Educator John McCormick works three jobs to support his family, but healthcare is an ongoing struggle.

He and his fellow public school teachers in West Virginia have gone on strike twice in the past few years. Inadequate health insurance coverage is a big reason why.

But that problem looms even larger now as the coronavirus spreads across the United States.

McCormick, a married father of four, worries about how the outbreak could impact his family's health and finances.

The number of COVID-19 cases in the US has surpassed 500 across 34 states by some estimates, with at least 22 deaths.

"Because my children are so young, aged three to eight, something like the flu or coronavirus would be extremely worrisome," McCormick, 37, told Al Jazeera. "At that point, they would have to go to the doctor regardless of whether or not we really had the money at the time. We would have to fall back on credit if no other options were available."

While McCormick would risk the financial blow and seek medical help, experts worry the disease could spread even faster if cost considerations deter people who are uninsured or underinsured from getting the testing or treatment they need.

The number of uninsured non-elderly people in the US rose to 27.9 million in 2018 under President Donald Trump - an increase of half a million from the previous year, according to the non-profit Kaiser Family Foundation (KFF).

Most uninsured people in the US are working poor - meaning they are from in low-income households that have at least one person working. People of colour are at higher risk of being uninsured than non-Hispanic whites, KFF notes.

"The uninsured in the US are more likely to delay or forego care due to cost than those who have health insurance, and they are less likely to have a usual place to go when they need medical care," said Jennifer Tolbert, the KFF's director of state health reform.

"While it is unlikely anyone would be denied testing if they are believed to be infected, given the public health implications of the virus, concerns over the cost of testing or treatment may cause some uninsured [people] to delay testing or avoid testing altogether," she told Al Jazeera.

Because my children are so young, aged three to eight, something like the flu or coronavirus would be extremely worrisome. John McCormick, West Virginia educator

High healthcare costs

Since it first appeared in the city of Wuhan, China, in December, the number of confirmed COVID-19 has has surpassed 100,000 globally and killed more than 3,500 with the vast majority of fatalities in China, according to the World Health Organization.

In the US, people who become infected could end up facing huge medical bills.

"For the uninsured who get sick, the cost implications of getting treatment can be significant," Tolbert explained. "While most of the cases of coronavirus appear to be mild, more severe cases require hospitalisation. For the uninsured, that could mean tens of thousands of dollars in medical bills that will not be covered by insurance."

But even those with health insurance could be pushed to the financial brink by the outbreak.

McCormick, who teaches high school social studies in Princeton, West Virginia, and serves as an adjunct professor at a community college and an online university, has health insurance for himself and his family that costs hundreds of dollars per month.

But that monthly premium is just the start. Like many health insurance plans, McCormick's policy requires him to chip in additional copays: $20 to see a regular doctor, $40 to see a specialist and $50 to access "urgent care" - a service that provides immediate outpatient care for those who are sick or injured.

With four kids in daycare and public school, that happens a lot in his family. And out-of-pocket costs can force some tough decisions.

McCormick brings home hundreds of dollars less per month in the summer than he does during the school year, so he or his wife calculate whether it is more economical for him to miss work - and possibly have his pay docked - so he can make an appointment with his regular doctor and only pay $20. Another choice is to go to work and seek treatment at an urgent care facility for $50.

But if they choose the less expensive option, they can still get stung financially down the line.

"Even when they are seen, we get follow-up bills that feel like we are being nickeled-and-dimed to death," McCormick said.

That experience has led both McCormick and his wife to put off seeking treatment for themselves when they fall ill.

"We will do what we have to do to get the kids treatment, but my wife and I have both avoided treatment to save money when times were lean," he said.

For the uninsured who get sick, the cost implications of getting treatment can be significant. Jennifer Tolbert, Kaiser Family Foundation

Scrambling to fill gaps

Last week, New York State Governor Andrew Cuomo ordered health insurers in the state to waive some fees and expenses associated with health insurance including out-of-pocket costs for certain urgent care facilities and doctors' offices, as well as emergency room visits related to the coronavirus.

But the directive does not dictate how self-funded, employer-based health insurance plans bill for coverage.

A recent experience of a Florida man illustrates just how cost-prohibitive seeking medical help for suspected coronavirus can be for the insured. Having returned from a business trip to China with flu-like symptoms, the man went to an emergency room where he tested negative for COVID-19, only to be presented with a $3,270 bill - $1,400 of which his insurance company says he is responsible for, the Miami Herald newspaper reported.

Part of the problem is deficient health insurance. Regulations relaxed by the Trump administration have allowed a rise in short-term policies that don't meet the requirements of the federal Affordable Care Act, often referred to as Obamacare.

Dubbed "junk" plans by their critics, these short-term policies offer coverage that lasts less than a year, places tight limits on doctor visits and covered benefits, and can exclude people with pre-existing conditions, according to a KFF analysis.

A person with such a plan may choose it because of its low premiums, then find it caps hospital coverage at $1,000 per day, even though the average cost of a three-day hospital stay in the US runs about $30,000, according to HealthCare.gov.

Lawmakers from multiple congressional committees have asked the Department of Health and Human Services and the Centers for Medicare and Medicaid Services to provide a detailed plan on how they plan to ensure uninsured and underinsured people are tested and treated for the coronavirus.

"Testing and treatment costs of thousands of dollars will cause many uninsured and underinsured individuals to avoid care for coronavirus-like symptoms," the committee chairs wrote in a letter this week. "That will not only hurt those who go untreated, but it will also hasten the spread of COVID-19."

Last week, Vice President Mike Pence announced that low-income Americans and pensioners over age 65 who have health coverage under federal programmes Medicaid and Medicare would have their testing costs covered.

But McCormick believes the government should step in and make coronavirus testing free to all who need it.

"We've bailed out banks, auto manufacturers, and farmers in recent years at great initial expense to taxpayers," he said. "Similar emergency funds should be allocated to ensure that tests are run and that monetary barriers don't keep people from finding out if they are carrying the disease."