Some were more comfortable with the risks they were taking than others.

Keith and Diana Buchanan of North Carolina gave up their expensive health insurance this year, and bought a Bowflex exercise machine. Keith said he got into the best shape of his life: “A lot of it is a result of knowing that we’re going to have to take care of our own health a little better,” he said.

Others weren’t so lucky. In West Virginia, Tara Sullivan, didn’t go to the doctor until her flu turned into pneumonia. The drugs she needed cost $250. Among the more financially strapped of those we chronicled, she was able to buy her meds only by skipping a payment on her gas bill. The utility threatened to turn off her heat in the middle of winter.

“We don’t have enough money to go out to eat or take my grandchildren to the movies, much less pay for health insurance,” Sullivan told us.

We also talked to people who couldn’t afford to go without insurance — some of the 133 million people with pre-existing conditions who might have been shut out of insurance markets before the Affordable Care Act.

Andrea Preston in Bloomington, Indiana, lives with a rare autoimmune disease that causes her airway to collapse. At 38, she needs repeated surgeries to keep it open; she has already had seven and takes 15 medications. Preston has insurance through her job as a technical writer, but even then, her medical bills accumulate faster than she can pay them. “It’s a rolling ball I can’t get ahead of,” she said in an email. “It’s slowly steamrolling me.”

In Chicago, Joe Della Croce, a Vietnam veteran and two-time cancer survivor, should be retired at the age of 79. Instead, he holds down a low-wage job at a Home Depot to get insurance for his wife Rose, 61, who has multiple sclerosis. She’s too young to get on Medicare and can’t afford medication without insurance.

“It wasn’t what he had planned to do in his later years,” Rose said.

“It’s a rolling ball I can’t get ahead of.  It’s slowly steamrolling me.”

If 2018 was the year that health care fell apart, 2019 isn’t looking much better. On a Friday night in mid-December, a Texas judge ruled that the entire Affordable Care Act ought to be struck down. For millions of people who have coverage, whether they get to keep it may come down to yet another high-stakes legal drama as the case works its way through the court system.