Majority of Uninsured Patients Experienced Catastrophic Costs for Heart Attack Pre-ACA

Before the implementation of the Affordable Care Act (ACA), a majority of uninsured patients who were hospitalized for a heart attack, stroke, or coronary artery bypass graft (CABG) surgery experienced catastrophic costs, according to a study presented at the American Heart Association’s Scientific Sessions 2017.

Catastrophic health expenditures are defined as hospitalization charges that are 40% or more of annual income after factoring in the cost of food. For many Americans, these medical costs can affect their ability to pay for essential expenditures, such as housing. The authors estimated annual patient income with data from the US Census and food costs with data from the US Bureau of Labor Statistics.

Data from the National Inpatient Sample indicated that 15% of all patients who experienced a heart attack or stroke between 2008 and 2012 were uninsured. Another 9% of patients who underwent CABG surgery were uninsured during this time.

Notably, a significant portion of these uninsured patients reached and exceeded the threshold for catastrophic health costs.

The authors found that 85% of heart attack patients, 75% of stroke patients, and 83% of CABG patients exceeded the threshold, according to the study.

Between 2008 and 2012, the hospitalization cost for heart attacks were $53,384, $31,218 for strokes and within the range of $85,891 and $177,546 for CABG surgery, according to the study.

“Medical bankruptcy is the leading cause of bankruptcy in the United States,” said first author Rohan Khera. “Until there is universal insurance coverage, a catastrophic health experience is very likely to turn into a catastrophic financial experience as well.”

The authors report that all 3 conditions are unanticipated health events that typically require costly treatments. The burden of heart disease is well-known among patients with insurance but is less understood among the uninsured population.

“Catastrophic health expenses are an important factor for physicians to consider, and should be thought of as an adverse effect when hospitalization is required for uninsured patients in the United States,” said first author Jonathan C. Hong, MD. “The majority of uninsured patients undergoing CABG will experience significant financial hardships that are often unexpected and difficult to plan for. Health policy that expands insurance coverage can help mitigate the economic burden for this life-saving procedure among this patient population.”

These findings suggest that having health coverage is important for preventing catastrophic healthcare costs for patients. The authors hypothesize that the decline in the uninsured rate due to the ACA may coincide with a reduced rate of patients experiencing catastrophic costs, according to the study.

“Although there is still a substantial number of people who are uninsured, the Affordable Care Act increased the number of people who do have insurance,” Dr Khera said. “Therefore, the number of people at risk for catastrophic healthcare expenses may have declined. The law also improves the ability to get insurance for people with medical illnesses given its protections for patients with pre-existing conditions.”