An early feature of the new health-care law that allows people who are already sick to get insurance to cover their medical costs isn't attracting as many customers as expected.
In the meantime, in at least a few states, claims for medical care covered by the "high-risk pools" are proving very costly, and it is an open question whether the $5 billion allotted by Congress to start up the plans will be sufficient.
Federal health officials contend the new insurance plans, designed solely for people who already are sick, are merely experiencing growing pains. It will take time to spread the word that they exist and to adjust prices and benefits so that the plans are as attractive as possible, the officials say.
State-level directors of the plans agree, in part. But in interviews, they also said that the insurance premiums are unaffordable for some who need the coverage - and that some would-be customers are skittish about the plans because federal lawsuits and congressional Republicans are trying to overturn the entire law.
The Pre-Existing Condition Insurance Plan, the program's official name, is an early test of President Obama's argument that people will embrace the politically divisive health-care overhaul once they see its advantages firsthand. According to some health-policy researchers, the success or failure of the pools also could foreshadow the complexities of making broader changes in health insurance by 2014, when states are to open new marketplaces - or exchanges - for Americans to buy coverage individually or in small groups.
Under the sprawling health-care legislation that Democrats pushed through Congress in March, the special health plans were designed as a temporary coping mechanism for a small but important niche among the nation's 50 million uninsured: people who have been rejected by insurance companies because they already are sick.
Twenty-seven states have created their own high-risk pools. The rest used an option in the law to let their residents buy coverage through a new federal health plan.
In the spring, the Medicare program's chief actuary predicted that 375,000 people would sign up for the pool plans by the end of the year. Early last month, the Health and Human Services Department reported that just 8,000 people had enrolled. HHS officials declined to provide an update, although they collect such figures monthly, because they have decided to report them on a quarterly basis.
"Like the rest of the country, we thought we'd have pretty much a stampede. That obviously hasn't materialized," said Michael Keough, executive director of North Carolina's plan. With nearly 700 participants, it is among the nation's largest so far, but it has one-third of the people expected by now.