Well, they can’t break up with healthcare. It would be a long, ugly divorce, and since they are second cousins, they have related family, and many children.
First, they are so intimately tied together, that there is no way to simply sever the relationship. They are intertwined, wed to each other through work and retirement. (insurance through work, Medicare/Medicaid)
Second, they both have assets, or more accurately, the assets have them and everyone else tied to them, and those assets refuse to let go. (pharmaceuticals, device manufactures, insurers)
Third, they would need a replacement in place - they still need to take care of themselves - so they would need to be having an affair on the side, and that would need to slowly take over the existing relationship. The issue is that people don’t change, and they often repeat the errors of their prior relationships, and worse, it is with another second cousin. The relationship is better, but with many of the same problems. (ACA, but with the same insurers, device manufacturers, hospital systems, etc.)
After a while, they find out that the new beau isn’t quite who they thought they were. They are a bit incompetent, a closet racist, and quietly draining their bank account without their knowledge. They want to go to therapy to resolve the problems, but unbeknownst to them, the therapist is a former classmate of the partner and sides with them on everything. (government capture)
Once they reach their wit’s end and the new partner has absconded with all their assets, they try legal action, but the courts and the judiciary are rigged in their favor. (legal precedents from prior corporate-friendly legislation and rulings).
At this point, with nowhere to turn, too frail after years of mistreatment and malnourishment, they are committed to a nursing home, where they die of COVID-19.