Us Expats And Health Care Reform

[taxout]

Non-resident aliens are subject to 30 percent withholding on Social Security payments, unless a treaty applies, but only on 85 percent of the payments. The effective tax rate is thus 25.5 percent.

In theory, taxing just 85 percent of the payments taxes only the "interest" portion of the payments, roughly at least.

The US-Thai Tax Treaty leaves taxation of US Social Security payments with the US.

Edited January 2, 2010 by taxout

[tomwct]

Wouldn't it be cheaper for the taxpayer if they found a way to make health care less expensive THEN find a way to insure the currently uninsured? I wonder if there will be any tort reform included in the new Health Care bill? How much do doctors pay in malpractice insurance just in case some ambulance chasing lawyer hits them with a $10 million lawsuit that of which 30-40% goes into the lawyers pocket? Surely tort reform is one way to bring the costs down.

There is two ways to immediately reduce health costs in the US!!! One way is to open the market, so people in Alabama can buy a policy now in Wyoming and reduce lawsuits to a maximum payout of $300,000 US plus medical care costs, if malpractice occurs. In addition, open medical schools to all, rather than rationing openings, but the OBAMA AMA has nixed this idea!!! So, before spending Trillions on a health care system that works for 90%, lets get smart and take small steps rather than Socialized medicine that does not meet US Standards and is not wanted by the majority or 85% that want no changes!!! My Dad is 84 and is very happy with his Medicare!!! Lastly, get rid of every politician voting for this bill, voting for saving Government Motors (GM), and anyone, Republican or Socialist Democrats voting for the Union Stimulas ($787 Billion without read first) in 2010, 2012, and 2014!!!

[Jingthing]

You can't be more socialized medicine than Medicare. The tea baggers are really kind of funny!

Perhaps the comedy quote of last year from a hysterical tea bagger --

“Keep your government hands off my Medicare”

Edited January 2, 2010 by Jingthing

[vageena]

dont you have to qualify for medicare. something like they only take geezers .

come on jing. you american. dont you believe in the people! or must the govt be involved mightily in our lives?

[Jingthing]

dont you have to qualify for medicare. something like they only take geezers .

come on jing. you american. dont you believe in the people! or must the govt be involved mightily in our lives?

When you form a coherent thought, give me a buzz ...

[PeaceBlondie]

Social security income is taxable.

It wasn't at first. Then it was partially included in gross income over a certain large amount. None of my SS is taxed.

[Jingthing]

Social security income is taxable.

It wasn't at first. Then it was partially included in gross income over a certain large amount. None of my SS is taxed.

I meant it is included in the pool of taxable income if you make enough to be taxed. I wasn't aware that only a portion of it is added to other income. What portion is that?

[chiang mai]

100% of SSI Pension income is taxable, provided of course the recipient exceeds the earnings threshold.

But perhaps more interesting trivia is what happens to a US citizen who has qualified for US pension payments under SSI and then, at some point in their lifetime, earns credits under a foreign scheme, such as the UK National Insurance Pension scheme. Well, the answer is that you can claim against both systems at retirement age but, your US based payments will be reduced by virtue of a US windfall tax based on your work overseas and the retirement benefits derived from that work. So US based SSI may not be what you think it will be, if you have earned credits against more than one system.

[taxout]

"100% of SSI Pension income is taxable, provided of course the recipient exceeds the earnings threshold."

No, only up to 85 percent, not 100 percent:

"No one pays federal income tax on more than 85 percent of his or her Social Security benefits based on Internal Revenue Service (IRS) rules."

https://www.socialsecurity.gov/planners/taxes.htm

[PeaceBlondie]

Social security income is taxable.

It wasn't at first. Then it was partially included in gross income over a certain large amount. None of my SS is taxed.

I meant it is included in the pool of taxable income if you make enough to be taxed. I wasn't aware that only a portion of it is added to other income. What portion is that?

If the only income you received during 2008 was your social security or the SSEB portion of tier 1 railroad retirement benefits, your benefits generally are not taxable and you probably do not have to file a return. If you have income in addition to your benefits, you may have to file a return even if none of your benefits are taxable.

Base amount. Your base amount is:

$25,000 if you are single, head of household, or qualifying widow(er),

$25,000 if you are married filing separately and lived apart from your spouse for all of 2008,

$32,000 if you are married filing jointly, or

$-0- if you are married filing separately and lived with your spouse at any time during 2008.

http://www.irs.gov/publications/p915/ar02....ublink100097874

[NovaBlue05]

"...........Most Europeans scratch their heads in incomprehension when they hear some of our US friends My explanation is decades of commercial propaganda from the so called health care industry, for profit hospitals, big pharma, and insurance companies. Probably a majority of Americans still actually believe the current pre-reform system is the best in the world. Obama's task dealing with such delusion was near impossible.

Most Americans are covered by their employers plan and ...frankly, I doubt they know just how obscenely overpriced medical care in the US actually is. I pay $150/month for family of 3.....employer pays the rest. If I were to get laid off and had to pay the entire premium, it would be $1350/month. That is group rates! This still has co-pays, deductibles, etc. A shitload of money....larger than a mortgage payment in most places. No wonder so few living in the US comprehend retirement until they are medicare eligible. Of course, with SS going bankrupt, it's in the governments interest to keep you working as long as possible. To them, the optimal would be that you drop dead at your retirement party

It's easy to sell this propaganda that no other nations system comes close to the US when probably 95% of US born Americans have never been to a hospital outside of the US

Edited January 2, 2010 by NovaBlue05

[jazzbo]

from The New York Times 14 OCT 2009

Nearly 65? Time for the Medicare Maze

http://www.nytimes.com/2009/10/15/your-mon...tml?_r=1&em

[Jingthing]

Typically if an UNINSURED person came to the ER in such a hospital, they would have received an EKG in the ER which in this case would have showed no heart attack. They would then be shown the door, and sent a massive bill. Not the same treatment. Ruch L. is a royal arse.

[Jingthing]

The point is that uninsured people are treated in ERs, but just stabilized (NOTHING MORE) and then sent away. They could have a terminal condition that really requires a comprehensive treatment plan, but that doesn't matter, they are sent away until the next crisis. That is completely different treatment than well insured people get. Even the AMA is on record that being uninsured results in premature death for many thousands of Americans annually. Each year these American deaths dwarf the victim numbers of 9-11, but pompous buffoons like Rush simply don't care. And he parades himself as a patriot. Hardly.

Edited January 3, 2010 by Jingthing

[NovaBlue05]

It's easy to sell this propaganda that no other nations system comes close to the US when probably 95% of US born Americans have never been to a hospital outside of the US

What percentage would guess of the world's non-American population has been treated in an American hospital? 99.9%? So what does that say about them?

Fwiw, I'm guessing less than 0.5% but that's basically irrelevant. That quote is about the effectiveness of health industry fueled propaganda on a target audience with a limited frame of reference

I'm American and spent 10 days in an EU hospital for a broken elbow. Cost me only $2000 and the invoice was only one page long. Of course, I can't straighten out my arm more than maybe 50%. Maybe a fully-functional arm would be worth the mountain of debt. As they say....Up to you. You make that call

[koheesti]

The point is that uninsured people are treated in ERs, but just stabilized (NOTHING MORE) and then sent away. They could have a terminal condition that really requires a comprehensive treatment plan, but that doesn't matter, they are sent away until the next crisis.

My sister was paralyzed from the waist down in a car accident 20 years and 1 week ago. She was pretty poor and I doubt she had insurance. They medevac'd her to the hospital where she was treated for months and went through rehab for months more. Her debt is somewhere around $700,000. If she ever comes into money, the state first gets their share.

[Jingthing]

It sounds like they got her on an indigent program. If your health expenses wipe you out to poverty, sometimes there are options. Poor people in general avoid care because of fear of the expense. Then they show up too late with terminal cancer or untreatable diabetes, etc. These are hard cold facts completely verified by the AMA, so please no BS that this isn't happening.

Claims that the uninsured can always go to an emergency room for charity care ignore the fact that American taxpayers pay a high price for that care. And it ignores the abundant evidence that people who lack insurance don’t get necessary preventive care or screening tests, and suffer gravely when they finally do seek treatment because their diseases have become critical.

The American Cancer Society now says the greatest obstacle to reducing cancer deaths is lack of health insurance. It is so persuaded of that fact that two years ago, instead of promoting its antismoking campaign or publicizing the need for cancer screening, it devoted its entire advertising budget to the problem of inadequate health insurance coverage.

http://www.nytimes.com/2009/12/30/opinion/30wed2.html?_r=4 Edited January 3, 2010 by Jingthing

[BEENTHEREDONETHAT]

WHY DONT YOU WHO DONT BELIEVE USA MEDICAL CARE IS THE BEST, COME UP WITH A COUNTRY WHO HAS A BETTER SYSTEM.

americas one can improve but it doesnt need to go socialist,

If I got sick in the US and was able to travel, I would, without hesitation come to Thailand for any medical care. In fact I would pick Thailand over anyplace I am familiar with for medical care.

[flying]

If I got sick in the US and was able to travel, I would, without hesitation come to Thailand for any medical care. In fact I would pick Thailand over anyplace I am familiar with for medical care.

I live in the US & have a residence in Thailand as well.

My wife always comments anytime we have to go to a doctor here how much it sucks compared to Thailand.

We have insurance but I still do dental work in Thailand.

I dont need any medical work yet but the few times we use the medical here we are always amazed at how poor the service is.

[Jingthing]

I don't like the new bill. But I don't like the current system either. Why do you think the democrats had to settle for such a half baked sausage reform instead of going with a REAL proven model of universal health they could have just copied from a number European countries? Think that one over a lukewarm cup of rancid tea.

Edited January 4, 2010 by Jingthing

[RustyYellowDodge]

As a general goal - i think that universal care should be desired. It's not a socialist statement to wish that all people can enjoy good health, without going broke to do so. The politics of the situation make me queasy, so I'll just keep doing my part to help others, and see where that takes me.

[citizen33]

I suppose it is akin to pissing into the wind, but:

1. How would foreigners without direct experience of the US system know how well it performs? Well, they might like to read what the Institute of Medicine wrote in Crossing the Quality Chasm: A New Health System for the 21st century. See also commentary on this report such as the paper at this link:

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1276338/

2. How might we challenge the commonsense observation that universal healthcare would be too expensive for the US, while the existing 'entrepreneurial' system is just fine? Well we might point out that every other major industrialised country already has UC, and that when we compare costs we find that the US is spending 16% of GDP on its health care system compared with the OECD average of 8-10%. No other large country spends more than about 11% and yet all cover the whole population.

Edited January 4, 2010 by citizen33

[flying]

IRS To Be Charged With Levying Fines Against Americans Without Health Insurance

January 3rd, 2010

IRS Building In Washington DC

Digital News Report – Besides collecting taxes and going after tax cheats, the Internal Revenue Service (IRS) will be going after Americans who do not purchase private health insurance.

The new health care legislation being debated in Congress will put the IRS in charge of making sure Americans purchase a health insurance policy. Those who don’t pay will be penalized because all Americans will be forced to purchase a policy.

Besides making sure citizens do buy insurance, the IRS will assess penalties on those who do not. They will also collect new fees from businesses and oversee enforcement.

Already understaffed and overburdened, the IRS will need more agents. The CBO estimates that the extra cost would be $5 to $10 billion over the first 10 years. So far, neither bill in the House or the Senate includes any funding this.

ByTim Edwards

[flying]

Why the Health-Care Bills Are Unconstitutional

If the government can mandate the purchase of insurance, it can do anything.

While the article is interesting I always like reading the comments best

[sbk]

This thread seems to have been hijacked to some extent by our resident troll. I considered closing it but have deleted all non-relevant off topic bs instead. Please do not feed the troll, use the report button to have it removed and the person dealt with, cheers.

And while we are at it, lets do try to veer towards the Thailand based aspect of this topic and how its relevant to Americans living in Thailand.

[Jingthing]

OK, as the moderate US health care reform will soon become law, I would like to summarize my understanding of its impact on American expats. Please remember this topic is supposed to be about impact on expats, not whether you are for or against reform and to argue the politics of it (which you can get enough about on US media 24/7).

-- Expats over 65 in Thailand always have had the option of repatriating if they develop a serious or expensive chronic medical condition to enroll in Medicare. That is, IF they are well enough to take the long plane ride! Remember for various and often legitimate reasons not all expats have any or adequate Thai health insurance. Also note the infamous donut hole is being eliminated, so the financial aspects of Medicare will be improved for the elders.

With the new reform they can still repatriate to get on Medicare.

-- Now with the new reform, in 2014 (four years from now), expats who will be UNDER 65 will have a similar amount of health care in the US security as medicare age people. This makes being an expat a little more attractive. Under the current pre-reform system if you develop certain medical conditions while living abroad, it means you may never be able to purchase private health insurance in the US (but could get it from certain employers if you can land a benefits type of job). Now after four years, younger expats will no longer have that worry. The new reform also provides subsidies to lower income people to buy private insurance if you don't get from employer. As it is now, many people don't buy insurance who are allowed in the system because they simply can't afford the high premiums.

-- As far as I can tell, bona fide expats will NOT be required to obtain US insurance, in 2014. US residents will be required to do so, under the penalty of modest fines for low income people, or major fines for high income people.

Expat impact? Those who live abroad part time will likely be in the required class. That may be a disadvantage for partial expats.

-- Cost and access issues. For those that repatriate, the new reform does not deal very aggressively with massive cost issues, except in the sense of providing subsidies to low income people to get the insurance. High income people especially and probably also middle income people will pay higher taxes to pay for this. Not sure how to define these income levels, but for sure those earning over 250K are going to be considered rich and will be soaked. For everyone, ACCESS is going to be a bigger problem. At least an additional 30 million people will be in the system, so most people will have INSURANCE, but that doesn't necessary mean the ACCESS to the care will always be easy. You still need enough health care workers and facilities to deal with it.

Overall summary, overall impact on expats rather minor, but for a small percentage of us (those under 65 needing to repatriate after 2014) it could be life saving.

Edited March 21, 2010 by Jingthing

[hhgz]

"Why the Health-Care Bills Are Unconstitutional"

This article is over 3 months old, and does not reflect the health care bill that is currently written.

According to the SSA, some Medicare Advantage programs DO provide coverage outside of the US.

Edited March 21, 2010 by hhgz

[gregb]

-- Now with the new reform, in 2014 (four years from now), expats who will be UNDER 65 will have a similar amount of health care in the US security as medicare age people. This makes being an expat a little more attractive. Under the current pre-reform system if you develop certain medical conditions while living abroad, it means you may never be able to purchase private health insurance in the US (but could get it from certain employers if you can land a benefits type of job). Now after four years, younger expats will no longer have that worry. The new reform also provides subsidies to lower income people to buy private insurance if you don't get from employer. As it is now, many people don't buy insurance who are allowed in the system because they simply can't afford the high premiums.

Hmm....so how exactly do you think this would work? Lots of people can't afford any premiums.

An expat living in Thailand develops a major health related problem. He returns home, and has no money to purchase health insurance. Is he then required to wait an entire year until the government cuts him a check on his tax refund before he can then take that money and obtain care? Or will the government immediately subsidize health insurance? If the former, what happens if he has an accident before tax rebates roll around?

In either case, would the health insurance subsidy be subject to confiscation for back taxes, support payments, student loans, etc? If so, it would seem that a portion of the expat population (and a somewhat higher than average portion compared to the domestic population) will never actually receive the subsidy anyway. So basically, for these people, whereas today they could return home and move in with a friend uninsured, they will now be penalized for moving back to the states and moving in with a friend uninsured. Aside from penalizing them for returning home, they receive nothing.

I am glad to hear that full time expats will be exempt. This kind of ill conceived legislation is a great reminder of why we should never try and repatriate. I fully support universal health care, such as offerred to Canadians. This attempt to punish Americans for breathing is a disaster.

BTW, what happens if, as an expat, we return for holiday, and have an accident while in the US? Are penalties applicable in that case?

Overall summary, overall impact on expats rather minor, but for a small percentage of us (those under 65 needing to repatriate after 2014) it could be life saving.

And if I have interpreted the exact implementation mechanisms correctly, for a small percentage (those currently experiencing financial hardship in a way that can be targeted by the IRS) it will provide absolutely nothing other than more punitive punishments.

I would be very interested to know if I have made invalid assumptions in this analysis, but from my brief scan of the legislation, it looks like there are isolated cases where the impacts would be substantially more than "minor".

[Jingthing]

There will be subsidies based on income. People with no money may go on medicaid. I don't how ASSETS vs. income fit into the picture, and I am very curious about that. I don't think there is any linkage between owed taxes and being eligible to obtain insurance/subsidies. After all, having insurance is going to be a requirement. I don't think there is any waiting period to get the insurance other than expected processing delays. For example, a sick expat could fly back and likely obtain insurance quickly. Sure, the devil is in the details and things can change. I also favor single payer, but that isn't possible given the political realities. What we are getting instead is rather a mess but it will help many people who are currently left out of the system. A major flaw I see now is that healthy people will skip the insurance and pay the penalty, and then sign up if they get sick. This is a good reason for single payer in my view, everyone is in the pool all the time, as they should be.

Of course, I haven't read the bill. Not many people have.

Edited March 21, 2010 by Jingthing

[flying]

Of course, I haven't read the bill. Not many people have.

Including the folks voting on it.....DeJa Vu TARP