One year after UnitedHealthcare’s CEO was shot and killed, the crisis in U.S. health care has gotten even worse — in ways both obvious and hidden.

People increasingly can’t afford health insurance. The costs of both Obamacare and employer-sponsored insurance plans are set to skyrocket next year, in a country where health care is already the most expensive in the developed world.

Yet even as costs surge, the companies and the investors who profit from this business are also struggling financially. Shares in UnitedHealth Group, the giant conglomerate that owns UnitedHealthcare and that plays a key role in the larger stock market, have plunged 44% from a year earlier. (It was even worse before a rally in UnitedHealth shares on Wednesday.)

“UnitedHealth’s reputation in the investment community, before December 4 last year, was [as] a safe place to put your money. And that basically got all blown up,” says Julie Utterback, a senior equity analyst who covers health care companies for Morningstar.

Then, on Dec. 4, 2024, United Healthcare CEO Brian Thompson was shot on a Manhattan street on his way to an investor event. The shocking act of violence sparked a widespread consumer outcry over U.S. health care costs and denied claims, and plunged UnitedHealth Group into a public relations disaster.

But that was only the start of the business woes for the company and its entire industry — which are facing regulatory scrutiny, tightening margins, and investor skepticism. Many of UnitedHealth’s top competitors have also seen their shares suffer in the past year, at a time when the stock market in general has been hitting tech-driven record highs. The S&P 500’s healthcare index has lagged the larger market. And some Wall Street analysts are bracing for another rocky year in the business of health care.

“Near term, there’s a lot more volatility to come,” says Michael Ha, a senior equity research analyst who covers health care companies for investment bank Baird.

Dec. 4 started to reveal the depth of U.S. health care problems

This wide-ranging crisis for both consumers and businesses underlines the brokenness of the U.S. health care system: When neither the people it’s supposed to serve nor the people making money from it are happy, does it work at all?

“We’re really at an inflection point,” says Katherine Hempstead, a senior policy officer at the Robert Wood Johnson Foundation and the author of a book about the insurance industry.

“Every segment of the health insurance business right now is stressed,” she adds.

These stresses became brutally visible a year ago — and persist today. Luigi Mangione, the 27-year-old suspect in Thompson’s killing, was in court this week for hearings ahead of his trial.

But the crisis in U.S. health care is much bigger than his case. Here are three main ways it’s playing out this year, from Main Street to Wall Street.

Prices are going up — and people are getting ready to go without medical care

No matter how you get your health insurance, it will likely cost more next year.

For the roughly 24 million people who get their insurance through the government’s health care exchanges, Affordable Care Act subsidies are set to expire at the end of the year — sending premiums soaring. Another 154 million people are insured through their employers — and premiums for those plans are also set to skyrocket.

Costs are increasing for several reasons: Drug companies have developed more effective cancer treatments and weight-loss drugs — which they can charge more for. More people are going back to the doctor after the pandemic kept them away, which is creating more demand and allowing providers and hospitals to increase prices. And some hospitals, doctors’ offices, insurance companies and other businesses within the health care system have merged or consolidated, often allowing the remaining businesses to raise prices for their services.

The end result is that nearly half of U.S. adults expect they won’t be able to afford necessary health care next year, according to a Gallup poll published last month.

Jennifer Blazis and her family are among them.

“It just always blows me away, how much I have to consider cost when something happens with the kids,” the 44-year-old nonprofit worker and mother of four told NPR this fall in an interview for its Cost of Living series.

Blazis and her family live in Colorado Springs and get their insurance through her husband’s small property-management business. She says she’s postponing leg surgery that would address a condition that’s causing her pain, but which her doctors say is not yet urgent.

“We wait to go to the doctor because we know if we do, we’re going to get hit with just a massive bill,” Blazis says. “And this is with … a really good health insurance plan that our [family] company pays a ton of money for.”

Yet even the biggest businesses selling these services are struggling

Some of those increased costs are also hitting insurers — even the ones that also control other parts of the health care ecosystem.

UnitedHealth Group is far more than just the owner of the largest U.S. health insurance company. It’s one of the largest companies in the world, and it’s involved in almost every part of how Americans access health care — from employing or overseeing 10% of the doctors they see to processing about 20% of the prescriptions they fill.

It’s also one of the most influential stocks on Wall Street. UnitedHealth Group is one of 30 companies that makes up the blue-chip Dow Jones Industrial Average — so what happens with its shares helps determine what happens with the overall stock market.

The company has had a miserable year on both fronts. The reasons come down to profits, more than PR: UnitedHealth and its competitors have been facing rising costs in the Medicare Advantage businesses that allow private insurers to collect government payments for managing the care of seniors.

These programs were once widely seen as money-makers for big health insurers – but now they’ve gotten UnitedHealth embroiled in financial and regulatory trouble, including a Department of Justice investigation into its Medicare business. The company abruptly replaced its CEO in May, a few months before it acknowledged that it was facing the government probe.

Now UnitedHealth is trying to get rid of about 1 million Medicare Advantage patients — and otherwise move on from the past year’s many problems.

“We want to show that we can get back to the swagger the company once had,” Wayne DeVeydt, UnitedHealth’s chief financial officer, told investors last month.

One prominent investor is betting it can: In August, Warren Buffett’s Berkshire Hathaway disclosed that it had bought more than 5 million shares in UnitedHealth Group. The news helped lift the stock from its depths — but it still has a long way to go for both its share price and its profits to recover from this year’s slump.

Chief Executive Stephen Hemsley acknowledged as much in October, promising investors “higher and sustainable, double-digit growth beginning in 2027 and advancing from there.”

Spokespeople for UnitedHealth declined to comment for this story.

Wall Street used to think health care was safe. It’s waiting for a turnaround

Health care spending accounts for about a fifth of the U.S. economy, making the for-profit companies that earn this money some of the most powerful in the world.

That’s helped their appeal to investors, who traditionally tend to consider health care stocks “defensive,” or safe, investments. That appeal sometimes overrides the industry’s current financial challenges: In the past month, as Wall Street had its now-quarterly panic over the artificial intelligence bubble, health care stocks actually outperformed the broader market for a few weeks.

Still, health care is massively lagging the market in the long term.

Morningstar’s Utterback is optimistic that the industry can eventually turn around its deeper financial, regulatory, and reputational problems. She even calls most health care stocks “undervalued” currently — but she warns that investors will have to have a lot of patience if they want to see bets on the sector pay off.

“My explicit forecast period is 10 years. It’s not three,” she says. “There’s a murky outlook here for the next couple years, at least.”

A Pentagon watchdog has determined that Defense Secretary Pete Hegseth risked the safety of U.S. servicemembers by sharing sensitive military information on the Signal messaging app, according to a source who has reviewed the forthcoming inspector general report. 

The report, which is expected to be released as early as Thursday, was launched after a journalist for The Atlantic revealed in March that he had been added to a chat on the encrypted messaging app in which Hegseth and other top officials were discussing plans for U.S. airstrikes against Houthi rebels in Yemen. 

A summary of the report provided to NPR finds that had a foreign adversary intercepted the intelligence discussed in the chat, it would have endangered both U.S. servicemembers and the mission at large. 

The investigation was conducted by Pentagon Inspector General Steven Stebbins. His findings were shared with NPR by a source who has seen the document but was not authorized to discuss it publicly.

The report concludes that Hegseth, who sent the information about targets, timing and aircraft to two Signal groups, including his wife and brother, violated Pentagon policies about using personal phones for official business. Hegseth would not sit for an interview with investigators, the report said, and would only provide a written response.

In his response, Hegseth stated that he was able to declassify information; the inspector general did not determine whether Hegseth had declassified information in the chat by the time it was shared, but acknowledged that, as secretary of defense, he had the authority to do so.

Hegseth also told the inspector general that he believed the investigation was political and that he lacked faith in Stebbins, according to the source.

In a statement, chief Pentagon spokesman Sean Parnell said the findings absolved Hegseth of any wrongdoing.

“The Inspector General review is a TOTAL exoneration of Secretary Hegseth and proves what we knew all along — no classified information was shared. This matter is resolved, and the case is closed,” Parnell said.

In a separate statement, White House press secretary Karoline Leavitt defended President Trump’s national security team and its handling of sensitive information.

“This review affirms what the Administration has said from the beginning — no classified information was leaked, and operational security was not compromised,” Leavitt said. 

The report is the product of months of investigation. The probe was launched in April in response to a request from the top Republican on the Senate Armed Services Committee, Roger Wicker of Mississippi, and Jack Reed, the panel’s top Democrat. 

Over the course of the investigation, the report states, Hegseth only provided a few of his Signal messages to the inspector general. As a result, Stebbins was forced to rely mostly on screenshots of the chat from the Atlantic, according to the source. 

One member of the Armed Services committee, Arizona Democrat Mark Kelly, responded to the report by saying “it’s pretty clear he shouldn’t have been using his cell phone and an unsecure app, unofficial app with regards to DOD, to be sharing that kind of information.” 

“It’s not too hard to see how our adversaries can get that information and pass it on, to the Houthies in this case, and put those lives at risk,” Kelly said. 

The report’s expected release comes as Hegseth faces pressure to answer for the administration’s controversial campaign to strike boats in the Caribbean Sea that are allegedly carrying drugs to the U.S. from South America. One of those strikes has forced the administration to answer questions about whether the U.S. fired on the survivors of a bombing on Sept. 2, a move that military experts say could constitute a war crime if the administration’s claim to be at war with narco traffickers is to be accepted. 

Hegseth’s leadership at the Pentagon has been dogged by controversy. Critics have highlighted that the Army National Guard combat veteran and former Fox News host lacks the same level of experience as his predecessors at DOD. 

In his Senate confirmation hearing, the social conservative told lawmakers that “lethality, meritocracy, warfighting, accountability and readiness” were his top priorities for the role. Since being sworn in, he’s overseen the agency through drastic changes, firing several top officials, placing restrictions on troops and veterans that are transgender and rebranding the agency as the Department of War. 

The White House reiterated continued confidence in Hegseth on Wednesday, with Leavitt saying in a statement that, “President Trump stands by Secretary Hegseth.”

NPR disclosure: Katherine Maher, the CEO of NPR, chairs the board of the Signal Foundation.

Gabriel Sanchez contributed reporting.

When I first read about how Texas Republicans were preparing to engage in mid-decade redistricting, I sent a text message to a Republican aide in state government, jokingly wondering if Missouri would get in on the fun.

It’s no secret that my interest in Missouri redistricting borders on obsession. Some of my love for the subject stems from its importance. The lines and where they are drawn can determine which party has a better shot at winning any given district. But I also have a lifelong interest in cartography, including nearly winning my middle school geography bee and getting to talk to a National Geographic mapmaker while tagging along on a work trip with my dad.

Still, at the time I sent that text, I thought there was no way that Missouri Republicans would plunge back into congressional mapmaking in 2025 — especially after redistricting in 2022 sparked a bitter schism within the Missouri legislature.

I was wrong.

Very wrong.

Missouri ended up becoming the second GOP-led state behind Texas to redraw congressional lines at the behest of President Trump. And Missouri Republicans were upfront about their rationale: They wanted to oust Democratic Congressman Emanuel Cleaver of Kansas City to help prevent Republicans from losing control of the U.S. House in 2026.

And Missouri Republicans didn’t just pass a new map: They broke all sorts of legislative norms and precedents to push it to Gov. Mike Kehoe’s desk.

But in the rush to obtain a short-term victory for Republicans in Washington, D.C., Missouri Republicans may have ushered in the new map’s doom from at least two different directions.

EnterAir Bud 

Redistricting detractors have filed a slew of lawsuits — including a particularly important one around whether it’s even allowed for Missouri lawmakers to redraw congressional boundaries in the middle of a decade. That case is still in its early stages, but the Missouri Supreme Court is expected to decide sometime next year.

On the surface, redistricting foes seem to have a solid case — a constitutional amendment that they say only allows for congressional redistricting after a census. But Missouri Republicans appear to have a secret weapon to counter that contention: The Air Bud Rule.

In the 1997 Walt Disney film, a referee allows Buddy the Dog to play basketball because, after searching frantically through a rule book, “there ain’t no rule that says a dog can’t play basketball.”

Flash forward to 2025: Defenders of the Missouri redistricting plan have rallied behind a similarly constructed argument: “There’s nothing in the Missouri Constitution that says lawmakers can’t redistrict mid-decade.”

Air Bud analogy is a slam dunk

When I first heard this argument, I started to ask Missouri lawmakers if they’d seen Air Bud. 

Some, like Republican Secretary of State Denny Hoskins, had seen it — and acknowledged that the GOP defense of the map was basically the Air Bud Rule. (When he was a state senator, Hoskins successfully sponsored a bill designating two legendary canines, Old Drum and Jim the Wonder Dog, as Missouri’s official Historical Dog and the state’s official wonder dog.)

“Other states have different processes as far as when they can redistrict for congressional seats. But in Missouri, there’s nothing, in my opinion, that says that we cannot do this,” said GOP Secretary of State Denny Hoskins, who then joked that the new map should be named the “Air Bud Clause” if judges uphold it.

The analogy gained popularity among those entangled in redistricting.

Democratic state Rep. Mark Boyko mocked Republicans by citing the Air Bud Rule on the House floor. And during arguments earlier this month in Jefferson City, Chuck Hatfield, an attorney representing plaintiffs trying to strike down the new congressional lines, said in court this month, “we don’t do Air Bud rules in Missouri for very good reason, but that’s essentially what the argument is from the state.”

“It’s like if my children ask me: ‘Can we have ice cream tonight?’ And I say, we’re going for ice cream tomorrow,’” Boyko said. “And they say: ‘Well, you haven’t said we’re not having ice cream tonight, so we’re having ice cream tonight, too.’ No.”

Although Missouri Attorney General Catherine Hanaway had never seen the film, in an interview with me, she said the “ain’t no rule that says a dog can’t play basketball” principle is “not a bad analogy” in describing the state’s main argument.

“The Constitution says that redistricting shall happen after the decennial census. It doesn’t say that it shall happen immediately after; that it should happen only once per decade; that it can’t be revisited,” Hanaway said. “I don’t know what happened to Bud. I’m guessing he probably didn’t get to play basketball since you’re using that analogy. But I think our chances of prevailing are pretty good.”

When I informed her that Buddy not only got to play basketball, but he also played football in the classic film Air Bud: Golden Receiver, Hanaway said: “Man, I have missed a whole genre. I really got to catch up on that.”

A surprise referendum

But the biggest threat to the Missouri redistricting plan may not be the lawsuits.

One day, after the draining first week of the redistricting special session in September, I took a walk near my house in St. Louis. That’s when a question popped into my head: If lawmakers managed to pass the map, were there enough members in the Missouri House to make the map go into effect right away? If not, Republicans wouldn’t be able to avoid Missouri’s very robust referendum process.

While getting my kids ready for bed, I realized the answer was … no. The new map that Trump and Missouri Republicans wanted so badly could be subject to a statewide vote. If signature gatherers just got enough names collected before Dec. 11, the map couldn’t go into effect for the 2026 election cycle, defeating the entire purpose of the redistricting special session.

My story for St. Louis Public Radio was published before members of the House ended up giving first-round approval to the redistricting bill. Lawmakers ended up passing the map anyway, without much trouble — even though voters could end up wiping out their work.

After the special session ended, though, it was clear that a lot of lawmakers had no idea that the map could potentially be nullified through a statewide vote.

Opponents of the map have been scouring the state to collect signatures to put the plan up for a statewide vote. State Rep. Bryant Wolfin said he was unaware the map could go up for a statewide vote — adding “I guarantee the majority of the caucus did not as well.”

Whether the Trump White House realized that Missouri’s new map could be put up for a vote is unclear. Officials did not reply to a request for comment. But there’s no debate that the referendum generated a lot of excitement among despondent Missouri Democrats who suffered through yet another bad election cycle in 2024.

“I don’t even like politics, OK? I just know we need transparency,” Jefferson City resident Frida Tucker told me in September. “We need to stop the power grab. We don’t need to do it every three years, OK? Like, something’s not right here.”

So what did I learn from following along on this wild Missouri redistricting saga?

For one thing, it’s important to pay attention to seemingly insignificant details, like the vote count of a bill that was always expected to pass.

And other takeaway? Maybe revisit 1990s Disney films before a redistricting cycle, because you never know when a throwaway scene could inspire a legal theory that sinks or saves a nationally-watched proposal.

Jason Rosenbaum is a political correspondent for St. Louis Public Radio.