The shooting death of high-ranking UnitedHealth Group Inc. executive Brian Thompson has uncovered a deep anger among Americans who say the health insurance industry has too often failed to cover large medical bills and stood in the way of necessary care.

“There’s clearly a sense of real discontent and distrust of the industry revealed in social media,” said Brian Klepper, principal of the Healthcare Performance Inc. consulting firm. “That’s not a healthy environment for an industry to prosper.”

The reaction to the shooting is a wake-up call for sprawling companies that have seen their profits and stock prices rise over the past few years. Social media has given millions of Americans the means to amplify their long-simmering dissatisfaction with health insurers, and in the wake of Thompson’s death, X, Reddit, TikTok and other platforms lit up with hatred aimed at the industry.

Kevin Farmer, a University of Florida orthopedics and sports medicine professor who posted on X about the shooting, said frustration with insurance is something doctors see every day. “I mean, what that can do to someone’s emotional thought process and reaction,” Farmer said. “They feel helpless.”

The motive for Thompson’s killing remains unclear. New York police released images Thursday of a man they said is wanted in connection with the shooting and searched a Manhattan hostel where the person is believed to have stayed.

No direct evidence has emerged to connect the shooting with any dispute over UnitedHealth’s business, though a shell casing and live ammunition round inscribed with “delay” and “depose” were recovered from the sidewalk at the midtown hotel where Thompson, 50, was attacked. The words echo complaints many American consumers have aired about long waits for insurers to pay medical bills and legal fights over claims.

While the inscriptions suggest the shooting might be tied to an insurance dispute, investigators also have to consider whether they may be a distraction designed to divert from the true motive, said Joseph Giacalone, a former New York Police Department sergeant who’s now a professor at the John Jay College of Criminal Justice.

“They are going to take everything seriously but have to have an open mind that this could be a potential ruse,” he said.

Though insurers have rarely discussed it publicly, concerns that a frustrated policyholder could turn to violence have long percolated within the industry.

Former health-insurance executive Michael Sherman said when he worked at Humana Inc. more than a decade ago the company had built “safe rooms” for executives at its Louisville, Kentucky, headquarters. Later, when he became the chief medical officer at Point32Health, he said the nonprofit insurer based in Massachusetts installed a panic button under his desk and hired private security for the executive suite.

Still, Sherman said the idea that an insurance executive could be targeted by a killer was largely unthinkable.

“People are shocked,” he said. “This is shaking people up and causing them to think more about the implications of these decisions, and perhaps the need for more security.”

Humana declined to comment on its security procedures.

Security steps

Thompson’s killing should compel insurers to reexamine their security measures, from increasing surveillance of executives’ parking spots to adding panic buttons and bullet-resistant safe rooms to their executive suites, said Paul Sarnese, the former president of the International Association for Healthcare Security and Safety, an organization dedicated to protecting the health-care industry.

UnitedHealth had a security team at the New York Hilton Midtown hotel for its investor day, but it didn’t have anyone stationed outside where the executive was shot, according to a person familiar with the matter. The company didn’t comment on the security situation.

Sarnese said threats against health-care workers in general have increased since the Covid-19 pandemic, when many Americans grew disillusioned with recommendations about masking, isolating while sick and vaccines.

Health insurers, who in the routine course of their business make millions of decisions every year that can have profound effects on people’s physical and financial wellbeing, are especially likely to elicit emotional responses from the public. A Gallup survey last fall asked respondents what they thought of the services provided by health insurers. Sixty-eight percent gave ratings of “only fair” or “poor.” Only 5% said it was “excellent.”

“Imagine having a pre-existing condition and being denied your medical care,” Sarnese said. “You’re not only putting all this stress on someone who has a medical condition, but now you’re putting financial stress on their families. That stress can really push someone to threaten executives or act upon their threats.”

The online vitriol generated by the Thompson shooting spilled into policy decisions by other insurers. Former Washington Post writer Taylor Lorenz generated an outcry after she posted on Bluesky Wednesday about a policy change from some units of Elevance Health Inc. that doctors said would limit coverage if operations ran long.

“And people wonder why we want these executives dead,” she wrote. On Thursday, Elevance backtracked.

“There has been significant widespread misinformation about an update to our anesthesia policy,” Elevance spokesperson Leslie Porras said. “As a result, we have decided to not proceed with this policy change. To be clear, it never was and never will be the policy of Anthem Blue Cross Blue Shield to not pay for medically necessary anesthesia services.”

Several hours after the shooting on Wednesday, Sarah London, chief executive officer of health insurer Centene Corp. pulled out of a planned appearance at a conference sponsored by Forbes in New York. London canceled out of respect for Thompson, not because of security concerns, according to a person familiar with the matter. Centene’s investor day that was scheduled to be held in person next week was moved online.

Centene declined to comment on its security procedures.

Industry officials defended the role that insurers play in the health-care system and said that the wave of hate that bubbled up on social media in the aftermath of Thompson’s killing was unwarranted.

“The people in our industry are mission-driven professionals working to make coverage and care as affordable as possible and to help people navigate the complex medical system,” Mike Tuffin, president and CEO of trade group America’s Health Insurance Plans, said in a statement. “We condemn any suggestion that threats against our colleagues — or anyone else in our country — are ever acceptable.”

Lightning rod

UnitedHealth is one of the largest health care conglomerates in the U.S., housing the UnitedHealthcare insurance business that Thompson led, as well as vast operations focused on managing drug benefits and doctors’ offices. As a result of that broad reach, it has become a frequent target for criticism.

The company was among a group of insurers that was slammed in a Senate report earlier this year for using automated tools to increase claim denials. The rate at which the company denied prior authorization for post-acute care more than doubled from 2020 to 2022, the Senate report found.

In February, Bloomberg reported that the Department of Justice had opened an antitrust investigation into the company. Last month, the U.S. sued to block its $3.3 billion purchase of Amedisys Inc. over concerns the deal would harm competition in the market for home-health and hospice services.

Also this year, the company’s Change Healthcare technology business was the target of hackers who gained access to the medical and other personal information of millions of Americans.

(With assistance from John Lauerman, Antonia Mufarech and Robert Langreth.)

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