The suspect accused of shooting dead the chief executive of UnitedHealthcare has pleaded not guilty to 11 murder and terror charges.
Prosecutors say Luigi Mangione shot dead Brian Thompson as he was walking to an investor conference in Manhattan, New York, on the morning of 4 December.
The 26-year-old was formally charged last week by the Manhattan district attorney with multiple counts of murder, including murder as an act of terrorism.
The defendant was shackled and seated in a Manhattan court as he entered his pleas to state-level charges today.
A small group of protesters had gathered outside the courtroom in sub-zero temperatures, waving signs expressing support for the defendant and anger at healthcare companies.
One placard read "DENY, DEFEND, DEPOSE", a phrase police say had been etched onto shell casings at the crime
scene.
The words reflect tactics insurers are accused of employing to avoid paying out on claims to US patients.
In a statement, a spokesperson for New York Mayor Eric Adams, Kayla Mamelak Altus, said: "The cold-blooded assassination of Brian Thompson - a father of two - and the terror it infused on the streets of New York City for days has since been sickeningly glorified, shining a spotlight on the darkest corners of the internet."
Despite facing terrorism charges, Mangione has been lauded as a folk hero by some Americans who despair at the enormous healthcare costs and power of insurers to refuse to pay for some treatments.
Outside the courthouse, Staten Island resident Natalie Monarrez said she took part in the demonstration because she had lost both her mother and her lifetime savings because of denied insurance claims.
She said of the shooting: "As extreme as it was, it jolted the conversation that we need to deal with this issue."
She added: "Enough is enough, people are fed up."
Read more on Mangione:
Hero or villain: Everyone has thoughts on alleged killer
The suspect was detained in a Pennsylvania McDonald's after a five-day search, carrying a gun that matched the one used in the shooting and a fake ID, police said.
He was extradited from Pennsylvania on Thursday and quickly rushed to New York City.
As well as this state trial, he also faces federal charges. The two cases will proceed on parallel tracks, prosecutors have said.
The state charges allege Mangione intended to "intimidate or coerce a civilian population" and influence
policy, while the federal charges accuse him of stalking and killing someone.
According to federal prosecutors, the police who arrested him also found a notebook containing writing that expressed "hostility towards the health insurance industry and wealthy executives in particular".
Mangione is being held in a Brooklyn federal jail alongside several other high-profile defendants, including rapper Sean "Diddy" Combs and Sam Bankman-Fried, co-founder of failed crypto exchange FTX.
(c) Sky News 2024: Luigi Mangione pleads not guilty to murder and terror charges over healthcare CEO's killing