UnitedHealth Group has long insisted it operates two distinct yet complementary businesses: United Healthcare, the largest health insurance provider in America, and Optum, a sprawling collection of health services. Together, they make up the largest healthcare company in the world. And for decades, that size has made the company a lightning rod for criticism. The animosity is not new.
In 2006, CEO and Chairman William McGuire resigned amid a scandal over allegedly backdated stock options. McGuire had led the company for fifteen years and was the architect of its aggressive expansion, growing revenue from under one billion dollars to over seventy-one billion during his tenure. His compensation had already drawn criticism, with more than one point seven billion dollars in unexercised stock options accumulated under his name. The accusation was that he manipulated the grant dates of those options to fraudulently inflate their value.
In the end, he forfeited a significant portion of them, paid a seven million dollar fine to the SEC, and was barred from serving as an officer or director of a public company for ten years. UnitedHealth itself paid over nine hundred million dollars to settle class action lawsuits with shareholders. By 2011, Business Insider had placed the company on its list of the nineteen most hated companies in America. The resentment has only deepened since.
At the center of it all is scale. UnitedHealth now sits at number three on the Fortune 500 with four hundred billion dollars in revenue. The company grew through multibillion-dollar acquisitions, including a two point three billion dollar purchase of a chain of two hundred outpatient surgery centers in 2017. Some deals drew federal scrutiny.
The Department of Justice challenged its thirteen billion dollar acquisition of the medical payment processor Change Healthcare on antitrust grounds, though the deal ultimately went through. Then in 2024, Change Healthcare became the target of a massive cyber attack that compromised the information of over one hundred ninety million people, including highly sensitive patient diagnoses and treatment records. Since the company manages a third of all US patient records, it was the largest healthcare data breach in the nation’s history. The breach not only exposed personal information; it forced people to confront just how much control one company holds over the healthcare system.
Claim denials have been another persistent source of anger. In 2025, the non-profit KFF released a report finding that United Healthcare denied thirty-three percent of in-network claims from Affordable Care Act plans, a higher rate than any other provider. The company pushed back, saying the figure reflected only a small portion of its business and pointed to its own claim that only two percent of all claims are denied for eligible members when submitted properly. Still, the company’s track record has long raised questions.
After its eight point one billion dollar acquisition of Pacificare in 2005, California alleged more than one hundred thirty thousand violations over a single year, including wrongful denials and incorrect payments, resulting in a fine of three point five million dollars. In 2009, a dispute over a database used to determine out-of-network payment rates led UnitedHealth to pay fifty million dollars to help create a new database in New York, plus a three hundred fifty million dollar settlement in a class action lawsuit led by the American Medical Association. The company admitted no wrongdoing. Medicare Advantage has proven even more complicated.
The program allows private insurers like United Healthcare to offer medical plans to people sixty-five and older. For the seven point eight million people enrolled, the government reimburses the company, and it pays more when an enrollee has a potentially expensive medical condition. That structure creates an obvious incentive to exaggerate the severity of conditions. In 2011, a whistleblower alleged that his performance evaluations were based on risk adjustment targets.
By 2025, the Department of Justice was conducting civil and criminal investigations into the company’s Medicare Advantage practices, revealed just days after CEO Andrew Witty resigned following a sharp drop in the stock price. Reports then surfaced that the company had been secretly paying nursing homes to reduce hospital transfers of elderly enrollees in order to save on treatment costs. The company has also faced backlash over drug pricing through Optum Rx, one of the largest pharmacy benefit managers in the country. PBMs act as middlemen connecting insurers, drugmakers, and pharmacies, and the three largest now administer an estimated eighty percent of all prescriptions in the United States.
Optum Rx became a major player after the company acquired Catamaran in 2015 for nearly thirteen billion dollars. In early 2025, the FTC released a report finding that the big three PBMs generated more than seven point three billion dollars in revenue between 2017 and 2022 from dispensing drugs above their estimated acquisition cost. Some of those drugs treated serious conditions like heart disease, HIV, and cancer. The criticism was straightforward: the companies were making billions by marking up life-saving medications, making them harder to obtain.
Underneath all of these specific grievances lies a broader frustration. The US healthcare system is expensive, confusing, and restrictive. Claims get denied, networks are limited, and patients struggle to navigate it. People need somewhere to direct that anger, and UnitedHealth, as the largest, most vertically integrated company in the system, has become the symbol of everything wrong with it.
In December 2024, that resentment reached its darkest point. Brian Thompson, the head of United Healthcare, was shot and killed in what authorities believed was an act motivated by anger at the healthcare industry. Some people publicly expressed support for the alleged killer, based on their own frustrations with the system. The killing was condemned, and it was not a solution to the industry’s problems, but it underscored how completely UnitedHealth had come to represent an entire system that millions of Americans passionately dislike.
The company’s defenders argue that its scale allows it to deliver services more effectively. Its critics see an irresponsible, dangerous corporation that prioritizes profit over patients. Either way, the hatred companies like this generate is rarely born in a single moment.
It accumulates over years, through scandals, denied claims, hidden practices, and a growing sense that the institution at the top of American healthcare has lost sight of the people it is supposed to serve.