HOUSTON (AP) — Sara Rodriguez recently received a $4,000 bill for a six-hour emergency room visit to treat a fever. She says she can’t pay, but she’s also not planning to buy health insurance through the new federal marketplace.

Rodriguez, like others gathered in a Houston gymnasium listening to a presentation about the health care overhaul, says she can’t afford insurance, even for $50 a month. With two young children and barely $400 of income a month after paying rent, she struggles to feed her family.