He sounds like a trust fund kid whose entire family was wealthy. He went to an ivy league school and his family lives in a mansion in a golf community in Maryland. They probably have insurance and the means to pay for a back surgery out of pocket.
from CNN
Family: The suspect is the grandson of Nicholas Mangione, a prominent Baltimore real estate developer, and his wife, Mary C. Mangione, a philanthropist who died last year. The Mangione family owns Lorien Health Systems, a nursing home chain in Maryland, and Luigi volunteered there in 2014, according to his LinkedIn page.