Garnaus acknowledges that insurance will be good for her health and finances in the long run but says she’s barely able to cover the increased monthly costs. With government subsidies, her monthly insurance premiums are $13.50, and co-pays to see her oncologist are $20. When lab work or a CT scan is required, it can cost up to $100 more.

“I’m continuously getting into debt,” she said. Under her plan, she says, she can have up to $2,250 in annual out-of-pocket payments.

During a workday lunch break last month, Garnaus said she was contemplating skipping CT scans recommended by her doctors because of the added cost. “It’s a very scary situation,” she said.

Jennifer Tolbert, director of state health reform at the Kaiser Family Foundation, a healthcare research group, said that previously uninsured patients living on the cusp of poverty and now required to buy insurance may struggle with the new financial obligations but should focus on the upside.

“These individuals will pay more,” she said, “but they will get better benefits.”