ANAHEIM, CALIF. (FRONTLINE MEDICAL NEWS) – Before the Affordable Care Act, over 1 in 8 people under 60 years old hospitalized for acute myocardial infarction or stroke had no insurance, and it ruined most of them financially, according to an analysis presented at the American Heart Association scientific sessions.

The importance of the study is that it shows what could happen if the ACA goes away. Debate over its future is “all about pushing people off insurance.” Plans floated in early 2017 “would have increased the uninsured rate to 49 million people,” said lead investigators Rohan Khera, MD, a cardiology fellow at the University of Texas Southwestern Medical Center, Dallas.

He and his colleagues looked into the issue because “it’s important that health policy debate be informed by evidence. We might be reversing course. This is what we [could] go back to,” Dr. Khera said in an interview.

And even under the ACA, there are still about 27 million people in the United States, about 8.6% of the population, who don’t have health insurance. Although that’s down from about 44 million people (14.5%) before the ACA, a considerable number of people still face financial ruin if they have a serious medical problem. “Until there is universal coverage for those without resources, catastrophic illness will remain a disabling financial threat to many Americans,” Dr. Khera said.

In a review of the National Inpatient Sample, the investigators identified 39,296 acute myocardial infarction (AMI) and 29,182 stroke hospitalizations among people aged 18-60 years with no insurance from 2008 to 2012, which corresponded to 188,192 AMI and 139,687 stroke hospitalizations nationwide. Overall, the uninsured made up 15% of AMI and stroke hospitalizations among the nonelderly.

By using U.S. Census data to estimate annual income, and U.S. Bureau of Labor Statistics data to estimate food costs, the team found that the median hospital charge for AMI – $53,384 – exceeded 40% of the annual income left after food costs in 85% of uninsured subjects. The median stroke bill – $31,218 – exceeded 40% of what was left over after food in 75%. The situation was deemed “catastrophic” in both instances.

It’s true that hospitalization costs might have been reduced or waived in some cases, but the analysis did not consider missed work, disability, and outpatient costs. If anything, the financial burden on the uninsured was underestimated, Dr. Khera said.

The work was funded by the National Institutes of Health, and published in Circulation (2018 Nov 13. doi: 10.1161/CIRCULATIONAHA.117.030128 ) to coincide with the presentation. Dr. Khera had no disclosures.


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