‘Insurance just keeps getting worse’: This Texas doctor went viral after detailing negative experience with giant health insurer — all while operating on a patient. Here are 3 big takeaways

Americans may not be getting the care they need

A recent Kaiser Family Foundation (KFF) report found that in 2023, 19% of in-network claims under Marketplace health insurance plans were denied. The rate was even higher — 37% — for out-of-network claims.

Making matters worse, fewer than 1% of consumers appeal denied claims. And even when they do, they often lose: 56% of appeals are upheld. Meanwhile, UnitedHealthcare says it approves and pays about 90% of the medical claims it receives, with about half of the unpaid claims attributed to administrative errors.

Yet frustration with the insurance industry runs deep. After Thompson's accused killer, Luigi Mangione, was captured, many were quick to argue that Thompson had it coming — accusing him of prioritizing profit over patient care.

That 90% approval rate is also questionable. Miranda Yaver, an assistant professor of health policy and management at the University of Pittsburgh, said, "It can be difficult to estimate exactly how many claims are denied in a given year by health insurers because not all health insurers report this data."

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Medical debt is a huge problem

According to KFF, about 6% of U.S. adults owe more than $1,000 in medical debt, and roughly 1% — or 3 million people — owe over $10,000.

In total, Americans owe at least $220 billion in medical debt. Unsurprisingly, those most affected are people with disabilities, those in poor health, low-income individuals and the uninsured.

New rules prevent medical debt from appearing on credit reports, which helps protect consumers’ credit scores. However, that doesn’t erase the debt itself. Many people who can’t afford their medical bills negotiate lower costs down with providers, but others are forced to pay off their debt over time — often at the expense of other financial obligations and goals.

Change is sorely needed

Thompson's killing was a wakeup call for the insurance industry. If the shooting is confirmed to be linked to insurance policies, it "could cause companies in the sector to make some changes," said Ron Culp, a public relations consultant at DePaul University, in an interview with Crain's.

Meanwhile, concerns about health care access loom large. The Center on Budget and Policy Priorities cautioned last year that President Trump's return to the White House could pose significant risks to health coverage, particularly in the areas of Medicaid and the insurance marketplaces. During his first term, Trump attempted to repeal the Affordable Care Act (ACA).

A recent KFF poll found bipartisan agreement on key health care reforms, such as increasing price transparency and tightening regulations on insurers’ approval and denial of prescription drugs. However, 40% of Republicans still believe repealing the ACA should be a top priority.

President Trump signed an executive order to make health care pricing more transparent. During his first term, he also signed the No Surprises Act to protect consumers from unexpected medical bills. Still, there’s more work to be done in the fight for insurance reform, and consumers can only hope that lawmakers will make it a priority.