Almost Half of Nonelderly Patients With CVD Have Financial Hardship From Medical Bills

Debra L Beck

February 14, 2019

Among nonelderly adults living in the United States with atherosclerotic cardiovascular disease (ASCVD), 45.1% report feeling financial hardship related to paying their own or their families' medical bills, a report suggests.

Roughly one in five of these individuals (18.9%), or an estimated 1.64 million Americans, said they are unable to pay their bills at all.

Even those with insurance — and almost 90% of this sample reported having coverage — said they experienced financial hardship because of the high cost of insurance, including deductibles, copays and coinsurances.

"Our study underscores the fact that while insurance coverage is critical to protect against risk of financial burden from unexpected medical bills, current insurance structure falls short in protecting from financial hardship," senior author Khurram Nasir, MD, MPH, MSc, Yale School of Medicine, New Haven, Connecticut, said in a statement.

The findings were published online February 11 in the Journal of the American College of Cardiology.

The study is timely, given the strong push from Democratic lawmakers to expand public insurance to more Americans. House and Senate Democrats unveiled a bill on February 13 that would allow anyone older than 50 years to buy into Medicare, as reported by Politico.

A poll published in January by the Kaiser Family Foundation suggests that 77% of Americans would support such a Medicare buy-in option.

The bill is considered an incremental, and politically more palatable, option to rolling out "Medicare for all." The plan's sponsors suggest that premiums from new enrollees will cover the expanded patient care, in part because Medicare has lower overhead costs and lower profit margins than the private insurance market.

The Consequences of Financial Hardship

The researchers assessed the potential consequences of this financial hardship, including financial distress (derived from six questions about their level of worry concerning several financial matters), food insecurity in the previous 30 days, and cost-related medication nonadherence in the previous 12 months.

The findings: nearly one in three ASCVD patients who reported financial hardship from their medical bills said they were suffering from financial distress, were cutting back on basic amenities, such as food, or were not taking needed medications as prescribed to save money.

Those reporting difficulties were not just from poor or lower-income strata, they were also middle- and higher-income individuals (based on family income as a percentage of the federal poverty limit). That said, uninsured and low-income individuals reported the highest burden of financial hardship and inability to pay.

The authors, led by Javier Valero-Elizondo, MD, MPH, Yale New Haven Health, New Haven, used data from the National Health Interview Survey (NHIS) from 2013 to 2017 to assess the national burden of financial hardship from medical bills among individuals with ASCVD.

Individuals were defined as having medical-related financial hardship if they or anyone in their family reported having difficulty paying medical bills in the previous year, or were currently paying off medical bills over time. If they reported problems paying bills, they were then asked if they had bills they are unable to pay at all.

From the total NHIS sample of 164,696 Americans, 6160 adults self-reported having ASCVD and being between 18 and 64 years of age. Those older than 65 years, and covered by Medicare, were excluded.

Nasir and Valero-Elizondo reported no conflict of interest.

J Am Coll Card. Published online February 11, 2019. Abstract

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