Insurance and Cardiovascular Health: Time for Evidence to Trump Politics.

Abstract

The United States is entrenched in a fierce debate over healthcare reform. The Affordable Care Act (ACA) strove to reduce the number of uninsured individuals, and after its implementation, 20 million Americans gained insurance coverage. Ongoing shifts in health policy imperil these gains. As options for repealing, replacing, or revising the ACA are debated, we aim to outline what is known about the relationship between insurance coverage and cardiovascular care, the impact of the ACA on cardiovascular care, and areas where gaps in our knowledge remain. Understanding these relationships may help clinical leaders and policymakers better craft future policy initiatives. Routine medical care is essential for appropriate risk factor screening and treatment. Insurance mediates access to health care, so it is not surprising that uninsured individuals are less likely to receive screening for hypertension, diabetes mellitus, and hypercholesterolemia. Even when diagnosed, treatment and control of cardiovascular risk factors is lower in the uninsured population.1 Perhaps, in part, because of these disparities, coronary artery disease is more prevalent in low-income populations, who are generally at greater risk of being uninsured. Furthermore, although rates of acute myocardial infarction decreased in the US population the decade before the ACA, …