For the last five or six years, Jeff Acton has gone without health insurance while hoping that his irregular heartbeat wouldn't land him in the hospital.

"I was always worried that if something did happen, I'd get this big monster bill in front of me, and I never wanted to have to do that," he said.

Acton, of Fulton, Mo., recently enrolled in a new program created by the federal health care overhaul that allows uninsured people with pre-existing medical conditions to apply for high-risk insurance pools in each state.

A majority of Americans receive health insurance through their employers. Another significant proportion are eligible for Medicare or Medicaid government insurance programs. The remaining 10 to 15 percent are either self-employed, work for small companies or are otherwise uninsured.

Many of those uninsured have pre-existing health conditions that have made it difficult or impossible to qualify and pay for private health insurance.

The federal Patient Protection and Affordable Care Act sent $5 billion to the states to coordinate high-risk coverage at market value for these residents until 2014, when insurance companies will be required to offer coverage at similar prices to all applicants regardless of health status.

There are 734,100 Missouri residents who don't have health insurance and 1.7 million uninsured in Illinois, according to the Kaiser Family Foundation. It is not known how many in the uninsured population also have pre-existing health conditions, but estimates put the ratio at nearly one in four.

That means close to 170,000 Missourians could be eligible for the high-risk pool.

Since enrollment in the pool opened in July, Missouri has received just 70 applications and approved 47. The state's $81 million share of the federal subsidy is expected to accommodate 1,000 applicants this year.

"We know we have over 1,000 people in the state that don't have insurance coverage and have a pre-existing condition," said John Huff, Missouri insurance director. "We're just now starting some outreach ... and making sure that folks know the coverage is available."

Illinois received $196 million in federal funding to operate its high-risk insurance pool, expected to provide coverage to 5,000 residents. So far, more than 1,600 have applied.

The programs are aimed at people who aren't insured through their employers, do not qualify for government insurance and have been refused coverage by private insurance carriers.

With private plans, people with health conditions ranging from hay fever to cancer have been rejected for coverage or charged exorbitant rates.

"The majority of the insurances I did enroll for wouldn't accept me because of my height and weight, the prescription medicine, or I'm just too high-risk," said Acton, who owns a refrigeration and appliance company.

Acton, 43, said he cobbled together some basic insurance for doctors' visits and the six medications he takes, but the coverage was not inclusive.

"They skimmed the surface ..."‰, but they wouldn't take care of anything major," he said.

Missouri's high-risk insurance plan is comprehensive and covers 80 percent of medical and prescription costs, but it's not free. Premiums range from $423 to more than $900 a month and must stay comparable to what a healthy person would pay for private insurance in the marketplace. The plan carries a $1,000 deductible, with a maximum yearly out-of-pocket cost to consumers of about $6,000 for medical care and prescriptions.

To be eligible, residents must have been uninsured for at least six months and have a pre-existing condition.

The Illinois plan differs slightly from Missouri's, offering a $2,000 deductible, 20 percent co-pay and an annual maximum out-of-pocket cost of $2,350. Prescription coverage also includes a 20 percent co-pay and an annual maximum cost of $1,600.

Both states have long operated their own high-risk insurance pools, but the premiums on those plans are more expensive than the federal pool or private insurance.

To apply for insurance coverage in Missouri, visit www.mhip.org or call 1-800-821-2231. Illinois residents visit Insurance.Illinois.gov/IPXP or call 1-877-210-9167.