38-year-old elementary school teacher Heather Holland became the latest victim of the flu epidemic — largely due to her health insurer’s high copay costs.

Holland passed away last week from the flu, leaving behind her husband, a 10-year-old daughter, a 7-year-old son, and a classroom of second graders without their teacher. The Weatherford Democrat reported that Holland had been prescribed flu medication, but didn’t pick it up because she couldn’t afford the $116 copay. By the time her husband found out, he paid cash for the medication, but by then it was too late.

“Friday night, things escalated and she ended up in the ICU,” Frank Holland told the Democrat. “I have to be strong for the kids but it’s still surreal, it hasn’t all set in.”

“We’ve been together a long time, over half my life. She’s my best friend, my soulmate, my everything,” Holland continued. “It hasn’t set in with [the children] yet either.”

Holland’s case is just one example of thousands of insured Americans across the U.S. every year going without necessary healthcare due to cost barriers. A 2014 study by the Commonwealth Fund  found that roughly 31 million Americans with health insurance were “underinsured,” meaning they still lacked the financial means to get healthcare due to high deductibles and copays preventing them from seeing a physician or getting necessary medication.

Dr. Robert Zarr, president of Physicians for a National Health Program — an advocacy group of healthcare providers pushing for universal healthcare in the United States — broke down the astronomically high costs that underinsured working-class Americans have to cope with on a regular basis, citing figures from the Kaiser Family Foundation and Healthpocket.com.

“The average deductible – i.e. before insurance kicks in — for families with popular silver plans in 2015 is estimated to be $6,010, and out-of-pocket costs for copayments and deductibles, after premium payments, for a family of four with an income of about $60,000 per year can be as high as $13,200,” Zarr stated in a press release. “And of course this applies to ‘in network’ services only. Out-of-network costs can go much, much higher. Such financial barriers are untenable, economically and morally.”

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Data by healthcare.gov (Chart by Healthpocket.com)
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Data and chart by Kaiser Family Foundation

As the charts above show, Holland having health insurance didn’t necessarily mean she could afford the medication that may have saved her life. The Atlantic reported on this phenomenon last year, in analyzing non-employer plans available on the healthcare.gov marketplace. In some cases, the cap on out-of-pocket healthcare costs exceeded what most working families might pay for a car (emphasis ours).

Even a gold-plated insurance plan with a low deductible and generous reimbursements often has its holes. Many people have separate—and often hard-to-understand—in-network and out-of-network deductibles, or lack out-of-network coverage altogether.  Expensive pharmaceuticals are increasingly likely to require a significantly higher co-pay or not be covered at all. While many plans cap out-of-pocket spending, that cap can often be quite high—in 2017, it’s $14,300 for a family plan purchased on the ACA exchanges, for example.

As of late January, the Texas Department of State Health Services found that since October, nearly 2,900 people have died from the flu. 2,720 Texans who died of the flu were over the age of 50, making teacher Heather Holland’s case all the more abnormal. Acting CDC director Anne Schuchat recently told USA Today that this year’s flu season is the worst in nearly a decade.

 

Scott Alden is a freelance contributor covering national politics, education, and environmental issues. He is a proud Toledo University graduate, and lives in the suburbs of Detroit.

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