HHS, bowing to pressure from the tax preparation firm Jackson Hewitt and state officials, proposed a rule requiring insurers accept all types of payment options, including replenishable debit cards, to ensure the millions of people eligible for insurance subsidies in the exchanges but who lack traditional bank accounts can pay their monthly premiums.
The proposal was applauded by Jackson Hewitt, which recently issued a report finding nearly one in four of the uninsured population lacks a bank account and noting many insurers had already suggested they would not accept non-traditional payments for the monthly premiums, potentially undermining the goal of the health law.
The report, which relied upon detailed responses pulled from 2008 U.S. Census information, found that more than one in four Americans - 27 percent -- that would be eligible for premium tax credits under the health reform law don't have a checking account. The report further notes that African-American and Hispanic-Americans are 40 percent more likely to be "unbanked" than white residents in the same income category.
Here is an excerpt from the proposed rule:
- CMS writes: “We propose to require QHP issuers at a minimum accept a variety of payment formats, including, but not limited to, paper checks, cashier’s checks, money orders, and replenishable pre-paid debit cards, so that individuals without a bank account will have readily available options for making monthly premium payments. Issuers may also offer electronic funds transfer from a bank account and automatic deductions from a credit or debit card as payment options.”
Bravo! The devil is in the details as the saying goes. This example illustrates why we must be hyper-vigilant about the nooks and crannies of health care reform that could unintentionally exacerbate disparities in access to insurance coverage.
Thanks to Lee Dixon, Director, Policy Research & Development, Community Care of North Carolina for bringing this important development to our attention.