The poor seem to need more convincing that they'd be helped by the new Medicare prescription drug benefit that begins next month.
The Social Security Administration says it has approved just 661,000 applications for a subsidy that makes the new drug benefit much more affordable for low-income senior citizens and the disabled.
That's just a fraction of the 7 million people who are believed eligible for the subsidy.
Social Security says about 1 million applications remain under review, and new applications are coming in at the rate of 100,000 a week.
So far, rejections outnumber approvals by about 3-to-1.
Experts from various advocacy groups and research groups described the numbers as a letdown.
"They're disappointing, but not unexpected," said James Firman, chairman of the Access to Benefits Coalition, an organization of interest groups trying to get people to enroll in a private Medicare drug plan. "We knew it was going to be difficult to find and enroll people. We also knew the strategy of going to 19 million people was likely to backfire."
The federal government cast a wide net, sending application letters to 19 million people who might meet the program's asset and income restrictions. The new prescription drug benefit under Medicare begins Jan. 1. Under the program, the federal government subsidizes coverage, but to a much greater extent for the poor.
Ron Pollack, executive director of Families USA, an advocacy group that has criticized the Medicare drug benefit as overly complex, agreed with Firman's assessment.
"Unfortunately, these numbers are very discouraging, and it now appears likely that many millions of low-income seniors will be without the help they need to make drugs affordable," Pollack said.
Agency officials said they didn't know what to expect in terms of public response. However, they stressed, "We're still in the early part of this particular process."
"Clearly, this is a difficult population to reach," said Mark Lassiter, spokesman for the agency.
Thus far, SSA has received about 3.8 million applications for the low-income subsidy.
Gary Karr, spokesman for the Centers for Medicare and Medicaid Services, said the agency knew that enrollment would require grass-roots campaigns that involve personal contact with poor beneficiaries.
"We've had multiple events targeting that population, and obviously with these numbers, we're going to continue that," Karr said. "It's always difficult to reach the population that we're targeting here, but we're going to keep that up because the coverage is so important."
The Social Security Administration followed up its original mailing with 9 million phone calls and 5 million letters.
Firman said his organization would meet with the SSA in coming days to discuss more targeted outreach efforts where it would be easier to find large numbers of poor people. For example, he said many states have programs that help senior citizens pay for their prescription drugs. Such programs often have similar types of income restrictions as Congress established for the low-income subsidy.
"There has to be a much better coordination of public and private efforts so that a lot more of the people who apply are actually eligible," Firman said.
To qualify for the low-income subsidy, beneficiaries must have incomes below 150 percent of the federal poverty level — $14,355 for a senior living alone, $19,245 for a couple. There also is a limit on assets: $11,500 for an individual and $23,000 for a couple. The actual amount of the drug subsidies provided to these beneficiaries varies based on their income and assets, but it averages $2,100.