One of the first parts of the new health care law ready for consumers – special health plans devoted to the insurance industry’s rejects – is attracting only a fraction of the predicted customers, prompting the Obama administration and states to step up their strategies to motivate people to buy them. At the same time, since the plans opened for business in the late summer and early fall, the medical bills so far are, in at least a few states, much higher than anticipated, raising the question of whether $5 billion that Congress has devoted to the program could run out even if relatively few people join.

Federal health officials contend that the plans, known as high-risk pools, are experiencing expected growing pains. It will take time to spread the word that they exist and to adjust prices and benefits so the plans are as attractive as possible, they 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’ stability as federal lawsuits and congressional Republicans are trying to overturn the entire law.