Speculation has reigned about how long it would take the federal money subsidizing high-risk pools to run out, thwarting those with pre-existing conditions from getting coverage under one of health reform's major early policy changes. But now it looks like the $5 billion Congress set aside for the high-risk pools might last a lot longer than many thought it would.

That's the good news. The bad news is that a tiny, tiny fraction of those who are eligible for the pools have signed up so far. People who qualify for and need coverage aren't getting it -- at least yet. The policy designed to provide a safety net until health reform's biggest changes -- such as prohibiting the denial of coverage based on pre-existing conditions -- take effect in 2014 is playing a far lesser role than many of its backers likely hoped. The pools are pegged as one of the early tests of health reform.

Across the country, only 3,600 people have applied -- and only 1,200 have been approved -- for coverage in the high risk pools that began in July, according to state and federal data analyzed by Kaiser Health News. This is a program that the Congressional Budget Office expected to attract about 200,000 recipients by 2013. An estimated 4 million people are thought to meet the eligibility requirements, which include proving that one can't get coverage through the normal avenues and that one hasn't been insured for six months.

What's going on here? Causes for the low enrollment levels may range from a lack of publicity (although the high-risk pools have received considerable media coverage), to premiums that, while lower than other options, may still be out of the reach of many individuals with pre-existing conditions. A 45-54 year-old nonsmoker in Florida, KHN reports, would have to pay $556 a month. That's still a fair amount of money. And in Illinois, a 50-year old participating in the state's federally funded pool has to pay $347 a month, according to this article.

It remains to be seen whether the slow uptake with the high-risk pools is a result of the pools being too new, and not well publicized, or whether the eligibility requirements are more of a barrier than policymakers believed they would be. The small number of applicants suggest the former might be the problem, but it's possible that many have heard about the requirements and have chosen not to apply. KHN reports that the Government Employees Health Association, under contract to run the high risk pools in 22 states, hasn't yet begun a "major marketing campaign."

If the problem turns out to be one of knowledge and publicity, the slow start for the high-risk pools presages a tough task ahead for the implementers of health reform to educate the public on the many, many moving parts of the new health law. If the eligibility requirements are the bigger culprit, policymakers should be prepared to reexamine the requirements so that the $5 billion is spent most efficiently.