UnitedHealthcare CEO's shooting opens a door for many to vent frustrations over insurance

For years, patients in the U.S. health care system have grown frustrated with a bureaucracy they don’t understand.

Doctors are included in an insurer’s network one year but not the next. Getting someone on the phone to help can be next to impossible. Coverage of care and prescriptions is often unceremoniously denied.

This week’s fatal shooting of UnitedHealthcare CEO Brian Thompson has unleashed a wave of public feeling — exasperation, anger, resentment, helplessness — from Americans sharing personal stories of interactions with insurance companies, often seen as faceless corporate giants.

In particular, the words written on ammunition found at the shooting scene — “delay,” “deny” and “depose,” echoing a phrase used to describe how insurers dodge claim payouts — amplified voices that have long been critical of the industry.

“All of a sudden, I am fired up again,” said Tim Anderson, describing how his wife, Mary, had to deal with UnitedHealthcare coverage denials before she died from Lou Gehrig’s disease, or amyotrophic lateral sclerosis, in 2022.

Anderson said they couldn’t get coverage for machines to help his wife breathe or talk — toward the end, she communicated by blinking when he showed her pictures. The family had to rely on donations from a local ALS group, he said.

“The business model for insurance is don’t pay,” said Anderson, 67, of Centerville, Ohio.

“When Mary could still talk, she said to me to keep fighting this,” he added. “It needs to be exposed.”

For Anderson and others, Thompson's death and the message left at the scene have created an opportunity to vent their frustrations. Conversations at dinner tables, office water coolers, social gatherings and on social media have pivoted to the topic, as police efforts to find the gunman keep the case in the news.

Hans Maristela said he understands why the chatter is bubbling up. The 54-year-old caregiver in California was moved to comment on Facebook about UnitedHealthcare's reputation of denying coverage. As a Catholic, he said, he grieves Thompson's death and feels for his family, especially with the holidays around the corner.

But he sees frustration with insurers even among his clients, most of them wealthy older people who've not been shielded from high out-of-pocket costs.

“And then you know the CEO of this company you pay a lot of money to gets $10 million dollars a year, you won’t have a lot of sympathy for the guy," Maristela said, citing Thompson's compensation package that included base pay and stock options. “Health care is a business, I understand, but the obsession with share price, with profit, has to be reevaluated.”

University of Pennsylvania researcher Michael Anne Kyle said she's not surprised by the growth of conversation around insurers.

“People are often struggling with this by themselves, and when you see someone else talk about it, that may prompt you to join the conversation,” she said.

Kyle studies how patients access care and said she's seen frustration with the system build for years. Costs are rising, and insurers are using more controls such as prior authorizations and doctor networks to manage them. Patients are often stuck in the middle of disputes between doctors and insurers.

“Patients are already spending a lot of money on health care, and then they’re still facing problems with the service,” she said.

Insurers often note that most of the money they bring in goes back out the door to pay claims, and that they try to corral soaring costs and the overuse of some care.

In Ohio, Anderson said his initial reaction to the CEO shooting was to question whether it was connected to a coverage denial, like the ones he'd experienced with his wife.

“I definitely do not condone killing people,” he said. “But I read it and said, 'I wonder if somebody had a spouse whose coverage was denied.’”

It's something Will Flanary, a Portland-based ophthalmologist and comedian with a large social media following, saw online a lot in the shooting's immediate aftermath and found very telling.

“It’s zero sympathy,” he said. “And the lesson to take away from that is not, ‘Let’s shame people for celebrating a murder.’ No, it’s: ‘Look at the amount of anger that people have toward this system that’s taken advantage of people and do something to try to fix that.’”

Flanary's content, published under the name Dr. Glaucomflecken, started out as niche eye doctor jokes and a way to cope with his own experiences with two cancer diagnoses and a sudden cardiac arrest. But it has evolved, featuring character skits that call attention to and satirize the decisions of large health insurers, including UnitedHealthcare.

He said he's never seen conversations around health insurance policy take off the way they did this week — and he hopes these new voices can help bring about change.

“I’m always talking about how powerful social media can be with advocacy," he said, "because it really is the only way to put a significant amount of pressure on these corporations who are doing bad things for patients.”

The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group and the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

A New York City Police officer walks through brush and foliage in Central Park near 64th Street and Central Park West, Friday, Dec. 6, 2024, in New York, while searching for a backpack police believe was dropped in the park by the person suspected of killing UnitedHealthcare CEO Brian Thompson on Wednesday, Dec. 4, 2024. (AP Photo/Ted Shaffrey)

Members of the New York police crime scene unit pick up cups marking the spots where bullets lie as they investigate the scene outside the Hilton Hotel in midtown Manhattan where Brian Thompson, the CEO of UnitedHealthcare, was fatally shot Wednesday, Dec. 4, 2024, in New York. (AP Photo/Stefan Jeremiah)

This undated photo shows Tim Anderson and his wife Mary in Glacier National Park in Montana. (Tim Anderson via AP)

This undated photo provided by UnitedHealth Group shows UnitedHealthcare chief executive officer Brian Thompson. (AP Photo/UnitedHealth Group via AP)

Bullets lie on the sidewalk at the scene outside the Hilton Hotel in midtown Manhattan where Brian Thompson, the CEO of UnitedHealthcare, was fatally shot, Wednesday, Dec. 4, 2024, in New York. (AP Photo/Stefan Jeremiah)

This selfie provided by Hans Maristela shows him on Nov. 24, 2024, in California. (Hans Maristela via AP)

The UnitedHealthcare headquarters in Minnetonka, Minn., lowered its flags to half-staff on Wednesday, Dec. 4, 2024, in honor of CEO Brian Thompson, who was fatally shot outside a hotel in New York. (Kerem Yücel/Minnesota Public Radio via AP)

WASHINGTON (AP) — The Justice Department has ordered federal prosecutors to investigate state or local officials who they believe are interfering with the Trump administration's crackdown on immigration, saying they could face criminal charges, in an apparent warning to the dozens of so-called sanctuary jurisdictions across America.

The memo, from acting Deputy Attorney General Emil Bove, signals a sharp turnabout in priorities from President Joe Biden’s Democratic administration, with the Justice Department’s civil division told to identify state and local laws and policies that “threaten to impede” the Trump administration’s immigration efforts and potentially challenge them in court.

It also tells prosecutors in no uncertain terms that they will be on the front lines of an administration-wide effort to crack down on illegal immigration and border crime and that they are expected to carry out the policy vision of President Donald Trump’s Republican White House when it comes to violent crimes, the threat of international gangs and drug trafficking.

“Indeed, it is the responsibility of the Justice Department to defend the Constitution, and accordingly, to lawfully execute the policies that the American people elected President Trump to implement,” wrote Bove, who prior to joining the administration was part of the legal team that defended Trump against two criminal cases brought by the Justice Department.

“Sanctuary” has no legal definition, but the term encompasses a range of protection for immigrants, particularly those living in the U.S. illegally. Most often, the laws put legal limits on how law enforcement in those jurisdictions can cooperate with federal immigration authorities.

Courts have repeatedly upheld most sanctuary laws, and legal experts said that while prosecutions are possible, they doubted the charges would have any traction in court.

“What would you charge these people with?" asked Robert J. McWhirter, a constitutional scholar and longtime Arizona-based immigration lawyer. “Nothing obligates local law enforcement to cooperate with federal law enforcement on any issue. Not even bank robbery.”

In Chicago, which has some of the strongest sanctuary protections nationwide, city leaders brushed off word of potential investigations. The nation’s third-largest city has been a sanctuary city for decades, limiting cooperation between police and federal immigration agents.

“If the federal government is going to investigate, that is their prerogative,” said Alderman Andre Vasqez, who is Mayor Brandon Johnson’s handpicked chair of the City Council immigration committee.

Vasquez, the son of two Guatemalan immigrants, noted a 2016 campaign rally at the University of Illinois Chicago that Trump abruptly scrapped as crowds of boisterous protesters grew. The cancellation remains a badge of honor for many young activists in the Democratic stronghold.

“There will always be that kind of relationship between Chicago, President Trump and the Republican Party,” said Vasquez. “I was born and raised in Chicago, in an immigrant family. It will take more than that to make me feel a little scared.”

Bove's memo says federal prosecutors must “take all steps necessary to protect the public and secure the American border by removing illegal aliens from the country and prosecuting illegal aliens for crimes committed in U.S. jurisdiction."

It also directs prosecutors to investigate for potential criminal charges against state and local officials who obstruct or impede federal functions. As potential avenues for prosecution, the memo cites a conspiracy offense as well as a law prohibiting the harboring of people in the country illegally.

“Federal law prohibits state and local actors from resisting, obstructing and otherwise failing to comply with lawful immigration-related commands and requests,” the memo says. “The U.S. Attorney’s Offices and litigating components of the Department of Justice shall investigate incidents involving any such misconduct for potential prosecution.”

But in Colorado, where state law bars local law enforcement from helping federal immigration agents without a court order, the attorney general’s office said it knew of no state or local officials obstructing immigration enforcement.

“The federal government—not local law enforcement—is responsible for enforcing federal immigration laws," the office of Phil Weiser, a Democrat, said in a statement.

The memo includes a series of directives beyond those related to sanctuary jurisdictions. It suggests there will be a spike in immigration cases under the new administration, instructing U.S. attorney’s offices across the country to inform courts of its policy “and develop processes for handling the increased number of prosecutions that will result.” Any decisions by federal prosecutors to decline to prosecute immigration violations must be disclosed to Justice Department headquarters in so-called urgent reports, which are used to update leadership on law enforcement emergencies or significant matters of national interest.

The memo also says the department will return to the principle of charging defendants with the most serious crime it can prove, a staple position of Republican-led departments meant to remove a prosecutor’s discretion to charge a lower-level offense. And it rescinds policies implemented by Biden Attorney General Merrick Garland, including one designed to end sentencing disparities that have imposed harsher penalties for different forms of cocaine.

“The most serious charges are those punishable by death where applicable, and offenses with the most significant mandatory minimum sentences,” Bove wrote.

It is common for Justice Departments to shift enforcement priorities under a new presidential administration in compliance with White House policy ambitions. The memo reflects the constant push-and-pull between Democratic and Republican administrations over how best to commit resources to what officials regard as the most urgent threat of the time.

The edict to charge the most readily provable offense, for instance, is consistent with directives from prior Republican attorneys general including John Ashcroft and Jeff Sessions, while Democratic attorneys general including Eric Holder and Garland have replaced the policy and instead encouraged prosecutorial discretion.

Associated Press writers Sophia Tareen in Chicago and Colleen Slevin in Denver contributed to this report.

President Donald Trump speaks in the Roosevelt Room of the White House, Tuesday, Jan. 21, 2025, in Washington. (AP Photo/Julia Demaree Nikhinson)

FILE - The logo for the Justice Department is seen before a news conference at the Department of Justice, Aug. 23, 2024, in Washington. (AP Photo/Mark Schiefelbein, File)