USA topic -- Expat specific issues regarding repeal and replace of Obamacare

[Jingthing]

THIS IS NOT A POLITICAL DEBATE THREAD!

 

OK, it happened, the republicans have released a rough sketch of their repeal and replacement plan for ACA (Obamacare). 

This thread is started to discuss the very specific aspects of this new plan that impact EXPATS and REPATRIATING EXPATS.

ONLY THAT.

 

This new plan is just a starting position and nobody knows yet what the final result will be. However, it's safe to assume there is a high probability that ACA will be at least adjusted significantly and rebranded. 

 

I've been following this closely and can suggest some areas that seem to be of potential impact to expats.

 

This is a thread in progress, as final details emerge about these changes. Nobody knows how long that will take.

 

I will outline some things I have identified as EXPAT SPECIFIC issues:

 

MANDATE and PENALTIES

The mandate will probably go away along with IRS penalties for not having insurance. Bona fide expats were already excluded from this but many Americans living abroad spend significant amount of time in the U.S. anyway and they were not exempt. Figuring that all can be a hassle for expats, so that change will likely be welcome to expats as long as they stay expats.

 

ACA SUBSIDIES vs. REFUNDABLE TAX CREDITS

The ACA replacement plan seems determined to do away with the subsidies based on income that has made buying coverage affordable for lower income Americans that make enough to be in the cutoff to be eligible for ACA subsidies. That will likely be gone.

The replacement likely will be refundable tax credits based on age, not income. The refundable part of that is interesting. That means even if you don't owe taxes, you still get a check from the IRS.  Higher income will be stepped down from tax credits. There is an internal republican debate about regular tax credits vs. REFUNDABLE tax credits. Obviously refundable tax credits will be much better for lower income Americans. 

Expat impact?

Well, I will assume that expats abroad not buying U.S. health insurance will be ineligible from the tax credits.

 

RETURNING EXPATS CONCERNS

If you're repatriating to the U.S. and entering a job with employer paid health insurance ... NO CHANGE.

If you're over 65 returning to the U.S. you are eligible for MEDICARE  and don't need to worry about the ACA replacement ... NO CHANGE

If you're under 65 and very wealthy, well then you don't have to worry because you can afford retail health insurance even without tax credits.

If you're returning to the U.S. in dire poverty, you may be eligible Medicaid. Medicaid will likely be done based on state grants and objective analyses suggest the benefits will be less generous.

Even in dire poverty, there is no guarantee you will be eligible for Medicaid in your new U.S. state. Those rules vary. Assets are generally looked at. 

If you were eligible before for EXPANDED MEDICAID (only now in some states) which is designed for those above dire poverty and below the minimum cutoff for current ACA subsidies, there is a fair chance that program will continue but only temporarily. It will probably be phased out. I don't know if new people will be able to enroll after the ACA replacement passes. That is very relevant to returning expats in that economic level. Open question. If returning expats could benefit from Expanded Medicaid even for a few years, it will be important to know if that is possible, as far as choosing which states to return to. If new enrollments in Expanded Medicaid are stopped, then the choice of state would be irrelevant. 

Age -- ACA gave a break to older Americans and a hit to younger Americans, not pricing the insurance as high as usage indicated. 

That is going away. 

Which means insurance if you have to pay for it even with increased TAX CREDITS for older people under 65 will be higher than now. 

So returning expats especially older ones that will need to buy insurance may need to know if they can even afford to repatriate. 

Staying abroad may be the more rational economic choice.

 

PREEXISTING CONDITIONS (change to continuous coverage rules)

The current ACA policy on this will likely change. Instead of mandates/non-coverage penalties to the IRS, the new proposal says the insurance company will add a SURCHARGE of 30 percent for one year after starting a plan when there is a gap in coverage.

Considering older Americans already with high rates, add 30 percent, egads.

Now the OBVIOUS expat issue with this is will the new finalized law excuse returning expats from the surcharge.

Keep in mind it's not the government anymore in charge of this. It will be private for profit insurance companies.

This could be a very big deal for returning expats if the law does not FORCE the insurance companies to not charge the surcharge to returning expats.

If they don't do that (wouldn't count on it) the obvious question is whether the U.S. insurance companies would accept coverage abroad to avoid the surcharge. That would be good for expats that have coverage abroad, but again, I would not count on that. 

 

These are the EXPAT SPECIFIC issues that I can think of right away.

I'm sure there are others.

I'm sure as the changes progress to law this will all become clear, but I now think it is not too early to start discussing this stuff.

 

Please respect that this is NOT a political debate thread. There are always other threads for that in the World Forum. Also please refrain from personal insults about your fellow Americans who may be in a different economic situation than you. So please: RESPECT. 

 

http://www.sfgate.com/news/medical/article/House-GOP-releases-bill-replacing-Obama-health-10981377.php
 

Quote

 

House GOP releases bill replacing Obama health care overhaul

 

 

 

 

Edited March 7, 2017 by Jingthing

[beachproperty]

Sooooo........What is it you want to discuss?

 

Affordable care Act? no impact.

New law ? ...no impact.

 

No matter how much you write on the "good or bad" of the new law .....everyone's situation is DIFFERENT!

[Jingthing]

23 minutes ago, beachproperty said:

Sooooo........What is it you want to discuss?

 

Affordable care Act? no impact.

New law ? ...no impact.

 

No matter how much you write on the "good or bad" of the new law .....everyone's situation is DIFFERENT!

I totally agree.

Everyone's situation is different.

If you read the OP you would already realize that I have indicated specific groups that will not be impacted by the repeal and replace of ACA.

Such as those already over age 65.

What do I want to discuss?

That's all in the O.P. and I of course welcome any other suggestions that other people think of that may have expat and returning expat specific relevancy.

For those like you apparently where it is already clear that you think there will be no impact to you personally to the changes, well that's cool, so this topic doesn't interest you in a personal way.

But I assure you that it does others.

 

(BTW, if you think I have missed some other groups of Americans that don't need to worry about the changes such as over 65s, please mention those here as that might be helpful to others in those groups.)

 

If people want to talk about their personal situation especially as returning expats and how they think that these changes impact on them, that's welcome of course. So personal impact or more general impact both but please folks keep it in the realm of specific issues for expats and returning expats, not political debate about the law changes.

 

I do have a general concern that the lawmakers won't prioritize the expat specific issues that I already detailed and I reckon there are more that I haven't thought of. Such as excusing returning expats from the 12 month 30 percent surcharge. This is all stuff that at least is worth WATCHING for a lot of us. 

 

To add to the truth of the everyone's different theme, assuming some of these changes happen, there will be winners and losers economically speaking and getting coverage at all speaking. But those are more general political questions. Those kinds of things are only relevant here if they can be tied into the EXPAT (and returning expat) theme of this thread in a practical way. 

 

An example of that is something I already raised. The question of assuming expanded medicaid is temporarily kept in some states during a transition period, will returning expats be able to start NEW in that system, the ones that fall into the economic level of being eligible for that under ACA. 

 

While very little can be said definitely yet about these changes, starting now when we've finally got a rough idea of the initial change plan, can help people watch the progress of the changes towards law with an awareness of the EXPAT (and returning) SPECIFICS parts of it. 

 

Edited March 7, 2017 by Jingthing

[beachproperty]

I Still fail to see the relevance in my situation..... you apparently want to speak ad nauseam ...OK .....but for people in my situation its unnecessary ....leave it at that.

[Jingthing]

9 minutes ago, beachproperty said:

I Still fail to see the relevance in my situation..... you apparently want to speak ad nauseam ...OK .....but for people in my situation its unnecessary ....leave it at that.

Goodbye then.

 

A detail about the actual topic. The initial proposal is saying that expanded Medicaid (in the states it's offered) would be in effect until 2020 and then stopped. The question of enrolling after the new law takes effect or not still unknown. Of course none of this is definite yet. Just the beginning as far as specific details are concerned. 

 

To repeat the returning expat aspect of that, if you plan on returning before 2020 and you would be eligible for expanded Medicaid, knowing whether or not new enrollments will be allowed could impact your choice of STATES to move to as not all states ever offered it. 

Edited March 7, 2017 by Jingthing

[lannarebirth]

I think the new law as proposed is poorly conceived. I thought the same about the ACA. The new law saves my family $7,500/ year, if our premiums don't go down, which I expect they will, saving us even more.

[beachproperty]

42 minutes ago, lannarebirth said:

I think the new law as proposed is poorly conceived. I thought the same about the ACA. The new law saves my family $7,500/ year, if our premiums don't go down, which I expect they will, saving us even more.

I fail to see the relevance...you think its poorly conceived  .....Yet ....You saved $7500/yr and you expect to save MORE! What's the problem?

Edited March 7, 2017 by beachproperty

[Jingthing]

This thread is specifically LIMITED to how the probable changes to ACA will impact some EXPATS and some RETURNING expats.

It is not a general discussion of the law.

It is not a political debate thread.

Please respect the well defined LIMITATIONS of this topic and for more general political debate on the law changes please post in one of the many ACA related topics on the WORLD FORUM. 

Current USA expats (with no plans to expatriate) may no doubt may be impacted by the changes to the ACA. But those potential impacts are not EXPAT or RETURNING EXPAT specific issues. 

 

There can be exceptions to this when information about the GENERAL law changes can be clearly CONNECTED to the expat relevancy. For example, if we learn that no new people will be able to enroll in expanded Medicaid, that is relevant to the expat aspect as returning expats are a subset of ALL people. 

 

This is an EXPAT forum and this is an EXPAT topic. No doubt there are thousands of forums in the U.S. for U.S. residents to discuss and politically debate these general issues (including here on the WORLD FORUM). 

 

If there aren't any or many people that feel this topic as defined (LIMITED) resonates for them enough to post ON TOPIC, that is fine. Then the thread will die a natural death. But I want people to give it a chance to be about what it is about. SEE THE O.P. for guidance. 

Edited March 7, 2017 by Jingthing

[lannarebirth]

11 minutes ago, beachproperty said:

I fail to see the relevance...you think its poorly conceived  .....Yet ....You saved $7500/yr and you expect to save MORE! What's the problem?

 

I think it is bad for society. I also think it is being paid for in the wrong manner. I don't see any relationship at all between a person's income, or lack of it, and the type of healthcare they should expect in a healthy society.

Edited March 7, 2017 by lannarebirth

[Jingthing]

This is NOT a political debate thread. 

I suppose I need to be more explicit now.

It can not be a political debate thread.

It is not allowed for members to start political debate threads on this HOME COUNTRY forum.

I did not start one but if members insist on trying to hijack this thread by insisting on making it a political debate thread, the potential PRACTICAL value this thread may have for real life issues for expats and returning expats will be over as the thread will be toast.

Clear enough now?

Edited March 7, 2017 by Jingthing

[CaptHaddock]

I don't see how they get 60 votes in the Senate to pass any bill overturning the ACA.  They can make some changes in budget reconciliation, but not the whole hog.

[Jingthing]

7 hours ago, CaptHaddock said:

I don't see how they get 60 votes in the Senate to pass any bill overturning the ACA.  They can make some changes in budget reconciliation, but not the whole hog.

That is unknowable at this point.

The premise of THIS thread is that the new president ran on a clear agenda of repealing the ACA along with promises to change it to something else.

Yesterday we got a lot of details of what that "something else" is intended to be. 

All I'm trying to do here is to frame any potential changes with the specific perspective of EXPATS and RETURNING EXPATS concerns in mind.

This is a perspective you're not going to find in the USA media for obvious reasons.

Obviously, this would be more "real" if we had the language of any final LAWS that may result of all this.

But we don't so the only source material we have now are the earlier stage proposals. 

I thought that was enough material to at least get started with framing the expat and returning expat specific concerns, including defining parts that are obviously not expat or returning expat specific concerns.

A good chance I was wrong, and this is too early, in which case the concept of this topic may just fizzle until we get some more final details (which might take months or years) and/or specific expat personal cases that people share that shed more light on these issues. 

Edited March 8, 2017 by Jingthing

[beachproperty]

Jingthing.......What you are asking us to do is speculate as the

unknown law (not passed) and what unknown effect it may have on us Expat's. Think it's best to just let this thread "fizzle" as you put it.

 

POST CLOSED

Edited March 8, 2017 by beachproperty

[Jingthing]

Just now, beachproperty said:

Jingthing.......What you are asking us to do is speculate as the an unknown law (not passed) and what unknown effect it may have on us Expat's. Think it's best to just let this thread "fizzle" as you put it.

 

POST CLOSED

It's weird to me how emotionally engaged you are in heckling aggressively on this thread when you've made it crystal clear that none of the potential changes can possibly impact on you personally. Then you fail to tell us why. For example, if you're over 65, then that would be why, but you don't bother, you just come back to make hostile noise, as if the very idea of this thread concept offends you.

Yes, let it be.

If the actual topic speaks to nobody especially this early, that is fine.

I've already said as much. 

 

[partington]

2 hours ago, beachproperty said:

Jingthing.......What you are asking us to do is speculate as the

unknown law (not passed) and what unknown effect it may have on us Expat's. Think it's best to just let this thread "fizzle" as you put it.

 

POST CLOSED

He's not asking you to do anything. If you don't like the topic stay away from it. What kind of delusional entitlement makes you feel you can keep returning to a topic that you have already declared doesn't interest you, and ask people to stop posting in it?

 

What is forcing you to keep clicking on it?  It just makes you seem slightly crazed.

[beachproperty]

16 minutes ago, partington said:

He's not asking you to do anything. If you don't like the topic stay away from it. What kind of delusional entitlement makes you feel you can keep returning to a topic that you have already declared doesn't interest you, and ask people to stop posting in it?

 

What is forcing you to keep clicking on it?  It just makes you seem slightly crazed.

Well I will not make this about me as you have and I believe Jingthing can speak for himself ....but its about some unpassed bill and since its upassed it's consequences are known.....NO EFFECT! NIL!

Edited March 8, 2017 by beachproperty

[Jingthing]

Here's something on topic. Currently under ACA insurance companies are allowed to charge older people. (under. 65) three times as much as young adults. Under the proposed ACHA they will be allowed to charge five times as much. I think this is expat relevant because a large portion of expats are older so for those that have been abroad a long time there was already going to be a big price shock if repatriating but this would mean a much bigger one. Add the 30 percent possible surcharge to that and you'd get a price perhaps most people couldn't really afford.

[Jingthing]

Here is a very clear graphical presentation comparing the current ACA to the proposed details of the GOP plan. It's the clearest explanation I've seen yet. Definitely worth a look to anyone interested in what's going on now in D.C. on health care:

 

How the House Republicans’ proposed Obamacare replacement compares

On Monday, House leaders released legislation to replace the Affordable Care Act. If it passes, here’s what would change.

https://www.washingtonpost.com/graphics/politics/how-aca-replacement-compares/

 

In reference to the article, I had wondered before in the current proposed GOP plan whether if you could be a new enrollment in EXPANDED Medicaid (in the states that offer it) after the law is passed, as it would be phased out.

According to the language in the link, it sounds like you would be able to.

That would be of interest to returning expats after the GOP passes who are eligible to expanded Medicaid, moving to an Expanded Medicaid state,  as they obviously wouldn't currently be in the program because of living abroad.

Expanded Medicaid is only for low income people in between homeless style level poverty and the lower level of the ACA subsidy level kick in, which under the GOP plan would go away.

 

This stuff is not simple!

Quote

 

Under the GOP plans, the states would continue getting enhanced federal funding until 2020. After that, the government would keep paying 90 percent for beneficiaries already on the rolls as long as they remain eligible.

After 2020, new beneficiaries would be funded at a lower level.

 

 

As I discovered previously, IRA withdrawals are counted as income for purposes of figuring eligibility (or not) for expanded Medicaid or ACA subsidies (going away). 

 

So if you make over the level for expanded Medicaid even just a little bit, under the GOP plan, you'd be kicked into the regular market, which would only be "subsidized" by refundable tax credits that are definitely going to be less subsidy that current ACA subsidies at lower income levels. 

Edited March 8, 2017 by Jingthing

[oldcarguy]

it does not change the high cost of healthcare at the Hospital level ,

 

$2000-$4000  tax credit is not going to be enough for most poor or middle class families

 

and it is just going to put more of the costs on the States , who do not have the $$$$

 

We need  a good system to keep  poor people healthy so the rest of use do not get sick from them ,

 

and then if they go after Medicare it will  get worse,

 

like everything there is a middle ground , I hope they find it ,

 

one way is to allow doctors from other countries into the USA to earn a green card by working in the poor areas 2-3 years,

something like a Medical Peace Corp

[Jingthing]

Of course, there is more cost to the consumer than only the insurance, if people can even afford the insurance with tax credits which in many cases under the GOP plan is going to be less or much less than the current ACA subsidies. 

 

Connecting it to the expat angle on this thread, it seems to me both the not ideal ACA status quo and the coming GOP plan of some kind are likely to be major influences in expatriation and repatriation decisions for many Americans.

 

In other words, I think more Americans are going to expatriate for access to more affordable health care even paying retail with no insurance and many Americans currently living abroad are going to either delay or forget about repatriation influenced by health care access and costs. 

 

Obviously, back to the OP, it depends on many personal factors, so this situation impacts some Americans massively, and some not at all. 

Edited March 8, 2017 by Jingthing

[lannarebirth]

2 hours ago, oldcarguy said:

it does not change the high cost of healthcare at the Hospital level ,

 

$2000-$4000  tax credit is not going to be enough for most poor or middle class families

 

and it is just going to put more of the costs on the States , who do not have the $$$$

 

We need  a good system to keep  poor people healthy so the rest of use do not get sick from them ,

 

and then if they go after Medicare it will  get worse,

 

like everything there is a middle ground , I hope they find it ,

 

one way is to allow doctors from other countries into the USA to earn a green card by working in the poor areas 2-3 years,

something like a Medical Peace Corp

 

I don't think there is a middle ground. If I had my way, absolutely no one, including the poor and the old would get subsidized healthcare, unless it was available to everyone. That's how you create unity. Not by creating a system of winners and losers.

[Jingthing]

A general thing that may be too obvious to state, but that's never stopped me before.

 

The consensus analysis of the GOP plan(s) vs. ACA is that many millions of people currently on ACA (or Medicaid) are going to lose their health insurance. 

 

The clear consensus is that the GOP plan(s) are about potential "access" rather than any kind of ideological government decree that all Americans should have health coverage. 

 

So I assume it follows that among returning expats that aren't in the "safe" classes such as having a U.S. job that provides insurance, over 65, etc. that a higher percentage than before will not be able have insurance upon their return. 

 

A news blip I just heard is a proposal that some states should be able to keep ACA if they choose. Not just expanded Medicaid but ACA.

 

Personally, and I'm sure there are millions of others, ACA would work better for me than the proposed GOP plan so in the (unlikely perhaps) event that some states are allowed to keep ACA, then that's an expat angle as then you could choose your target state based on that difference. 

Edited March 8, 2017 by Jingthing

[oldcarguy]

46 minutes ago, lannarebirth said:

 

I don't think there is a middle ground. If I had my way, absolutely no one, including the poor and the old would get subsidized healthcare, unless it was available to everyone. That's how you create unity. Not by creating a system of winners and losers.

or give everyone the same plans as Federal workers.......

[Jingthing]

7 minutes ago, oldcarguy said:

or give everyone the same plans as Federal workers.......

People that post here, please at least TRY to explain why your post has anything to do with the focus of this thread ... expat and potential returning expat specific concerns about ACA changes.

More general political debate fits in the multiple NEWS threads always running in the WORLD NEWS forum. 

That said, I think I can do that for you in this case.

IF the USA went with a Canadian style universal system, I think it's obvious that fewer people would expatriate in the first place for health care access and cost reasons, and more expat Americans would find repatriating more attractive than before. 

Edited March 8, 2017 by Jingthing

[sirineou]

All economics can be expressed in the following sentence.

There is no such thing as a free lunch.

Health insurance has to be paid by either the consumer, the government , the insurance company or a combinations of all three.

Conservatives  want to decrease the role the government plays in this combination . The insurance companies are pulling out of markets because they say they are not making enough or are loosing money and since the Government will not subsidize the short fall , it is only inevitable that the Consumer will pay more.

 Personal I have the following question how does tax credits help someone who has a low enough income and does not pay tax, lets say some one who got sick and as a result his or hers income is reduced below the taxable level?

[partington]

Deleted - sorry not a political thread but a practical one, so my comment off topic.

Edited March 9, 2017 by partington

[Jingthing]

Moving target here so I've got some updates and clarified information.

 

First of all, as far as this thread is concerned there are some implicit basic assumptions. 

 

-- Probably there is going to be some kind "Repeal and Replace" GOP plan passed this year.

 

-- Probably it is going to have some or more likely a lot of the already published specific details in the initial bill.  (Though obviously not 100 percent the same.)

 

-- The president will sign it.

 

-- If all that blows up which is of course possible, then we'll be in a different situation at least for awhile. ACA status quo under a government that is not working to make it work.  (In which case, this particular thread will become obsolete, at least for awhile.)

 

Moving on, I've got some rather surprising updated clarification.

 

As I already stated the TAX CREDITS which are for people that don't get insurance via employer, Medicaid, or Medicare, which will by proposal increase with age bracket are what are called REFUNDABLE tax credits.

 

This is a big deal. The REFUNDABLE part. What it means is that if you owe 2,000 at tax time and your tax credit is 2,000 you then owe no taxes. But the REFUNDABLE part means that if owe 2,000 at tax time and your tax credit is 2,000 the IRS sends you a check for 2,000.

 

But wait, there's more. A big WOW for the expat angle.

 

This refundable tax credit (used for offsetting actual tax liability or as a check if the credit is above the tax liability) applies even if you don't purchase health insurance!

 

That kind of shocked me when I heard about it but I think I've got that right now.

 

This gets weird. So you're an expat living abroad, buying non U.S. insurance or not. Does that mean you would also get an IRS tax credit (or actual check) as well?  Well, if there isn't any language in the final bill cutting expats from the refundable tax credits, then the answer would probably be yes. But hey, don't count on that one yet!

 

This isn't the place to debate the logic of any of this (that's politics). Just updating the information.

 

There is a faction that does not want any tax credits (which by design replace the ACA SUBSIDIES) or if tax credits, they don't want refundable tax credits.

So major changes like that are possible at this stage.

 

On the question of expanded Medicaid being continued to 2020 under the proposed first draft bill, now there is a congressional faction that is pushing for that to be shortened to 2018.

 

That is expat relevant if you would be repatriating to a Medicaid expansion state and hoped to use the expanded Medicaid as a temporary bridge to something else, like employer coverage or Medicare when aged into it. That bridge would be much shorter if changed to 2018.

 

Another detail, I read it is still possible for some states to drop expanded Medicaid, so I'm assuming there won't be any new states adopting it during the bridge period. That might be expat relevant when choosing a state to move to. 

States controlled by republicans (such as Arizona) would logically be more likely to drop it even during the bridge period than solid "blue" states like Massachusetts.

 

I have another expat related conclusion that I think I can already make.

 

If you are a younger expat (say 20s or 30s) and plan to repatriate and you're healthy and you don't have a job lined up back in the U.S., if the GOP health plan is proposed as passed, you will be in an OK place. Why? Well, the GOP plan intends to allow insurers to offer "bare bones" plans that don't offer very much but are cheaper that make sense to younger, healthier people. Also under the current plan there will no penalty for not purchasing insurance right away, you'll still be getting those refundable tax credits even if you don't, and should you get sick and really need the insurance, you can then sign up and pay a 30 percent surcharge for one year on your new plan. It is already predicted that under the new plan many healthy young Americans will do that anyway, not buy it, take the credit, buy it later if you need it and take the surcharge hit, so by repatriating in that class (younger and healthy) you'd just be another person in that pool of other younger healthy Americans that never left home.

 

To add for the younger people, under the GOP plan children up to age 26 can be included on their parent's plan. 

Edited March 9, 2017 by Jingthing

[Jingthing]

Small update on this. 

 

It was strongly communicated by the white house that the 2020 date for phasing out expanded Medicaid is not negotiable. There is a faction pushing to end it earlier, 2018, but based on the news today, that won't happen.

 

Expat relevance as before, for some repatriating expats to some U.S. states, if they're eligible for expanded Medicaid they might at least be able to use it as a temporary bridge, with the cutoff date probably 2020.

The general consensus in the news about the group hit most hard financially by the proposed changes:

 

Older (age 60 up to 65)

Health problems

Low Income / Poor

Living in Rural Areas 

 

Expat relevance, if you're in that group, consider not repatriating if you can avoid it, or if you do, consider not moving to a rural area. 

Edited March 10, 2017 by Jingthing

[Jingthing]

As was predicted by some, this initial health bill most likely isn't going anywhere towards being made law without some very major changes.

So I suppose the topic here may best be on hold until that happens, or whatever happens. Months or years away perhaps.

I still think they'll probably pass something eventually, will repeal, and tax credits will replace ACA subsidies, but things are  just too half baked now to provide any meaningful practical advice regarding the focus of this thread, expats and especially potential returning expats. 

Edited March 15, 2017 by Jingthing

[gk10002000]

For the last 15 years I was a contract engineer and I had  Florida Blue Cross. I have no chronic ailments and I had a very cheap with a fairly high deductible plan but low premiums that met all my needs.  I don't give a darn about paying 10K every now and then if I had some injury.  All I wanted was the 1 Million big ticket coverage.  A few years ago Obamacare came along, and while my Fl BC BS plan was "grandfathered, and I could and did keep it and I did not have to deal with the Government exchanges, my premiums started going up 28% every year, and in the last year went up 35%.  Had I gone through the exchange, my premiums would have been almost $500 a month, and this is for a single person, non smoker with zero conditions!  This was a big factor in my taking a direct salary job with one of the big Aerospace firms.  Now at work I pay $94/month and I am quite happy with that.  I have no idea what things will be like out there for people that are not covered by their employer's plan.  I had a good deal as an independent but Obamacare made it an almost unworkable deal.  I am still peeved that the US Supreme Court did not rule against the ACA.  What right does the government have to tell me what type of insurance I or anybody else should have?  What's next, mandatory insurance for your pet?