Us Expats And Health Care Reform

[ThailandLovr]

Yes, Brit (BTW, I'm on your side). The question is what change is almost immediate. I think, but I could be wrong and I apologize if I am, but expanded coverage to the 32 million previously uninsured plus some insurance changes aren't delayed until 2014. Very difficult to reverse either.

Edited March 22, 2010 by ThailandLovr

[Jingthing]

Obama won the election and this is what he chose to spend most of his political capital on. It is done. Deal with it.

[up-country_sinclair]

Right Up_c, plus there are practical problems reversing certain changes which would already be in effect.

It seems most doesnt go in affect until 2014, so it would be quite easy.

Procedurally and politically, it would be quite difficult.

After becoming law, the following will immediately go into effect:

*The Medicare "doughnut hole" will be closed for senior citizens. In other words, they'll be paying less for their medications.

*Children will not be denied health insurance because of preexisting conditions.

*Parents will be able to keep their college aged children on their insurance policies until they are 26 years old.

*A massive tax credit for small businesses to supply health insurance to their employees.

If Republicans decide to campaign on the theme of repealing this legislation, they'll be following down the path of Alf Landon.

[ThailandLovr]

Jing is right about the liberal court coming. Even though the next judges likely to retire are liberal judges, their replacements will be younger liberals who could serve for 20+ years. Then once a conservative judge goes, and is replaced by an Obama nominated liberal, the Court will be liberal for years to come.

Edited March 22, 2010 by ThailandLovr

[Jingthing]

The republicans are going to make gains and may retake the house, but they are also going to make enemies by fighting against measures that many people love in this new bill. Also I think they have lost Latinos completely, and that is a fast growing population. They are celebrating prematurely.

[jazzbo]

http://www.ama-assn.org/ama1/pub/upload/mm...age-support.pdf

[ThailandLovr]

Agreed Jing. The strategy for the Dems will be to aggressively be spinning everything favorable to the bill for the next 6 months. Personally, I think they will take a bit of wind out of the sails of discontent by then. November will be tough on Dems for sure, but not a disaster as many think at this time IMHO.

[britmaveric]

Nah think it will be reversed after Nov elections or like I said the Supreme Ct will just rule its Unconstitutional and keep it going into affect. (btw no conservatives are retiring anytime soon)

Especially when yank people find out - how much this is really going to cost then. There will be an all out revolt.

Besides remember Dr(s) can turn away anyone in this govt pool and just state they do not accept the insurance.

Edited March 22, 2010 by britmaveric

[up-country_sinclair]

Nah think it will be reversed after Nov elections or like I said the Supreme Ct will just rule its Unconstitutional and keep it going into affect. (btw no conservatives are retiring anytime soon)

On what grounds could this legislation be considered unconstitutional? If your opinion is based on the fact that citizens are required to buy it, then car insurance would also be 'unconstitutional'.

Especially when yank people find out - how much this is really going to cost then. There will be an all out revolt.

The non partisan Congressional Budget office states that it's going to save 140 Billion in the next ten years, and nearly a trillion in the following ten.

Besides remember Dr(s) can turn away anyone in this govt pool and just state they do not accept the insurance.

I've never heard or read this. Not saying it isn't true, but it's the first time I've come across it.

Edited March 22, 2010 by up-country_sinclair

[britmaveric]

^you actually believe this will save you lot dosh? (all of your entitlement programs are broke, such as social security, medicare, medicaid) Gullible yanks come to mind.

Car insurance analogy is faulty - driving is a priviledge.

Unconstitutional from what I read... medical insurance is not commerce related. (maybe if you could buy insurance across state lines then that would be the case, but as is I think it doesnt pass the test)

Dr's turning it down? Yes - from what I read they already do this with medicare/medicaid, since reimbursement doesnt match their actual costs.

[up-country_sinclair]

^you actually believe this will save you lot dosh? (all of your entitlement programs are broke, such as social security, medicare, medicaid) Gullible yanks come to mind.

I'm neither an accountant or a legislator. I will, however, take the word of the Congressional Budget Office.

Car insurance analogy is faulty - driving is a priviledge.

Driving is a privilege, but having insurance is the law.

And by the way, if you read my post, you'll see that I never claimed that it was a legitimate comparison.

Unconstitutional from what I read... medical insurance is not commerce related. (maybe if you could buy insurance across state lines then that would be the case, but as is I think it doesnt pass the test)

Of course this legislation is related to the budget. Health care costs are bankrupting the country.

But you posted the Republicans will have a 2/3 majority in the House and the Senate so that they can override a veto, so it's a moot point.

Dr's turning it down? Yes - from what I read they already do this with medicare/medicaid, since reimbursement doesnt match their actual costs.

Their actual costs or their desired profit margins?

[ThailandLovr]

The problem with Congressional Budget Office figures is they just price out according to the defined scenario(s) given them. They are robots. They do not comment on the feasibility of the scenario or the validity of the underlying assumptions - they just price out according to the scenario. Pelosi is as smart as they come. I believe she reverse-engineered (so to speak) the numbers (tweaked the model parameters) to formulate a scenario which resulted in the numbers she wanted. An accurate scenario or not? I doubt she cared. She got her numbers and that's all that "counted".

Edited March 22, 2010 by ThailandLovr

[gregb]

OK,

So given that we are now going to be punished with this ill conceived legislation, I have been truly making an attempt to understand its consequences. It appears, to fully understand the legislation, you have to look at 2 complete files:

HR 3590, the original disaster and

HR 4872, amendments to the disaster

I can not find anywhere that someone has merged both of these into an easy to read format for us lay people. If someone knows of such a document, please post.

My first question is "How do we know for sure expats are excluded." Seems a simple enough question. But it is slow going to find the provision that actually exclude expats. The relevant text I have found in HR 3590, Section 1501 is as follows:

15 ''CHAPTER 48—MAINTENANCE OF

16 MINIMUM ESSENTIAL COVERAGE

17 ''SEC. 5000A. REQUIREMENT TO MAINTAIN MINIMUM ESSEN

18 TIAL COVERAGE.

19 ''(a) REQUIREMENT TO MAINTAIN MINIMUM ESSEN

20 TIAL COVERAGE.—An applicable individual shall for each

21 month beginning after 2013 ensure that the individual, and

22 any dependent of the individual who is an applicable indi

23 vidual, is covered under minimum essential coverage for

24 such month.

So, who is an "applicable individual"? That is answered down below.

11 ''(d) APPLICABLE INDIVIDUAL.—For purposes of this

12 section—

13 ''(1) IN GENERAL.—The term 'applicable indi14

vidual' means, with respect to any month, an indi15

vidual other than an individual described in para16

graph (2), (3), or (4).

17 ''(2) RELIGIOUS EXEMPTIONS.—

...

13 ''(3) INDIVIDUALS NOT LAWFULLY PRESENT.—

14 Such term shall not include an individual for any

15 month if for the month the individual is not a citizen

16 or national of the United States or an alien lawfully

17 present in the United States.

18 ''(4) INCARCERATED INDIVIDUALS.—Such term

19 shall not include an individual for any month if for

20 the month the individual is incarcerated, other than

21 incarceration pending the disposition of charges.

So, everyone is an applicable individual unless they have a religious exemption, are currently in prison, or are "Not lawfully present". But the "not lawfully present" only includes people who are not citizens or nationals of the US, or an alien lawfully present in the United States.

OK, well, what is a "national" of the United States? According to Wikipedia: "Not all U.S. nationals are U.S. citizens; all U.S. citizens are U.S. nationals. "

So, I can find absolutely zero exemptions for expats here. None. There are no amendments to this section in HR 4872. It would appear that all US citizens, regardless of their domicile, are "applicable" individuals. So now, we know we are all subject to this law, even though we are living in Thailand, and we have to figure out what is "minimum essential coverage". I was starting to panic until I came across this in subparagraph (f) where they are discussing what is "minimum essential coverage":

11 ''(4) INDIVIDUALS RESIDING OUTSIDE UNITED

12 STATES OR RESIDENTS OF TERRITORIES.—Any appli

13 cable individual shall be treated as having minimum

14 essential coverage for any month—

15 ''(A) if such month occurs during any pe

16 riod described in subparagraph (A) or ( B ) of sec

17 tion 911(d)(1) which is applicable to the indi

18 vidual, or

19 ''( B ) if such individual is a bona fide resi

20 dent of any possession of the United States (as

21 determined under section 937(a)) for such

22 month.

Whew. So, section 911(d)(1) is of course our well known "bonafide residence test" which means 330 days outside of the US. I was worried for a second, but there it is. You can go home for a short trip and not be subject to these rules. That was the real question which started my inquiries.

I could find nothing in the laws which answer my other questions of exactly how the IRS intends on implementing tax credits for people who might need them. It is clear from 1401 section 36B, ( b )(2)( B )(ii) that anyone not making above the poverty line does not qualify for tax credits. They will still be required to be processed under the existing Medicaid program. So some of my concerns about going home destitute don't seem to be affected by this legislation. If you're really broke, it is still Medicaid for you.

If you have some income so you don't qualify for Medicaid, there is a provision for advanced payments of the tax credit, but there is no guarantees that says the IRS has to actually provide these to you if you have financial difficulties in a manner that the IRS can attach. In fact, they are specifically defined to be only advanced payments of tax credits, and the IRS is fully empowered to seize any tax refund. It seems there is no reason that they could not seize these advanced payments as well.

So I maintain there could be alot of poor, working people left with no option for healthcare under this scheme. It all depends on how the IRS elects to fulfil its mandates. I'll be curious to see how that turns out.

Here is a nasty provision from section 1401( c )(1)( C ) that I came across while scanning:

13 ''( C ) MARRIED COUPLES MUST FILE JOINT

14 RETURN.—If the taxpayer is married (within the

15 meaning of section 7703) at the close of the tax

16 able year, the taxpayer shall be treated as an ap

17 plicable taxpayer only if the taxpayer and the

18 taxpayer's spouse file a joint return for the tax

19 able year.

So, if you are maintaining coverage under this law, and trying to take the tax credit you are entitled to for maintaining your coverage under the law, and you have a Thai wife who does not possess a TIN therefore you need to select "married filing separately" so that her offshore income is excluded from US taxes, the government will give you the finger.

Nice. Uncle Sam is a real bastard.

I will say, that all this research only took me about 6 hours. For as big as this legislation is, it is actually surprisingly well written and coherent. That does not mean I agree with it, but I was expecting something more akin to the tax code. This is actually fairly straightforward.

I will however, ask again, why can't we just have a simple, universal coverage system like Canada? This legislation still sucks.

[Jingthing]

I will however, ask again, why can't we just have a simple, universal coverage system like Canada? This legislation still sucks.

Why not indeed? Of course that was the real answer, not only for universal coverage but also for cost control. But the insurance companies, big pharma, big hospitals, and the AMA had to be served, so instead of copying tried and true elegant solutions from other countries, we are experiencing so called American exceptionalism (code word for there are still lots of republicans, independents, and libertarians). Of course, in this case it means as Americans we are FUBAR. Still, better than nothing for those it helps.

Edited March 22, 2010 by Jingthing

[jazzbo]

Scenario: At the Rose Garden signing for the recently passed Healthcare bill, President Obama, with pen in hand, looks down at the paper and says, "You know, as someone who taught Constitutional Law at the University of Chicago for 12 years, I know dam_n well that components of this Legislation are Unconstitutional and therefore I have decided to VETO the bill... have a nice day."

Yes... and that girl in your bed is Chutima Miss Thailand 2009

[fiddlehead]

I just saw this in a boston publication: Under the federal plan, starting in 2014, the annual penalty for not having insurance is $95, but rises after that. In 2016, for example, a person would pay the greater of two alternatives: either a flat annual fee of $695 or 2.5 percent of their annual income.

Edited March 23, 2010 by fiddlehead

[PeaceBlondie]

'11 ''(4) INDIVIDUALS RESIDING OUTSIDE UNITED

12 STATES OR RESIDENTS OF TERRITORIES.—Any appli

13 cable individual shall be treated as having minimum

14 essential coverage for any month—

15 ''(A) if such month occurs during any pe

16 riod described in subparagraph (A) or ( B ) of sec

17 tion 911(d)(1) which is applicable to the indi

18 vidual, or

19 ''( B ) if such individual is a bona fide resi

20 dent of any possession of the United States (as

21 determined under section 937(a)) for such

22 month.'

I've always used the bona fide residence law. Don't know if it has a 30 day limit. However, the language is not clear.

[jazzbo]

IRS Foreign Earned Income Exclusion - Physical Presence Test

http://www.irs.gov/businesses/small/intern...d=96968,00.html

If you do not meet the 330 day test, a BUPA policy might meet the qualifications of Sec. 222 Essential Benefits Package (from the original HR 3962) -- as per Sec. 222(a)(3) BUPA imposes no lifetime or annual limit only 'per incident' limits ... you might be required to take on an outpatient package if you currently have inpatient only.

Update: Section 122 Essential Benefits Package Defined of HR 4872 is the same definition i.e. no annual or lifetime limits, outpatient, etc.

Edited March 23, 2010 by jazzbo

[ThailandLovr]

A poll I heard about today:

Approval ratings:

Nancy Pelosi - 11%

Harry Reid: 8%

I believe this signifies most Americans, irrespective of their political preference, disapprove of the law-making process itself as executed by Pelosi and Reid, not necessarily the legislation involved.

It just doesn't pass the sniff test in regards to being representative government. It is important somehow that confidence in the governing/law-making process is restored. Not sure cleaning house in November will necessarily accomplish that. The proof will be in the pudding.

Edited March 23, 2010 by ThailandLovr

[jazzbo]

from The New York Times 21 MAR 2010 -- The Times asked several public figures (among them former Senator Rick Santorum whose piece is entitled "Devastating to America") to comment on the Legislation

Richard Reeves is the author of a presidential trilogy: “President Kennedy: Profile of Power,” “President Nixon: Alone in the White House” and “President Reagan: The Triumph of Imagination.”

The guy in South Carolina who yelled at his congressman to “Keep your government hands off my Medicare!” was on to something important. Once the government offers an entitlement it belongs to the people — and they will fight to keep it. So President Obama’s success in moving toward universal health care (the core of the reform package is expanding the number of Americans covered) will become part of the American social fabric, a birthright, like Social Security and Medicare.

And the Republicans were right too, in understanding that this bill is a significant expansion of the American welfare state.

What they didn’t understand was that you can’t beat something with nothing.

President Obama and the Democrats had something to offer. The Republicans didn’t.

Edited March 23, 2010 by jazzbo

[Jingthing]

Correct. The republicans are totally disingenuous. They had power recently for eight years and didn't do one thing to deal with health care access; meanwhile based on AMA statistics hundreds of thousands of Americans died sooner than they had to for lack of medical care, dwarfing the 9-11 fatality numbers. Today they say they agree they want insurance companies to cover people with preexisting conditions but they ignore the reality that you need a bigger pool of healthy people in the insurance system to make that feasible (the Obama plan). It is clear to many that the republicans really are not interested in universal health care access for Americans. They never offered any ideas that would cover any more than additional million or two Americans, as opposed to 30 million for the Obama bill. It will be interesting to see if their hypocritical squawking about "Armageddon" ends up blowing back in their deserving faces ...

Edited March 23, 2010 by Jingthing

[britmaveric]

And if the Repubs are right?

[jazzbo]

... from those wonderful folks who brought you 'Shock and Awe'...

[Jingthing]

And if the Repubs are right?

Right about what? That poor people, sick people, mostly black and Latino people don't deserve health care in the country which they claim has the best health care system in the world? Yes, this is a race issue in the US. The majority of the uninsured are minorities. Could it be as I think that the republicans are owned by the health business and know these groups they don't care about dying early almost never vote republican? Your US views are interesting considering your pro red stance in Thailand. Edited March 23, 2010 by Jingthing

[ThailandLovr]

About this time last year Obama said it was absolutely crucial for Health Care Reform to pass in order for the economy to recover and return to prosperity.

OK, now the economy can SURGE ahead! :D

Edited March 23, 2010 by ThailandLovr

[midas]

I am not American but I am flabbergasted by the apparent apathy of the American people

regarding this new proposal to give even more incredibly intrusive powers to the Internal

Revenue Service ( who some claim is virtually a branch of the Federal Reserve ) as part of this reform.

And what about Ron Pauls bill to AUDIT THE FED ? How far do those in control of Obama and really in

control of the USA want to screw the American people not content in having stolen trillions from

future generations in the financial crisis , now they also want to act like the Gestapo.

Surely America - rnough is enough ! its nauseating to watch a once great country being raped

[ThailandLovr]

Everybody in America hates the IRS. The IRS involvement in this reform strategically didn't come up until recently, or the people would have completely freaked out. Sleight of hand.

Edited March 23, 2010 by ThailandLovr

[Oldvisitor]

What Obama ( Oblama ) is pushing trough, about basic healthcare rights, is basic in most Western EU countries. He does the right thing, I support him fully in this.

[midas]

What Obama ( Oblama ) is pushing trough, about basic healthcare rights, is basic in most Western EU countries. He does the right thing, I support him fully in this.

Then you must also believe in the toothfairy

There is nothing basic about " pushing through " something which even blind Freddie

would understand is against the USA Consitution...........or doesnt a small document like that

mean anything to you anymore............

Like I said............America is morally bankrupt

[ThailandLovr]

What Obama ( Oblama ) is pushing trough, about basic healthcare rights, is basic in most Western EU countries. He does the right thing, I support him fully in this.

..and now European style VAT taxes will be coming to the USA, Charles Krauthammer predicts:

http://www.businessandmedia.org/articles/2...0323075843.aspx

Seems a certainty to me to help pay for all the spending. Spend and tax, spend and tax, the liberal's mantra.

Oops, excuse me. Health Care Reform will result in savings to America

Edited March 23, 2010 by ThailandLovr