USA topic -- coming changes to Obamacare/Medicare/Medicaid under new president

[Jingthing]

Americans -- expats, future expats, and future repatriates are all quite often interested in how the U.S. health care system may impact their lives and future plans.

 

Well, change is afoot.

 

Of course Americans abroad (other than military) are not in the U.S. health care system as far as access to it abroad. 

 

But the specific details of the U.S. health care system may deeply impact life planning decisions related to both expatriating and repatriating.

 

So I'm starting this topic because the president elect will be in office soon and he has intentions (although very very very unclear) to make changes to Obamacare, probably Medicaid, and shock of shocks, maybe even Medicare.

 

I expect this thread to be a work in progress as actions and speeches are made by the president elect and congress reacts. It now gets REAL. 

 

http://www.nytimes.com/2016/11/12/business/insurers-unprepared-for-obamacare-repeal.html?_r=0

Quote

 

“Health care is shaping up as a priority for the Trump administration and Republicans in Congress,” said Larry Levitt, an executive at the Kaiser Family Foundation, which closely tracks health policy. “But we still have very little detail about what that really means.”

The health care industry, which invested hundreds of millions of dollars in preparing for business under the Affordable Care Act, is disoriented about what to do next — and scrambling for ways to avoid a financial shock. A repeal of the act would mean the loss of millions of customers for insurance companies and uninsured people turning to hospital emergency rooms for basic care.

 

 

The details are all up in the air now, so nobody can give anyone clear assurances, but I suggest reading this article for a very good overview of the starting point.

I realize the part about potential changes to MEDICARE are going to shock some people, so here's some info about that. Of course, that doesn't mean it will ever happen. It is something that Ryan majority leader of Congress has wanted for a very long time, but the president elect even hinting at that is totally new.

 

Quote

The new plans drop all mention of reining in high drug prices, which Mr. Trump had advocated for months, and add new language about modernizing Medicare, a potential nod to congressional efforts to give people vouchers toward buying private health insurance.

Quote

 

“This is Day 1 of figuring out what all of this means,” Mr. Glick of Oliver Wyman said Wednesday.

 

 

 

More will no doubt come later and this is likely to get quite interesting.

 

In responding to this, there is no need to say we don't know what exactly will change yet, because that's EXACTLY the point of this first post. What we do know almost definitely is that there will be changes and those changes are likely to impact on the lives of Americans including many expats, future expats, and those considering repatriation. 

 

Extra credit item -- TEASER!

Imagine if they did make Medicare a voucher program which you would use to buy private insurance. While they might not desirable for elder Americans in the U.S. as it would represent a dismantling of the FDR New Deal, but just imagine if those vouchers were also possible to be used to buy private insurance abroad! Of course I just made this idea up and it seems very very unlikely a right wing government would EXPAND such a benefit that doesn't exist now ... but if they did go down that route of vouchers to replace Medicare, it's something that politically active expats would probably want to actively lobby for. There have been weak lobbying efforts over the years to include expats in Medicare but they never go anywhere and nobody really expects them to EVER. 

Edited November 12, 2016 by Jingthing

[ClutchClark]

This has the potential to be an excellent thread over the coming months (and years).

 

Nice work JT. 

 

I hope the contributions can avoid the political aspects.

 

Here is arecent Forbes article describing Ryan's "hatchet" agenda. All seniors should be wary of this guy. He is no friend to seniors and the last guy Trump should be working with.

 

http://www.forbes.com/sites/howardgleckman/2016/06/22/what-paul-ryans-latest-health-proposal-would-mean-for-seniors/#3446b8305f39

 

"House Speaker Paul Ryan’s proposed blueprint for health reform would make major changes in medical care for seniors, raising out-of-pocket costs for some and shifting others from traditional Medicare coverage to commercial insurance. "

 

 

 

 

 

 

 

 

Edited November 12, 2016 by ClutchClark

[taxout]

Medicare as we know it is a Sacred Cow. It's about the only part of the U.S. medical insurance system that more or less works, and it has immense popular support. The support's not just the over-65s. Just about every American in their 50s and early 60s is counting the days till they reach the Medicare safe harbor and escape the expensive clutches of Obamacare.

 

I can think of no better way for the Republicans to toss away their majority in both houses come the next election than to tinker with Medicare.

 

 

[WaywardWind]

Insofar as Obamacare is concerned, the current news seems to be that they want to keep some parts - keeping the ban on denial for pre-existing conditions, allowing coverage for young adults on their parents' policies, maintaining the cap on the admin costs of providers, etc. - while eliminating the mandate and government subsidy/tax credit provision. That simply will not fly with insurance providers, and millions of people currently enrolled will lose coverage. Unless there is some alternative which maintains the nature of ACA as essentially a very large group policy and spreads the insurers' risks over a very large pool of both healthy individuals and those who need care, the insurers will walk away.

 

Single-payer (Medicare for all) remains the best alternative for ensuring access to health care for all Americans, but that is a third rail for Republicans and conservatives because of the vast influence of the insurance industry and the medical profession.

 

As far as Social Security is concerned, there are major difficulties ahead. The logical steps to preserve its solvency are raising the cap on contributions, applying the contribution requirement to all income including capital gains above a certain level, increase the tax rate, raising the retirement age, and cutting benefits. None of the first three have any chance with this Congress, so raising the retirement age for younger workers and cutting benefits will surely be the only possibilities that will receive consideration, with raising the age being the favored route so as not to face the wrath of current recipients and the seniors' groups.

 

Additionally, we will likely see changes in the way that COLA increases are calculated from a straight CPI analysis to a chained CPI, which is predicted to reduce the COLA. Any chance for a CPI-E formula, which focuses more accurately on goods and services most commonly purchased by the elderly, will be off the table.

 

Ironically, the increased cost of goods and inflation which will flow from Trump's economic proposals will likely result in an increase in the COLA  over the next few years, but will likely be insufficient to make up the difference in increased cost of consumer goods.
 

[taxout]

"Ironically, the increased cost of goods and inflation which will flow from Trump's economic proposals will likely result in an increase in the COLA  over the next few years, but will likely be insufficient to make up the difference in increased cost of consumer goods."

 

But inflation, and hopefully economic growth, will increase social security tax payments.

 

And it's a strong, growing economy that really supports social security. Fiddling around with the numbers is worthless if there's not a flourishing economy behind them to provide the goods and services over-65s use, but don't themselves produce.

 

Take care of the economy and you take care of social security.

Edited November 12, 2016 by taxout

[BKKdreaming]

And the number of people living "too long" will continue ,  when all these numbers were calculated 20-30 years ago you were to work to your 60s and die in your 70s , 

 

those numbers do not work anymore with so many living till their 80s and 90s.....

 

And add the "Arms race" where every Hospital has to have the newest machines ,  when another hospital 2 miles away already has one......

 

Trump care will have as many problems as Obama care ,  unless the Hospital costs go down which is unlikely !

 

 

[WaywardWind]

17 minutes ago, taxout said:

"Ironically, the increased cost of goods and inflation which will flow from Trump's economic proposals will likely result in an increase in the COLA  over the next few years, but will likely be insufficient to make up the difference in increased cost of consumer goods."

 

But inflation, and hopefully economic growth, will increase social security tax payments.

 

And it's a strong, growing economy that really supports social security. Fiddling around with the numbers is worthless if there's not a flourishing economy behind them to provide the goods and services over-65s use, but don't themselves produce.

 

Take care of the economy and you take care of social security.

That is the old trickle down theory utilized in the 1980s; it didn't work then, and won't now.  The rich will get richer, and the poor and middle class will continue to be left by the side of the road.

[ClutchClark]

18 minutes ago, WaywardWind said:

That is the old trickle down theory utilized in the 1980s; it didn't work then, and won't now.  The rich will get richer, and the poor and middle class will continue to be left by the side of the road.

 

I would rather see politics stay out of this thread and have it be a source of reference for everyone without having to sift through opinions.

 

Just the Facts Ma'am.

[taxout]

Has nothing to do with trickle down economics. Nothing at all.

 

When the economy isn't doing well, you haven't got much to divide among the people, whether old or young, poor or rich. There's just not much to trickle down.

 

The sine qua non is a strong economy. How the fruits of that strong economy are divided up, trickled down to use your term, is another question. But you never even get to address that question unless you first develop a vigorous economy.

 

(Trickle-down theory is related to some mechanisms that can be used to develop a strong economy; non-trickle-down approaches can also be used.)

Edited November 13, 2016 by taxout

[ubonjoe]

5 hours ago, ClutchClark said:

I hope the contributions can avoid the political aspects.

If starts going political it will be closed unless people stop when it does go that way after a warning about it.

[Jingthing]

Yes, please try to keep the partisan politics at a minimum here. These changes may be a life and death matter for some of us, and that includes Americans of varied political flavors. 

[ubonjoe]

A off topic post has been removed.

[Jingthing]

I want to add that potential changes to social security under the new government are not intended to be part of this topic.
It's scope is changes to U.S. medical care programs. Be assured in the coming months and years that will turn out to be quite a wide topic in itself.

[mania]

Note: all changes mentioned here are speculation

this is on topic

[sirineou]

As said by others,  Trump is already walking back his campaign promise of " Repeal and Replace"

He said he will keep parts,of Obama Care. most  noticeable the pre existing condition coverage.

The Affordable Care Act (ACA} is like an alalgebraic  expression. You can't change the value of  any factor without affecting the   value of an other factor. If you want the expression to balance

The additional cost to Health Insurance Co. of covering pre existing condition in the ACA is , or will be , by the expanding the pool of insured, and balancing the pre existing conditions, by young healthy clients. 

So if you repeal ACA and reduce the pool, how do insurance co. pay for pre existing conditions?

Expect only face saving changes,  

[rijb]

Ryan tells Baier, “Because of Obamacare, Medicare is going broke.”

The Speaker is plainly and demonstrably wrong. Repealing the Affordable Care Act wouldn’t help Medicare’s finances; it would do the exact opposite, pushing the Medicare system closer to insolvency.

 

http://www.msnbc.com/rachel-maddow-show/after-gop-wins-paul-ryan-puts-medicare-the-crosshairs

[Dtrump]

Old guys just go home and get covered by medicare Part A don't they? 

American citizens who have made sufficient contributions are entitled to the following:

Part A: Hospital insurance free of any monthly premium.

In general, Part A covers: 

• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial care isn't the only care you need)
• Hospice
• Home health services

https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

Edited November 14, 2016 by Dtrump

[taxout]

Don't get too excited about "free" Part A. It's got its gotchas, like the "two-midnight" rule and the "formally admitted" requirement.

 

"A doctor makes an official order which says you need 2 or more midnights of medically necessary to treat your illness or injury and the hospital formally admits you."

 

https://www.medicare.gov/coverage/hospital-care-inpatient.html

 

Further, Part A only covers hospital charges. If you have surgery, for example, the various doctors' fees will not be covered by Part A, but by Part B, if you've paid for it.

 

There's also a $1288 deductible to be paid if you are admitted to a hospital and covered by Part A.

 

Finally, remember that a lot of stuff that in Thailand would mean a few days in the hospital is done with day surgery in the U.S. -- various laparoscopic surgeries, for example -- and that means you have to look to Part B not Part A for coverage,

Edited November 14, 2016 by taxout

[NeverSure]

On 11/12/2016 at 3:10 PM, WaywardWind said:

-snip-

 

Single-payer (Medicare for all) remains the best alternative for ensuring access to health care for all Americans, but that is a third rail for Republicans and conservatives because of the vast influence of the insurance industry and the medical profession.

 

 

Medicare is far from single payer. I have to pay $104 per month for almost nothing, and then pay another $162 per month to a private insurance company for "Part F" which is "Medigap". Medigap is one step up from part C which is called Medicare Advantage. The government subsidizes my Part F to the insurance company. F is real health insurance and I have no deductibles or co-pays ever. 

 

I pay about another $30 per month to another private company for RX. It is also subsidized by the government. Obviously without the subsidies my premiums would be far higher.

 

I agree that Medicare is a sacred cow that can't be messed with if it would disadvantage seniors. Washington DC would burn to the ground.

 

The OP is about Obamacare. Obamacare was always going to be a disaster and must be fixed or replaced. I haven't seen anything specific about what will be done.

 

Cheers.

[taxout]

"The government subsidizes my Part F to the insurance company."

 

In some states, Medigap subsidies are available to low-income seniors.  But insurance companies receive no general subsidy from Medicare on  Medigap policies. That is, Medigap rates are intended to cover the full cost of the program to the insurance company as well as provide a profit.

 

(Americans living overseas aren't eligible for a Medigap policy.)

[Jingthing]

In the sparse vague information trump has provided about his backing off on really killing Obamacare, I've heard nothing about the question of subsidies, which most people using the program get and need.

 

So far I'm hearing this, and it doesn't even begin to add up to anything possible:

 

Preexisting condition allowance continued.

Current Obamacare there is no extra charge for high risk.

trump doesn't say for his plan. Which let's face it, he doesn't have yet.

 

Children up to 26 covered under parents plan. trump wants to keep.

 

No import of meds from abroad competition, which I'm pretty sure but not certain he said he wanted to do in campaign.

As we all know, cost of meds in the U.S. is the highest in the world by far.

 

trump says -- mandate gone

trump says -- penalty for non-insurance gone

 

How does that work? Answer. It can't.

 

 

Much more in the link:

http://money.cnn.com/2016/11/11/news/obamacare-ezekiel-emanuel-interview/index.html

 

trump made no mention of the "high risk pool" mentioned in the video in his recent announcements of backing off killing Obamacare.

 

Bottom line, still very early, we know very little, trump changes his mind radically quite a lot. Probably something very different will be said later, and again and again like that until we really know.

Edited November 14, 2016 by Jingthing

[Jingthing]

1 hour ago, NeverSure said:

 

Medicare is far from single payer. I have to pay $104 per month for almost nothing, and then pay another $162 per month to a private insurance company for "Part F" which is "Medigap". Medigap is one step up from part C which is called Medicare Advantage. The government subsidizes my Part F to the insurance company. F is real health insurance and I have no deductibles or co-pays ever. 

 

I pay about another $30 per month to another private company for RX. It is also subsidized by the government. Obviously without the subsidies my premiums would be far higher.

 

I agree that Medicare is a sacred cow that can't be messed with if it would disadvantage seniors. Washington DC would burn to the ground.

 

The OP is about Obamacare. Obamacare was always going to be a disaster and must be fixed or replaced. I haven't seen anything specific about what will be done.

 

Cheers.

Correction.

 

The title of this topic is this:

 

USA topic -- coming changes to Obamacare/Medicare/Medicaid under new president

 

This topic DOES include Medicare in the event that there are changes proposed to Medicare during the trump presidency. As mentioned, in the OP, Paul Ryan wants such changes, and some recent language by trump hints that he may eventually be open to it.

 

As with all of this, still early, we'll be watching and reacting as new information becomes available. 

Edited November 14, 2016 by Jingthing

[WaywardWind]

2 hours ago, NeverSure said:

 

Medicare is far from single payer. I have to pay $104 per month for almost nothing, and then pay another $162 per month to a private insurance company for "Part F" which is "Medigap". Medigap is one step up from part C which is called Medicare Advantage. The government subsidizes my Part F to the insurance company. F is real health insurance and I have no deductibles or co-pays ever. 

 

I pay about another $30 per month to another private company for RX. It is also subsidized by the government. Obviously without the subsidies my premiums would be far higher.

 

I agree that Medicare is a sacred cow that can't be messed with if it would disadvantage seniors. Washington DC would burn to the ground.

 

The OP is about Obamacare. Obamacare was always going to be a disaster and must be fixed or replaced. I haven't seen anything specific about what will be done.

 

Cheers.

Every single aspect that you write about is your choice, with the exception of Part A which is free, and Part B if you haven't opted out.

 

Part A, the hospitalization insurance, is the component which is designed to prevent catastrophic financial results in the event of a serious and/or chronic illness or injury, and that is the part that would be covered in a single payer system.

[elgordo38]

On 11/13/2016 at 4:20 AM, ClutchClark said:

This has the potential to be an excellent thread over the coming months (and years).

 

Nice work JT. 

 

I hope the contributions can avoid the political aspects.

 

Here is arecent Forbes article describing Ryan's "hatchet" agenda. All seniors should be wary of this guy. He is no friend to seniors and the last guy Trump should be working with.

 

http://www.forbes.com/sites/howardgleckman/2016/06/22/what-paul-ryans-latest-health-proposal-would-mean-for-seniors/#3446b8305f39

 

"House Speaker Paul Ryan’s proposed blueprint for health reform would make major changes in medical care for seniors, raising out-of-pocket costs for some and shifting others from traditional Medicare coverage to commercial insurance. "

 

 

 

 

 

 

 

 

Just start again from day one and accumulate another huge startup cost. The downsizing or doing away with it will also cost. Mr. Taxpayer make my day reach for your wallet. 

[Jingthing]

An insider I know in health care told me when Obamacare started that it would ruin her professional life. It didn't. The same person tells me now politics aside Obamacare is now too ingrained to kill. Well I think we do know trump could have killed it if he wants but now he's backtracking and offering us a mess of word salad that can't possibly work. You can't keep the preexisting condition thing and no mandate yet that's what he's saying now. So either he has a radical plan that he won't talk about openly for political reasons or he has no real replacement plan and is stalling. I assume the latter but time will tell.

[SpokaneAl]

16 hours ago, Dtrump said:

Old guys just go home and get covered by medicare Part A don't they? 

American citizens who have made sufficient contributions are entitled to the following:

Part A: Hospital insurance free of any monthly premium.

In general, Part A covers: 

• Hospital care
• Skilled nursing facility care
• Nursing home care (as long as custodial care isn't the only care you need)
• Hospice
• Home health services

https://www.medicare.gov/what-medicare-covers/part-a/what-part-a-covers.html

Those items you listed often have dollar and/or time limitations. As workers we paid for part a during our working life. However, there are major holes in part a that are normally fixed via part b, c, d, etc which, of course have additional monthly premiums.  One's medical issues usually play a big part in determining which additional Medicare parts one purchases.

 

And of course all this is pretty much moot for expats outside the US.

[Jingthing]

OK, I need to pipe in here.

This isn't about advice for using status quo Medicare.

The only relevant thing about Medicare on THIS thread is about any talk or actions (IF ANY) that might happen as trump becomes president and has to cooperate with Ryan, who is on long record favoring dismantling all new deal FDR programs including Medicare. If there is no talk and no action about that in future, then in that case Medicare changes won't be relevant here.

 

If people want to talk about issues with status quo Medicare (yes, I know, it's quite complicated) I suggest starting a separate thread for that. I'm sure there would be interest in that.

 

Cheers. 

Edited November 15, 2016 by Jingthing

[mania]

40 minutes ago, Jingthing said:

An insider I know in health care told me when Obamacare started that it would ruin her professional life. It didn't. The same person tells me now politics aside Obamacare is now too ingrained to kill. Well I think we do know trump could have killed it if he wants but now he's backtracking and offering us a mess of word salad that can't possibly work. You can't keep the preexisting condition thing and no mandate yet that's what he's saying now. So either he has a radical plan that he won't talk about openly for political reasons or he has no real replacement plan and is stalling. I assume the latter but time will tell.

Political rhetoric

he said...she said....

zero facts and links

[SpokaneAl]

38 minutes ago, Jingthing said:

An insider I know in health care told me when Obamacare started that it would ruin her professional life. It didn't. The same person tells me now politics aside Obamacare is now too ingrained to kill. Well I think we do know trump could have killed it if he wants but now he's backtracking and offering us a mess of word salad that can't possibly work. You can't keep the preexisting condition thing and no mandate yet that's what he's saying now. So either he has a radical plan that he won't talk about openly for political reasons or he has no real replacement plan and is stalling. I assume the latter but time will tell.

One of the major challenges in replacing Obamacare is paying for those pre-existing conditions. Obamacare was counting on plenty of healthy people signing up and that has just not happened. The healthy, especially the young healthy, are willing to roll the dice and use that money for other, fun stuff, and as a result Obamacare digs itself deeper and deeper as only those who need the coverage and medical care are signing up and insurance companies are bailing from the money loosing proposition.

[Jingthing]

7 minutes ago, SpokaneAl said:

One of the major challenges in replacing Obamacare is paying for those pre-existing conditions. Obamacare was counting on plenty of healthy people signing up and that has just not happened. The healthy, especially the young healthy, are willing to roll the dice and use that money for other, fun stuff, and as a result Obamacare digs itself deeper and deeper as only those who need the coverage and medical care are signing up and insurance companies are bailing from the money loosing proposition.

That is correct. The original REPUBLICAN plan which Obama copied (it could have been called Nixoncare or Romneycare) dealt with that by having MANDATES with penalties for non-compliance. That hasn't worked well enough (so are you going to blame Nixon for that?) for multiple reasons. Possibly because the penalties are not nearly harsh enough. I'm not saying I support this structure, that's not the point, though I never did, I've always thought the only solution for both full access and extreme cost control is a nationalized system paid as any nationalized program through taxation.