Fewer cardiac arrests after Affordable Care Act expanded coverage

[Suppressed]

Fewer cardiac arrests after Affordable Care Act expanded coverage
28th June 2017 by Katherine Lindemann
Incidence of cardiac arrest dropped by 17 percent among middle-aged adults after the ACA went into effect.

The United States has 350,000 cases of out-of-hospital cardiac arrest each year, a vast majority of them fatal. To determine how Oregon’s implementation of the Affordable Care Act, popularly known as “Obamacare,” impacted these devastating events, researchers crunched the numbers. A recent study in the Journal of the American Heart Association compared emergency medical care statistics for an urban county before and after the law went into effect.  After the Affordable Care Act was implemented, incidence of cardiac arrest was 17 percent lower. We spoke with senior author Sumeet Chugh to learn more.

ResearchGate: What motivated this study?

Sumeet Chugh: Health insurance has an overall health benefit, but there is little information on major adverse events, such as sudden cardiac arrest. Lethal in nine out of ten patients who experience this condition, cardiac arrest is a human catastrophe that affects a 1,000 Americans a day.

RG: What did you find?

Chugh: Expansion of health care insurance as a result of implementing the Affordable Care Act in Oregon significantly reduced the burden of sudden cardiac arrest (by 17 percent) among 45- to 64-year-old residents of Multnomah County. Such an effect was not observed in the over 65 age group, for whom coverage did not change.

RG: What do you think led to this decrease in incidents of cardiac arrest?

Chugh: It’s likely multifactorial, possibly with a significant contribution from access to preventive health care enabled by the insurance expansion. At least 50 percent of this age group—both men and women—experience warning signs in the weeks that precede the sudden cardiac arrest event. While this would need to be specifically evaluated, it is possible that new access to health care encouraged some of these patients to see providers and receive treatments that prevented sudden cardiac arrest.

By the time sudden cardiac arrest happens, it is lethal for the vast majority of patients. Therefore, only prevention will make a real impact. Our findings underline the important role of prevention in this regard, and more work is needed to tease out and focus on specific aspects that help the most.

...

Excerpt.  Read more at https://www.researchgate.net/blog/post/fewer-cardiac-arrests-after-affordable-care-act-expanded-coverage

The paper may be downloaded for free from http://jaha.ahajournals.org/content/6/7/e005667
Figures and data here: http://jaha.ahajournals.org/content/6/7/e005667/tab-figures-data

[Wingnut]

[rodamala]

 The A.C.A. being signed into law alone has reduced heart attacks by 17%?

Right.  Whatever.

Bunch of quacks.

[Jazzhead]

The A.C.A. being signed into law alone has reduced heart attacks by 17%?

Right.  Whatever.

Bunch of quacks.

Not necessarily.   A key philosophical point behind the ACA's design is to eliminate co-pays and deductibles for preventive services - on the theory that it is ultimately less expensive to treat disease before it becomes lethal and requires drastic measures.    All the noise has been with respect to the ACA's coverage of contraceptives,  but the value of preventive care with no financial barrier to access extends to all kinds of potentially expensive-to-treat conditions, such as diabetes and, as here, cardiac issues. 

There may be other factors at work here as well.   If one has insurance, one is in a position to establish a relationship with a primary care physician - and it is widely believed that having an ongoing relationship with a doctor is a factor in promoting good health.   The ability to call up a doctor who knows your medical history when you have symptoms of heart disease has got to be a good thing.   

 Another recent phenomenon is the rise of walk-in clinics.  They seem to be everywhere in Philadelphia,  and I've used them when because they're utterly convenient when, say, you need an anti-biotic to deal with a toothache or minor surgery such as the draining of a cyst that makes walking painful. 

Bottom line is that having good health insurance is a good thing - for you, and more broadly for the nation if everyone gets more attuned to good health habits and prevention.   The need to reform the ACA shouldn't blind you to the good things that comprehensive health insurance, including low-cost coverage of preventive services,  can provide.   Heck, even the peace of mind of having good insurance can reduce stress and, indirectly, keep people healthier.   

[INVAR]

The A.C.A. being signed into law alone has reduced heart attacks by 17%?

Right.  Whatever.

Bunch of quacks.

^^ THIS!

Typical Pravda Total Bovine Excrement by an org attempting to save the existence of while whitewashing the miseries caused by ObamaCare, same as our resident Leftist.

[Jazzhead]

^^ THIS!

Typical Pravda Total Bovine Excrement by an org attempting to save the existence of while whitewashing the miseries caused by ObamaCare, same as our resident Leftist.

The ACA HAS been a boon for some folks.   As significant as its problems are,  it is senseless to be willfully blind to the positive aspects of folks, sometimes for the first time, being able to get health insurance.   

The trick is to keep the good and fix the bad. 

[INVAR]

A key philosophical point behind the ACA's design is to eliminate co-pays and deductibles for preventive services

Total, complete and abject HORSESHIT!

Everyone's minimum premiums, co-pays and deductibles are three to ten times what they were BEFORE ObamaCare.

How stupid do you take us for to keep spewing this pro-Obama Marxist claptrap of yours?

The ACA HAS been a boon for some folks.   

For Obama's Free Shit Army - they and you make me pay for their free ride.

it is senseless to be willfully blind to the positive aspects of folks, sometimes for the first time, being able to get health insurance.

WELFARE is not health insurance.

And that is the only boon to anyone that the monstrosity you keep pushing as good.
 

The trick is to keep the good and fix the bad. 

There is no fixing it.  It's Marxism/Statism on steroids and has no place in a Republic.  Only Statists and Socialist tyrants push ObamaCare as some kind of good.

[thackney]

sometimes for the first time, being able to get health insurance

Is there any statistics about first time health insurance versus being subsidized by others?

[andy58-in-nh]

Take a look at the sample size: one county, about 350 people. Put another way, that's about 0.0001% of the American population.

[Suppressed]

^^ THIS!

Typical Pravda Total Bovine Excrement by an org attempting to save the existence of while whitewashing the miseries caused by ObamaCare, same as our resident Leftist.

I posted a link to the paper.  Would you please critique the specifics you're objecting to?  Was the methodology wrong? 

[thackney]

A key philosophical point behind the ACA's design is to eliminate co-pays and deductibles for preventive services

My opinion is that is more damaging in the long run.  It teaches people not to value their own health, it is someone else's responsibility to pay for all of it.

Educating people to create and use health savings accounts makes people more proactive about their health care, and puts competition into play to reduce costs.  No cost to the user ALWAYS results in cost running up out of control, resulting in the problems we already have.

[skeeter]

The ACA HAS been a boon for some folks.   As significant as its problems are,  it is senseless to be willfully blind to the positive aspects of folks, sometimes for the first time, being able to get health insurance.   

The trick is to keep the good and fix the bad.

It just hasn't been a boon for me. I've lost three plans in as many years and have seen my premiums go up by over three times for plans that are vastly inferior to what I had in 2007.

But I'm sure some parasites absolutely love it.

[Suppressed]

Take a look at the sample size: one county, about 350 people. Put another way, that's about 0.0001% of the American population.

You just made an apples-to-oranges comparison.  Comparing to the American population, you should be comparing to the county population included in the study.  It's given as 636,000 adults.  That's about 0.25% of the US.  The analysis showed a lot of statistical power.

[Suppressed]

Is there any statistics about first time health insurance versus being subsidized by others?

Not exactly what you were asking, but here's the figure for uninsured in the study:


Uninsured. All data are for Multnomah County, Oregon. X‐axis shows year of study and y‐axis shows proportion of population. Data for each age‐stratified group are shown with 95% CI. Time periods before and after the Affordable Care Act implementation are highlighted.


I haven't read the details of the paper to know for sure what other factors were or weren't considered, but it would have taken a large demographic shift (e.g., change in age brackets) to account for the drop they saw (102 --> 85).

And I recognize that even at a 95%, 1 in 20 times, the study is giving a spurious result. 

[Suppressed]

It just hasn't been a boon for me. I've lost three plans in as many years and have seen my premiums go up by over three times for plans that are vastly inferior to what I had in 2007.

But I'm sure some parasites absolutely love it.

And that's one of the problems/societal questions...

I suspect that the ACA has reduced the healthcare of people who already had great healthcare, but significantly improved care for those who didn't.  Many who had great care might still get good care, because they are paying more to keep quality up...so there won't be a reduction in outcomes for the more wealthy.  But there will be significant increases for the poor.

It's just a different way of framing the wealthier paying to help the poor.  By removing the ACA, there will probably be a significant adverse effect on the poor, but the question is, what do we do about that?  Anything?  Tax and pay for it another way?

Everyone wants someone else to pay for things.

[Mom MD]

^^ THIS!

Typical Pravda Total Bovine Excrement by an org attempting to save the existence of while whitewashing the miseries caused by ObamaCare, same as our resident Leftist.

Interesting, but does not prove causality.  Also there may have been more in hospital arrests...would like to see the data.  After30+ years in medicine (or any science) one thing you realize is you can manipulate data to show almost any outcome you want.

[Mom MD]

Not necessarily.   A key philosophical point behind the ACA's design is to eliminate co-pays and deductibles for preventive services - on the theory that it is ultimately less expensive to treat disease before it becomes lethal and requires drastic measures.    All the noise has been with respect to the ACA's coverage of contraceptives,  but the value of preventive care with no financial barrier to access extends to all kinds of potentially expensive-to-treat conditions, such as diabetes and, as here, cardiac issues. 

There may be other factors at work here as well.   If one has insurance, one is in a position to establish a relationship with a primary care physician - and it is widely believed that having an ongoing relationship with a doctor is a factor in promoting good health.   The ability to call up a doctor who knows your medical history when you have symptoms of heart disease has got to be a good thing.   

 Another recent phenomenon is the rise of walk-in clinics.  They seem to be everywhere in Philadelphia,  and I've used them when because they're utterly convenient when, say, you need an anti-biotic to deal with a toothache or minor surgery such as the draining of a cyst that makes walking painful. 

Bottom line is that having good health insurance is a good thing - for you, and more broadly for the nation if everyone gets more attuned to good health habits and prevention.   The need to reform the ACA shouldn't blind you to the good things that comprehensive health insurance, including low-cost coverage of preventive services,  can provide.   Heck, even the peace of mind of having good insurance can reduce stress and, indirectly, keep people healthier.

Nice try.  I have cared for people on these Obama care plans.  After crippling rates and copays, it covers almost nothing.  They have almost no skilled rehab or home health care options.  The case managers tell me if they were uninsured, we could get them charity care. But since they have insurance no dice.  The only ones who make out well on Obama care is those who are on expanded medicaid. And they call ambulances to go to the ER for a sore throat because it costs them nothing. Obama care is destroying medical care in this country

[skeeter]

And that's one of the problems/societal questions...

I suspect that the ACA has reduced the healthcare of people who already had great healthcare, but significantly improved care for those who didn't.  Many who had great care might still get good care, because they are paying more to keep quality up...so there won't be a reduction in outcomes for the more wealthy.  But there will be significant increases for the poor.

It's just a different way of framing the wealthier paying to help the poor.  By removing the ACA, there will probably be a significant adverse effect on the poor, but the question is, what do we do about that?  Anything?  Tax and pay for it another way?

Everyone wants someone else to pay for things.

Unless someone can prove to me that people were going without care and dying in the streets before  2010 I will look at ACA as not just another welfare program, but one that has significantly jeopardized my own health as I am far less likely to seek care than I was prior to its passage.

Call me callous and selfish, but frankly I'm pretty tired of watching my own standard of living decay for the benefit of others who in many cases do not deserve the benefit they are getting at my expense.

Besides, we all know where this is headed - we haven't begun to see people 'dying in the streets' if the State gets full control over the system.

[Suppressed]

Interesting, but does not prove causality.  Also there may have been more in hospital arrests...would like to see the data.  After30+ years in medicine (or any science) one thing you realize is you can manipulate data to show almost any outcome you want.

Definitely.

And no offense meant to you with your profession, @Mom MD, but I think that a lot of medical research is one of the worst offenders of that.

Still, I think that it's more valuable for people to provide substantive critique, rather than just yell, "It must be wrong!" and stick their heads in the sand.

[thackney]

Everyone wants someone else to pay for things.

While I agree there is need to help the truly poor and those in the midst of a bad temporary life event, I contend this has proved to be a bad way to accomplish it.

The costs have far been put on the backs of the middle class, forcing far too many of them to lose the health coverage they had, while subsidizing immense coverage for the poor.  We have tried it, it is an obvious failure.

[ConstitutionRose]

It just hasn't been a boon for me. I've lost three plans in as many years and have seen my premiums go up by over three times for plans that are vastly inferior to what I had in 2007.

But I'm sure some parasites absolutely love it.

Same here.  We both lost jobs to business closures.  Started our own and got insurance thru a small business association.  That plan was killed by ACA.  Insurers in our state have dropped out until there is effectively only one.  Plans that we could barely afford (and which offered us little beyond catastrophic coverage) have disappeared and been replaced by plans that offer even less and are not affordable.  I'm thinking the only way to get help for my husband's increasing medical costs is to close our business.  We owe $70,000 from the last hospital stay. 

What kills me is that in my husband's case, what we need to care for him effectively is that certain medications be either reduced in price or covered under one of the insurance formularies.  The  primary medicine, Insulin U 500 isn't even something that the drug companies have spent millions researching.  It is, however $1300 to $1800 a vial.

[Wingnut]

Wingnuts affordable care act would include a ban all insurance coverage for patients and also malpractice coverage. 
Ban Lawyers from suing anyone.  Doctors get paid in cash or with farm animals for their service.  If you need hospital care... Hospitals can only charge a flat rate per day per bed like a hotel room. 

[Frank Cannon]

Expansion of health care insurance as a result of implementing the Affordable Care Act in Oregon significantly reduced the burden of sudden cardiac arrest (by 17 percent) among 45- to 64-year-old residents of Multnomah County. Such an effect was not observed in the over 65 age group, for whom coverage did not change.

Notice how we don't get haw many cardiac arrests happened in OR or over how many years this was compared? This omission is intentional.

[driftdiver]

Am I reading this wrong or are they trying to use a reduction of incidents in ONE county during a small time period as proof the ACA works?

Thats ridiculous.   More likely that everyone who was on the verge, had a heart attack and died prior to this time period.

[skeeter]

Same here.  We both lost jobs to business closures.  Started our own and got insurance thru a small business association.  That plan was killed by ACA.  Insurers in our state have dropped out until there is effectively only one.  Plans that we could barely afford (and which offered us little beyond catastrophic coverage) have disappeared and been replaced by plans that offer even less and are not affordable.  I'm thinking the only way to get help for my husband's increasing medical costs is to close our business.  We owe $70,000 from the last hospital stay. 

What kills me is that in my husband's case, what we need to care for him effectively is that certain medications be either reduced in price or covered under one of the insurance formularies.  The  primary medicine, Insulin U 500 isn't even something that the drug companies have spent millions researching.  It is, however $1300 to $1800 a vial.

We also ended up getting group coverage through our business. At least for the time being.

But compared to your situation I have no room to complain. Honestly, I hope your situation works itself out satisfactorily. Best of health to you both.