In the latest fix, members of a health plan for low-income Los Angeles County residents now can pay their premiums with cash at neighborhood stores, a more convenient option for some people without bank accounts.
"It really is a testament to how far we've come in terms of the implementation of the ACA that now we're really addressing these on-the-ground, everyday issues and barriers," said Amy Adams, senior program officer for California HealthCare Foundation's Improving Access team.
Roughly 4 million Californians have become insured under the national health law, which required nearly everyone to have health insurance starting in 2014. The state's uninsured population has dropped by half to 11%.
Consumer advocates have long pushed for easier ways for the working poor to pay their insurance premiums. A report released before the implementation of Obamacare last year found that 27% of Americans and 19% of Californians who were uninsured and eligible for subsidies didn't have bank accounts.
The insurance plan that rolled out the neighborhood cash payment system this month, L.A. Care Covered, is among those offered to patients who are eligible for government subsidies through the state's health coverage exchange, Covered California. Members can pay their premiums at 1,953 stores in California, including all 7-Elevens, by scanning a bar code linked to their account.
"We're very excited," said Laura Jaramillo, an L.A. Care Covered official. "We feel that that's going to make it extremely easy and convenient for them to pay their premiums."
Jaramillo said officials hope a few thousand of the plan's 17,000 Covered California members will use the new payment option. It's not clear how many members lack bank accounts, she said, but about 40% mail in a money order, cashiers' or personal check, instead of paying with a credit card online. An additional number also pay with a prepaid debit card online, she said.
Before the Affordable Care Act took effect last year, Obama administration officials ordered health plans to accommodate people who don't have bank accounts by accepting paper checks, cashier's checks, money orders and prepaid debit cards. They opted not to require that they accept cash, saying it would be too complicated. Managers at Covered California also discussed requiring health plans to accept cash payments, but decided against it.
Danny Shader, founder and chief executive officer of PayNearMe, the company partnering with the Los Angeles health plan, said that low-income people without bank accounts haven't been able to benefit from innovations in online payments. "They're, in fact, shut out of the digital economy," he said.
Health plan members without bank accounts have typically had to wait in line and pay a fee to get a money order or a cashier's check. With the new payment system, members pay no fees when they use cash to make a premium payment at a participating store. Instead, the health plan is charged a fee equivalent to a payment for a credit card transaction.
"It's as quick as buying a carton of milk," Shader said.