'I can't go on like this': US asks what's next for healthcare

Special education teacher Robin Ginkel has spent almost two years fighting with her insurance company to try to get it to pay for back surgery that her doctors recommended after a work injury left her with a herniated disc and debilitating pain.

The plan didn't seem "ridiculous", she said: "I'm asking to get healthcare to return to a normal quality of life and return to work."

Initially rejected, the 43-year-old from Minnesota spent hours on hold appealing the decision - even lodging a complaint with the state - only to see her claims denied three times.

Now she is bracing for the battle to start again, after deciding her best option was to try her luck with a new insurance company.

"It's exhausting," she said. "I can't keep going like this."

Ms Ginkel is not alone in throwing up her hands.

Roughly one in five Americans covered by private health insurance reported their provider refused to pay for care recommended by a doctor last year, according to a survey by health policy foundation KFF.

Brian Mulhern, a 54-year-old from Rhode Island, said his health insurance firm recently rejected a request to pay for a colonoscopy after polyps were discovered on his colon - a discovery that prompted his doctor to advise a follow-up exam within three years instead of the typical five.

Faced with $900 in out-of-pocket costs, Mr Mulhern put off the procedure.

Long simmering anger about insurance decisions exploded into public view earlier this month after UnitedHealthcare CEO Brian Thompson was murdered - and the killing unleashed a startling wave of public outrage at the industry.

The crime sent shockwaves through the system, prompting one insurance company to reverse a controversial plan to limit anaesthesia coverage, and hit the share prices of major firms.

Though the reaction raised the possibility that scrutiny might force change, experts said addressing the frustration would require action from Washington, where there is little sign of a change in momentum.

On the contrary: just in the last few weeks, Congress again failed to move forward long-stalled measures aimed at making it easier for people on certain government-backed insurance plans to get their claims approved.

Derrick Crowe, communications and digital director of People's Action, a non-profit that advocates for insurance reform, said he was hopeful the shock of the murder would force change on the industry.

"This is a moment to take a moment of private pain and turn it into a public collective power to ensure companies stop denying our care," he said.

Whether the murder will strengthen appetite for reform remains to be seen.

Politicians from both parties in Washington have expressed interest in efforts that might rein in the industry, such as toughening oversight of algorithms and rules that would require the break-up of big firms.

But there is little sign the proposals have meaningful traction.

Trump's nominee to run the powerful Centers for Medicare & Medicaid Services (CMS), TV doctor Mehmet Oz, has previously endorsed expanding coverage by Medicare Advantage - which offers Medicare health plans through private companies.

"These plans are popular among seniors, consistently provide quality care and have a needed incentive to keep costs low," he explained in 2022.

Prof Buntin said Republican election gains indicate that the US is not about to embrace the alternative - a publicly run scheme like the UK's National Health Service - anytime soon.

"There's a distrust of people who seem to be profiting or benefiting off of illness - and yet that's the basis of the American system," she said.