As the coronavirus spreads across the US, tens of millions of Americans may not seek medical help either because they are uninsured or undocumented. That puts everyone in society at greater risk.
Sebastian shows me his hands. His skin is dry and cracked through over washing.
“I’ve always been obsessed with washing my hands because growing up I knew if I got sick I wouldn’t be able to see a doctor,” he tells me.
Sebastian has lived in the US since he was three years old, after having been brought here from Mexico by his parents. He is one of the estimated 11 million people in the country who are “undocumented”.
No US citizenship for him means no US health insurance.
Even the language of Barack Obama’s Affordable Care Act makes it very clear that undocumented immigrants are excluded (permanent residents and those living in the US on visas are eligible to buy private insurance).
“I never went to a doctor, if I got sick my mom would always try to treat it at home, but I remember getting very sick sometimes and missing a lot of school,” says Sebastian.
The day we meet is the day the first coronavirus case has been confirmed in his area, but Sebastian says that while his family have seen all the news about the virus, their reality remains the same.
“Being undocumented it’s hard to get medical attention. There’s the aspect of presenting yourself to the legal system at medical facilities and that runs the risk of deportation,” he says.
“My family may not be criminals, but they sure are undocumented and seeing a doctor scares them.”
For everyone in the US, whether they are undocumented or not, there is also the huge expense involved in even just seeing a doctor.
More than 27 million people in America have no medical insurance at all, a number that has been growing dramatically during the Trump presidency.
A consultation with a doctor for someone without insurance costs hundreds of dollars.
But there are tens of millions more who are classed as being “underinsured” – having basic insurance that often only covers a fraction of the cost of any check ups or treatment.
“During the flu season we are getting sick a lot, but taking my children to see their paediatrician costs $100 each visit just for a check,” says Lisa Rubio, 28, who has basic health insurance through her employer.
“I started with a cough and a sore throat a week ago, but if the doctor tells me they can’t prescribe anything, that it’s just a virus, I have to decide whether it’s worth it to take away money from my bills and my children’s other needs.”
Last year, being underinsured contributed to a devastating episode for Lisa.
“I got sick. I felt pain coming in my chest. But for me to go see a doctor even though I am insured, I couldn’t afford it so I tried to ignore the pain.”
“Two weeks later, in the middle of the night, my lung just collapsed completely. They had to do intensive care but said if I had caught it sooner, it would have been better,” she says.
Lisa suffers these problems even though she herself is an administrator in a hospital in Tucson.