SATURDAY, April 7, 2018 -- Having a chronic heart condition is stressful enough, but new research suggests the cost of caring for the condition is also a huge financial burden for poorer families in the United States.
One in four low-income families carry a significant financial load from out-of-pocket expenses for chronic heart disease treatment. For one in 10 low-income families -- including those who have insurance -- those expenses trigger a catastrophic financial crisis, the study found.
What's surprising is that these financial burdens generally weren't caused by a long hospital stay or expensive medical procedures. Instead, the costs of prescriptions, clinic visits and maintaining insurance coverage were often to blame for their financial woes, study author Dr. Rohan Khera explained.
"In the setting of current policies, it's important to realize the financial effects of chronic disease. People suffer from the disease and from the costs of chronic disease. It's a double-whammy," Khera said. He's a cardiology research fellow at the University of Texas Southwestern Medical Center in Dallas.
The researchers also found that low-income families with insurance had higher rates of out-of-pocket costs than those without insurance. Khera said this finding suggests that insurance subsidies likely aren't covering enough of the insurance expense for low-income families, and that out-of-pocket maximums in insurance plans should probably be based on income levels.
The study included about 22,000 U.S. adults with chronic heart disease who represented more than 20,000 families. Chronic heart disease was defined as a build-up of plaque in the arteries affecting the heart, brain or peripheral blood vessels.
The study defined low-income as income less than 200 percent of the U.S. federal poverty limit. As an example, a family of four would need to make less than $50,200 a year to be in that category in 2018, according to the U.S. Department of Health and Human Services.
The median income in the study was just under $40,000 a year.
The average out-of-pocket expenses were $2,450. These expenses represented a median of 6.4 percent of income for low-income families and 5.5 percent of income for mid-/high-income families, according to the report.
Still, low-income families had three times higher odds of having chronic heart disease expenses that were greater than 20 percent of their income compared to mid-/high-income families. And low-income families had nine times higher odds of having overall health care costs that reached more than 40 percent of their income, the investigators found.
"Chronic disease costs really exaggerate the disparity between low-income and high-income families," Khera said.
Dr. James Catanese, chief of cardiology at Northern Westchester Hospital in Mount Kisco, N.Y., said that the problem isn't likely to get better any time soon.
"It's not surprising that this is such a big problem," he said. "Once you have established heart disease, there's a lot of care people need. And part of the problem now is with high-deductible health plans. People have to pay deductibles of several thousand dollars before their insurance companies start to pay. It makes people delay coming in for earlier care," Catanese explained.
And although people can see a primary care physician for a physical, if they need to see a cardiologist, that's no longer considered preventive care, and it will cost people money even though they have insurance, he noted.
"We've created a barrier for people to get to the doctor. It's almost like they don't have insurance until everything falls apart," Catanese said.
If cost is an issue for you, he recommended talking to your doctor. It's not always comfortable to bring up finances, but it's important to do so, he said.
"We don't want people having to choose between food or medicine, or between medicine and getting gas in the car," Catanese said. "If I understand what's happening, I can usually help. There are a lot of good generic medicines that we can usually use. But if you don't tell me that you're not taking the medicine because you can't afford it, and I see your blood pressure or cholesterol is creeping up, I'll think you need more medication."
Khera agreed that high deductibles and less robust insurance coverage will "accentuate this problem. Insurance already hasn't been sufficiently protective."
The study was presented Friday at an American Heart Association meeting in Arlington, Va. Findings presented at meetings are typically viewed as preliminary until they've been published in a peer-reviewed journal.
Learn about the societal costs of heart disease from the American Heart Association.
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