With about 3,600 people now enrolled in its PA Fair Care program, Pennsylvania is an unusually productive outlier when it comes to recruiting customers to its 10-month-old, high-risk, health insurance plan.
The 2010 Affordable Care Act called for $5 billion in federal subsidies to be spent on creating a "pre-existing condition insurance plan" in each state, one of the first provisions of the health care overhaul to be put into effect.
But nearly a year into the program, nationwide interest in the plans has been underwhelming so far.
The plans are meant to enroll people who have a difficult time getting policies on the individual market because of previous illnesses or conditions that put them in higher risk categories, making them too expensive to cover.
To be eligible, a person must be without insurance for at least six months and prove that he has a health condition that limits his access to insurance.
A program meant to help people denied private insurance because of pre-existing conditions has had limited participation so far.
States with most participation
North Carolina 1,505
States with least participation
District of Columbia 27
West Virginia 27
North Dakota 11
Source: U.S. Department of Health and Human Services, Pa. Department of Insurance
• Most data as of May 31. Pa. is through July 22
• • Massachusetts and Vermont not included because they have already implemented many of the broader market reforms that will take effect nationally in 2014.
States had the option of creating their own high-risk plans or letting the federal government administer the plans for them. Pennsylvania, along with 26 other states, is operating its own program. Many of the plans went into effect Aug. 1, 2010; Pennsylvania's Fair Care launched two months later.
With monthly premiums of $283, Pennsylvania's version of the program has more enrollees than any other state's. California, as of May 31, had 2,256 enrollees, second-most. North Dakota, on the low end of the spectrum, had 11.
Add them all up, and there were 24,712 enrollees nationwide as of May 31 -- a disappointing total for a program that officials had hoped, a year ago, would have enrolled more than 200,000 by this point as a way of bridging the those in the high-risk category until 2014. At that point, insurers won't be permitted to exclude or deny coverage to customers because of pre-existing health conditions.
Pennsylvania, meanwhile, has exceeded its initial goal of enrolling 3,500 people.
There is still space for more, said Kim Bathgate, marketing director at the state Insurance Department. The state is receiving $160 million from the federal government to run its version of the plan.
Why has Pennsylvania met its goals while other states have not?
"The simple answer comes down to: We had the lowest premiums," Ms. Bathgate said. "We did do some marketing of the program, but it was very limited" -- a few radio spots and Internet advertisement buys.
The poor turnout in the rest of the country is one of the reasons that the U.S. Department of Health and Human Services has revamped the program, streamlining eligibility standards and lowering premiums in 18 states.
Premium price seems to be one of the driving factors in the success, or failure, of the high-risk plans: In California, for example, premiums can be as low as $127 monthly but as high as $652, depending on the applicant's age and where he lives. Utah's coverage costs up to $744 a month. Washington state's premiums top out at $1,642 monthly for smokers.
Keith Maley, spokesman for HHS, said the department was also reaching out to groups such as the National Kidney Foundation and the American Heart Association, whose members often have chronic illnesses that make it more difficult to obtain insurance.
"There's no question that we have to continue to do outreach," he said. "This is a very targeted population."
The federal version of the program -- called the Pre-existing Condition Insurance Plan, operated by the Government Employees Health Association -- has also made it a bit easier to apply for the benefits. Previously, an applicant needed to procure a denial letter from an insurer to show that he had tried but failed to obtain a policy.
Now, applicants just need a letter from a physician explaining their high-risk condition.
But some groups aren't satisfied with the changes. An advocacy group representing farmers and rural businesses, known as Communicating for America, says the six-month wait is too long for some of its members.
"HHS and Congress need to reduce the waiting period from six months to three months, or eliminate the waiting period altogether and move instead to an annual open-enrollment period," the group's president, Wayne Nelson, said in a statement.
The high-risk plans, including Pennsylvania's, are temporary and are meant to expire in 2014, if President Barack Obama's health care law withstands court challenges.