The monthly mortgage payment is the heaviest expense facing the average U.S. family but for heart patient Frank Amend, an engineer from North Carolina, the biggest cost is healthcare.

That’s why Amend and tens of thousands of patients with similar conditions find themselves at the center of debate over how to reform the $2.5 trillion U.S. healthcare sector - and whether the country can afford it.

Amend, 48, has insurance through his employer but since suffering a heart attack in 2003, his monthly out-of-pocket costs for premiums and medications have grown to consume as much as 20 percent of his wages, and he has become a strong advocate for broad healthcare overhaul.

He says he would like to start his own consulting firm, but can’t because the cost of obtaining health insurance for him and his family would be “financial suicide.”

A survey of heart patients by the American Heart Association shows that Amend is not alone. Cost of insurance premiums and medication is the top concern of heart patients, said the poll, released Thursday.

The online survey of 1,105 adults who said they had a heart condition, stroke or high blood pressure showed that 56 percent had trouble paying for prescription drugs or other medical care in the past few years. It was conducted from December 29, 2009 to January 5, 2010.

Stroke patients - 69 percent - were most likely to report having trouble paying medical bills.

Almost two thirds of heart patients - 64 percent - said making healthcare costs more affordable was a top priority for them.

AHA officials say they hope the survey will help jumpstart the drive for a more comprehensive approach to healthcare reform.

“The problem has not gone away,” association president Dr. Clyde Yancy said in an interview.

Nearly 10 percent of heart disease patients eventually file for bankruptcy, said AHA spokeswoman Suzanne Ffolkes.

‘ENTITLEMENT EXPANSION’

But a push by President Barack Obama and congressional Democrats to overhaul the sector to rein in costs and expand coverage to the uninsured has stalled in the face of Republican opposition and falling public support, denying Democrats victory on the top legislative priority.

Republicans say it is a mistake to expand the role of government in healthcare and oppose the roughly $1 trillion 10-year cost of expanding health insurance coverage at a time of record budget deficits.

“I don’t know how you spend a trillion dollars to create a new entitlement ... That’s not really reform, that’s entitlement expansion,” Representative Dave Camp said in an interview this week. He and other Republicans are pushing for less sweeping legislation that focuses on costs.

COSTS DISCOURAGE PATIENTS

About 46 percent of those who said they had trouble paying medical bills said they had to delay getting needed healthcare and 43 percent said they failed to fill a prescription because of the expense.

“The high cost of healthcare is forcing many of our patients to not take advantage of, or to forego, life-saving treatments and medications,” Nancy Brown, chief executive of the Heart Association said in an interview. “They really are making life and death decisions because of the cost of healthcare.”

The majority of those surveyed said they had some form of health insurance. About 16 percent of the non-elderly adults surveyed said they had no medical insurance.

Some 46 million people in the United States lack health insurance and many with coverage find it inadequate when it comes to preventive care or when struck by major illness.

“Everyone believes that if you have insurance, there’s no issue here,” Dr. Yancy said. “There is a big, big problem with the underinsured - those who have insurance and are still having difficulty receiving care.”

The Heart Association and other healthcare advocacy groups are pushing for broad healthcare reform.

The U.S. Senate and House of Representatives have passed sweeping reform measures but efforts to merge the two bills into a single piece of legislation stalled when Democrats lost their “supermajority” of 60 seats in the Senate after a special Massachusetts election last month.

The online survey conducted by research firm Synovate had a margin of error of plus or minus 3 percentage points.

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By Donna Smith

WASHINGTON (Reuters)