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I wrote them this past week asking why I wasn't getting any or very few impressions on my US program.
This is the approximate answer paraphrased.
"We see that your program was opened in 2006.
We see that you are receiving some impressions but not nearly as many as you could be. Sometimes when a campaign or ad group is not getting very much activity for a long period of time the ad will start showing less and less because it is not performing. That may be what has happened with your campaign.
My suggestion is to start two brand new campaigns and copy all of the data over from your existing campaigns."
At that point I stopped reading.
What a farce!
edit: I might add that we have a very high CTR & position for the few impressions we are getting
This sounds like it is an issue with your Distribution Channel. By the sounds of it, you had created a campaign with both US and UK targeting and you are not getting any results with the US targeted Ad Groups. To resolve this, you can create a account (Accounts & Billing Tab) and select the EN-US Distribution channel. This will allow any campaigns you create to deliver in the US.
Brian H - MSFT
My total spend for the last few months is around US$20 per month with them.
My spend with AdWords for the same keywords is around US$800 per month.
I just don't have the time or energy to try & correct their internal glitches.