It will be years before the most sweeping parts of health care reform take effect.

But some provisions will start in just a few months.

For Jim Lewis of Charlotte, that will be a relief.

Lewis, 44, has had diabetes for more than 20 years, and for most of that time, insurance covered his medicines and two hospital stays for infections that led to amputation of one of his big toes.

But he spent eight months recuperating from those infections, and the loss of income from his construction business led to a cascade of problems. He lost his home and his car, and he let his health insurance lapse because he couldn't afford the premiums.

Then, last fall, he went back in the hospital with another infection that left him owing $30,000 in medical bills.

"I know there's more than me out there who's struggling like this," Lewis said. "I'm self-employed. I was trying to live the American Dream."

About 1.75 million non-elderly North Carolinians lacked health insurance coverage in 2009, according to an N.C. Institute of Medicine estimate.

Later this year, Lewis and others like him should be able to get affordable insurance despite pre-existing medical conditions through a national high-risk insurance pool. "This law's going to help," he said. "They won't be able to gouge me, and they won't be able to say 'We're not going to cover you.' It will be a godsend when I can afford to get my own policy again."

Lewis might also benefit from an expansion of Medicaid, the federal-state health program for the poor. The expansion will cover childless adults for the first time, but like the provision requiring legal residents to buy health insurance or pay a fine, it doesn't become reality until 2014.

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