RALEIGH The thousands of low-income North Carolinians denied health insurance in a Republican-drafted measure that passed the House on Wednesday are left with few options for coverage.

It’s a reality that Chiyanna Henry knows all too well. The Selma mother of three, the youngest of which is 22 months old, is among the 1.5 million uninsured in the state.

Her husband receives health coverage through his IT job at a community college, but can’t afford to cover the whole family at $900 a month. “I’m just praying,” said Henry, 41.

The federal health care law anticipated covering people like Henry through Medicaid by expanding eligibility to anyone making less than 138 percent of the federal poverty level, or about $38,000 for a family of five. But Gov. Pat McCrory and Republican lawmakers are concerned about the potential cost to the state and are moving quickly to block the expansion.

Adam Searing, a health policy expert at the N.C. Justice Center, which advocates for the poor and opposes the legislation, said the hardest hit are low-income citizens who don’t qualify for Medicaid.

“They will continue to get expensive care in emergency rooms or limited care in overextended community health clinics,” he said. “They will get half the care a person with insurance receives and get sicker and die earlier than those insured.”

The second component of the law, an online marketplace to purchase health insurance, will begin enrollment in October but coverage won’t begin until Jan. 1, 2014.

It can’t come soon enough for Stephen Wissink, a 55-year-old cancer survivor. He can’t find a reasonably-priced policy, even with a subsidy from his employer, given his medical history. And now he needs more tests.

“Until we get a health care exchange, I’m kind of at wit’s end about what to do,” said Wissink, who lives in Raleigh and works in advertising. “I want to be able to afford health insurance to get relief from the pain of neurological damage and if this stuff does come back, I want to catch it early.”

State loses control

The Medicaid expansion would have covered about 500,000 North Carolina residents. Another 700,000 are expected to seek coverage through the insurance exchanges.

The Affordable Care Act includes caps on how much insurance premiums in the exchange can cost. For those at the 138 percent of poverty level, it is 2 percent of income. The sliding scale caps premiums at 9.5 percent of income for those at 400 percent of the federal poverty level, income equivalent to about $92,000 for a family of four.

But it doesn’t include any assistance for those making below the poverty level, or about $11,000 for an individual, because the law presumed those people would be covered by the Medicaid expansion.

The federal government will operate North Carolina’s exchange in 2014 because the state missed a 2012 deadline to establish its own. And it would remain a federal entity under the law that has now passed the Senate and a preliminary House vote.

The state will pay the federal government $181 million annually to run the exchange.

By relinquishing control, the state will not have the authority to review insurance plans in the exchange marketplace for compliance with regulations nor the ability to mediate disputes between doctors, insurers and patients. The N.C. Department of Insurance gets 1,200 calls a month to a hotline from consumers seeking insurance help.

“So basically the consumer, when they could have easily, quickly do what they do now which is contact us … will be calling 1-800-WASHINGTONDC (to talk to) someone that doesn’t know North Carolina, doesn’t know our people, doesn’t have accountability to respond quickly,” said Insurance Commissioner Wayne Goodwin, a Democrat who favors a state-run exchange.

Republican lawmakers said they would consider ways to address Goodwin’s concerns. But they challenged the notion of a state-run exchange, contending that the federal law leaves little room for flexibility. “Washington will dictate the exchange,” said Rep. Justin Burr, an Albemarle Republican and co-chairman of the House health care committee. “The partnership (model) and state-based exchange are really an illusion.”

The legislation received preliminary House approval Wednesday by a 75 to 39 vote. In the floor debate, Republicans emphasized the cost and the troubles in the current Medicaid system as reasons not to move forward with the Medicaid expansion. As for the insurance exchange, Republicans have rejected it, saying they don’t want to be part of implementing what they refer to as Obamacare.