Enrollment into HCTC advance payment rose from 4,000 in September 2003 to nearly 16,000 in December 2005. Between 13 and 21 percent of eligible individuals received HCTCs in some form during the latter month. Surveys of beneficiaries and officials confirm that unaffordable coverage and program complexity are the main barriers to enrollment. Nevertheless, West Virginia enrolled between 43 and 59 percent of eligible beneficiaries; a project in Virginia enrolled more than 90 percent of callers who waived confidentiality of tax records; and HCTCs covered 53 percent of eligible Bethlehem Steel retirees. Future credits could be structured to increase enrollment substantially.