More than three-fourths of patients without health insurance who were hospitalized for heart attack, stroke or coronary artery bypass graft (CABG) surgery incurred catastrophic healthcare expenses before the passage of the Affordable Care Act (ACA), according to research presented Nov. 13 and 14 at the American Heart Association’s scientific sessions in Anaheim, California.
Catastrophic health expenses were defined as hospitalization costs that exceeded 40 percent of a person’s annual income after factoring in the cost of food. Patient income was determined via the U.S. Census and food costs were estimated from the U.S. Bureau of Labor Statistics.
“Medical bankruptcy is the leading cause of bankruptcy in the United States,” lead study author Rohan Khera, MD, a cardiology fellow at the University of Texas Southwestern Medical Center, said in a press release. “Until there is universal insurance coverage, a catastrophic health experience is very likely to turn into a catastrophic financial experience as well.”
Khera’s group studied hospitalization expenses for heart attack and stroke, while another group—led by Jonathan C. Hong, MD—analyzed hospitalization expenses for CABG.
The researchers, who collaborated on the studies, reported 15 percent of all heart attack and stroke patients were uninsured during the study period (2008-2012). Nine percent of patients who underwent CABG during the same timeframe were without insurance.
In that uninsured population, hospital bills exceeded the threshold for catastrophic expenditures in 85 percent of heart attack patients (median charges $53,384), 75 percent of stroke patients (median charges $31,218) and 83 percent of CABG patients (costs ranging from $85,891-$177,546).
“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,” Hong said. “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.”
Khera pointed out the ACA increased the proportion of patients who have insurance, so the number of people at risk for catastrophic healthcare expenses may have declined. But there is still a “substantial number of people who are uninsured,” he said.