Us Expats And Health Care Reform

[Jingthing]

Major health care reform is coming. It will be the biggest change in the system since medicare was established. There is talk now that Americans will be REQUIRED to have some kind of health insurance. Now we will not be getting Canadian/Euro style universal single payer health care. That is completely off the table. In other words, there is going to be a private cost to buy the insurance and probably some tax cost for those now getting it "free" from employers. My concern is that expats are going to be caught up in this and not be exempt from this requirement. With any requirement, there has to be TEETH, so there will be some kind of penalties for not having it. As expats, we should be exempt from this requirement, of course, but that doesn't mean we will be. Stay tuned ...

Edited May 24, 2009 by Jingthing

[BigSnake]

Stay Tune indeed. Most American expats I know in Thailand have some local form of Health Care, most are Retired Military type. Are these folks exempt? Hmmmmm!! I wonder

Edited May 24, 2009 by BigSnake

[Jingthing]

You can be sure that expat concerns are pretty much at the BOTTOM of their priorities, as usual. The requirement will be for USA based health care. I don't think the military people have anything to worry about. As you know, expats are not eligible to use medicare anyway. Logically, we will be exempt from this, but I am concerned our issues will fall through the cracks.

Edited May 24, 2009 by Jingthing

[longball53098]

Yes its quite possible, we, the retired military have cause for concern. We have available an insurance coverage known as Tricare. As expats we don't have the same coverage as retired military in the US. Our plan is based on what is know as the "standard" plan. They have made several proposals already to make "adjustments" to the Tricare system to save money.As you mention the expat community will be on the bottom of the list when it comes time to consider all the ramifications a new plan will have. They will consider what's best for the "masses" not the few living outside the country.

[wallacern]

Retired US military expats are already getting screwed by the US government on health care. At age 65 we must enroll in medicaire part B (about $100/mo) or we can no longer use tricare.

That is money down the drain since medicare is not available to expats.

[PeaceBlondie]

Retired US military expats are already getting screwed by the US government on health care. At age 65 we must enroll in medicaire part B (about $100/mo) or we can no longer use tricare.

That is money down the drain since medicare is not available to expats.

Agreed - they charge $100 every month, or you lose TriCare coverage.

[flying]

There is talk now that Americans will be REQUIRED to have some kind of health insurance.

I would think that would be a given.

Isn't it a requirement in many countries?

Otherwise wouldn't immigrants/retirees just be a time bomb waiting to go off?

Unless of course they just allow you to sign a waiver giving them the right to tap your 400/800k visa required amount for a medical emergency you might have while there.

Otherwise wouldn't it just be a liability they do not need.

Places like New Zealand wont even let a student in without medical insurance.

Same here in the US when we sponsor our wives/husbands for a green card.

EDIT: oops I see now it said US based?? Thats a rip.........I could see TL requiring some TL based insurance but

why US based?......odd but nothing seems surprising anymore.

Edited May 26, 2009 by flying

[Pakboong]

Retired US military expats are already getting screwed by the US government on health care. At age 65 we must enroll in medicaire part B (about $100/mo) or we can no longer use tricare.

That is money down the drain since medicare is not available to expats.

Not true at all. We are eligible for Tricare for life at 65. Must pay the Medicare part B premium but still a good deal. I do exepect however, for Obama to eliminate this program at some point as too costly.

[Jingthing]

Not true at all. We are eligible for Tricare for life at 65. Must pay the Medicare part B premium but still a good deal. I do exepect however, for Obama to eliminate this program at some point as too costly.

I understand your concern but eliminating health benefits for military veterans would be a very politically stupid move, and I seriously doubt he would do that. Cheers. Now of course there may be some kind of reorganization of the program. I also do not anticipate that non-military expats will be granted Medicare benefits, that would not really help him politically, sad to say. Obama intends to build a left-center political machine that will dominate for 50 years, he is the most transformational president we have had since FDR, so yes, big changes are coming, but not much that will ruin his chances of going for his goal.

Edited May 26, 2009 by Jingthing

[longball53098]

Retired US military expats are already getting screwed by the US government on health care. At age 65 we must enroll in medicaire part B (about $100/mo) or we can no longer use tricare.

That is money down the drain since medicare is not available to expats.

Not true at all. We are eligible for Tricare for life at 65. Must pay the Medicare part B premium but still a good deal. I do exepect however, for Obama to eliminate this program at some point as too costly.

Yes true, retired military members do not get Tricare for life when living outside of the US. It is Tricare Overseas and has the same coverage as Tricare Standard and as stated we have to pay the Med B to stay in the system but cannot use Medicare out side the US. So the 100+ a month/1200 per year is a waste for us. I could use that money to buy a health insurance plan here.

TRICARE Standard Overseas is a fee-for-service option. TRICARE Standard Overseas gives you more choices in the providers you can see for care, but costs you more in out-of-pocket costs. TRICARE Extra is not available in overseas locations.

Key features of TRICARE Standard Overseas includes:

* Higher out-of-pocket costs than TRICARE Prime Overseas.

* Freedom to choose from any qualified host nation provider.

* Referrals not required, but some care may require prior authorization.

* You may have to pay for services when they are received and then seek reimbursement.

* You may have to submit health care claims.

* There is no assigned primary care manager.

* No enrollment process, which means no enrollment forms to fill out and no annual enrollment fees for retirees and others.

* Receive care in a military treatment facility on a space-available basis only.

If the O man tries to do away with Tricare he will have a huge fight on his hands from the VFW and other groups I think.

[BEENTHEREDONETHAT]

Once you reach 70 it is very very difficult and unreasonable expensive to get any kind of health care coverage. I'm self insured and so far it is working fine. With any luck when the time comes (in the distant future) I will just die in my sleep. That is the most cost effective way to go.

[Jingthing]

Well, you may know there is a new wrinkle in the news, increased chatter about a VAT tax for the US, and elimination of the need to even file normal income tax for people earning under 250K USD (most of us I imagine). This would pay for everything including health care coverage for everyone, but you still have to wonder how such a radical reform (and quite interesting and exciting I think) would impact expats. Of course expats don't spend in the US so wouldn't be paying this VAT. It seems likely then that we wouldn't be covered under a VAT funded health care system unless we move back to the US, but I am getting ahead of myself, this is only in the talking stage. As the US now faces massive deficits and more to come with ambitious new programs, something BIG has got to give, so maybe it is the current tax system that will give. Interesting times ...

[CaptHaddock]

Well, you may know there is a new wrinkle in the news, increased chatter about a VAT tax for the US, and elimination of the need to even file normal income tax for people earning under 250K USD (most of us I imagine).

The chance that the US will replace income tax with a VAT is pretty close to zero. What is much more likely is a VAT in addition to income taxes perhaps with some reform of income taxes. Sales taxes, such as VAT, are regressive which is contrary to the interests of much of the Democrat base.

[Jingthing]

Well, you may know there is a new wrinkle in the news, increased chatter about a VAT tax for the US, and elimination of the need to even file normal income tax for people earning under 250K USD (most of us I imagine).

The chance that the US will replace income tax with a VAT is pretty close to zero. What is much more likely is a VAT in addition to income taxes perhaps with some reform of income taxes. Sales taxes, such as VAT, are regressive which is contrary to the interests of much of the Democrat base.

Yes, that is the conventional wisdom, but we are living in a transformational time.

Basic commodities like food would have no or a reduced VAT solving the regressive issue. I don't agree the chances are zero. The budget problems are really massive especially with baby boomers coming of old age. Obama has a mandate to solve big problems with radical solutions and the reduction in paperwork and eliminating filing for most would be politically appealing. He doesn't need even one vote in the over 250K set. The USA is no longer the country it was and when we come out of this current crisis, the new normal will be very different than the old normal. Frankly, it is more about sustainable survival now (and health care for all is part of that) as opposed to Hummers and phony wealth built on phony mortgages. Time to grow up and yes that does mean a more Europeanized America, heavily taxed gas, health care access for all, less of an obscene pay ratio between the top and the bottom, and yes, why not a VAT tax? BTW, a lot of fiscally conservative people also favor a VAT tax and tax simplification, if we can actually pay for the government services we need, rather than falling deeper and deeper into debt.

Edited May 31, 2009 by Jingthing

[flying]

Now that we have in essence entered the third term of Bush nothing would surprise.

Would be funny though to add a Vat as we near the beginning of the depression. See what that gets them.

The change that was promised turned out to be a hyper acceleration of what Bush & Greenspan started.

Lastly it is most funny to hear those that left America whine about change or better yet bennies.

LOL

Edited May 31, 2009 by flying

[CWMcMurray]

The Flat tax has long been championed by Forbes during his many presidental primary campaigns... never seemed to gain any sort of traction or support...

Without going into any of the details of the prosed system, I think it very unlikely that this will gain the support needed to completely over haul the entire Tax structure of the US.

[Jingthing]

Some pretty mainstream sources, such as Fortune magazine, are calling a USA VAT tax INEVITABLE. Of course the details would need to be worked out. I don't think a big VAT on top of the current system would be politically possible, so if the VAT comes, I would expect an easing on the poor and middle classes for other taxes:

http://www.money.cnn.hu/2008/12/01/news/ec...sion=2008120209

NEW YORK (Fortune) -- It's highly possible, if not inevitable, that Americans will soon live under a radically different tax system - one that the pundits and politicians aren't talking about.

BTW, starting recently, people ARE talking about this. Hardly impossible.

In case you haven't noticed, a lot of "highly unlikely" things have happened lately, a bankrupt General Motors, the collapse of the housing and stock markets, a bipartisan political consensus for some kind of universal health coverage, the election of a super intelligent African-African president, etc. More to come for sure. BTW, this really is not a left vs. right issue, it is a pay the bills and the money has to come from somewhere issue.

Edited June 1, 2009 by Jingthing

[CWMcMurray]

Some pretty mainstream sources, such as Fortune magazine, are calling a USA VAT tax INEVITABLE. Of course the details would need to be worked out. I don't think a big VAT on top of the current system would be politically possible, so if the VAT comes, I would expect an easing on the poor and middle classes for other taxes:

This is the only part I think you are wrong on...

The VAT will not be a replacement of the present income tax system (ie "Flat Tax"), when and if it comes will be in addition to the present tax structure.

They may try to initally make is small or reduce income tax to make it more palatable (ie we are not raising taxes, we are just making them simplier to understand).

But then down the road personal taxes would come back up and US citizens will paying the same level taxes that many European countries are paying...

[PeaceBlondie]

The Flat tax has long been championed by Forbes during his many presidental primary campaigns... never seemed to gain any sort of traction or support...

Without going into any of the details of the proposed system, I think it very unlikely that this will gain the support needed to completely over haul the entire Tax structure of the US.

"Publisher" Steve Forbes never seemed to publish flat tax details. It seemed impossible tnen; still does.

[flying]

super intelligent African-African president

LOL

Now there is a T shirt eh?

As to whether or not it is true remains to be seen

[Jingthing]

Uh.

Huh.

[flying]

Uh.

Huh.

I was thinking more along these lines.....

Edited June 1, 2009 by flying

[Jimjim]

Just read something about a Brit who was living in Thailand and went back home for a cancer checkup, was told he's have to pay for tests, as he had been out of Britain for more than 3 months. The NHS he'd been paying in to his whole life explained that it was a resident issue, not a citizenship issue. What a crock, I say. So, who knows how they'll treat expats if reform passes? Remains to be seen. Pay for it but not get to use it overseas? That'd be useless for expats but wouldn't be surprising.

[Jingthing]

Pay for it but not get to use it overseas? That'd be useless for expats but wouldn't be surprising.

I agree, it would not. Most of the older US retired expats who are non-military have paid into Medicare our entire lives, yet living abroad, we are cheated out of this benefit. Some big changes are going to happen almost definitely, we will just have to watch it and see what the impact is going to be on expats. There is at least one organization concerned with these issues, perhaps we should consider supporting them?

http://www.aca.ch/joomla/index.php

Edited June 1, 2009 by Jingthing

[EndofDays]

Major health care reform is coming. It will be the biggest change in the system since medicare was established. There is talk now that Americans will be REQUIRED to have some kind of health insurance. Now we will not be getting Canadian/Euro style universal single payer health care. That is completely off the table. In other words, there is going to be a private cost to buy the insurance and probably some tax cost for those now getting it "free" from employers. My concern is that expats are going to be caught up in this and not be exempt from this requirement. With any requirement, there has to be TEETH, so there will be some kind of penalties for not having it. As expats, we should be exempt from this requirement, of course, but that doesn't mean we will be. Stay tuned ...

It is not coming...even his supporters are quietly saying that it will never happen, just another step into bankrupting America. Obama doesn't care though, because he actually believes his own ideology in creating a new social state similar to that of many European countries...yea, can't wait...yipee, fun times. What you should worry about is taxes. Obama has already stated that he doesn't believe that Americans living and working outside the U.S. should be exempt from paying the first $91,00 in taxes. He cannot touch it now because Bush signed a law protecting the exemption until 2011, I beleive.

[EndofDays]

Some pretty mainstream sources, such as Fortune magazine, are calling a USA VAT tax INEVITABLE. Of course the details would need to be worked out. I don't think a big VAT on top of the current system would be politically possible, so if the VAT comes, I would expect an easing on the poor and middle classes for other taxes:

http://www.money.cnn.hu/2008/12/01/news/ec...sion=2008120209

NEW YORK (Fortune) -- It's highly possible, if not inevitable, that Americans will soon live under a radically different tax system - one that the pundits and politicians aren't talking about.

BTW, starting recently, people ARE talking about this. Hardly impossible.

In case you haven't noticed, a lot of "highly unlikely" things have happened lately, a bankrupt General Motors, the collapse of the housing and stock markets, a bipartisan political consensus for some kind of universal health coverage, the election of a super intelligent African-African president, etc. More to come for sure. BTW, this really is not a left vs. right issue, it is a pay the bills and the money has to come from somewhere issue.

You want to solve healthcare, Jingthing, then cut out the lawyers. Health care costs rise along with the amount of money the medical community has to put into malpractice insurance. Super-intelligent? The man won't give a speech without a teleprompter. Say what of how Bush spoke, he shot from the hip and didn't have to hold up a speech due to the malfunction of the teleprompter. the man's two main qaulifications for being a polticitian, his soapbox in Chicago was crime and educaiton. Well, Chicago is pretty much near the bottom in education but near the top in crime. We electected a Cult of Personality. The auto industry is bankrupt due to the power of the unions and the idiotic EPA standards that are forced upon them. There are American made cars currently in Europe that cannot be sold in the U.S. due to emission standards and other EPA rules. Now, he wants higher emission standards? The Left and the unions have made the U.S. auto industry impotent and now they want to do the same with Health Care. There is a reason why people the world over come to the U.S. to get the best health care.

[sleepyjohn]

You want to solve healthcare, Jingthing, then cut out the lawyers.

Yes it's truly time for a revolution in the US.

The US population seems to have gradually accepted as normal the most egregious health care system with the moneygrubbing hands of insurance compnies, lawyers, pharma and yes very much doctors bleeding you dry. The US has people have been slowly conditioned into thinking it is normal, and yes a European or a Canadian model is exactly what you need. You have become a country so obsessed with perfect health and perfect teeth that people work themselves to an early death struggling to acheive it, and if you have the misfortune to be in ICU well you're simply not allowed to die.

I am disappointed that Obama, who promised to get rid of insurance companies, is not now doing so.

What the hel_l have insurance companies got to do with deciding who should get treatment? Why are they even there?

Edited June 2, 2009 by sleepyjohn

[Jingthing]

Major expansion of health care access is DEFINITELY coming. People who don't realize that are completely out of touch with today's political realities. It is true Euro/Canadian style single payer universal health care is off the table, probably out of realpolitik and the fact that the insurance industry is just too powerful to kill (and that is a shame). I didn't start this thread to argue about health care reform, of course I am for it as are most Americans. I started it to consider the impact of these changes on expats. However, as we don't yet have info on the actual changes that are going to happen, this is probably premature.

[Lost in LOS]

we as expats get screwed by paying taxes here as if we still lived in the US

a vat tax would be great and then it all would be equal but they will never do it. aside from putting lawyers and accountants out of business they cant keep there eye on us. its a big brother thing, they know where we go, we live, we travel etc due to deductions and credit cards etc. vat tax they will lose their info on us, cant let that happen

there is something on snopes that they irs is trying to get us citizens to list all their guns on their returns and pay a fee for having them, scary

[Jingthing]

vat tax they will lose their info on us, cant let that happen

We would still need to report foreign bank accounts over a certain amount. It is true, Uncle Sam is a very nosy bugger ...