Nearly two months after Jackie Stasik was hospitalized with influenza and an aggressive case of pneumonia, she's still too sick to speak loudly.
A tracheostomy tube and ventilator that helped pump oxygen into her lungs for weeks was only recently removed, so her husband Kevin Stasik does most of the talking for her. Jackie's voice is a whisper, almost impossible to understand.
H1N1 virus can hit healthy adults particularly hard
Influenza lingers on doorknobs this time of year. It loves kisses on the cheek, close talkers and holiday parties.
While epidemiologists - the experts who study disease and how it spreads - say it can be hard to track the origin of any single case of the flu, Kevin Stasik suspects his 6-year-old daughter brought H1N1 into their North Charleston home from a Halloween party.
Five of the six Stasik family members became sick that week.
On Oct. 30, six days after Kevin Stasik's wife Jackie, 46, first fell ill, a family doctor in Summerville found a spot of pneumonia on one of her lungs. Two days later, pneumonia covered both her lungs.
"She really was as sick as anybody I have ever seen - certainly as anybody that had ever walked into my office," said Dana Simpson, the Stasiks' family physician.
An ambulance transferred Jackie Stasik from Simpson's office in Summerville to Trident Medical Center in North Charleston on Nov. 1. She's still there.
When H1N1 first emerged in April 2009, it was commonly called swine flu.
This strain, which shares some of the same genes as the type of flu typically found in pigs, sparked a worldwide pandemic, infecting more than 60 million residents in the United States that year and killing more than 12,000, according to the Centers for Disease Control and Prevention.
"It has circulated every flu season since 2009," said Riyadh Muhammad, a pediatrician and medical consultant for the South Carolina Department of Health and Environmental Control.
While it's merely considered another strain of seasonal flu now, H1N1 can hit healthy adults harder than some other strains, "which typically impact the very, very young and the very, very old," Muhammad said.
Each week during flu season, DHEC tests samples of the flu virus sent from clinicians around the state. Data from the most recent reporting week shows all 15 of the positive flu samples tested by the state health department were confirmed as H1N1.
The CDC has confirmed 598 cases so far this season in Region 4, which includes South Carolina and several other Southern states. That's the third highest incidence rate of H1N1 out of 10 regions around the United States.
In South Carolina, the Lowcountry is ground zero for the flu this season. Of the six flu-related deaths in South Carolina since September, five of them were reported in Charleston, Berkeley and Dorchester counties.
Jackie Stasik, one of 401 South Carolinians who have been hospitalized with the flu this season, was never vaccinated, her husband said, because she has an egg allergy.
It's a common misconception that adults and children with egg allergies cannot be vaccinated for the flu, Muhammad said.
While there are traces of egg proteins in some flu vaccines, there are also egg-free vaccines, she said. All of them guard against H1N1.
"The best way to protect yourself from influenza and its severe complications is to get your flu vaccine every season," Muhammad said.
"I have been at my wife's bedside every single day," said Stasik, a retail manager and his family's primary breadwinner. "I have not taken a paycheck since early November."
The ordeal hasn't been easy - and not only because Jackie is so severely ill. The Stasiks, with four daughters at their North Charleston home, made little money even before her hospitalization.
So Kevin Stasik, 35, finds himself walking a fine line this winter between preserving his "pick yourself up by your bootstraps" principles and accepting help that he wishes his family didn't need.
His church congregation paid his recent electric bill. Extended family members who have helped care for the Stasik girls are "tapped out," Kevin said. "This has been very, very difficult."
And it may get worse. Six South Carolinians - five of them from the Lowcountry - have died from the flu so far this season, according to the state health department.
The flu won't kill Jackie Stasik, but it may bankrupt her family. She is the only one among them with no health insurance, her medical bill already exceeds $800,000 - and it's hard to say how high it will go.
Below the poverty level
One week before Christmas, Jackie Stasik, 46, left the hospital for the first time since she was admitted Nov. 1.
Nurses at Trident Medical Center rolled her outdoors for a few minutes. She is too weak to walk, or even stand up, but this gave her a chance to soak up some sunshine.
"Nurses from different parts of the hospital came out to see her because when she was admitted, she was literally probably within an hour of not surviving," Kevin Stasik said. "It's now to the point where it looks like she's going to be walking out of here."
By then, Kevin Stasik said his wife's hospital bill could top $1.5 million. And the bills won't stop when she walks out the door. Jackie Stasik will need extensive - and expensive - rehabilitation services at home.
Trident Medical Center provided Kevin Stasik a Medicaid application to complete on the unlikely chance that Jackie qualifies for the government's low-income health insurance program.
"To be honest, I'm trying to fill out these forms, and I really don't know what I'm filling out," he said. "I hate it. I hate it. I hate it."
The Stasiks are officially poor. Kevin estimates that he earns about $24,000 a year; Jackie, an independent photographer, works only part-time. Her new business, Riverfront Photography, has not generated any money yet, he said.
The Stasiks live below the federal government's poverty level, so three of their four daughters qualify for Medicaid cards. The eldest daughter, 19, is too old to qualify for Medicaid under her family's umbrella.
The family's poverty also qualified them to receive food-stamp benefits this year - "an absolute necessity," Kevin Stasik said.
But Medicaid eligibility rules for adults in South Carolina are strict. While there are some exceptions to income limits, Jackie Stasik probably earns too much to qualify herself.
Eligibility for the program is largely based on combined family income. Jackie Stasik might qualify if she and her husband earned a combined $17,093 or less per year.
The income threshold is higher for some patients with qualifying conditions, like pregnancy or breast cancer, but the flu isn't a qualifying condition.
Kevin Stasik, an Air Force veteran, doesn't need a Medicaid plan because he is partially covered by VA health benefits, although these don't extend to his wife.
"I don't want to live off the state," Kevin said.
The federal Affordable Care Act tried to change Medicaid eligibility rules in South Carolina.
The law intended to expand Medicaid coverage to anyone in the country who earns up to 138 percent of the federal poverty level, but the Supreme Court ruled in 2012 that states are not required to accept federal money to grow the program.
South Carolina is one of half of all states opting out of Medicaid expansion.
If the state chose to expand Medicaid, Jackie Stasik would likely have qualified for it on Jan. 1.
"I don't think there's anybody in this state who doesn't want to help people that are truly in need," said S.C. Medicaid Director Tony Keck. Both Keck and Gov. Nikki Haley oppose expanding Medicaid under the Affordable Care Act.
"Nobody can afford a million and a half hospital bill, even if you do have good insurance," Keck said. "I mean, even if you have good insurance, it becomes incredibly expensive because of co-pays and out-of-pockets and everything else. It's a bigger question than just insurance."
The Medicaid agency, which costs more than $6 billion a year in South Carolina, already consumes more of the state budget than any other program. Keck argues that there's little correlation between health insurance and healthy outcomes, and that spending more money doesn't make sense.
"We absolutely do not need to put more money into the system," he said. "We need to figure out how that money can be better spent."
'Rock and a hard place'
Medicaid expansion advocates, including hospital administrators, argue that South Carolina is squandering a chance to extend health insurance to hundreds of thousands of poor, working adults - like the Stasiks - at little cost to the state.
"Though they live in poverty, they are left out of any Affordable Care Act coverage or coverage assistance because South Carolina has not yet chosen to reclaim our dollars and extend coverage through Medicaid," said Rozalynn Goodwin, vice president for community affairs at the South Carolina Hospital Association.
The federal government will cover 100 percent of Medicaid expansion costs through 2017 for states that choose to participate. After that, each participating state must kick in a small percentage. The state's obligation gradually increases each year to a maximum 10 percent match in 2020. The federal government will continue funding 90 percent of expansion costs after that.
There are plenty of people who disagree with Keck and Haley's position to turn down that federal money, but Kevin Stasik isn't one of them.
"I know I'm between a rock and a hard place," he said. "I do know it would benefit me, but I would just be breaking a system that's already broken."
He said he would rather pay a small part of his wife's hospital bill each month than accept a government handout that his family doesn't qualify for.
"I will pay the hospital as much as I can each and every month, whether it's $100, $50 - whatever I can do."
'God is providing'
If Jackie Stasik is determined to be eligible for Medicaid, the program might retroactively cover some of her medical expenses.
Even if she doesn't qualify, Jackie could enroll in private health insurance next year. During any other year, health insurance companies likely would have denied her coverage because of her illness. That's not allowed any more under the Affordable Care Act.
But unlike millions of Americans, including more than 300,000 South Carolinians, who can apply for a federal subsidy to help pay for private health insurance in 2014, the Stasiks probably won't qualify.
In a cruel twist of politics and bureaucracy, they are likely too poor for financial aid.
The Stasiks fall into what's commonly called the Affordable Care Act's "coverage gap."
The federal law provides subsidies only for individuals who earn between 100 percent and 400 percent of the federal poverty level. Everyone below that threshold, including the Stasiks, would not have needed the subsidy if South Carolina had accepted the federal Medicaid expansion money.
This means the Stasiks, and an estimated 194,000 other South Carolinians, are too poor for a health insurance subsidy, but make too much to qualify for Medicaid.
"This situation puts a face on the 200,000 South Carolinians in the new coverage gap," said Goodwin, with the hospital association.
But Kevin Stasik isn't worried about the coverage gap.
He's not too concerned about this hospital bill either, and it's unlikely that Trident Health will ever actually collect the full amount anyway.
A spokeswoman for the hospital said Trident Health has several ways to help uninsured patients figure out how to pay their bills.
Most of Jackie Stasik's bill probably will be absorbed into the hospital's uncompensated care budget. The state and federal governments reimburse hospitals for some of those costs every year, but not all of them.
For now, Kevin Stasik said he is solely focused on helping Jackie become well again.
"God is providing," he said. "God is going to get me through this."
Reach Lauren Sausser at 937-5598.
Family members are frequent visitors to Jackie Stasik’s room at Trident Medical Center, including her husband Kevin (from left) and daughters Brianna, Alaina and Kalista.×
Jackie Stasik leans down to give her youngest daughter, 6-year-old Alaina, a kiss on Monday during a visit at Trident Hospital.×
Kevin Stasik’s wife, Jackie, of North Charleston, got the flu before Halloween and a week later she was hospitalized with pneumonia and has been at Trident Hospital ever since. (Brad Nettles/Staff) 12/23/13×
Jackie Stasik visits with her family (from left), husband Kevin, 14-year-old Kalista, 6-year-old Alaina and 17-year-old Brianna at Trident Hospital on Monday, December 23, 2013. Stasik, of North Charleston, got the flu before Halloween and a week later she was hospitalized with pneumonia and has been there ever since. (Brad Nettles/Staff) 12/23/13×