for treatment and used prior authorizations to deny coverage, said Christine Ebner, chief economist at the nonprofit RAND Corporation, a think tank.
She said premiums were about $25,000 (£19,600) per family.
“On top of that, people face out-of-pocket costs, which can easily reach thousands of dollars,” she added.
UnitedHealthcare and other insurance providers have faced lawsuits, media investigations, and government investigations into their practices.
Last year, UnitedHealthcare settled a lawsuit brought by a chronically ill college student, whose story was covered by the news site ProPublica, who says he was saddled with $800,000 in medical bills when his doctor prescribed medications were denied.
The company is currently facing a class-action lawsuit that claims it uses artificial intelligence to end treatment early.
The BBC has contacted UnitedHealth Group for comment.
With reporting by Tom Bateman
