On Wednesday, as the US supreme court prepared to hear oral arguments over the future of the Affordable Care Act, LaDonna Appelbaum was on her way to a chemotherapy appointment. A year ago she was diagnosed with stage three breast cancer, and thanks to the ACA and the subsidies it provided, she was able to afford health insurance that covers a large part of her surgeries and treatment. An adverse ruling in King v Burwell could put an end to that.

The case before the supreme court argues that the ACA subsidies offered in 34 states – including Missouri, where Appelbaum lives – are illegal. The suit was brought by four residents of Virginia, a state that, like Missouri, uses the federally supported exchange rather than setting up one for itself. The plaintiffs say they were not supposed to qualify for premium tax credits, which according to the law were supposed to be available only on exchanges ‘“established by the states”.

Without the subsidies, the plaintiffs argue, their health insurance would have been unaffordable and they would be exempt from having to purchase it to comply with the law. If the supreme court rules in their favor, some 8-9 million Americans could lose their subsidies, making their health coverage significantly more expensive and possibly unaffordable. Appelbaum is one of those Americans.

The 48-year-old didn’t always go through life without health insurance. She had it for six years when in 2010, having just miscarried, Appelbaum found out that her and her husband’s policy didn’t cover pregnancies and miscarriages. According to an analysis by the National Women’s Law Center, before the ACA went into effect only 12% of insurance plans offered in the individual market covered maternity services.

Hoping to have a baby, Appelbaum set out to find an insurance plan that would cover a future pregnancy – only to find out that such a plan would cost “somewhere between $1,000-$1,600 more a month than I was currently paying”.

“I couldn’t wrap my head around that. Being as aggravated and as mad as I was at the insurance company, I stopped paying for health insurance for Tom and I and we went without,” she says.

That is, until February 2014, when they enrolled in health insurance through the federally supported marketplace on healthcare.gov. They found a reasonable plan provided by Anthem Blue Cross that cost them about $180 a month, with subsidies covering a little over $600. Last year, her husband was in a boating accident and injured a tendon in his hand. The surgery, cast and physical therapy would have cost them about $30,000 without coverage. And the costs would have kept on coming as, months later, Appelbaum was diagnosed with breast cancer.

“That changed my life forever,” she says. “Since my diagnosis I had all kinds of pre-surgical testing, a double mastectomy, and I started chemo back in November and am still in the process of it.”

After the chemo treatment that she will receive while the supreme court hears oral arguments in King v Burwell, Appelbaum has four more treatments left. Then it’s on to radiation. The only reason she can afford all of these treatments is the subsidies that have kept her health insurance costs low. If they go away, Appelbaum is afraid she won’t be able to afford the necessary treatment.

“I am petrified, to be quite honest, of what can happen. I am more scared right now that the Republicans and the supreme court might kill me rather than my cancer,” she says, crying. “I know that’s horrible to say, but I feel like I am getting the treatment that I need. My doctors are wonderful. And then I get scared whenever I hear that they might take the subsidies away or they might repeal it. I honestly don’t know how we would pay for this.”

Appelbaum, an office manager at her husband’s law firm, says she isn’t embarrassed to say she doesn’t have money to pay for her insurance without the subsidies – especially because in 2010 a close friend died of breast cancer after losing her insurance post-diagnosis.

“Whenever I think about what I am going through, I have to think about [her] and what she went through because she didn’t have the Affordable Care Act to help her like I have,” she says. “That’s one of the reasons that I am so vocal about it.”

Her friend was a strong supporter of the ACA and of President Obama. She asked to be cremated in her Obama T-shirt.

Stephanie Burton, 33, is also from Missouri, and she too is worried about how she will be able to afford her health insurance without subsidies. She has taken her concerns all the way to the steps of the US supreme court.

Within a week of buying her health insurance in January 2014, Burton saw a doctor to help get a handle on her diabetes. Prior to that, she had been uninsured for five years. Having graduated law school right after the recession, Burton says she was essentially forced into private practice. With her diabetes and narcolepsy – both of which are pre-existing conditions – she would have had to pay about $750 a month for health insurance. That’s as much as she was paying for her mortgage.

Her current Blue Cross Blue Shield plan, purchased through the federal marketplace, cost her $70.17 a month in 2014. This year the plan went up by $20, to $90.17. The subsidies cover about $298 a month, she says.

“Being a mom and not having medical insurance for yourself is irresponsible, because you’ve got to be able to take care of yourself and keep yourself in good health if you are going to take care of your family,” says Burton, who is a single mother of four (her children qualify for state-provided health insurance). “[Now] I got a great insurance and don’t have that stress of wondering if something happens to me, what’s going to happen to my children.”

If the court rules against subsidies in King v Burwell, Burton says she won’t be able to afford her plan any more.

“For me to lose my subsidy, I would go back to not being covered again and have my diabetes go back to being out of control again,” she says. “I am hoping that the supreme court will rule in our favor and keep the subsidies in place. I don’t think it should have to be a situation where you have to chose between good health and providing for your family.”