Us Expats And Health Care Reform

[rakman]

How the government is going to take over health care and make it better ...

Not wishing for a debate about the wisdom of any changes, only to monitor the potential impact on expats, when something happens. Obama won the election on the clear platform of massive reform and massive increase of coverage for the uninsured and his political future depends on him delivering a lot of that. However, I do need to correct you on something. Universal health care, similar to Canada and France, run by the government is NOT on the table for negotiation, so you are getting your knickers in a twist about something that is not only not going to happen, it isn't even going to be talked about!

Currently, 83% of the US population is covered by health insurance. One of the current proposals (there are 5 in the Senate alone) will increase coverage to 94% ( illegal aliens get covered as there is NO check on status ) at a Senate Budge Office estimated cost of USD $849 billion additional dollars and in addition to the USD $500 billion cut in Medicare. Have you ever seen a government program cost as much as proposed? NEVER.

Which is the insurance company that denies twice as many cases as the nearest competitor? MEDICARE, the government program.

Where will the Canadians go for good health care if the US goes Rationed Healthcare? Where will the medical advances come from? How can the US pay for this boondoggle ( with a tax on all medical "devices" [like Q-tips to Oxygen to tapons?]).

Estimates are everyone will pay much more in the long run.

Oh, for those that are "bitching" about the cost of procedures, they are an invention of the GOVERNMENT DRG's (Diagnose Related Groups) sort of like the car repair estimate book a shop uses to estimate repairs. Get rid of Cost Accounting (required by the GOVERNMENT) and competition will lower costs.

FREEDOM is the highest right.

Any government powerful enough to give you everything is powerful enough to take away all you have.

[rakman]

If this thing passes I am going to look into filing my taxes with Thailand instead of the USA in order to qualify for the the 911d expemption.

Expats living here more than 180 days per year do have an obligation to pay Thai income tax unless they are expempted by a taxation treaty as we are. Thai does not enforce this and we have the option to pay either country and the treaty says that the other country can not come after us for double taxation.

Are you suggesting that even if we do not generate any income in Thailand, we can legally choose to file a Thai return on our U.S. generated income?

sorry to prick your bubble Paperwerks as you did not interprete the double tax agreement properly. of course you can opt to pay your income tax in Thailand. BUT it is still mandatory for you to file an IRS tax return. you are not charged double taxes but the IRS will deduct from your tax bill the taxes you have already paid to the thai taxman.

in other words: if your thai taxes are higher than the U.S. ones you don't pay a single penny, if they are lower you are required to hand over the difference into the claws of the IRS. if you don't pay anything in Thailand because income tax collection is not enforced you pay as you have paid and will pay till the end of your natural life or till you drop U.S. citizenship.

advice: abandon any wet dream, get a chilled beer from the fridge and relax!

edited for addition:

Are you suggesting that even if we do not generate any income in Thailand, we can legally choose to file a Thai return on our U.S. generated income?

not even in wet dreams!

And for US citizens abroad, who are required to file IRS tax returns, if you want to drop your citizenship, there is a 39% exit tax on all your worth. The IRS has deemed no matter where you are, if you earn income, you must pay, pay, pay. Not much is exempt from the taxman, and it's going to get much, much worse. I'm planning to quit my evil high paying, highly taxed job, retire to Thailand and live a quiet life, and figure out how to suck every dime out of a failed socialist system.

[Naam]

And for US citizens abroad, who are required to file IRS tax returns, if you want to drop your citizenship, there is a 39% exit tax on all your worth. The IRS has deemed no matter where you are, if you earn income, you must pay, pay, pay. Not much is exempt from the taxman, and it's going to get much, much worse. I'm planning to quit my evil high paying, highly taxed job, retire to Thailand and live a quiet life, and figure out how to suck every dime out of a failed socialist system.

however the IRS has no means to enforce "pay, pay, pay" once you money is offshore as its jurisdiction ends at the borders of The Greatest Nation on Earth™.

[Jingthing]

The intention of this thread was NOT to debate the fiery issue of US health care reform. The intention was based on what will happen to expats when this reform bill (whether it is really "reform" or not isn't the point, it will be a big bill with real consequences) DOES pass. It is clear to me now that something will be passing.

As the bill is still being processed like sausage, there is really still no specific information about what will be in the final bill that President Obama signs into law regarding the obligation of all Americans to obtain or buy insurance, the fines for not having it, and how expats can obtain a legitimate exclusion. Again, stay tuned, but please stop posting political propoganda about the US health care issue. To repeat, this is about the EFFECT ON EXPATS. If this thread continues to go in that direction, it is will be legitimately closed, and I think we need this topic to stay around as details emerge about the FINAL BILL and its effect on EXPATS.

Edited October 15, 2009 by Jingthing

[OriginalPoster]

I'm planning to quit my evil high paying, highly taxed job, retire to Thailand and live a quiet life, and figure out how to suck every dime out of a failed socialist system.

Now that's a plan. I'm thinking in the same terms but I'm not confident that I'll be able to capitalize on whatever "socialist" measures are put in place when living outside the US. If they decide to exclude expats from healthcare coverage (which seems likely) and increases taxes on investment income & capital gains (which seems possible), then we are SOL.

[PeaceBlondie]

Back on topic: I'm left here with one federal insurance coverage for retired civil servants; FEHBP. A well-informed friend tells me the Congress may change that, and we'll wake up to discover unexpected changes.

[OriginalPoster]

And for US citizens abroad, who are required to file IRS tax returns, if you want to drop your citizenship, there is a 39% exit tax on all your worth. The IRS has deemed no matter where you are, if you earn income, you must pay, pay, pay. Not much is exempt from the taxman, and it's going to get much, much worse. I'm planning to quit my evil high paying, highly taxed job, retire to Thailand and live a quiet life, and figure out how to suck every dime out of a failed socialist system.

however the IRS has no means to enforce "pay, pay, pay" once you money is offshore as its jurisdiction ends at the borders of The Greatest Nation on Earth™.

Really? Does that mean that as a US citizen (who is living outside the US) I can park my money in a Singapore bank or brokerage and simply ignore the US governments' demands than I pay tax on any income that the parked money generates in Singapore?

Edited October 15, 2009 by OriginalPoster

[hhgz]

"Does that mean that as a US citizen (who is living outside the US) I can park my money in a Singapore bank or brokerage and simply ignore the US governments' demands than I pay tax on any income that the parked money generates in Singapore?"

You can always ignore requests to fulfill your responsibilities. However, when your assets are seized for failure to pay your taxes, interest, and penalties, it's your fault.

[Jingthing]

Tax policy is a legitimate expat concern. However, we are nowhere even near knowing the details of the final bill, including taxation/fee implications, so again, premature.

Its an idle dream but I wouldn't mind a US based health care insurance policy that does NOT exclude preexisting conditions, that covers internationally. Thailand health insurance is a lower cost structure but has the same anti-consumer policies, excluding preexisting conditions, total cap limits, and I suspect at least trying to kick you out if you do get sick and/or very old. First rate health care in Thailand when you pay direct seems cheap only when compared to the insane prices in the US; that still doesn't make it cheap.

Edited October 15, 2009 by Jingthing

[samran]

Tax policy is a legitimate expat concern. However, we are nowhere even near knowing the details of the final bill, including taxation/fee implications, so again, premature.

Its an idle dream but I wouldn't mind a US based health care insurance policy that does NOT exclude preexisting conditions, that covers internationally. Thailand health insurance is a lower cost structure but has the same anti-consumer policies, excluding preexisting conditions, total cap limits, and I suspect at least trying to kick you out if you do get sick and/or very old. First rate health care in Thailand when you pay direct seems cheap only when compared to the insane prices in the US; that still doesn't make it cheap.

jinjers....

aren't there already a few US health schemes that would happily pay for treatment for you in Thailand? Bamrungrad always bangs on how US insurance schemes now working with them.....I'm sure this applies to other thai hospitals as well...

[Jingthing]

There may be but if there are, they are currently subject to same issues as other privately purchased US health insurance. People with very common preexisting conditions cannot buy the insurance in the first place. With health care reform, those rules may change. Most older people have preexisting health conditions. Get the problem?

[samran]

There may be but if there are, they are currently subject to same issues as other privately purchased US health insurance. People with very common preexisting conditions cannot buy the insurance in the first place. With health care reform, those rules may change. Most older people have preexisting health conditions. Get the problem?

gradually...

keep up the good work at raising awareness.

[Naam]

There may be but if there are, they are currently subject to same issues as other privately purchased US health insurance. People with very common preexisting conditions cannot buy the insurance in the first place. With health care reform, those rules may change. Most older people have preexisting health conditions. Get the problem?

for me it was always a mystery why a mandatory health insurance system does not exist in the Greatest Nation on Earth™ and that nowadays an estimated 40-45 million inhabitants are not insured. but what can one expect from a country that spends (meanwhile) trillions on wars overseas but has power lines, telephone lines, tv-cables et al above ground?

[CaptHaddock]

for me it was always a mystery why a mandatory health insurance system does not exist in the Greatest Nation on Earth™ and that nowadays an estimated 40-45 million inhabitants are not insured.

Because of the power of vested interests. The US health care system is uniquely successful at diverting 16% of GDP into their pockets. That dough, in turn, buys a lot of influence, the purpose of which is to keep up the flow.

[Jingthing]

This issue is coming along.

It now seems highly probably some kind of so called health care "reform" will be signed into law by Obama quite soon.

It will not include the "public option" nor will it include medicare "buy in" for those aged 55 and under 65. (Thanks to Senator Joe "Benedict Arnold" Lieberman. )

My current understanding of the reform is that all Americans will be required to obtain some kind of health insurance by the year 2014. The trade off is that this insurance will be easier to purchase for those with preexisting conditions and there will be subsidy options for people who can't afford the insurance. There will be penalties as well for not being insured, also kicking in in 2014.

There are only my rough draft understandings. I don't know of any specific language in the house bill (already passed) or the senate bill (in process) about any EXPAT extensions for the insurance requirement. However, I posted to this thread again because if the imminent passage of this major legislation, we should know something fairly soon.

Of course the final text of the bill that President Obama will sign doesn't even exist yet.

Edited December 15, 2009 by Jingthing

[hhgz]

"Of course the final text of the bill that President Obama will sign doesn't even exist yet. "

That's the most important thing to remember. Every day, Fox News has daily breathless snippets of what has been added or deleted.

[Jingthing]

Yes. I heard one today. There was some talk of allowing people to buy insurance policies originating OVERSEAS (which are cheaper than US based policies) to qualify for the be insured requirement. This was nixed. As you can see, the most important element here is that the insurance and health industry people get the maximum money and maximum profits.

BTW, I think most people have been exposed to the more right wing criticisms of the so called health care reform. This is the best item I have read about the left wing side of it, also opposing the chopped liver we seem to be stuck with. I do believe something will pass, but like Howard Dean, I think the big winners are the insurance industry and big pharma rather than the people. Its a crying shame.

http://www.washingtonpost.com/wp-dyn/conte...9121601906.html

Edited December 17, 2009 by Jingthing

[taxout]

"If you want to drop your citizenship, there is a 39% exit tax on all your worth."

This is not correct.

First, the exit tax doesn't apply to everyone, but only to those with either significant income (average income for the past five years greater than about US$140,000) or assets (US$2,000,000 or more), or who haven't been filing Federal returns, etc.

http://www.irs.gov/businesses/small/intern...d=97245,00.html

Second, the tax isn't on your net worth; rather you're treated as having sold all your assets on the date of expatriation and taxed on the unrealized gains in your assets, but only to the extent they exceed US$600,000.

http://www.irs.gov/publications/p519/ch04....blink1000154092

The exit tax rules apply not only to US citizens, but also to some foreigners who relinquish their green cards.

Edited December 17, 2009 by taxout

[taxout]

And just to return to the original topic of this thread for one brief moment, the Senate health bill, like the House bill, does contain an exception for expatriates based on the "330/365 days foreign presence" or "bona fide foreign resident" tests of the foreign earned income exclusion.

Edited December 17, 2009 by taxout

[flying]

Dont know how it will affect ex-pats but.........

http://news.yahoo.com/s/usnews/20091224/ts...hangehealthcare

"Required coverage (the "individual mandate"). American citizens and legal residents would be required to have health insurance, or pay a fine. For an individual, the fine would be $750 per year or 2 percent of household income, whichever is greater; for a family, the maximum fine would be $2,250 per year or 2 percent of household income. The fines would go into effect gradually, starting in 2014. The House bill is similar, with exemptions for certain low-income people."

Also although they say none with pre-existing conditions would be turned away....One has to wonder what their cost will be.

Easy enough to say none turned away but they do not say they would limit the cost of those folks to anything.

[Naam]

"If you want to drop your citizenship, there is a 39% exit tax on all your worth."

This is not correct.

The exit tax rules apply not only to US citizens, but also to some foreigners who relinquish their green cards.

in my [not so] humble view the exit tax applies only to those who have not done their homework well in advance.

[flying]

"If you want to drop your citizenship, there is a 39% exit tax on all your worth."

This is not correct.

The exit tax rules apply not only to US citizens, but also to some foreigners who relinquish their green cards.

in my [not so] humble view the exit tax applies only to those who have not done their homework well in advance.

I like the way you think

[Yamantaka]

I think it is great that the millions of families who have had no coverage will have it now. We are the only developed western nation that does not provide health care for everyone, which is more than a little embarrassing. I don't hold out much hope for those if us who live abroad though. I lost home, business and life savings in the tsunami and although there was thankfully plenty of aid to Thais who lost their homes and for Americans who lost their homes and businesses to Katrina, there was no provision for a Yank who lost it all here. I think this is the risk we all take by choosing to leave the safety of our home country. I haven't been to a doctor or dentist in five years and probably won't go to one ever again unless I can find investors to resurrect my business. Some days you get the bear, and some days the bear gets you, right!?

[flying]

I think it is great that the millions of families who have had no coverage will have it now. We are the only developed western nation that does not provide health care for everyone, which is more than a little embarrassing.

I am not so sure. Seems like another golden fleece to me.

I mean who does not have medical coverage? None are refused.

If you do not have $$$ you have social services/welfare/food stamps/dhhs or what ever they call it these days.. Any emergency room will take you in. This is just another way for the govt to spread their costs of their ill run programs as they deem fit.

It is mostly lip service...who are they going to fine 2% of their income?? Those who work & can afford it already have it mandatory as part of the labour laws here. Work more than 20 hours a week & your employer provides a good portion of it & the balance is small due to them buying in a group plan.

If they really want to help us get the he!! out of the way. Allow the free market to compete. They do not allow sales of health insurance to cross State lines.Why?? If they did the costs would drop due to fair competition. But no that is against their law.

As for preventive health care....Well even those of us who have always paid never really get true preventive health care.

[Pakboong]

If we really wanted to solve this problem, we would have to attack some really sacred cows. The FDA and AMA are huge political influences. Simply by doubling the amount of medication that could be routinely dispensed by one prescription from the current 90 day supply to 180 days would eliminate 10s of millions of unnecessary doctors fees and save well in excess of $100,000,000,000 per year. We are apparently happy with our lot in life because we sit by and let these people rob us blind.

Imagine if we dicided by buy our brand meds from Europe and our generics from India we could save a couple of trillion but who's counting?

[Jingthing]

I think it is great that the millions of families who have had no coverage will have it now. We are the only developed western nation that does not provide health care for everyone, which is more than a little embarrassing. I don't hold out much hope for those if us who live abroad though. I lost home, business and life savings in the tsunami and although there was thankfully plenty of aid to Thais who lost their homes and for Americans who lost their homes and businesses to Katrina, there was no provision for a Yank who lost it all here. I think this is the risk we all take by choosing to leave the safety of our home country. I haven't been to a doctor or dentist in five years and probably won't go to one ever again unless I can find investors to resurrect my business. Some days you get the bear, and some days the bear gets you, right!?

You are correct. Many millions of Americans will now be able to obtain health insurance and health care. In 2014, all preexisting condition exclusions will be abolished and lower income people will have their insurance plans subsidized. Emergency room care isn't health care the way it is used by uninsured people, it is crisis management. People show up and they are stabilized. Many people show up with terminal diseases, way too late to have any chance of a cure, because they lacked medical coverage. In the US, uninsured people have a significantly lower life expectancy.

This does have an expat angle. Thai private insurance excludes chronic preexisting conditions as well. Either the condition is excluded (as well as sometimes every imaginable related disease) or you don't get the policy in the first place. Americans who get sick here and don't have proper coverage will now be much more likely to repatriate for medical care. We already see this with expats from countries with more open health care access. In 2014 you could develop a serious disease in Thailand, without Thai or US insurance, fly to the US (if you can, that's a problem) and sign up for insurance and be eligible for treatment for that disease right away. Of course I am talking about pre-Medicare age Americans. This has already been the case with Medicare (with complexities of course).

Edited December 27, 2009 by Jingthing

[flying]

You are correct. Many millions of Americans will now be able to obtain health insurance and health care. In 2014, all preexisting condition exclusions will be abolished and lower income people will have their insurance plans subsidized.

Yes & all of this will be brought to you by the same group responsible for much of the current mess.

Healthcare Bill a Nightmare Before Christmas

millions will still be left without health insurance.Estimates are that the low-coverage plans would only cover 60% of costs. Even worse news comes for the more than 20 million people who will likely remain uninsured. They will now also have to forfeit 2% of their annual income because of it. A nightmarish scenario indeed – uninsured and penalized!

All pre-existing conditions abolished?? At what cost to whom?

Magic dust will be sprinkled on these & all will be fine? Low income already has fully subsidized plans under DHHS

All of this will be run by the same govt that cannot even run a win/win situation like the Postal Service without massive yearly losses......

Yes we all await this miracle...............NOT

Edited December 27, 2009 by flying

[hhgz]

"All pre-existing conditions abolished??"

No, "all pre-existing conditions" are not abolished. What is abolished is the insurance company's ability to refuse to cover "pre-existing conditions".

[Jingthing]

"All pre-existing conditions abolished??"

No, "all pre-existing conditions" are not abolished. What is abolished is the insurance company's ability to refuse to cover "pre-existing conditions".

That is clearly what I meant --

all preexisting condition exclusions will be abolished

The financial trade off for the private insurance companies is that because having health insurance will be REQUIRED, they will have a lot more money coming in, of the healthy people that don't make many claims.

[Naam]

I think it is great that the millions of families who have had no coverage will have it now. We are the only developed western nation that does not provide health care for everyone, which is more than a little embarrassing. I don't hold out much hope for those if us who live abroad though. I lost home, business and life savings in the tsunami and although there was thankfully plenty of aid to Thais who lost their homes and for Americans who lost their homes and businesses to Katrina, there was no provision for a Yank who lost it all here. I think this is the risk we all take by choosing to leave the safety of our home country. I haven't been to a doctor or dentist in five years and probably won't go to one ever again unless I can find investors to resurrect my business. Some days you get the bear, and some days the bear gets you, right!?

You are correct. Many millions of Americans will now be able to obtain health insurance and health care. In 2014, all preexisting condition exclusions will be abolished and lower income people will have their insurance plans subsidized. Emergency room care isn't health care the way it is used by uninsured people, it is crisis management. People show up and they are stabilized. Many people show up with terminal diseases, way too late to have any chance of a cure, because they lacked medical coverage. In the US, uninsured people have a significantly lower life expectancy.

you are both right and i really appreciate your thoughts/comments. healthcare care coverage is one important step (only 63 additional steps to go) for the Greatest Nation on Earth™ on her way to drop the status of a Third World Nation and become a respected member of the international community.

p.s. next step to become a "First World Nation" is to produce less cruise missiles, bunker busters and similar military ordinance, reduce number of military manpower outside U.S. borders and use saved money and manpower to bury power lines, phone lines, cable and the like below ground.