The Once— And Future?— Catastrophic Cost of MI & Stroke

–Obamacare has protected many people with heart disease.

Cardiovascular disease can often have a catastrophic economic effect on people who don’t have insurance. Two studies presented at the American Heart Association in Anaheim illustrate how the Affordable Care Act, aka Obamacare, likely has helped hundreds of thousands of people avoid financial apocalypse.

The first study, presented by Rohan Khera (UT Southwestern) and published simultaneously in Circulation, calculated the financial effects of having a MI or stroke in people under the age of 65 in the 5 years (2008-2012) before the implementation of the ACA.

By way of background, about half of all MIs and 40% of strokes occur in people below the age of 65. The authors calculated that there were nearly 1.3 million MI hospitalizations and 1 million stroke hospitalizations during this period in the under 65 age group. Approximately 1 in 8 of these patients were uninsured, meaning there were almost 200,000 MI and 140,000 uninsured hospitalizations during the 5 year period.

The “vast majority” of these patients “are at risk of catastrophic healthcare expenses.” The researchers found that for 85% of the MI patients and 75% of the stroke patients the “hospital bills exceeded the threshold for a catastrophic health expense.” They defined a catastrophic health expenditure as a hospitalization bill that was more than 40% of annual income after eliminating the cost of food.

“Medical bankruptcy is the leading cause of bankruptcy in the United States,” said Khera, 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.”

The ACA has reduced the risk of financial catastrophe as the percentage of people without insurance has dropped substantially, although there are still a significant number of people without insurance.

In a second study Haider Warraich (Duke University) and colleagues found that the expansion of Medicaid under the ACA has significantly improved the insurance status of non-elderly heart patients in the US.

The study showed that between 2010 and 2015, the percentage of patients with atherosclerotic cardiovascular disease (ASCVD) without insurance declined from 19% to 13%. The authors reported that the number of people under the age of 65 with ASCVD declined from 1.5 million in 2010 to 1 million in 2015. The largest part of this decline was a result of the Medicaid expansion.

The authors noted that “ACA repeal, particularly rollback of Medicaid, could have very serious consequences for patients with ASCVD.”