Low-income families hit hard by heart disease costs, even with insurance

Out-of-pocket costs for chronic heart disease and stroke cause significant financial strain for one in four low-income families, even if they have health insurance, according to new research.

Insurance failed to protect low-income families from monumental costs caused by heart disease, said Dr. Rohan Khera, lead author of the preliminary research presented at the American Heart Association’s Quality of Care and Outcomes Research conference in Arlington, Virginia. The lack of quality health insurance is a big problem for these families, said Khera, a cardiology fellow at UT Southwestern Medical Center in Dallas.

Researchers studied the “financial toxicity” from out-of-pocket annual health costs for adults with atherosclerosis — a build-up of fat and cholesterol that can reduce blood flow in the arteries and lead to heart attack, stroke or peripheral artery disease.

Using a national government survey from 2006-2015, they compared out-of-pocket medical expenses and household income for 22,521 adults in 20,600 families. Expenses included insurance premiums and deductibles, hospitalizations and doctor visits, and prescription costs.

The research revealed one in 10 low-income families had catastrophic costs, and one in four had high costs, even though most — up to 93 percent in 2015 — had health insurance.

Catastrophic financial burden represented out-of-pocket costs exceeding 40 percent of total family income, and high financial burden represented costs more than 20 percent, according to researchers. They defined low income at 200 percent below the federal poverty limit. During the study period that meant a family of four earned from $20,000 to $24,250.

“What good is insurance if you’re paying 40 percent of your annual income toward health care?” Khera said.

Heart disease can have a tragic effect on low-income families, said Dr. Adrian Hernandez, a cardiologist and professor of medicine at Duke University Medical Center in Durham, North Carolina.

“Not only do they have to deal with the change in their health, but they also have the hardship of dealing with financial catastrophe,” said Hernandez, who was not involved in the research. “The two likely combine for poor health and poor quality of life.”

Low-income people with low education have double the risk of coronary heart disease as those with high income and education, according to a 2015 study. Heart disease was costlier than any other disease in 2013-2014, according to the National Heart, Lung, and Blood Institute.

In the current study, researchers found that low-income families with health insurance had higher out-of-pocket costs than their uninsured counterparts, as well as higher costs than middle- or high-income families who had health insurance.

This is most likely because uninsured people may be opting out of health care altogether by not going to the doctor or buying prescribed medications, Khera said. “Some people who have heart disease and spent less [in the study] may have needed to spend more, if their resources allowed.”

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