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

127 posts in this topic

It's the culture not the politics. I had premium healthcare in business and was never taxed on the compensation. As a property owner, I deduct mortgage interest and local property tax from my total tax burden. Unions and public sector retirees don't pay taxes on their lifetime healthcare benefits. ACA was never looking deep at these     entitlements, except for the scant Cadillac Tax which wasn't a full income tax and was way out of the mainstream for most people and these people could care less. 


Sorry peope, it's a sorry state of affairs, but all this mess was around before Trump. Everybody's got their self-interests in play, and if somebody else pays or our debt increases or someone gives you their vote. Damn the rest. Well, why aren't we like Europe, because we are not, that's not our culture. Change the culture, you might change the politics. Besides NFL preseason is near. There you go, 

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ID: 122   Posted (edited)

Well, I think everyone can agree that the culture of the USA is not the same as the culture of a typical European nation.


In the wake of the big news of the senate bill failing, there was immediate talk (from within the senate and the president) that congress should vote for a simple REPEAL to actually happen two years after the vote. The idea was that within the two years some democrats would be "persuaded" to work with the republicans  because something is better than nothing. However, there was a general consensus that simple just repeal would be politically risky and create even greater uncertainty with both the insurance industry and the public needing health coverage.


ANYWAY, quickly moving story, already three republican senators have stated they are firm nos on simple repeal, killing any chance that such a bill could pass. That doesn't necessarily mean that the senate leadership won't still call for such a vote to record it, even  if they know it will lose. 


Going from there, OK, obviously nobody knows for sure yet.


Another thing the president has tweeted about is to just let Obamacare die. Well there is an active and passive way to do that. For example, when congress does it's budget it can actively take steps to deny budget to help support the bill. 


What I'm getting at here, is as the republican party even lacking the votes to pass anything on health care (at least, yet) still has considerable power to influence things.


So, barring other developments (very possible),  some rough basic choices that party now has now that Obamacare remains the law of the land include:


-- Accept it is the law of the land. Actively support it and work on smaller step fixes to it, including working with some democrats to do that. The latter is supported by the democratic party leadership.


--  Accept it is the law of the land for now. Passively just leave it for now. Don't actively try to sabotage it though.


-- Actively working to speed up Obamacare failing (through budget measures, executive orders, rhetoric, etc.)


The context of these rough choices are that people's health care coverage is on the line and there is a midterm election coming up in 2018. 


Want to participate in a POLITICAL DEBATE about these big recent developments? If so, please do that here:







Edited by Jingthing

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ID: 123   Posted (edited)

A bit of an aside.


A more general article about the issues U.S. expats face abroad with medical costs. Touching on temporary trips back to access U.S. based medical care (covered by private insurance or Medicare).


I think probably less relevant to U.S. expats in Thailand than where the article is about, Ecuador. That's because Thailand is so far from the U.S. I reckon a much smaller percentage will be keeping up their their private (excepting Medicare) insurance while living here.


Anyway, I still think it's worth a look. 




Expenses that many expats and potential expats fail to consider: Travel back home and medical costs


Again, we’re making assumptions, but it’s easy to imagine this couple’s medical costs associated with their time in the United States exceeding US$15,000 a year.

Those medical costs will likely go up whether or not the US. Congress repeals Obamacare. Insurance companies already predict big increases, especially for individuals (as opposed to groups). The low-cost, high-deductible plan that costs only US$500 a month might disappear.

Note that we’re assuming this couple of retirees is younger than 65. After age 65, most Americans would be covered by Medicare during trips back to the United States. (Medicare doesn’t cover medical costs overseas, but I recommend keeping it even if you do retire overseas as a back-up.)







Edited by Jingthing

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ID: 124   Posted (edited)

I know many people are wondering, what now?


Well, nobody knows for sure, but I can now provide more specific details on how the president can (if he chooses) sabotage the existing law (ACA) and potentially send it into a death spiral.


I will try the best I can to present this in a neutral, fact based way.


Two basic things --


Cost sharing funding.

This is the money the federal government is supposed to pay to insurance companies that pays for the SUBSIDIES that millions of lower income people get (based on income) to purchase ACA private market policies.


It is a fact that the president has already (long ago actually) threatened to stop this funding. 


It is a fact that insurance companies have complained about this and have clearly said that premiums have already been raised as a proactive tactic to protect against this risk of trump actually doing that.


Which obviously follows, if that is really cut off, the insurance companies will understandably totally freak, massive raising the premiums again and/or withdrawing entirely.


With those much higher premiums, many fewer people will be able to afford to purchase the insurance. That would filter out more healthy people. If you have a serious illness, you're more likely to buy the insurance no matter what. So the pools become more unhealthy, higher cost, higher risk.

PLUS there could also be a more official loosening of enforcement of the MANDATE (and penalties) which was already suggested by a very early executive order from the president. At that time that order was seen in the context that the republicans would be able to legislatively kill ACA.


But they have failed to kill it legislatively. But there may be these other ways if the choice is made to go this route and intentionally attack any chance of sustainable viability for the law.


Perhaps interesting from a chess playing POV, but of course people's access to health care is on the line. 


This post can be the seen in the context of my previous post suggesting there are three rough basic paths the ruling party can take to deal with the reality of ACA still being the law of the land. Active Support and attempts at fixing flaws of the law of the land (ACA) / Passivity / Active Sabotage.


This post is obviously about the details of potential active sabotage. Of course there are grey zones between these three options. Also, there is a difference between rhetoric and action. For example the president might tweet (as he has) just let ACA die (passive response), but if he takes any active action to help it die (those threats about cost sharing were already going there) then that is action. 

Edited by Jingthing

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ID: 126   Posted (edited)

Minor update.

Under pressure from the president (see his twitter account) the senate republican leadership is now saying they will be going ahead with some kind of vote about the health care issue. Not clear yet if it will be a just repeal or another version of repeal and replace. The general consensus is that they won't have the votes to pass anything like that soon especially considering McCain is out of the picture. News reports saying pushing a vote is largely about applying pressure to the dissenting republicans and at least getting a vote recorded for political purposes. It's theoretically possible the pressure could work and they could pass something, but the news consensus is that the pressure won't work. 


So short version, possible but very unlikely to pass. 

Edited by Jingthing

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Well, at this point, it seems clear that the president and republican leadership is pushing strongly for a senate vote on "something" quite soon. By "something" I mean they haven't announced whether the actual vote is going to be repeal and replace or just repeal. The ailing Senator McCain is reported to be planning to travel back the D.C. for the vote. My impression is that he will be in repeal and replace or repeal side. But it still seems doubtful that they can get to the 50 votes on either option. But until they vote, we do not know for sure. 

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BANGKOK 26 July 2017 10:02