The state House gave final approval Thursday to a plan to build a government-sponsored insurance pool for people with serious illnesses who cannot afford or qualify for private coverage. It could help as many as 14,000 people in North Carolina within 10 years.

Thirty-four states already offer such insurance plans.

For at least four years, legislators have talked about offering insurance to people whom companies won't cover, or will cover only at high costs. Now the bill needs only the signature of Gov. Mike Easley to make it a reality.

Barbara Garlock of Raleigh has been waiting for legislators to approve such a program. She might need it.

Garlock, 47, was diagnosed with cancer three years ago, when her husband was self-employed, and has undergone treatments since then.

An insurance plan with a $1,800 monthly premium and a $10,000 deductible was the most affordable she could find -- easier on the family budget than the policy they found that would have cost $3,400 a month.

Garlock's husband now gets insurance through an employer, but she fears having to go back to search for coverage if he should change jobs.

"It's scary enough to face the prospect of dying," Garlock said in a trembling voice. "It's even scarier to think that your family could lose their home because you got sick."

The insurance won't be free. Subscribers will pay 65 percent of the cost through their premiums. Premiums will be set at 150 percent to 200 percent of what a healthy person would pay for private insurance.

Establishing a high-risk insurance pool was a priority for Democratic lawmakers this year, but questions about how to pay complicated the debate.

In May, the House decided to put an assessment on private health insurance policies, but key senators did not like that idea. The Senate decided to take revenue from an existing tax on health insurance premiums. In addition, the state employee health plan will pay about $700,000 a year into the pool, the equivalent of $1.50 for each person who has state government insurance. The Health and Wellness Trust Fund, which handles some of the money that comes from the state's share of the 1998 tobacco settlement, will provide $5 million in the first year. The Senate approved the insurance plan Wednesday.

The premium tax is expected to provide $14.3 million to the insurance program next year.

It is important to connect private insurance companies to the high-risk insurance pool, said Rep. Verla Insko, a Chapel Hill Democrat and the bill's sponsor.

"The taxpayers of the state are accepting some of the risks that are normally borne by the health insurance industry," she said.

Enrollment would start no later than Jan. 1, 2009. About 2,000 people are expected to enroll in the first year, Insko said. As many as 14,000 people are expected to have the insurance in 10 years. People who enroll buy the insurance for three years, on average.

North Carolina has lagged in adopting an insurance program for people with serious illnesses.

Workers who lost their jobs and their health insurance in the 2001 economic downturn awoke policymakers to the need, Insko said. The state has taken steps to insure more children, too.

"Our consciousness is being raised here in North Carolina," she said.