This piece has been updated from its original email version.
Last week, the CEO of UnitedHealthcare was gunned down in midtown Manhattan. The shell casings recovered at the scene had the words “Deny,” “Defend,” “Depose” etched onto them in an apparent reference to the “delay, deny, defend” strategy healthcare giants deploy to avoid covering claims by patients.
In the wake of the killing, the online world erupted, largely in celebration—much to the horror of pundits, right-wing media, and politicians on both sides of the aisle. But cutting through the noise has been an emerging dialogue about the inadequacies of America’s for-profit healthcare system.
Americans pay more for healthcare than people in other wealthy nations. In 2021, the U.S. spent roughly 3.8 times the average of nations in the Organization for Economic Cooperation and Development (OECD). That cost is not reflected in health outcomes. The U.S. ranked 32nd out of 38 OECD countries in terms of average life expectancy and 33 out of 38 OECD countries in terms of infant mortality. In 2022, the U.S. had 22 maternal deaths per 100,000 live births, which is roughly double the OECD average.
Meanwhile, wages have not kept up healthcare premiums and medical debt is the leading cause of bankruptcy in the U.S. Americans routinely skip doctor visits due to cost. Research from 2020 published in The Lancet found that 68,000 American deaths could be prevented annually by the implementation of a Medicare for all system. Unsurprisingly, the U.S., with its lack of a universal healthcare system, was hit harder by the COVID-19 pandemic than its peer nations. A Yale study from 2022 found that hundreds of thousands of lives could have been saved had the country had a single-payer system.
The real beneficiaries of the current system are insurance giants, who have been raking in staggering profits for years. As The Lever recently reported, profits have risen 230 percent since the passage of the Affordable Care Act. The biggest beneficiary was UnitedHealth Group, which owns UnitedHealthcare and Optum. The company made $22 billion in profits in 2023–up from $20.6 billion in 2020 and 17.3 billion in 2021.
Yet, the issue of healthcare reform barely came up during the 2024 presidential cycle and despite the discourse sparked by the shooting, neither major party has sought to capitalize on the moment and make the case for the establishment of a national healthcare system. Important Context looked at one reason for the silence: money. Using data compiled by the group OpenSecrets, we found that major insurers spent millions on politics this past election cycle (2023-2024), including donations to candidates from their political action committees and lobbying.
The details are below. The spending covered in this article represents only part of the health insurance industry’s political activities.
UnitedHealth Group
The nation’s largest health insurer spread its wealth around. According to OpenSecrets, in the 2024 cycle, UnitedHealth Group’s PAC gave more than $371,000 to Republican House candidates and $276,000 to Democratic House candidates. The top recipients were nine Republicans and five Democrats. Among them was ranking member on the House Ways and Means Committee Richard Neal (D-Mass.).
From the database:
Pete Aguilar (D-Calif.)—$10,000
Gus Bilirakis (R-Fla.)—$10,000
Angie Craig (D-Minn.)—$10,000
Tom Emmer (R-Minn.)—$10,000
Virginia Foxx (R-NC)—$10,000
Andrew Garbarino (R-NY)—$10,000
Brett Guthrie (R-Ky.)—$10,000
Steven Horsford (D-Nev.)—$10,000
Darin LaHood (R-Ill.)—$10,000
Nick Langworthy (R-NY)—$10,000
Blake Moore (R-Utah)—$10,000
Richard Neal (D-Mass.)—$10,000
Frank Pallone Jr. (D-NJ)—$10,000
Haley Stevens (D-Mich.)—$10,000
Tim Walberg (R-Mich.)—$10,000
The PAC also gave $34,000 to GOP Senate candidates and $49,000 to Democrats. Democrat Jon Tester (D-Mont.), who lost, was the top recipient with $10,000, followed by Democrat Jacky Rosen (D-Nev.) at $7,500, and Republican Dan Sullivan (R-Alaska) at $6,500.
It spent $873,000 backing state and local candidates and $192,000 on state and local parties.
The PAC donated $30,000 a piece to the National Republican Congressional Committee (NRCC), the National Republican Senatorial Committee (NRSC), the Democratic Senatorial Campaign Committee (DSCC), and the Democratic Congressional Campaign Committee (DCCC).
Beyond its PAC’s activities, UnitedHealth Group spent $16.6 million on lobbying in the 2024 cycle.
Cigna Corp.
The PAC affiliated with Cigna Corp. spent $763,000 on donations to federal candidates. Of that, 48 percent went to Republicans and 51 percent went to Democrats.
The PAC gave over $313,000 to Republican House candidates and more than $334,000 to Democratic House candidates. Among the top recipients were House Majority Leader Steve Scalise (R-La), House Minority Leader Hakeem Jeffries (D-NY), and Neal with $10,000 each.
From the OpenSecrets database:
Pete Aguilar (D-Calif)—$10,000
Don Bacon (R-Neb)—$10,000
Brendan Boyle (D-Pa)—$10,000
Eric Burlison (R-Mo)—$10,000
Joe Courtney (D-Conn)—$10,000
Angie Craig (D-Minn)—$10,000
Sharice Davids (D-Kan)—$10,000
Tom Emmer (R-Minn)—$10,000
Drew Ferguson (R-Ga)—$10,000
Kevin Hern (R-Okla)—$10,000
Hakeem Jeffries (D-NY)—$10,000
John Larson (D-Conn)—$10,000
Richard Neal (D-Mass)—$10,000
Steve Scalise (R-La)—$10,000
Jason Smith (R-Mo)—$10,000
Darren Soto (D-Fla)—$10,000
Ann Wagner (R-Mo)—$10,000
The PAC gave generously to Senate candidates from both parties as well—$54,000 for Republicans and $57,000 for Democrats. The top recipients were Rick Scott (R-Fla) with $10,000 and Eric Schmitt (R-Mo) with $8,500.
Cigna’s PAC gave nearly $112,000 to state and local parties and nearly $739,000 to state and local candidates. The national parties were major recipients of Cigna cash, receiving more than $107,000. The NRCC, NRSC, DCCC, and DSCC each got $30,000.
Outside of PAC contributions, the insurance giant spent roughly $17.3 million on lobbying.
Blue Cross Blue Shield Association
The OpenSecrets data showed that Blue Cross Blue Shield Association, the provider federation consisting of dozens of independent and locally operated BCBS companies, was another prolific spender. Its PAC was a donor to both major parties. It gave $203,000 to Republican House candidates and $127,000 to Democrats. The top recipients were:
Alma Adams (D-NC)—$10,000
Angie Craig (D-Minn.)—$10,000
Claudia Tenney (R-NY)—$9,000
Kevin Hern (R-Okla.)—$8,000
Robin Kelly (D-Ill.)—$8,000
Steve Womack (R-Ark.)—$8,000
The PAC gave $43,000 to GOP Senate candidates and $38,000 to Democrats. The top recipients were Sherrod Brown (D-Ohio) and Tester. Brown also lost his seat.
Both major parties were direct recipients of PAC money from Blue Cross Blue Shield. The Republican National Committee and the Democratic National Committee each received $15,000. The NRCC got $28,000 while the NRSC got $15,000. The DCCC and the DSCC received $36,000 and roughly $48,000 respectively. The Blue Dog PAC, representing the conservative Blue Dog Democrats also received $10,000.
Blue Cross Blue Shield spent a total of $49.5 million on lobbying in the 2024 cycle.
Elevance Health
Formerly known as Anthem, Inc., Elevance Health gave big money to both political parties through its PAC according to OpenSecrets. It spent $1 million on federal candidates, split roughly evenly between Republicans (~$528,000) and Democrats (~$513,000). It gave roughly $435,000 to Republican House candidates and $452,000 to Democrats. Among the top recipients were Scalise, Jeffries, and Neal.
Pete Aguilar (D-Calif.)—$10,000
Andre Carson (D-Ind.)—$10,000
Katherine Clark (D-Mass.)—$10,000
Angie Craig (D-Minn.)—$10,000
Suzan DelBene (D-Wash.)—$10,000
Tom Emmer (R-Minn.)—$10,000
Virginia Foxx (R-NC)—$10,000
Josh Gottheimer (D-NJ)—$10,000
Brett Guthrie (R-Ky)—$10,000
Kevin Hern (R-Okla.)—$10,000
Steven Horsford (D-Nev.)—$10,000
Hakeem Jeffries (D-NY)—$10,000
Susie Lee (D-Nev)—$10,000
Frank Mrvan Jr (D-Ind.)—$10,000
Richard E Neal (D-Mass.)—$10,000
Frank Pallone Jr. (D-NJ)—$10,000
Linda Sanchez (D-Calif.)—$10,000
Steve Scalise (R-La.)—$10,000
Terri Sewell (D-Ala.)—$10,000
Jason Smith (R-Mo.)—$10,000
Darren Soto (D-Fla.)—$10,000
Claudia Tenney (R-NY)—$10,000
Elevance’s PAC gave $93,000 to Republican Senate candidates and $61,000 to Democrats. Among the top six recipients, each getting $10,000, only two were Democrats.
Jim Banks (R-Ind.)—$10,000
John Barrasso (R-Wyo.)—$10,000
John Curtis (R-Utah)—$10,000
Martin Heinrich (D-NM)—$10,000
Lisa Blunt Rochester (D-Del.)—$10,000
Rick Scott (R-Fla.)—$10,000
The PAC gave $60,000 to the NRSC, $30,000 to the NRCC, $70,000 to the DSCC, and more than $42,000 to the DCCC. It gave nearly $651,000 to state and local candidates and more than $122,000 to state and local parties.
Kaiser Permanente
OpenSecrets did not have any PAC donations listed for Kaiser Permanente. The company did, however, spend $7.6 million on lobbying.
CVS Health
CVS Health, which owns the insurance company Aetna, gave $461,000 to federal candidates, including more than $228,000 to Republicans and $227,000 to Democrats according to OpenSecrets. It spent over $205,000 on Republican House candidates and $209,000 on Democratic House candidates. Among the recipients receiving $10,000 donations were six Republicans and four Democrats including Jeffries and Neal.
Eric Burlison (R-Mo.)—$10,000
Tom Emmer (R-Minn.)—$10,000
Brett Guthrie (R-Ky.)—$10,000
Kevin Hern (R-Okla.)—$10,000
Hakeem Jeffries (D-NY)—$10,000
John Larson (D-Conn.)—$10,000
Richard Neal (D-Mass.)—$10,000
Frank Pallone Jr. (D-NJ)—$10,000
David Schweikert (R-Ariz.)—$10,000
Terri Sewell (D-Ala.)—$10,000
Jason Smith (R-Mo.)—$10,000
CVS Health’s PAC gave $23,000 to GOP Senate candidates and $18,000 to Democrats. Bob Casey (D-Pa) was the top recipient.
The PAC gave $125,000 to national parties. It spent $30,000 a piece on the NRSC, the NRCC, the DSCC, and the DCCC. It donated $87,000 to state and local parties, and more than $330,000 to state and local candidates.
CVS Health itself spent $19.8 million on lobbying.
America’s Health Insurance Plans
America’s Health Insurance Plans is an industry trade group representing the health insurance industry. Its members include Aetna, several Blue Cross Blue Shield companies, CVS Health, Elevance, Kaiser Permanente, and many other companies.
According to OpenSecrets, its PAC spent over $139,000 on federal candidates, including more than $67,000 that went to Republicans and $72,000 to Democrats. For House candidates, the spending breakdown was $52,000 for the GOP and more than $45,000 for Democrats. The top recipient was Katherine Clark. The AHIP PAC’s Senate spending broke the other way with more than $26,000 going to Democrats as opposed to over $15,000 to Republicans.
The group itself spent $9 million on lobbying.