Health insurance does little to protect low-income families from crippling financial hardship when a relative has atherosclerotic cardiovascular disease (ASCVD), according to a study published July 3 in JAMA Cardiology.
Based on a nationally representative dataset from 2006 through 2015, a quarter of low-income families containing a person with ASCVD spent at least 20 percent of their annual income after food expenses on out-of-pocket healthcare costs. Approximately 11.1 percent of families earning less than double the federal poverty limit experienced out-of-pocket costs greater than 40 percent of their post-subsistence income.
Previous studies have focused on the financial impact of specific cardiovascular events like heart attacks and strokes, but the longer-term costs of continuing care for chronic conditions like ASCVD hasn’t been well-studied, according to the investigators.
“Although financial hardship from out-of-pocket healthcare expenses decreased for low-income families over the last decade, even in the contemporary era, low-income families remain at three-fold higher odds of high financial burden (20 percent of income) and nine-fold higher odds of catastrophic financial burden (40 percent of income) than mid/high–income families,” wrote lead author Rohan Khera, MD, with the University of Texas Southwestern Medical Center, and colleagues.
“Moreover, even low-income families with health insurance are not sufficiently protected, as in recent years, a third of low-income families with either self-purchased or employment-based private insurance coverage still faced a catastrophic expense from out-of-pocket longitudinal healthcare costs.”
The researchers noted healthcare expenses are the leading cause of bankruptcy in the United States, but given their results, simply expanding access to insurance may not be enough. The two largest categories of spending for families with ASCVD were insurance premiums and medications, and those costs were especially high for those who purchased their own private insurance.
“Our findings highlight that high insurance premiums and out-of-pocket spending on prescription medications represent potential targets for health policy interventions with the goal of reducing financial hardship from healthcare costs,” Khera et al. wrote. “Until high healthcare expenses are addressed, use of healthcare services will likely impede the financial stability and upward mobility of low-income families. Moreover, patients and their families will continue to be at risk for negative health consequences from major financial hardship.”
The authors noted their study only focused on a single year of healthcare expenses due to a lack of follow-up with specific families over subsequent years. However, given the chronic nature of ASCVD—and that nonacute factors were the primary drivers of out-of-pocket costs—they would expect the financial burden to continue throughout each patient’s lifetime.
Their analysis included 22,521 adults with ASCVD from 20,600 families. From their sample, they estimated almost 2 million low-income American families with this condition spend at least 40 percent of their after-food income on medical expenses each year.
Daniel joined TriMed’s Chicago editorial team in 2017 as a Cardiovascular Business writer. He previously worked as a writer for daily newspapers in North Dakota and Indiana.