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, chair of a national association of state high-risk insurance pools. “That said, enrollment so far is lower than we would have expected.”…

What happens with the Pre-Existing Condition Insurance Plan is important because it could foreshadow problems with major changes under the law that are still a few years away.