WASHINGTON - It's a centerpiece of President Barack Obama's health care remake, a lifeline available right now to vulnerable people whose medical problems have made them uninsurable.
But the Pre-Existing Condition Insurance Plan started this summer isn't living up to expectations. Enrollment lags in many parts of the country. People who could benefit may not be able to afford the premiums. Some state officials who run their own "high-risk pools" have pointed out potential problems.
"The federal risk pool has definitely provided critical access, in some cases lifesaving access, to health insurance," said Amie Goldman, chairwoman of a national association of state high-risk insurance pools. "That said, enrollment so far is lower than we would have expected." California, which has money for about 20,000 people, has received fewer than 450 applications, a state official said. The Texas program had enrolled about 200 by early September, an official there said.
Goldman, who runs the Wisconsin pool, said there have been fewer than 300 applications so far, though her program has room for about 8,000 people.
That's not how it was supposed to work.
Government economists projected as recently as April that 375,000 people would gain coverage this year, and they questioned whether $5 billion allocated for it would be enough.
Federal officials won't provide enrollment figures, saying several large states have yet to get going.
"We don't think this is getting off to a slow start," said Jay Angoff, director of a new insurance oversight office at the Department of Health and Human Services. "We think this is getting off to a good and orderly start." Angoff said he's confident more people will sign up, and he pointed out the program was set up in near-record time.
Possible problems with the Pre-Existing Condition Insurance Plan could foreshadow problems with major changes under the law still a few years away.