Uninsured Heart Patients Often Face Daunting Bills
MONDAY, Nov. 13, 2017 -- A life-threatening heart emergency can spell financial doom for people who don't have health insurance, a pair of new studies shows.
Around 4 out of 5 uninsured patients hospitalized for a heart attack, stroke or heart bypass surgery faced financial ruin before the Affordable Care Act (ACA) was passed in 2010, the researchers reported.
"Medical expenses are the No. 1 cause of bankruptcy in the United States," said Dr. Rohan Khera, lead researcher of one study and a cardiology fellow at the University of Texas Southwestern Medical Center in Dallas. "The uninsured are particularly vulnerable."
Both studies relied on the National Inpatient Sample, the largest publicly available inpatient health care database in the United States. One study focused on the financial toll of heart attacks and strokes, while the other examined the impact of heart bypass operations.
About 15 percent of all heart attack and stroke patients and 9 percent of heart bypass patients were uninsured between 2008 and 2012, according to the studies.
A large majority of those folks wound up with catastrophic health expenses that ate into their household finances, said Khera and Dr. Jonathan Hong, lead author of the heart bypass study and a cardiac surgery resident at the University of British Columbia in Vancouver.
The researchers defined catastrophic expenses as a hospital bill that exceeded 40 percent of a family's annual household budget, excluding money spent on food, Khera said.
"Any expense that is beyond the means of the patient and is being paid for by their savings has the potential of becoming catastrophic," potentially nudging them and their families into bankruptcy, Khera said.
Among the uninsured, hospital bills exceeded the threshold for a financial catastrophe for:
- 85 percent of heart attack patients,
- 75 percent of stroke patients,
- 83 percent of coronary bypass patients.
During the years of the studies, the average hospital bill for heart attacks reached $53,384, while strokes cost an average of $31,218. The cost for heart bypass surgeries ranged from $85,891 to $177,546.
The findings were to be presented Monday at the American Heart Association's annual meeting, in Anaheim, Calif. Research presented at meetings is considered preliminary until published in a peer-reviewed journal.
"This study really highlights how not only physiologically devastating an acute cardiovascular event can be, but how if somebody does not have health insurance, how in many cases it can be financially devastating," said Dr. Gregg Fonarow. He directs the Ahmanson-UCLA Cardiomyopathy Center and is co-chief of UCLA's Division of Cardiology.
"With such a significant proportion of individuals, where more than 40 percent of their annual income would just go to a single hospital bill, it really highlights the importance of access to health insurance that's affordable," Fonarow said.
This situation likely has improved in the wake of the Affordable Care Act, with the uninsured rate going from 14.6 percent in 2008 to 8.6 percent in 2016, Khera said.
It's likely that repeal of the ACA would cause the uninsured rate to increase again, forcing more people to face catastrophic expenses when they suffer a heart attack or stroke, Khera added.
"Health policy debate should consider the financial implications of major health care expenses," Khera said, adding that a growing uninsured rate would create a "definitely troubling trend towards increasing financial catastrophes."
The study shows there's a bare minimum of coverage that health care policy in the United States should require, said Dr. Vincent Bufalino, president of physician and ambulatory services for Advocate Health Care in Naperville, Ill.
"It tells us that at the very least, no matter what the solution is for health insurance in this country, there has to be catastrophic coverage," Bufalino said. "Maybe we won't have good preventive coverage, but good catastrophic coverage is going to be a must, no matter what."
For more on the cost of heart disease, visit the American Heart Association.
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Posted: November 2017