North Carolina could begin accepting applications Thursday for a new federal insurance pool that will allow chronically uninsured patients with pre-existing conditions to get coverage for a fraction of what they would pay a private insurer.

The program, the first major initiative enacted under the new health care law, will be offered side by side with an existing state high-risk insurance pool that targets people who have suddenly lost coverage because of job loss or because they've been turned down by private insurance companies.

An estimated 1.5 million people in North Carolina don't have health insurance. About 200,000 of those also have pre-existing conditions.

The state program, which launched in January 2009, has proven less popular than projected, with only 3,700 people enrolled. Michael Keough, executive director of the state's plan, said it may also take time for the federal program to catch on.

"We feel like there will be plenty of interest, but we don't feel like there's going to be a stampede at least to start with," he said. "It takes a while to get the word out, and there's a reason why people are uninsured ... they're a more price-sensitive crowd."

North Carolina is one of 35 states that operate their own high-risk pool. About 20 states have asked to manage the federal program in tandem with their own pools.

The state can't begin accepting applications until lawmakers approve the budget, which includes a contract with the U.S. Department of Health and Human Services. Applicants accepted into the federal pool could begin receiving coverage as early as August.

Congress has allocated $5 billion to run the federal program. North Carolina's share is expected to amount to $145 million.

The money is to fund the program until Jan. 1 , 2014, when insurers are required to accept all applicants regardless of their pre-existing conditions.

The state program, called Inclusive Health, offers premiums that are about 50 percent less than people with pre-existing conditions would pay from a private insurer. The federal program will offer even steeper discounts.

The average enrollee in the state program pays $561 a month for a plan with a $2,500 deductible; under the federal program, that same plan would cost $346 a month.

Adam Searing, director of the N.C. Justice Center's Health Access Coalition, said the federal program will help some, but not all, who need it. "You're still going to have a lot of people who can't afford the premiums," he said.

Comparison shopping

Searing said premiums should become even more affordable in 2014 when consumers will be able to compare different plans in the insurance marketplaces that will be created under the health care law.

Keough said those who have gone without health care for long stretches are often the toughest to sign up. "The big question is what kind of outreach and marketing will it take to pull people in who could benefit from this," he said.

Deborah Welch, an interior designer in Greensboro, plans to be among the first to sign up for the federal pool when it becomes available.

Welch is in her 40s and has been without health insurance for about two years. She last had insurance through Blue Cross Blue Shield. Welch said the company claimed that she did not fill out a questionnaire about her health history correctly and asked her for about $10,000 in retroactive premiums, which she couldn't pay.

She approached several other insurance companies, but the premiums were always too high.

"I just wanted some policy that would just protect me against the worst things on earth," Welch said. "Even if I had a huge deductible nobody would even give me that. I live my whole life in fear of what it would cost if I had anything happen to me."

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