The New York Police Department is trying to piece together clues that may lead to the identity of the suspected killer of UnitedHealthcare CEO Brian Thompson, who was fatally shot in Manhattan on Wednesday. Following what the police have called a "brazen targeted attack," many of the major health insurers proceeded to remove images of their leadership from their corporate websites. Thompson's murder has reignited important conversations about healthcare in the United States and lack of accessibility, with many social media users sharing horrific experiences navigating the country's healthcare system. This article examines some of the broader systemic issues within U.S. healthcare in more detail and explores how we can transform the broken system.

There are several issues with the American healthcare system that contribute to the systemic inequities. The first is the exorbitant costs of healthcare. KFF reported that health spending in the U.S. was projected to total $4.9 trillion by 2024. KFF polling data from 2024 revealed that nearly half of U.S. adults said that they had difficulty affording healthcare costs, with medical bills remaining a top financial worry for adults and their families. According to their data, one in four adults put off needed healthcare because of the cost and one in five adults haven't filled a prescription because of the cost. Black and Hispanic adults, women, parents, lower-income and uninsured adults experience a disproportionate amount of healthcare debt, KFF data revealed.

Structural inequities within society play an instrumental role in health outcomes. Research indicates that structural racism (redlining, environmental injustice, bias in medical care, food insecurity, maternal health rates, etc.) heavily contributes to health inequities. For years, many have been sounding the alarm about medical deserts -- the lack of necessary healthcare access that those living in rural communities face. 2021 research published in the Journal of the American Medical Association (JAMA) revealed that there were racial and ethnic differences in measures of health status, access and affordability, with poor, Black individuals reporting worse health compared to their counterparts.

Since former president Barack Obama signed the Affordable Care Act (ACA) into law in 2010, the number of uninsured individuals has decreased significantly. Individuals with health insurance are more likely to utilize preventative services that could lead to better health outcomes, research reveals. Data from the U.S. Department of Health and Human Services (HHS) indicated that there were significant declines in the uninsured rate of non-white populations between 2010-2022, signifying that the ACA led to historic gains in healthcare coverage. Despite these gains, the United States doesn't provide universal healthcare care coverage to its citizens like Canada, Denmark, France, Germany, Norway, the United Kingdom, and other countries in the Global North. Employer-sponsored health insurance is the golden handcuffs that keep many people hostage -- eHealthInsurance reported that as of 2022, 78% of the U.S. population was eligible for health insurance through their employer. Those who change or lose their job, part-time and gig-based workers, and seasonal employees are more likely to have gaps in their insurance coverage.

It's clear how broken America's healthcare system is. How can the system be reimagined for greater accessibility and equity? First, it's important to fight against the repealing of the ACA. While Trump's stance on the ACA has been conflicting, it's likely that under a second Trump presidency, the ACA subsidies implemented under the Biden administration will be eliminated, which will result in increases in premium payments. The data is clear -- expanding healthcare access through health insurance is linked to more positive health outcomes. Gaps in healthcare coverage results in poorer health outcomes, so there must be efforts made to ensure Americans are covered and that they do not have to pay astronomical costs for their monthly premiums.

Expanding Medicaid coverage can also improve healthcare outcomes for Americans. Cost continues to be a major barrier to healthcare coverage in the United States. According to American Medical Association (AMA), gains in health insurance coverage were the result of "the implementation of enhanced subsidies for ACA exchange marketplace plans, the continuous enrollment provision of Medicaid, several recent state Medicaid expansions, and improvements in enrollment outreach."

Another way to transform America's failing healthcare system is to address the high rate of insurance claim denials. Many have taken to social media to discuss their experiences with America's healthcare system and how an insurance claim denial impacted them or their family member. Many health insurance companies including UnitedHealth, Cigna, and Humana, have been sued for using faulty artificial intelligence models to wrongfully deny health insurance claims, without a physician's review or against a doctor's medical judgement. According to a ProPublica report, insurer denial rates are shrouded in mystery and there is a lack of transparency regarding why an insurance company rejects recommended care. Transforming the broken system should include requiring regulators to require insurers to reveal how often they deny claims and provide more specificity as to why.

The increased conversations around inequities within the country's healthcare system can make way for great improvements. In addition to pushing back against the repeal of the ACA, expanding Medicaid coverage, addressing faulty AI algorithms used to review insurance claims, and providing more transparency around claim denial, healthcare providers should also offer education and support around equitable care to address health disparities. Increasing access to healthcare through initiatives like mobile clinics can help underserved groups, including minoritized and vulnerable populations. In addition, telehealth services can bridge gaps in healthcare access by removing geographic barriers and could provide a comparable level of medical care as physicians.