Margaret Leatherwood has eight choices for health insurance next year but no good options.

The cheapest individual coverage available in her market would eat up nearly a quarter of the income her husband brings home from the oilfields.

The Bryson, Texas, couple makes too much to qualify for Affordable Care Act tax credits that help people buy coverage. But they don't make enough to comfortably afford insurance on their own, even though Paul Leatherwood works seven days a week.