Beyond Health Coverage: Why Americans Are Angry at Insurers and Three Reforms That Could Rebuild Trust
A national flashpoint, and a broader problem
In late 2024, a shocking killing outside an annual investors conference pushed America’s relationship with insurance into an uncomfortable spotlight. Authorities said UnitedHealthcare CEO Brian Thompson was shot and killed in what they described as a targeted attack. Investigators reported finding bullet casings inscribed with the words “delay,” “deny” and “depose”—a grim set of terms that echoed the title of an insurance scholar’s book, “Delay, Deny, Defend: Why Insurance Companies Don’t Pay Claims and What You Can Do About It.”
The public reaction that followed was equally unsettling. Instead of focusing on mourning, a torrent of online outrage turned into a referendum on health insurers’ handling of claims and coverage decisions. Some commenters blamed insurers for failing to pay for essential medical treatments, and online trolls even celebrated the alleged killer as a kind of vigilante. The intensity of that response signaled something deeper than a single news cycle: a level of resentment and rage that has been building for years.
While the immediate focus was on health insurance, the underlying frustration is not limited to medical coverage. The same dynamics—confusing products, unexpected gaps, and contentious claims handling—are visible across the insurance landscape. Homeowners insurance is becoming harder to get in many states, even as coverage shrinks. Auto insurance rates are rising sharply. For many households, insurance is supposed to be the stabilizer that protects financial security. Yet when people feel it fails at the moment they need it most, the sense of betrayal can be profound.
Why claim denials trigger the strongest outrage
Policyholders tend to be most outraged when insurers do not appear to keep their core promise: paying claims promptly and fairly. Recent stories about health insurance denials have amplified public attention, but the same complaint often appears in other lines of insurance as well. People describe a familiar pattern: companies delay paying some claims, deny other valid claims, and force policyholders to defend themselves in court. The allegation is that these tactics reduce claim costs and increase profits.
It is important to recognize that not every dispute is evidence of wrongdoing. Many claims involve good-faith disagreements about what happened and what the policy covers. A common example is roof damage: was it caused by hail (usually covered) or by wear and tear (usually not covered)? Those distinctions can be complex, and reasonable people can disagree. But outrage escalates when consumers believe denials are based on inadequate investigations or on reasons that feel spurious.
One widely cited example involves Hurricane Ian. A 2023 investigation concluded that, in the wake of the storm, some Florida insurance companies sought to limit payouts by altering the work of adjusters who inspected damaged homes. According to that reporting, some policyholders and their families had claims reduced by 45% to 97%. A nonprofit watchdog group, the American Policyholder Association, said it found “compelling evidence of what appears to be multiple instances of systematic criminal fraud perpetrated to cheat policyholders out of fair insurance claims.”
When situations like this occur, the harm is not only financial. The policyholder must spend time and effort fighting for what they believe they were owed in the first place. Even if an insurer later relents, the promise of prompt and fair claim settlement has already been compromised. That experience can shape how consumers view the entire industry, and it can spill into broader public anger—especially when many people share similar stories.
The trouble often starts before anyone files a claim
Some of the biggest problems arise long before a loss occurs. Many insurance consumers do not fully understand what they are buying. For homeowners, auto, and other types of insurance, companies often do not provide copies of policy language or accessible summaries of key terms to prospective policyholders. Even when consumers do get access to policies, many do not read them, or cannot easily understand them. Policies are long, complex legal documents, and most people are not trained to interpret them.
Consumers also cannot realistically anticipate all the ways a loss might occur—or how a policy’s exclusions, limitations, and conditions might affect coverage when it matters. Instead, many people rely on a general sense of reassurance built by marketing and familiar slogans. They believe they will be protected, that they will be “in good hands” or supported by a “good neighbor,” to borrow two iconic phrases from insurance advertising. That expectation can collide with reality when a claim is filed and the policy’s fine print becomes decisive.
Health insurance illustrates this complexity in a particularly visible way. Coverage can be limited by provider networks, medical necessity rules, and preauthorization requirements. Consumers may assume a treatment is covered, only to learn that the insurer requires prior approval or considers the treatment outside its rules. But homeowners insurance also contains surprises. Many homeowners reasonably expect that they will be fully covered for major losses. Yet insurers have been cutting back coverage to account for rising costs driven by inflation and climate change.
When disaster strikes and consumers discover significant protection gaps, many feel they did not receive the security they already paid for. That sense of being misled—whether by complexity, by lack of disclosure, or by assumptions that were never corrected—is a key ingredient in the anger now directed at insurers.
Why trust is hard to rebuild—and why it matters
Rebuilding trust in insurance will not be easy, but it is essential. Insurance functions as a major protector of financial security for the American middle class—when it works as intended. The recent public reaction to high-profile events and claim-denial stories suggests many Americans believe it is not working well enough.
According to the insurance scholar who authored “Delay, Deny, Defend,” the industry is unlikely to change on its own. Financial pressures from increasing losses and fierce market competition are significant. In that environment, insurers may have strong incentives to reduce claim costs and limit coverage. If the goal is for insurance to serve its social purpose—providing meaningful protection when losses occur—then lawmakers and regulators must play a more active role.
Based on research into how insurance markets function and where they fail, the scholar points to three broad areas where reform could make a practical difference. These proposals are not framed as a cure-all. Rather, they are presented as steps that could move the public conversation from rage toward regulation and, ultimately, toward a system that better aligns insurer behavior with consumer expectations.
Reform 1: Make insurance markets work better through clearer information
The first reform is straightforward in concept: improve the information available to consumers. Markets depend on information, and better information can lead to better outcomes. In insurance, however, consumers often buy policies without a clear understanding of what is included, what is excluded, and what conditions apply when a claim is filed.
Regulators could require that key information about coverage be available in an accessible format for all types of insurance. The goal is not to replace the full legal policy, but to ensure prospective policyholders can review understandable summaries of major terms before they commit. This would address a common complaint: that consumers only discover critical limitations after a loss.
Information about coverage is only part of the picture. Consumers also need information about the quality of the companies offering policies. One of the most meaningful measures of quality is whether a company pays claims promptly and fairly. Yet consumers currently have limited access to reliable information on that topic. The reform proposal calls for mandated disclosure so that consumers can compare insurers not only on price, but also on claims-handling performance.
In practical terms, this approach aims to reduce the gap between what consumers think they are buying and what they are actually buying. It also aims to reward insurers that consistently handle claims well, by making that performance visible in the marketplace.
Reform 2: Consider minimum coverage standards, especially for homeowners insurance
The second reform focuses on the content of coverage itself. As insurers cut back coverage to manage rising costs, consumers may find that policies no longer provide the kind of baseline protection they assumed was standard. This is particularly concerning in homeowners insurance, where the stakes can be high and losses can be catastrophic.
The proposal is for states to consider minimum coverage standards. The idea is not new in American insurance history. In 1943, New York addressed a similar challenge by legislatively adopting a Standard Fire Policy, a model that was later copied in many states. By setting a standard, lawmakers established a floor that insurers had to meet, ensuring that certain core protections were not eroded by market forces alone.
Health insurance offers a more recent parallel. Roughly 70 years after the Standard Fire Policy, the Affordable Care Act required insurers to cover 10 “Essential Health Benefits.” In both cases, lawmakers decided that certain forms of coverage were too important to leave entirely to the vagaries of the market.
Applying that logic today, states could examine whether homeowners insurance coverage has become too thin or too inconsistent to serve its purpose. Minimum standards would not eliminate all differences among insurers, but they could ensure that the basic promise of coverage remains meaningful across the market.
Reform 3: Strengthen remedies when insurers act unreasonably
The third reform addresses what happens when an insurer is found to have acted unreasonably. As noted, many disputes are in good faith. But when a claim is denied after an inadequate investigation or for reasons that do not hold up, the policyholder may face a long and costly fight to obtain benefits that were promised.
In those circumstances, the scholar argues that policyholders need effective remedies. Even when an insurer eventually pays, the policyholder has still been forced to spend time and effort to get what they were owed. The insurer, meanwhile, may have benefited from delay or from pressuring a policyholder to accept less than the claim’s fair value.
The proposed solution is twofold:
Require additional compensation to policyholders in cases where insurers are found to have acted unreasonably.
Create insurer disincentives for unreasonable conduct, helping level the playing field between large companies and individual consumers.
This approach aims to reinforce the original promise of insurance: prompt and fair claim settlement. When unreasonable conduct carries meaningful consequences, insurers have a stronger incentive to investigate properly and to make decisions that can be justified on the facts and the policy language.
From public fury to practical policy
The anger that surfaced after the killing of Brian Thompson revealed how intensely many Americans feel about insurance—and how quickly personal stories of claim denials and coverage gaps can become part of a larger cultural backlash. The reaction was not confined to health insurance, even if medical claims were at the center of the public conversation. It reflected broader anxieties about shrinking homeowners coverage, rising auto insurance costs, and the fear that the safety net people pay for may not be there when they need it.
The three reforms outlined by the insurance law scholar—clearer information, minimum coverage standards, and stronger remedies for unreasonable conduct—are framed as a meaningful response to that resentment. They share a common premise: insurance is too important to household stability to operate solely on assumptions, marketing slogans, or opaque contract language. If insurance is to function as a reliable protector of financial security, consumers must be able to understand what they are buying, trust that core protections will not quietly disappear, and have realistic options when the claims process breaks down.
Moving from rage to regulation is not about inflaming conflict between insurers and policyholders. It is about setting rules that make the market work better and that align industry incentives with the fundamental purpose of insurance. The public conversation may have been triggered by a disturbing event, but the policy questions it raised are longstanding—and, for many households, deeply personal.