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

[Kim1950]

It's the culture not the politics. I had premium healthcare in business and was never taxed on the compensation. As a property owner, I deduct mortgage interest and local property tax from my total tax burden. Unions and public sector retirees don't pay taxes on their lifetime healthcare benefits. ACA was never looking deep at these     entitlements, except for the scant Cadillac Tax which wasn't a full income tax and was way out of the mainstream for most people and these people could care less. 

 

Sorry peope, it's a sorry state of affairs, but all this mess was around before Trump. Everybody's got their self-interests in play, and if somebody else pays or our debt increases or someone gives you their vote. Damn the rest. Well, why aren't we like Europe, because we are not, that's not our culture. Change the culture, you might change the politics. Besides NFL preseason is near. There you go, 

[Jingthing]

Well, I think everyone can agree that the culture of the USA is not the same as the culture of a typical European nation.

 

In the wake of the big news of the senate bill failing, there was immediate talk (from within the senate and the president) that congress should vote for a simple REPEAL to actually happen two years after the vote. The idea was that within the two years some democrats would be "persuaded" to work with the republicans  because something is better than nothing. However, there was a general consensus that simple just repeal would be politically risky and create even greater uncertainty with both the insurance industry and the public needing health coverage.

 

ANYWAY, quickly moving story, already three republican senators have stated they are firm nos on simple repeal, killing any chance that such a bill could pass. That doesn't necessarily mean that the senate leadership won't still call for such a vote to record it, even  if they know it will lose. 

 

Going from there, OK, obviously nobody knows for sure yet.

 

Another thing the president has tweeted about is to just let Obamacare die. Well there is an active and passive way to do that. For example, when congress does it's budget it can actively take steps to deny budget to help support the bill. 

 

What I'm getting at here, is as the republican party even lacking the votes to pass anything on health care (at least, yet) still has considerable power to influence things.

 

So, barring other developments (very possible),  some rough basic choices that party now has now that Obamacare remains the law of the land include:

 

-- Accept it is the law of the land. Actively support it and work on smaller step fixes to it, including working with some democrats to do that. The latter is supported by the democratic party leadership.

 

--  Accept it is the law of the land for now. Passively just leave it for now. Don't actively try to sabotage it though.

 

-- Actively working to speed up Obamacare failing (through budget measures, executive orders, rhetoric, etc.)

 

The context of these rough choices are that people's health care coverage is on the line and there is a midterm election coming up in 2018. 

___

Want to participate in a POLITICAL DEBATE about these big recent developments? If so, please do that here:

(NOT HERE)

 

 

 

 

 

[Jingthing]

A bit of an aside.

 

A more general article about the issues U.S. expats face abroad with medical costs. Touching on temporary trips back to access U.S. based medical care (covered by private insurance or Medicare).

 

I think probably less relevant to U.S. expats in Thailand than where the article is about, Ecuador. That's because Thailand is so far from the U.S. I reckon a much smaller percentage will be keeping up their their private (excepting Medicare) insurance while living here.

 

Anyway, I still think it's worth a look. 

 

Quote

 

Expenses that many expats and potential expats fail to consider: Travel back home and medical costs

...

Again, we’re making assumptions, but it’s easy to imagine this couple’s medical costs associated with their time in the United States exceeding US$15,000 a year.

Those medical costs will likely go up whether or not the US. Congress repeals Obamacare. Insurance companies already predict big increases, especially for individuals (as opposed to groups). The low-cost, high-deductible plan that costs only US$500 a month might disappear.

Note that we’re assuming this couple of retirees is younger than 65. After age 65, most Americans would be covered by Medicare during trips back to the United States. (Medicare doesn’t cover medical costs overseas, but I recommend keeping it even if you do retire overseas as a back-up.)

 

 

 

https://cuencahighlife.com/travel-back-home-and-medical-costs-are-often-overlooked-by-expats-and-are-potential-budget-breakers/

 

 

[Jingthing]

I know many people are wondering, what now?

 

Well, nobody knows for sure, but I can now provide more specific details on how the president can (if he chooses) sabotage the existing law (ACA) and potentially send it into a death spiral.

 

I will try the best I can to present this in a neutral, fact based way.

 

Two basic things --

 

Cost sharing funding.

This is the money the federal government is supposed to pay to insurance companies that pays for the SUBSIDIES that millions of lower income people get (based on income) to purchase ACA private market policies.

 

It is a fact that the president has already (long ago actually) threatened to stop this funding. 

 

It is a fact that insurance companies have complained about this and have clearly said that premiums have already been raised as a proactive tactic to protect against this risk of trump actually doing that.

 

Which obviously follows, if that is really cut off, the insurance companies will understandably totally freak, massive raising the premiums again and/or withdrawing entirely.

 

With those much higher premiums, many fewer people will be able to afford to purchase the insurance. That would filter out more healthy people. If you have a serious illness, you're more likely to buy the insurance no matter what. So the pools become more unhealthy, higher cost, higher risk.

PLUS there could also be a more official loosening of enforcement of the MANDATE (and penalties) which was already suggested by a very early executive order from the president. At that time that order was seen in the context that the republicans would be able to legislatively kill ACA.

 

But they have failed to kill it legislatively. But there may be these other ways if the choice is made to go this route and intentionally attack any chance of sustainable viability for the law.

 

Perhaps interesting from a chess playing POV, but of course people's access to health care is on the line. 

 

This post can be the seen in the context of my previous post suggesting there are three rough basic paths the ruling party can take to deal with the reality of ACA still being the law of the land. Active Support and attempts at fixing flaws of the law of the land (ACA) / Passivity / Active Sabotage.

 

This post is obviously about the details of potential active sabotage. Of course there are grey zones between these three options. Also, there is a difference between rhetoric and action. For example the president might tweet (as he has) just let ACA die (passive response), but if he takes any active action to help it die (those threats about cost sharing were already going there) then that is action. 

[ubonjoe]

A off topic post commenting about moderation has been removed.

[Jingthing]

Minor update.

Under pressure from the president (see his twitter account) the senate republican leadership is now saying they will be going ahead with some kind of vote about the health care issue. Not clear yet if it will be a just repeal or another version of repeal and replace. The general consensus is that they won't have the votes to pass anything like that soon especially considering McCain is out of the picture. News reports saying pushing a vote is largely about applying pressure to the dissenting republicans and at least getting a vote recorded for political purposes. It's theoretically possible the pressure could work and they could pass something, but the news consensus is that the pressure won't work. 

 

So short version, possible but very unlikely to pass. 

[Jingthing]

Well, at this point, it seems clear that the president and republican leadership is pushing strongly for a senate vote on "something" quite soon. By "something" I mean they haven't announced whether the actual vote is going to be repeal and replace or just repeal. The ailing Senator McCain is reported to be planning to travel back the D.C. for the vote. My impression is that he will be in repeal and replace or repeal side. But it still seems doubtful that they can get to the 50 votes on either option. But until they vote, we do not know for sure. 

[Jingthing]

Rather a surprise.

Senate very narrowly (VP vote needed) approves bringing the issues to debate.

Reportedly 20 hours of debate are to follow, along with introduction of all kinds of amendments, and many votes they call Vote-a-rama.

What's next? Who knows?

But if they can pass something that can proceed to reconciliation with the house, then something. 

[PhuketSarah]

On 3/8/2017 at 7:52 AM, 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.

Agree,  never will it get the 60- unless McConnell has a trick about changing that rule- too.

[Jingthing]

Agree,  never will it get the 60- unless McConnell has a trick about changing that rule- too.

Alot could be done with 50 votes most probably.

[PhuketSarah]

16 minutes ago, Jingthing said:

Alot could be done with 50 votes most probably.

But not on a procedural bill - needs 60 to pass. 

[Jingthing]

But not on a procedural bill - needs 60 to pass. 

We have different information. Some elements of a bill may be challenged as impassable as a budget matter but that leaves a lot that can. It certainly does complicate the challenge for the repeal / replace advocates.

 

The fact that they did manage to move to debate and amend might be a sign of momentum for the majority republicans.

 

We shall see.

 

[CaptHaddock]

4 minutes ago, Jingthing said:

We have different information. Some elements of a bill may be challenged as impassable as a budget matter but that leaves a lot that can. It certainly does complicate the challenge for the repeal / replace advocates.

Hell, even without passing any bill at all, Trump can, and probably will, sabotage Obamacare through purely administrative means, such as not enforcing the mandata and not funding the subsidies. 

[Jingthing]

Hell, even without passing any bill at all, Trump can, and probably will, sabotage Obamacare through purely administrative means, such as not enforcing the mandata and not funding the subsidies. 

Well it's an objective fact that insurance company leaders have already complained that even the president’s threats of stopping the cost sharing has caused them to significantly raise premiums as a proactive defense. They're not going to be in the losing money business for very long. So yes it is true that the president has power to deeply damage ACA even short of passing any bill. But there is political risk in that.

[Jingthing]

I think this article details a lot of the current issues the senate is debating.

 

 

 

"And so began a legislative kaleidoscope scheduled to last for 20 hours of debate in coming days, followed by yet more amendments and votes. Even as it started turning, a new last resort already was in sight - a skimpy plan being dubbed "skinny repeal" that could stand mainly as a way to keep the health-care issue alive at least through the summer.

 

After seven years of GOP promises to tear down the ACA, this is the unpredictable course on which Senate Majority Leader Mitch McConnell, R-Ky., now finds himself. Despite his reputation as a master tactician, McConnell has been unable in recent weeks to wrangle his fractious caucus into a cohesive health-care voting bloc."

 

 

 

http://m.sfgate.com/news/article/Here-are-the-health-care-options-senators-will-11412133.php

 

 

[Jingthing]

Big news yet again.

Skipping ahead, if you don't know how we got here, check the web, the republicans failed to pass something they called a "Skinny Repeal" late at night by one vote. 

The key vote was by McCain.  The same McCain that was the key vote to bring the issue to the floor for debate. History in the making. 

That would have sent some kind of bill to the house for conference. 

But the house could have just passed the Skinny as is if they wanted to and that wasn't most republican senator's intention. 

So, anyway, it didn't pass.

So what now?

Well, as usual, more uncertainty.

But there seems to be a consensus that repeal or repeal/replace is dead for at least the short term future, possibly longer (after 2018 midterms), possibly forever.

The democratic senate leader Schumer has now called for bipartisan cooperation to work of fixing ACA instead of repeal and replace. 

Unclear whether that will actually happen. 

 

The president's first tweet response is this, indicating no leadership from there for bipartisan cooperation to fix ACA:

 

 

Quote

 

Donald J. Trump‏Verified account @realDonaldTrump  19m19 minutes ago

More

3 Republicans and 48 Democrats let the American people down. As I said from the beginning, let ObamaCare implode, then deal. Watch!

 

 

 

Also as the senate vote was so close (but what they were passing was really a bare bones bill)  it might become a republican main issue in 2018/2020 to just get a few more votes in there.

[Jingthing]

On 6/7/2017 at 3:29 AM, Jingthing said:

...

Of course it doesn't mean it will actually happen in Nevada, but still, interesting.

 

https://www.vox.com/policy-and-politics/2017/6/6/15731622/nevada-medicaid-for-all

 

 

 

I have an update on this. The bill to allow people to buy in to Medicaid was vetoed by the Nevada governor. There is now a promise to pass the same thing next year and try again. It's possible that things may change by then enough to have a chance to be signed.

It's would be an interesting experiment in that it could be an alternative for people that don't have any private "exchange" options and also the consensus is that the Medicaid buy in plan would be cheaper.

[craigt3365]

I've just started following this.  Looks like I might have to be in the U.S. next year. Perhaps for more than a month. From what I understand, less than a month is ok, you don't have to buy insurance.

 

I looked at the government website for the market place. Wow. Worse than doing taxes!

 

I'll look forward to any updates here, JT!

[Jingthing]

Over 30 days is trickier but the annual thing can be rolling so there's a good chance you can still use the expat exemption. In any case ACA still stands, the mandate still stands, and the expat exemption still stands. The only difference so far is an administration less enthusiastic about enforcing the mandate.

[Jingthing]

A bit of an update on how ACA is coming along.

It turns out that it is NOT imploding. Still flawed of course. 

 

 

Quote

 

Why Obamacare didn't implode

All of the law’s empty counties have been filled.

 

 

https://www.vox.com/policy-and-politics/2017/8/24/16193682/obamacare-empty-counties-fixed

[ELVIS123456]

QUOTE: 

 

Sixteen Obamacare co-ops have now failed. Illinois announced that Land of Lincoln Health, a taxpayer funded Obamacare co-op, would close its doors, leaving 49,000 without insurance. The co-op now joins a list of 15 other Obamacare co-ops that have collapsed since Obamacare has been implemented.  Failed co-ops have now cost taxpayers more than $1.7 billion in funds that may never be recovered.

 

Co-ops were hyped as not-for-profit alternatives to traditional insurance companies created under Obamacare. The Centers for Medicare and Medicaid Services (CMS) financed co-ops with startup and solvency loans, totaling more than $2.4 billion in taxpayer dollars. They have failed to become sustainable with many collapsing amid the failure of Obamacare exchanges.

 

Since September, 13 Obamacare co-ops have collapsed, with only seven of the original 23 co-ops remaining.  Illinois’ Land of Lincoln co-op faced losses of $90 million last year and is suing the federal government for the deficit caused by Obamacare.  Co-ops across the country have struggled to operate in Obamacare exchanges, losing millions despite receiving enormous government subsidies.

 

https://www.atr.org/illinois-obamacare-co-op-becomes-16th-collapse

 

I call that failing.  

But I am sure people with the view that Govt has a never ending supply of taxpayer's money, will disagree.

Obamacare will fail - when the State Govts does run out of money - Fed will not keep paying out.

Meanwhile, guaranteed Govt funding will attract a few 'hit and run' insurers.

And meanwhile the middle-class will have to pay more and more to prop it up, until they become poor and then they get back in on Govt funded subsidies.

Always eventually doomed to fail.

[Jingthing]

First of all, the link above from the famous right wing taxation lobbyist Grover Norquist is quite OLD: Wednesday, July 13th, 2016.

 

It would be interesting to know more CURRENT NEWS related to that specific aspect of ACA -- coops.

 

Another obvious question I have from that is what percentage of people buying into ACA exchanges (whether subsidized or not) are actually in coops?  I don't know as I've not really heard very much about such coops.

 

It's certainly not the entire program.

 

The issue I highlighted with the vox article is that concerns (hyped up or not) that there would be lots of U.S. counties without ANY options for ACA insurance are so far not proving to be real. 

 

To add, this is NOT a hot political debate thread. It's about describing practicalities for people that might be repatriating. 

 

News about the problems with coops fits. Political OPINIONS do not. 

 

Obviously it's impossible for anything to be 100 percent devoid of political implications. I'm talking about EXPLICIT stuff. 

 

Those that can't respect that restriction for this thread, please do not post here. 

To add, in case it needs explaining, the REASON I still think this NON POLITICAL DEBATE thread has value to continue to exist is because the story of potential large changes to ACA (whether through federal or state legislation or other factors) is not nearly over. 

[ELVIS123456]

On 8/28/2017 at 5:41 PM, Jingthing said:

First of all, the link above from the famous right wing taxation lobbyist Grover Norquist is quite OLD: Wednesday, July 13th, 2016.

 

To add, this is NOT a hot political debate thread. It's about describing practicalities for people that might be repatriating. 

News about the problems with coops fits. Political OPINIONS do not. 

Obviously it's impossible for anything to be 100 percent devoid of political implications. I'm talking about EXPLICIT stuff. 

Those that can't respect that restriction for this thread, please do not post here. 

 

Firstly - I was responding to your infamous left-wing Vox website's article: 1st line quote:

Two months ago, things looked dire for Obamacare — and not just because Republicans in Congress were still hell-bent on repealing and replacing it.

 

Vox is an American advocacy news website run by Vox Media, co-founded by liberal columnists Ezra Klein, Melissa Bell, and Matt Yglesias and launched in April 2014.  Vox presents with left wing bias in reporting and story choices. There is some use of loaded words, but most articles are sourced to credible information. (5/15/2016)

https://mediabiasfactcheck.com/vox/  (sorry that is from 2016).

 

But I heard what you have said - and in my opinion your post of a liberal article that Obamacare was fine, is in my opinion, wrong.  The article is wrong. IMO Obamacare is doomed not just because Trump and the Reps want shut down, but because it is a failed Govt run monopoly being propped up by Govt money. IMO.  So, for the benefit of others who may have read your post as meaning it was all fine, I quickly grabbed an article that showed it was not fine in July 2016, and one year later it is still being held together based on Federal Govt funding (that is under serious threat).  Sorry, but in my opinion Obamacare is doomed, and any expat expecting to be able to repatriate to USA and get free/subsidized medical insurance under Obamacare, needs to plan for other eventualities. IMO.

 

You - IMO - are in need of serious help, when you go back if you expect Obamacare to cover you. And I would warn all Expats not to expect and base their decisions on Obamacare being in place in the future. Universal medical insurance for the poor (Medicaid) was expanded under Obamacare, but whatever happens to that, Medicaid will still be there in one form or another.  It varies from State to State - and is a moving target - but check out this site:  https://obamacarefacts.com/obamacares-medicaid-expansion/

Meanwhile, relying on Obamacare or expecting it to remain fully in place, is going to be a problem, IMO, and it would be wise to put in place contingency plan/s.  Hope the link above helps.

 

 

 

[Jingthing]

I never said ACA is in great shape. Please desist with such blatant distortions. That is not OK. 

 

The article was about the situation with there being no ACA exchange options in many U.S. counties CURRENTLY being better than many expected or predicted. That's about objective facts, not the hot opinion game that you obviously and obnoxiously are trying to hijack this thread towards. 

Your "opinion" about whether ACA is doomed or not doomed is totally not on topic for this thread.

 

I agree that ACA is something to watch closely. The current party in power still is on record wanting to end it, which they failed to do so far, but they are still in power.

 

Which is the reason for this thread. To watch the changes in ACA to help repatriating Americans know more about the details of the situation. Currently and any changes that happen over time.

 

I'll ignore all your other hot insinuations. Take it elsewhere to other parts of the forum where it belongs. NOT HERE. 

[Jingthing]

It's time for an update on this. 

As people that care probably know, the republicans were unable to formally repeal and replace the ACA.

However, in the recent tax bill passed, the insurance MANDATE was repealed. 

The expat impact is obvious.

Even though bona fide expats are already exempt from the mandate there are some more "part time" expats that aren't.

I think it works like this now. 

For tax year 2017, the mandate is still in effect. However, enforcement might be more lax, emphasis on might.

For tax year 2018, the mandate is definitely gone.

 

The impact for people repatriating is that there is a general consensus that ACA plans will go up because of the end of the mandate. The mandate was about "encouraging" more young healthy people to participate so the pool of people will be getting less healthy and more expensive.

 

HOWEVER, for those eligible for subsidies based on lower income, there may be no increase at all, of course depending on the specific level of subsidies. 

 

People under 65 without employer provided plans still under the minimum income for subsidies would only have the option of Medicaid, expanded Medicaid in the states that offer it, or no insurance at all. 

 

Going forward, the President says he still wants to formally kill the ACA entirely. It's fair to say whether he is able to do that or not will be very dependent on the midterm elections in November 2018.

 

So most probably there won't be much happening as far as governmental changes to the ACA before November 2018.

 

So again, stay tuned. 

Reminder -- this is NOT a political debate thread here. It's about presenting useful information in as neutral a way as possible. Obviously, 100 percent neutrality can't be possible in anything about American government these days, but we can make an effort. 

[mania]

On 1/2/2018 at 8:44 AM, Jingthing said:

The impact for people repatriating is that there is a general consensus that ACA plans will go up because of the end of the mandate.

 

I don't know about any "general consensus " But I can tell you  100% facts are that prices went up when ACA started by 50% here

My wife & I I use to pay $400 a month & now same policy is over $600

I would not be surprised to see them go back down when ACA ended

 

All that was ever needed was to open cross state lines sales of Health Insurance & let the free market work. Insurers would try harder for our business

 

Instead they came up with this mess & we all are paying more for less

 

[Langsuan Man]

1 hour ago, mania said:

All that was ever needed was to open cross state lines sales of Health Insurance & let the free market work. Insurers would try harder for our business

Quote

Sorry, Trump: Selling Health Insurance Across State Lines Wouldn't Lower Costs

source: https://www.forbes.com/sites/brucejapsen/2016/10/10/sorry-trump-selling-health-insurance-across-state-lines-wouldnt-lower-costs/#34e1332f1514

[lopburi3]

1 hour ago, mania said:

 

I don't know about any "general consensus " But I can tell you  100% facts are that prices went up when ACA started by 50% here

My wife & I I use to pay $400 a month & now same policy is over $600

I would not be surprised to see them go back down when ACA ended

 

All that was ever needed was to open cross state lines sales of Health Insurance & let the free market work. Insurers would try harder for our business

 

Instead they came up with this mess & we all are paying more for less

 

My current (self plus one) insurance is available in any State - and costs a total of $1,622.42 per month.

[mania]

21 minutes ago, lopburi3 said:

My current (self plus one) insurance is available in any State - and costs a total of $1,622.42 per month.

That is a govt insurance program isn't it?

I was referring to private companies

 

[mania]

41 minutes ago, Langsuan Man said:

---politics cut out----

Thought this thread was not going political?

In any case my comments are my opinions not those of Politicians nor their opponents

Call us ostriches but we don't watch that mess here in the USA called news