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

[beachproperty]

41 minutes ago, Jingthing said:

Well, the current repeal and replace effort is not addressing changes to Medicare but of course Medicare isn't useful abroad.

However, as I mentioned, the proposed Medicaid cuts have an big impact on people over 65 as well because of funding for nursing home and long term home care.

I realize most people don't think about such depressing things until they or a relative needs them. But it's real. 

Medicaid is a no cost program for the POOR and it is run by the States within Federal guidelines.

Sooo.....Either program is no good for those abroad!

Real or not, nothing is written in stone at this point.....These are just ideas at this stage. Really don't see the point why you want to pontificate so Much on a subject wherein nothings been done so far.

 

[Jingthing]

6 minutes ago, beachproperty said:

Medicaid is a no cost program for the POOR and it is run by the States within Federal guidelines.

Sooo.....Either program is no good for those abroad!

 

Yes, of course, Medicaid, like Medicare can't be used while abroad.

I don't think I have EVER said it could be!

I was referring to issues that people REPATRIATING might experience with proposed changes in Medicaid, even for those past Medicare age (nursing homes/home health care). 

People may be wealthy enough at 65 but if they live very long and get sick the funds can easily melt away, so needing Medicaid assistance for long term nursing care for the elderly is very, very common. 

[beachproperty]

15 minutes ago, Jingthing said:

Yes, of course, Medicaid, like Medicare can't be used while abroad.

I don't think I have EVER said it could be!

I was referring to issues that people REPATRIATING might experience with proposed changes in Medicaid, even for those past Medicare age (nursing homes/home health care). 

People may be wealthy enough at 65 but if they live very long and get sick the funds can easily melt away, so needing Medicaid assistance for long term nursing care for the elderly is very, very common. 

I have a real problem with "might experience" and your pontificating as to what "might occur".

That's a lot of what if's, and maybe's.....Why don't you just wait till something is passed, if anything, then start a new thread as to the "real" problems an expat WILL face if repatriating.

[Jingthing]

26 minutes ago, beachproperty said:

I have a real problem with "might experience" and your pontificating as to what "might occur".

That's a lot of what if's, and maybe's.....Why don't you just wait till something is passed, if anything, then start a new thread as to the "real" problems an expat WILL face if repatriating.

I'll break this down now -- what I mean by might in this specific context of Medicaid for nursing care.

 

IF the ACA repeal and replace bill passes, there is in both the passed house version and the current senate version policies that will definitely impact negatively on Medicaid funding.

 

(They all agree to completely PHASE OUT expanded Medicaid.)

 

If you object to this point of this thread, which is clearly about a following a MOVING TARGET, I am sorry you feel that way, but the point of this thread is not to make everyone happy, but rather to attempt to cover this thing as it develops as explained in the O.P. 

 

So my answer to you is that I will continue to use the word MIGHT as these potential changes move along, and encourage others to use the word MIGHT if the word is useful for what they are trying to say. 

[beachproperty]

6 minutes ago, Jingthing said:

I'll break this down now -- what I mean by might in this specific context of Medicaid for nursing care.

 

IF the ACA repeal and replace bill passes, there is in both the passed house version and the current senate version policies that will definitely impact on Medicaid funding.

 

If you object to this point of this thread, which is clearly about a following a MOVING TARGET, I am sorry about that.

 

So my answer to you is that I will continue to use the word MIGHT as these potential changes move along, and encourage others to use the word MIGHT if the word is useful for what they are trying to say. 

A "MOVING TARGET" is the only thing in this thread which is TRUE so far.

[Jingthing]

3 minutes ago, beachproperty said:

A "MOVING TARGET" is the only thing in this thread which is TRUE so far.

I don't agree with that at all. You are welcome to post here on topic but not if your intention is a transparent hostile attempt to get the thread closed. 

Again, if you want a political debate, please post in the WORLD NEW forum.

Stating facts as I have  such as that all versions of the proposed republican health care changes include completely phasing out expanded Medicaid are fully verifiable FACTS. Yes, it is unknown whether they will pass anything, but it is very possible that they will, and some people are interested in following this MOVING TARGET.

If you're not, then please ignore this thread. 

[Jingthing]

On the topic of Medicaid's use for elder nursing care, this article covers the current situation. So that's the baseline.

If the republican bill passes, both the house and senate versions still include funding changes that would negatively impact on this baseline. 

It will depend on states. The federal government (proposed) will be lowering spending so that the states can choose to cover the difference, or not. Based on the history of expanded Medicaid, it's completely predictable that some states will and some states won't.

 

https://money.usnews.com/money/personal-finance/articles/2016-06-09/what-to-consider-if-you-may-depend-on-medicaid-for-nursing-care

[beachproperty]

It is NOT my intention to have this thread closed (although that might be a good thing) but to keep you "honest" and to let other readers know that no bill has passed (perhaps never will).

[Luckysilk]

23 minutes ago, beachproperty said:

A "MOVING TARGET" is the only thing in this thread which is TRUE so far.

Seriously what a lame thread if, if, if and more if's, just another thread to bash the Donald.

 

It's spreading false information and fear and should be closed until there is FACT.

[Jingthing]

Just now, beachproperty said:

It is NOT my intention to have this thread closed (although that might be a good thing) but to keep you "honest" and to let other readers know that no bill has passed (perhaps never will).

So you say.

Sir, I've been crystal clear that no signed bill exists yet, and that possibly no such bill will ever happen.

If you are making false charges like that, it indicates you haven't even read the thread, and are indeed here only to disrupt it in a destructive way.

Back to facts.

A bill has passed the house.

A bill is actively been worked on in the Senate.

We're at a critical phase now in the Senate.

If they pass something soon, it's reasonable to predict the reconciliated version will end up as signed law.

If they don't, the chances increase that repeal and replace will be dead, and they will move on to other matters such as taxation. 

But even if repeal and replace is "dead" that would leave the big question about whether the republican party in control starts to SUPPORT the existing law, ACA, with necessary fixes.

So the "dead" case may not really mean completely dead. 

[Jingthing]

8 minutes ago, Luckysilk said:

Seriously what a lame thread if, if, if and more if's, just another thread to bash the Donald.

 

It's spreading false information and fear and should be closed until there is FACT.

Sir, if you think any false information has been posted, you are welcome to post about that in a specific way. 

But this is not a political debate thread.

Certain things are facts.

As I stated, a good example, both the passed house version and the current version of not yet passed senate version both include a clear path to completely phase out expanded Medicaid.

For people that don't understand how U.S. law works, to say the house version has "passed" of course does not mean it is yet law, or will ever be law.

We're in a PROCESS now.

 

-- House passed their version

-- Senate working on their version

-- IF senate passes their version, goes to conference between house and senate

-- That final version of the bill goes to the president's desk, which in this case, it is predictable he will sign because he has said publicly many times that he will. 

 

If senate doesn't pass their version.

Then the health care issue doesn't go away. 

But it means it won't be addressed anytime soon (or ever) via an ACA repeal and replace effort. 

 

[beachproperty]

2 minutes ago, Jingthing said:

So you say.

Sir, I've been crystal clear that no signed bill exists yet, and that possibly no such bill will ever happen.

If you are making false charges like that, it indicates you haven't even read the thread, and are indeed here only to disrupt it in a destructive way.

Back to facts.

A bill has passed the house.

A bill is actively been worked on in the Senate.

We're at a critical phase now in the Senate.

If they pass something soon, it's reasonable to predict the reconciliated version will end up as signed law.

If they don't, the chances increase that repeal and replace will be dead, and they will move on to other matters such as taxation. 

But even if repeal and replace is "dead" that would leave the big question about whether the republican party in control starts to SUPPORT the existing law, ACA, with necessary fixes.

So the "dead" case may not really mean completely dead. 

Soooo......why not wait and see

Instead over 100 posts, most by you pontificating as to what if, maybe and so on.

I believe that it is best to wait THEN you can tell us what the SPECIFIC impact is on expats repatriating.

[Jingthing]

8 minutes ago, beachproperty said:

Soooo......why not wait and see

Instead over 100 posts, most by you pontificating as to what if, maybe and so on.

I believe that it is best to wait THEN you can tell us what the SPECIFIC impact is on expats repatriating.

I want to follow it as the process develops. That is why. If other people do too, then they are welcome to participate in good faith on this thread.

 

If you're not, you're very welcome to ignore this thread. Thank you! 

 

I fully understand that the U.S. health care debate is a very politically charged controversy now. That's why there are ALWAYS active threads on the WORLD NEWS FORUM that fully welcome impassioned political debate on these issues.

 

But not here. 

[Luckysilk]

21 minutes ago, beachproperty said:

Soooo......why not wait and see

Instead over 100 posts, most by you pontificating as to what if, maybe and so on.

I believe that it is best to wait THEN you can tell us what the SPECIFIC impact is on expats repatriating.

Absolutely wait and see, no one will read xxx pages of drivel "if" and once changes may or may not happen. 

 

Nothing here of value. 

[Jingthing]

5 minutes ago, Luckysilk said:

Absolutely wait and see, no one will read xxx pages of drivel "if" and once changes may or may not happen. 

 

Nothing here of value. 

If you think there is nothing here of value, surely it's not worth your time to continue to post on this "worthless" thread.

If you think it's worthless, please just ignore it.

If nobody else thinks it has any value, then nobody will read it.

[Jingthing]

Quick update.

The Senate released a version of their bill.

The general feeling is DOA, not quite enough votes.

Now a surprise. There is an alternative Senate version bill now from two senators. 

Don't know yet what's different about this newer plan but right now as the first released thing is DOA, that's were it's at now.

Keep in mind the number of votes needed to switch to get anything through is very few.

So just because this released version is DOA doesn't at all mean the Senate's effort is DOA. 

[Jingthing]

Update on the update. 

The new senate current version is still DOA.

What I previously described as an alternative senate plan is actually about a detail with a possible amendment.

 

This chart is really good and FACT PACKED!

If they pass a bill based on the current work, it's going to something like this.

We really do know quite a lot by now (roughly) on how this is going to be IF they pass it --

 

https://www.washingtonpost.com/graphics/2017/politics/obamacare-senate-bill-compare/?utm_term=.48c606f7ec3f

 

 

"How they would pay for coverage

The federal health insurance subsidies that help most people with ACA marketplace plans afford their coverage would change. Health care would get substantially less affordable for most of these people, especially those who are poor, unhealthy or old, according to Linda Blumberg of the Urban Institute, Christine Eibner of Rand Corp. and Karen Pollitz of the Kaiser Family Foundation."

 

 

[Monomial]

So JT,

 

I was thinking about this. Trying to look at this factually and doing my best to stay away from anything political, perhaps you need to change your perspective. Too much emphasis is being placed on health care insurance. Who can get insured, who loses their insurance, etc. The simple fact is, based on the laws that are being considered, the optimal strategy may be a completely different approach.

 

My point being: You need a health care strategy in the USA, not health care insurance. For some people, this may be the same thing. But for others, perhaps not. Example, if you arrange it so you have nothing to lose in a bankruptcy, then paying out of pocket for small things and allowing yourself to default on a hospital bill in the event of a major problem is a valid plan.  So what happens when you do this? The hospital is forced to absorb the loss, it is forced back onto the paying customers, and those who do qualify for health insurance see their premiums rise.

 

But this is a hidden cost, and not overt from the government. It is a way of offering health services that appear to be acceptable to the middle class and the wealthy. It has a similar effect to high deductible health insurance as well, as long as your assets are below the threshold where a bankruptcy could cause you harm. If you are the kind of person who wants to have expensive things and a good credit rating, then you may need to pony up a bunch for insurance if you are older or have preexisting conditions. However, with the repeal of the ACA, many who now stand to lose coverage may find the strategy listed above becomes more practical and less expensive overall.

 

Whatever the government decides about the replacement to ACA, it will not be universally good or bad. Some will win and some will lose. And I'm not convinced the poor will really lose all that much. It is simply a new set of rules, and the people need to adjust to it the same way they did to Obamacare. But in order to make the new rules work for you, you may have to structure your assets properly and discard the notion that bankruptcy is a moral issue. It is not. In the new order I think it is a valid health care strategy, and people should be encouraged to consider it. If I ever head back to the states it is something I will definitely discuss with legal counsel before deciding what, if any, insurance to buy.

 

So maybe only the wealthy really need insurance, and maybe the government is right to concentrate their efforts there. The bankruptcy strategy obviously isn't an option for them.

 

Just offering a contrarian perspective to consider in this thread.

 

[Jingthing]

16 minutes ago, Monomial said:

So JT,

 

I was thinking about this. Trying to look at this factually and doing my best to stay away from anything political, perhaps you need to change your perspective. Too much emphasis is being placed on health care insurance. Who can get insured, who loses their insurance, etc. The simple fact is, based on the laws that are being considered, the optimal strategy may be a completely different approach.

 

My point being: You need a health care strategy in the USA, not health care insurance. For some people, this may be the same thing. But for others, perhaps not. Example, if you arrange it so you have nothing to lose in a bankruptcy, then paying out of pocket for small things and allowing yourself to default on a hospital bill in the event of a major problem is a valid plan.  So what happens when you do this? The hospital is forced to absorb the loss, it is forced back onto the paying customers, and those who do qualify for health insurance see their premiums rise.

 

But this is a hidden cost, and not overt from the government. It is a way of offering health services that appear to be acceptable to the middle class and the wealthy. It has a similar effect to high deductible health insurance as well, as long as your assets are below the threshold where a bankruptcy could cause you harm. If you are the kind of person who wants to have expensive things and a good credit rating, then you may need to pony up a bunch for insurance if you are older or have preexisting conditions. However, with the repeal of the ACA, many who now stand to lose coverage may find the strategy listed above becomes more practical and less expensive overall.

 

Whatever the government decides about the replacement to ACA, it will not be universally good or bad. Some will win and some will lose. And I'm not convinced the poor will really lose all that much. It is simply a new set of rules, and the people need to adjust to it the same way they did to Obamacare. But in order to make the new rules work for you, you may have to structure your assets properly and discard the notion that bankruptcy is a moral issue. It is not. In the new order I think it is a valid health care strategy, and people should be encouraged to consider it. If I ever head back to the states it is something I will definitely discuss with legal counsel before deciding what, if any, insurance to buy.

 

So maybe only the wealthy really need insurance, and maybe the government is right to concentrate their efforts there. The bankruptcy strategy obviously isn't an option for them.

 

Just offering a contrarian perspective to consider in this thread.

 

I'll give you that. It is indeed contrarian. There will be winners and losers with any government policy and change in policy.

 

HOWEVER --

I'm strongly encouraging people to keep this thread about concrete / specific policies related to current ACA, how it may soon be changed (just a few senate votes away so that may be imminent) and how those changes would (or soon WILL) impact on expats and repatriating expats. 

 

Obviously, a bigger concern for repatriating expats than expats that will remain expats for life. 

 

[Jingthing]

OK, the senate bill process is now at a very "interesting" place.

The bill can't go forward if THREE republican senators are no votes.

TWO are very firm nos, one from the right, and one moderate.

That means only ONE more firm no and at least current bill is dead.

Now there are approximately TEN of them on the fence. That's a lot to be on the fence but so far not one of them has been willing to the be one person to kill the bill. 

Then real life happens.

The very famous senator McCain (one of the on the fence people) had a health crisis (ironic) and is currently hospitalized.

So the senate has now put this on hold until McCain recovers because they'll need every vote.

Rumors are if one of the approximately ten signals they've become a hard no then more of them will follow but that there needs to be the one to start it, and so far, that person hasn't emerged. 

To add, IF the senate does pass a bill, word is the house is ready to do a marathon session to move the reconciliation of the bill forward. 

So, that's where it's at today anyway. 

[gk10002000]

one of the things on the table that I read was that they would actually let people now choose the type and level of coverage they want, not what the current ACA mandates.  Of course if the insurance companies all collude and get together on prices, this may not be a big help

[Jingthing]

1 hour ago, gk10002000 said:

one of the things on the table that I read was that they would actually let people now choose the type and level of coverage they want, not what the current ACA mandates.  Of course if the insurance companies all collude and get together on prices, this may not be a big help

A lot of these details are covered in the informational link I recently provided.

https://www.washingtonpost.com/graphics/2017/politics/obamacare-senate-bill-compare/

 

Regarding what you mentioned --

Quote

States would be allowed to change what qualifies as an essential health benefit.  Under Cruz’s amendment, insurance companies will be able to sell bare-bones plans, as long as they also offer at least one that’s comprehensive. Experts expect this to drive up costs for sicker people.

 

ALSO, quite importantly ...

Quote

Instead of the mandate, people who had a break in coverage would have to wait six months before getting new coverage, incentivizing healthy people to stay in the market.  Being on a bare-bones plan, as allowed by Cruz’s amendment, counts as a break in coverage.

 

[ubonjoe]

A reply to a post deleted by the poster (now removed) has been removed.

[Jingthing]

The news now is that McCain will probably need at least two weeks to recover from surgery. That's really a long time in the context of the rushed schedule that was planned. 

It's hard to know whether this surprise long delay improves the prospects of the bill passing or hurts it.

Again, stay tuned. 

[Jingthing]

Well before I had said that employer provided insurance wasn't part of this topic except related to the mandate for larger employers to provide it proposed to be dropped by a republican bill.

 

Well this article does suggest another impact on employer provided insurance.

 

 

Quote

 

How the Republican health-care bill could raise premiums for 177 million Americans

...

But if the bill is passed and more people are uninsured, or public sector programs facing federal funding cuts decrease their reimbursements, Lansky said hospitals will simply shift those costs onto commercially insured patients — namely employers and employees.

...

 

 

 

 

www.washingtonpost.com/news/wonk/wp/2017/07/17/how-the-republican-health-care-bill-could-raise-premiums-for-177-million-americans/

 

 

 

 

[Kim1950]

2 hours ago, Jingthing said:

Well before I had said that employer provided insurance wasn't part of this topic except related to the mandate for larger employers to provide it proposed to be dropped by a republican bill.

For years family and I were well insured by my employer. Full dental, mental health, yoga, eyes, whatever. But, I didn't pay any taxes on this benefit. I never complained about the tax free compensation. Try going after that perk, but companies are slimming down that benefit for the lower tier employees or contracting the employee. Then you have people on local, state, or federal employment, and they could care less about all this healthcare salad. They are locked in good care for life. That's Living in America.

[Jingthing]

Yes, tax credits and/or refundable tax credits as are in  the different versions of the republican bills have been explained as justifiable for people purchasing insurance privately to be more fair to that group as people getting the benefit through their employer do not pay tax on it. 

[Jingthing]

In case you haven't heard. Big news.

The senate lost two more votes for their current version.

They couldn't afford to lose even  one more vote.

McCain's illness is irrelevant now to the vote.

It can't even go to the floor for debate.

 

Quote

 

2 more GOP senators oppose health care bill, killing it for now

 

The latest GOP effort to repeal and replace Obamacare was fatally wounded in the Senate Monday night when two more Republican senators announced their opposition to the legislation strongly backed by President Donald Trump.

 

 

http://www.baltimoresun.com/news/nation-world/ct-senator-oppose-health-bill-20170717-story.html

 

It's too early to declare the entire republican "repeal and replace" effort fully dead yet though. 

 

Again, stay tuned. 

[lopburi3]

9 hours ago, Kim1950 said:

Then you have people on local, state, or federal employment, and they could care less about all this healthcare salad. They are locked in good care for life.

Actually believe most are paying for their healthcare - but at a lower than full rate - but most will have family members directly affected by this issue.  

Even my subsidized federal healthcare is over $500 per month and have been paying same full rate all my life - so overall have paid high price when young and not using to continue paying same price when old and heavy user.

[Jingthing]

Yes, my understanding is that there is indeed often cost sharing in employer based plans. In my working experience with jobs providing health insurance, the benefit was always granted "free" and without tax though. 

 

But even with cost sharing the reality is still there that employed people are getting some compensation without taxation.

 

It seems to me it's a similar policy issue to mortgage interest deduction. Housing owners get that and renters don't.

 

The ACA doesn't mandate any specific level of cost sharing for employer based plans and neither do any of the republican proposed "replace" bills.