This is not much different from how many insured people approach their healthcare. My friends who live paycheck to paycheck do not seek medical attention unless it is some extreme life or death situation. Even though they are insured, they are afraid of paying copays and deductibles of $100-$500 for routine visits. If their annual physical results in even just a $50 bill, they will not go. Only when they are in severe 10/10 pain will they start to think about seeing a doctor.