Jingthing

USA topic -- Expat specific issues regarding repeal and replace of Obamacare

127 posts in this topic

ID: 1   Posted (edited)

THIS IS NOT A POLITICAL DEBATE THREAD!

 

OK, it happened, the republicans have released a rough sketch of their repeal and replacement plan for ACA (Obamacare). 

This thread is started to discuss the very specific aspects of this new plan that impact EXPATS and REPATRIATING EXPATS.

ONLY THAT.

 

This new plan is just a starting position and nobody knows yet what the final result will be. However, it's safe to assume there is a high probability that ACA will be at least adjusted significantly and rebranded. 

 

I've been following this closely and can suggest some areas that seem to be of potential impact to expats.

 

This is a thread in progress, as final details emerge about these changes. Nobody knows how long that will take.

 

I will outline some things I have identified as EXPAT SPECIFIC issues:

 

MANDATE and PENALTIES

The mandate will probably go away along with IRS penalties for not having insurance. Bona fide expats were already excluded from this but many Americans living abroad spend significant amount of time in the U.S. anyway and they were not exempt. Figuring that all can be a hassle for expats, so that change will likely be welcome to expats as long as they stay expats.

 

ACA SUBSIDIES vs. REFUNDABLE TAX CREDITS

The ACA replacement plan seems determined to do away with the subsidies based on income that has made buying coverage affordable for lower income Americans that make enough to be in the cutoff to be eligible for ACA subsidies. That will likely be gone.

The replacement likely will be refundable tax credits based on age, not income. The refundable part of that is interesting. That means even if you don't owe taxes, you still get a check from the IRS.  Higher income will be stepped down from tax credits. There is an internal republican debate about regular tax credits vs. REFUNDABLE tax credits. Obviously refundable tax credits will be much better for lower income Americans. 

Expat impact?

Well, I will assume that expats abroad not buying U.S. health insurance will be ineligible from the tax credits.

 

RETURNING EXPATS CONCERNS

If you're repatriating to the U.S. and entering a job with employer paid health insurance ... NO CHANGE.

If you're over 65 returning to the U.S. you are eligible for MEDICARE  and don't need to worry about the ACA replacement ... NO CHANGE

If you're under 65 and very wealthy, well then you don't have to worry because you can afford retail health insurance even without tax credits.

If you're returning to the U.S. in dire poverty, you may be eligible Medicaid. Medicaid will likely be done based on state grants and objective analyses suggest the benefits will be less generous.

Even in dire poverty, there is no guarantee you will be eligible for Medicaid in your new U.S. state. Those rules vary. Assets are generally looked at. 

If you were eligible before for EXPANDED MEDICAID (only now in some states) which is designed for those above dire poverty and below the minimum cutoff for current ACA subsidies, there is a fair chance that program will continue but only temporarily. It will probably be phased out. I don't know if new people will be able to enroll after the ACA replacement passes. That is very relevant to returning expats in that economic level. Open question. If returning expats could benefit from Expanded Medicaid even for a few years, it will be important to know if that is possible, as far as choosing which states to return to. If new enrollments in Expanded Medicaid are stopped, then the choice of state would be irrelevant. 

Age -- ACA gave a break to older Americans and a hit to younger Americans, not pricing the insurance as high as usage indicated. 

That is going away. 

Which means insurance if you have to pay for it even with increased TAX CREDITS for older people under 65 will be higher than now. 

So returning expats especially older ones that will need to buy insurance may need to know if they can even afford to repatriate. 

Staying abroad may be the more rational economic choice.

 

PREEXISTING CONDITIONS (change to continuous coverage rules)

The current ACA policy on this will likely change. Instead of mandates/non-coverage penalties to the IRS, the new proposal says the insurance company will add a SURCHARGE of 30 percent for one year after starting a plan when there is a gap in coverage.

Considering older Americans already with high rates, add 30 percent, egads.

Now the OBVIOUS expat issue with this is will the new finalized law excuse returning expats from the surcharge.

Keep in mind it's not the government anymore in charge of this. It will be private for profit insurance companies.

This could be a very big deal for returning expats if the law does not FORCE the insurance companies to not charge the surcharge to returning expats.

If they don't do that (wouldn't count on it) the obvious question is whether the U.S. insurance companies would accept coverage abroad to avoid the surcharge. That would be good for expats that have coverage abroad, but again, I would not count on that. 

 

These are the EXPAT SPECIFIC issues that I can think of right away.

I'm sure there are others.

I'm sure as the changes progress to law this will all become clear, but I now think it is not too early to start discussing this stuff.

 

Please respect that this is NOT a political debate thread. There are always other threads for that in the World Forum. Also please refrain from personal insults about your fellow Americans who may be in a different economic situation than you. So please: RESPECT. 

 

http://www.sfgate.com/news/medical/article/House-GOP-releases-bill-replacing-Obama-health-10981377.php
 

Quote

 

House GOP releases bill replacing Obama health care overhaul

 

 

 

 

Edited by Jingthing

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ID: 2   Posted

Sooooo........What is it you want to discuss?

 

Affordable care Act? no impact.

New law ? ...no impact.

 

No matter how much you write on the "good or bad" of the new law .....everyone's situation is DIFFERENT!

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ID: 3   Posted (edited)

23 minutes ago, beachproperty said:

Sooooo........What is it you want to discuss?

 

Affordable care Act? no impact.

New law ? ...no impact.

 

No matter how much you write on the "good or bad" of the new law .....everyone's situation is DIFFERENT!

I totally agree.

Everyone's situation is different.

If you read the OP you would already realize that I have indicated specific groups that will not be impacted by the repeal and replace of ACA.

Such as those already over age 65.

What do I want to discuss?

That's all in the O.P. and I of course welcome any other suggestions that other people think of that may have expat and returning expat specific relevancy.

For those like you apparently where it is already clear that you think there will be no impact to you personally to the changes, well that's cool, so this topic doesn't interest you in a personal way.

But I assure you that it does others.

 

(BTW, if you think I have missed some other groups of Americans that don't need to worry about the changes such as over 65s, please mention those here as that might be helpful to others in those groups.)

 

If people want to talk about their personal situation especially as returning expats and how they think that these changes impact on them, that's welcome of course. So personal impact or more general impact both but please folks keep it in the realm of specific issues for expats and returning expats, not political debate about the law changes.

 

I do have a general concern that the lawmakers won't prioritize the expat specific issues that I already detailed and I reckon there are more that I haven't thought of. Such as excusing returning expats from the 12 month 30 percent surcharge. This is all stuff that at least is worth WATCHING for a lot of us. 

 

To add to the truth of the everyone's different theme, assuming some of these changes happen, there will be winners and losers economically speaking and getting coverage at all speaking. But those are more general political questions. Those kinds of things are only relevant here if they can be tied into the EXPAT (and returning expat) theme of this thread in a practical way. 

 

An example of that is something I already raised. The question of assuming expanded medicaid is temporarily kept in some states during a transition period, will returning expats be able to start NEW in that system, the ones that fall into the economic level of being eligible for that under ACA. 

 

While very little can be said definitely yet about these changes, starting now when we've finally got a rough idea of the initial change plan, can help people watch the progress of the changes towards law with an awareness of the EXPAT (and returning) SPECIFICS parts of it. 

 

Edited by Jingthing

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ID: 4   Posted

I Still fail to see the relevance in my situation..... you apparently want to speak ad nauseam ...OK .....but for people in my situation its unnecessary ....leave it at that.

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ID: 5   Posted (edited)

9 minutes ago, beachproperty said:

I Still fail to see the relevance in my situation..... you apparently want to speak ad nauseam ...OK .....but for people in my situation its unnecessary ....leave it at that.

Goodbye then.:whistling:

 

A detail about the actual topic. The initial proposal is saying that expanded Medicaid (in the states it's offered) would be in effect until 2020 and then stopped. The question of enrolling after the new law takes effect or not still unknown. Of course none of this is definite yet. Just the beginning as far as specific details are concerned. 

 

To repeat the returning expat aspect of that, if you plan on returning before 2020 and you would be eligible for expanded Medicaid, knowing whether or not new enrollments will be allowed could impact your choice of STATES to move to as not all states ever offered it. 

Edited by Jingthing

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ID: 6   Posted

I think the new law as proposed is poorly conceived. I thought the same about the ACA. The new law saves my family $7,500/ year, if our premiums don't go down, which I expect they will, saving us even more.

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ID: 7   Posted (edited)

42 minutes ago, lannarebirth said:

I think the new law as proposed is poorly conceived. I thought the same about the ACA. The new law saves my family $7,500/ year, if our premiums don't go down, which I expect they will, saving us even more.

I fail to see the relevance...you think its poorly conceived  .....Yet ....You saved $7500/yr and you expect to save MORE! What's the problem?

Edited by beachproperty

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ID: 8   Posted (edited)

This thread is specifically LIMITED to how the probable changes to ACA will impact some EXPATS and some RETURNING expats.

It is not a general discussion of the law.

It is not a political debate thread.

Please respect the well defined LIMITATIONS of this topic and for more general political debate on the law changes please post in one of the many ACA related topics on the WORLD FORUM. 


Current USA expats (with no plans to expatriate) may no doubt may be impacted by the changes to the ACA. But those potential impacts are not EXPAT or RETURNING EXPAT specific issues. 

 

There can be exceptions to this when information about the GENERAL law changes can be clearly CONNECTED to the expat relevancy. For example, if we learn that no new people will be able to enroll in expanded Medicaid, that is relevant to the expat aspect as returning expats are a subset of ALL people. 

 

This is an EXPAT forum and this is an EXPAT topic. No doubt there are thousands of forums in the U.S. for U.S. residents to discuss and politically debate these general issues (including here on the WORLD FORUM). 

 

If there aren't any or many people that feel this topic as defined (LIMITED) resonates for them enough to post ON TOPIC, that is fine. Then the thread will die a natural death. But I want people to give it a chance to be about what it is about. SEE THE O.P. for guidance. 

Edited by Jingthing

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ID: 9   Posted (edited)

11 minutes ago, beachproperty said:

I fail to see the relevance...you think its poorly conceived  .....Yet ....You saved $7500/yr and you expect to save MORE! What's the problem?

 

I think it is bad for society. I also think it is being paid for in the wrong manner. I don't see any relationship at all between a person's income, or lack of it, and the type of healthcare they should expect in a healthy society.

Edited by lannarebirth
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ID: 10   Posted (edited)

This is NOT a political debate thread. 

I suppose I need to be more explicit now.

It can not be a political debate thread.

It is not allowed for members to start political debate threads on this HOME COUNTRY forum.

I did not start one but if members insist on trying to hijack this thread by insisting on making it a political debate thread, the potential PRACTICAL value this thread may have for real life issues for expats and returning expats will be over as the thread will be toast.

Clear enough now?

Edited by Jingthing

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I don't see how they get 60 votes in the Senate to pass any bill overturning the ACA.  They can make some changes in budget reconciliation, but not the whole hog.

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ID: 12   Posted (edited)

7 hours ago, CaptHaddock said:

I don't see how they get 60 votes in the Senate to pass any bill overturning the ACA.  They can make some changes in budget reconciliation, but not the whole hog.

That is unknowable at this point.

The premise of THIS thread is that the new president ran on a clear agenda of repealing the ACA along with promises to change it to something else.

Yesterday we got a lot of details of what that "something else" is intended to be. 

All I'm trying to do here is to frame any potential changes with the specific perspective of EXPATS and RETURNING EXPATS concerns in mind.

This is a perspective you're not going to find in the USA media for obvious reasons.

Obviously, this would be more "real" if we had the language of any final LAWS that may result of all this.

But we don't so the only source material we have now are the earlier stage proposals. 

I thought that was enough material to at least get started with framing the expat and returning expat specific concerns, including defining parts that are obviously not expat or returning expat specific concerns.

A good chance I was wrong, and this is too early, in which case the concept of this topic may just fizzle until we get some more final details (which might take months or years) and/or specific expat personal cases that people share that shed more light on these issues. 

Edited by Jingthing

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ID: 13   Posted (edited)

Jingthing.......What you are asking us to do is speculate as the

unknown law (not passed) and what unknown effect it may have on us Expat's. Think it's best to just let this thread "fizzle" as you put it.:post-4641-1156693976:

 

POST CLOSED

Edited by beachproperty
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Just now, beachproperty said:

Jingthing.......What you are asking us to do is speculate as the an unknown law (not passed) and what unknown effect it may have on us Expat's. Think it's best to just let this thread "fizzle" as you put it.:post-4641-1156693976:

 

POST CLOSED

It's weird to me how emotionally engaged you are in heckling aggressively on this thread when you've made it crystal clear that none of the potential changes can possibly impact on you personally. Then you fail to tell us why. For example, if you're over 65, then that would be why, but you don't bother, you just come back to make hostile noise, as if the very idea of this thread concept offends you.

Yes, let it be.

If the actual topic speaks to nobody especially this early, that is fine.

I've already said as much. 

 

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2 hours ago, beachproperty said:

Jingthing.......What you are asking us to do is speculate as the

unknown law (not passed) and what unknown effect it may have on us Expat's. Think it's best to just let this thread "fizzle" as you put it.:post-4641-1156693976:

 

POST CLOSED

He's not asking you to do anything. If you don't like the topic stay away from it. What kind of delusional entitlement makes you feel you can keep returning to a topic that you have already declared doesn't interest you, and ask people to stop posting in it?

 

What is forcing you to keep clicking on it?  It just makes you seem slightly crazed.

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BANGKOK 26 July 2017 10:03
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