For over a year now, the health law’s insurance program for those with pre-existing conditions has struggled with enrollment. The program, launched last summer in every state, was expected to be swamped by Americans who’d been denied coverage in the individual market.

But those crowds never showed up. The program’s enrollment has consistently lagged far behind initial projections. The chief actuary for Medicare estimated that 375,000 people would sign up by the end of 2010. As of June 30, only 27,489 have enrolled.

The low participation rate usually get chalked up to two reasons: expensive premiums and lack of awareness.

One state’s success in the program, however, suggests that those obstacles are not insurmountable: Pennsylvania boasts 3,617 enrollees, the most anywhere in the country. Pennsylvania’s high risk pool, called Pennsylvania Fair Cares, is outpacing more populous states like Texas and New York by well over a thousand members.

So what’s Pennsylvania doing right? Melissa Fox with the Pennsylvania Insurance Department says it mostly has to do with a few key factors that have reduced barriers faced in other states.

The state has kept premiums relatively low, charging $283 a month for anyone participating in the program. This is different from other states in two key ways. First, it’s relatively cheap. Secondly, it’s the same premium for everyone who enrolls. Many other states charge higher premiums to enrollees that they expect to be sicker - generally, older subscribers - and that can deter the exact people who would be most interested in the program.

Criteria to get into the program have been kept relatively broad. The health reform law requires only that those with pre-existing conditions are eligible, so Pennsylvania has used a more encompassing list of conditions.

The enrollment process itself is fast and easy to use. Pennsylvania uses an online-only application, which takes abut 15 to 20 minutes to complete. “By having the application online, the application process, and subsequent enrollment process if eligible, is much faster than other states,” Fox says. “The online application takes out a lot of the ‘middle man steps,’ such as calling and requesting an application, waiting to receive the application, filling out the application and then returning the application for processing.” A one-step application eliminates a lot of the points where an individual could quit on the sign-up process.

Taken together, those policy decisions have kept Pennsylvania on track with its projected enrollment numbers -- and are a pretty good model for what other states could be doing to catch up.