By Ransdell Pierson and Bill Berkrot
DALLAS (Reuters) - American cardiologists appear staunch in their support for President Barack Obama's healthcare reform, although some fear that its rocky launch could derail efforts to improve preventive care for needy patients.
The broad support for the Affordable Care Act, popularly known as Obamacare, emerged in interviews last week in Dallas with more than 20 cardiologists at the annual scientific sessions of the American Heart Association. The group has set an aggressive goal of reducing heart disease and deaths from heart disease and strokes in the United States by 20 percent by 2020.
Heart specialists say the key to achieving that goal is a greater focus on preventive care and access to medical services for more Americans. They view anything that gets more people tested and treated for high blood pressure, high cholesterol and atherosclerosis as a major improvement over treating heart attacks and strokes on an emergency basis.
The Affordable Care Act's emphasis on preventive care and increased access, as well as its ban on denying health insurance due to pre-existing conditions, accounts for much of the support in U.S. cardiology circles.
Some 7.3 million Americans with a history of cardiovascular disease are uninsured. They are expected to have access next year to treatment and preventive care under the new government-subsidized healthcare reform, said Dr. Elliott Antman, President elect of the American Heart Association.
"For people who have had a stroke who are uninsured, they're at 56 percent higher risk of dying from that stroke than patients who are insured," said Antman, a cardiologist at Brigham and Women's Hospital in Boston.
"So if we could deal with elevated blood pressure and cholesterol more effectively than we do now by chipping away at the barriers (to preventive care), just think how much progress that would be," Antman said.
Long a political target for Republicans who seek to delay or kill it, Obamacare faces a crucial test this weekend. The Obama administration has pledged to have major repairs in place to the HealthCare.gov enrollment website, which has been hobbled by technical problems since its launch on October 1.
Some of the doctors interviewed by Reuters said the website troubles, which have stymied efforts by millions of people to sign up for new health benefits under Obamacare, as well as uncertainty about how it will be implemented, have raised fears the program could be rolled back.
If Obamacare is derailed, either by political opposition or the administration's own inability to sign up enough people, "then we go back to the status quo ... and health outcomes will remain where they are or get worse because people don't have access to care," said Dr. Robert Talbert, a professor of pharmacy at the University of Texas at Austin.
"My take on this is we're already spending the money but it's not being used appropriately," said Talbert, referring to the costly use of emergency rooms for primary care.
Dr. Barry Franklin, director of preventive cardiology for William Beaumont Hospital in Royal Oak, Michigan, said uncertainty around Obamacare has rattled the medical community.
"It has already impacted hospitals, physicians and medical centers simply on the basis of uncertainty in terms of what will be the impact, how it will affect reimbursement," he said.
AVERTING HEALTH CRISES
Heart disease is by far the biggest killer in the United States, accounting for as many as one-third of all deaths. If serious advances in preventive care are not undertaken, the cost of treating heart disease alone could triple to $818 billion by 2030, according to the AHA.
Providing preventive care to more people is one focus of Obamacare, which assures free services based on age or risk factors, with no required co-payments if given by a network physician. Heart-related services include blood pressure and cholesterol tests, screening for abdominal aortic aneurysms and screening and counseling for obesity - a major risk factor for heart disease.
Nearly all Americans are required to have insurance under the new law, or pay a fine. About 7 million people are expected to enroll via online insurance exchanges in 2014. Another 9 million are likely to receive insurance through the law's expansion of the Medicaid program for the poor.
Dr. Lynn Mahony, who treats dozens of young adults, including some with hereditary heart defects, said many would be ineligible for treatment if Obamacare had not already enabled children to remain on their parents' insurance plans until age 26. "A lot of parents' policies had cut them off at 21."
"These children, when they become adults, will need ongoing regular cardiology follow-up, including surgeries, and without Obamacare they really often have no way to fund their care or procedures," said Mahony, a pediatric cardiologist and professor of pediatrics at the University of Texas Southwestern Medical Center in Dallas.
Once a child is diagnosed with an hereditary heart problem, doctors need to test the parents to see if they have the same condition and need potentially life-saving treatment for it.
"But much of the time, I'm unable to get the studies done because their parents have no health insurance," Mahony said. She expects that to change on January 1, when Obamacare fully kicks in.
Preventive care has been largely unavailable or haphazard for uninsured patients, according to Dr. Rose Kelly, a cardiac surgeon from the University of Minnesota in Minneapolis.
"They put their health last and then when they do get ill, they lose everything," Kelly said.
With the prevention push of Obamacare, she predicted far more patients will take care of themselves and not wait for a crisis before seeking healthcare.
"They'll get their blood pressure under control, and not show up for a stroke. I believe it will absolutely lower our healthcare costs."
Emergency rooms, which cannot turn away patients, for years have been the only resort for millions of Americans seeking primary care and emergency treatment. It is the most expensive type of care, creating a huge cost burden to hospitals treating uninsured patients who cannot pay.
"One of the good things is, after full implementation, there's potentially 30 million more paying patients. That's a good thing for hospitals and doctors," said Dr. Douglas Weaver, from Henry Ford West Bloomfield Medical Center in Michigan and a past president of the American College of Cardiology.
Several heart doctors said it remains to be seen if the ACA will work as well as they hope. But Dr. Nathaniel Reichek, director of research for St. Francis Hospital in Roslyn, New York, was by far the most pessimistic, saying that Obamacare could hasten a trend to cut payments to doctors for many services, threatening their ability to stay in practice.
"While the intentions are noble and some of the principles are very desirable, I'm concerned there's a disaster brewing," said Reichek.
Dr. Francisco Lopez-Jimenez, a Mayo Clinic cardiologist, sees Obamacare curbing the number of questionable surgical and diagnostic procedures and ensuring that they have proven their worth in clinical trials if they are to be reimbursed.
He expects Obamacare to intensify its prevention focus over time, for instance, possibly by encouraging greater use of cardiac rehabilitation after heart attacks.
The rehab, which includes exercise, diet and smoking cessation efforts, decreases the risk of another heart attack or death by 35 to 40 percent, Lopez-Jimenez said, but is currently used by fewer than one-third of patients.
"Old people and young people need to have healthcare, so they'll do better," said Dr. Ed McFalls, a cardiologist with the Veterans Administration Center at the University of Minnesota. "Let's stop arguing about an important principle: You take care of the old and you take care of the young and society pays for it."
(Additional reporting by Caroline Humer; Editing by Michele Gershberg and Dan Grebler)