BajaNomad

What New Health Care Ruling Means For Ex-Pat Californianos

DavidE - 6-29-2012 at 09:52 AM

A CUT & PASTE EXCERPT FROM THE S.F. CHRONICLE ONLINE

Note: I can't change the world, and I do not have a political point to make. What is, is, and the new law affects ex-pats from California. Griping about my posting of this means the griper would elect to keep people uneducated about the new law. Get the idea?

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No state is more prepared than California to move ahead with health care reform now that the Supreme Court has spoken.

The state, with the nation's largest number of uninsured people at 7 million, moved aggressively to implement the law from the moment it was signed by President Obama in March 2010.

Already, hundreds of thousands of low-income Californians have access to health care, thousands of people with pre-existing health conditions have coverage and parents can keep their adult children on their coverage until age 26.

The state has the potential to draw in billions of federal dollars to continue building the framework for the new law and to expand the number of people eligible for Medi-Cal, the state's Medicaid health program for the poor, by as many as 3 million people.

Thursday's Supreme Court decision is "a victory for consumers; it's a victory for California," said Anthony Wright, executive director of Health Access California, a consumer health advocacy group. "It's a huge relief for the half million who are already getting coverage under the law, it's a relief to millions who have new consumer protections they wanted to keep."

The ruling means continued health care for low-income Californians who are already covered through county-run programs and for young adults who have been allowed to stay on their parents' plans. Seniors stuck with high out-of-pocket costs for prescription drugs through Medicare will get relief, and thousands of people with pre-existing health conditions will not be denied insurance.

Osprey - 6-29-2012 at 10:45 AM

I know this won't even things out for you but retired down here in Baja Sur well below the U.S. tax payer imperitive I don't think I'll be much affected by the new laws/rules.

By living down here like this on a very pleasant shoestring we don't have to worry that we will have to pay for so many unfortunates, pre existings, poor, unemployed, drifters, grifters and people or groups who choose to live unhealthy lives, those who could earn an honest living but live off the dole, those who make $60,000 a year and retire on $1,600,000 a year.

I might (later, much later) move back to the U.S. of A. to get in on that pre existing thing -- took me a lifetime to develop a serious scirosis of the liver and spleen.

David E, thanks in advance for your contribution and for saving my sorry butt when I need boocoo bucks/transplants to live a little longer.

Hook - 6-29-2012 at 10:49 AM

Well, I'm not sure you're subject line is relevant. This article talks about people IN California. Ex-pats aren't.

There are still questions for those of us who have insurance OUTSIDE the U.S., yet continue to pay federal and/or state income tax with a nominal address. Will our non-U.S. insurance exempt us from the mandatory insurance requirement or the 1-2.5% tax, if we don't have insurance?

Get back to us with info on that, David, and you're on to something we ex-pats can use..................

[Edited on 6-29-2012 by Hook]

Osprey - 6-29-2012 at 10:57 AM

David, I guess I'm a griper but we've had other posts like yours on this forum:

{"Here's the specs and pics of a boat I really hate but I want you all to know about it." That's just how high I can jump to be egalitarian with all you folks.}

Health insurance/ expats

akshadow - 6-29-2012 at 11:01 AM

If on medicare I assume you "have insurance". If you are not and are citizens with ability come back to US any time you want or need health care why wouldn't you be required to pay into the system.
Just a thought not based on any real information since I have medicare and supplemental insurance, so at least this aspect of the crazy law will not directly affect me.
Quote:
Originally posted by Hook

There are still questions for those of us who have insurance OUTSIDE the U.S., yet continue to pay federal and/or state income tax with a nominal address. Will our non-U.S. insurance exempt us from the mandatory insurance requirement or the 1-2.5% tax, if we don't have insurance?

Get back to us with info on that, David, and you're on to something we ex-pats can use..................

[Edited on 6-29-2012 by Hook]

Hook - 6-29-2012 at 11:09 AM

Quote:
Originally posted by akshadow
If on medicare I assume you "have insurance". If you are not and are citizens with ability come back to US any time you want or need health care why wouldn't you be required to pay into the system.
Just a thought not based on any real information since I have medicare and supplemental insurance, so at least this aspect of the crazy law will not directly affect me.
Quote:
Originally posted by Hook

There are still questions for those of us who have insurance OUTSIDE the U.S., yet continue to pay federal and/or state income tax with a nominal address. Will our non-U.S. insurance exempt us from the mandatory insurance requirement or the 1-2.5% tax, if we don't have insurance?

Get back to us with info on that, David, and you're on to something we ex-pats can use..................

[Edited on 6-29-2012 by Hook]


Because we are happy with our own insurance that covers us OUTSIDE THE US and are happy with the care we recieve OUTSIDE THE US as well.

Not old enough for Medicare.

bajajudy - 6-29-2012 at 01:18 PM

I was concerned that when I turn 65 there would be some sort of deduction taken out of my measly check, so I called the office in Guadajalara. All of my paperwork comes through that office.
I was told that because my permanent address was in Mexico, I would not have to pay. However if I dont sign up there is a stiff penalty should I change my address later. I wonder if any of this new stuff will change that!?!?!?!

[Edited on 6-29-2012 by bajajudy]

akshadow - 6-29-2012 at 01:37 PM

Quote:
Originally posted by Hook
Quote:
Originally posted by akshadow

Because we are happy with our own insurance that covers us OUTSIDE THE US and are happy with the care we recieve OUTSIDE THE US as well.

Not old enough for Medicare.


Sounds to me like you will need to pay.

Cypress - 6-29-2012 at 01:57 PM

Quote:
Originally posted by akshadow
Quote:
Originally posted by Hook
Quote:
Originally posted by akshadow

Because we are happy with our own insurance that covers us OUTSIDE THE US and are happy with the care we recieve OUTSIDE THE US as well.

Not old enough for Medicare.


Sounds to me like you will need to pay.


Yep! Cough it up! You rich guys need to take care of us poor guys.:lol:

norte - 6-29-2012 at 01:58 PM

I guess those that complain can always move their incomes to Mexico (so they have no more incomes tax) renounce their citizenship and live abroad. No more insurance requirement. or do you like the fallback in the US but don't want to pay for it!

Pescador - 6-29-2012 at 02:16 PM

Until you renounce citizenship, you will be required to pay under the new law which goes into full effect in 2014.
Without turning this into an off Topic discussion, this stupid thing was sold on the basis of how it would get coverage for everyone. Well that is great, we just about doubled the eligible number of people and because of tighter controls and less pay, the number of doctors is dwindling. So now we are going to morph into the same type system that they have in Mexico. Everyone will be covered, but if you really want to see a doctor without a two year wait, you will have to find a doctor willing to take your money. Talk about one step forward and two back.
California was a guaranteed issue state meaning that if you were uninsured and got denied coverage, you could buy insurance from the high risk pool. The premiums were higher, but at least you were guaranteed to be able to buy coverage. Now everyone is forced to buy coverage and so far there is no exemption for those of us who choose to live outside of the United States.

DavidE - 6-29-2012 at 02:27 PM

This is what I learned from the news cut & paste

[expand the number of people eligible for Medi-Cal]

Any time-elective processes that I have elected to undergo, such as cataract surgery and spinal surgery, are now moved way up as far as urgency is concerned. When a mob of new uninsured hits the system it could take a long, long, wait to get this stuff on rotation. I am on the Fed system but it looks like that doesn't separate service from Medi-Cal patients.

I really try to learn everything I can about what is important to me. Small things like life-support, the certainty of blindness, being confined to a wheel chair, if I screw this up.

[Edited on 6-29-2012 by DavidE]

prorader - 6-29-2012 at 02:44 PM

Welcome to sergeo popular, the big court in the US will drive more to Mexico and there social medicine, cheaper life style. I have 2 operations and total medical care under sergeo popular, although not perfect, it has worked for me. The big problem here is when Calderon goes out and the new guy comes in. I think the idea was to take IMSS which is a faild system and the governement systems and make a total social welfare system such as Canada but more modern. In my case the system has worked but with the other medical systems in Mexico, everone feels the pain.

Hook - 6-29-2012 at 08:29 PM

Quote:
Originally posted by akshadow

Sounds to me like you will need to pay.


Based on what?

DavidE - 6-30-2012 at 07:09 AM

Pescador, the US needs more good doctors and nurses. A good doctor isn't in the trade because it only leaves him a two hundred thousand dollar a year income after taxes and liability insurance.

Everybody wants to be "The Hunt Brothers" and have their own cartel. Their own monopoly. Just ducky. Vitamins are now priced about ten times higher versus the cost of living then they were in the sixties and seventies. Repair shops demand a hundred dollars an hour. People buy and sell commodities and reap huge profits while doing absolutely zero (that's 0.000000000000000000000000000) toward productivity or research and development, while they sit behind a desk. Everybody wants to be a billionaire and China is just kicking our ass, because of this stupidity.

It's already starting to come crashing down. Greedy politicians, greedy market manipulators, greedy banks, and a weary public. Common sense is dead. America is screwing itself right into the ground.

Pescador - 6-30-2012 at 03:37 PM

Quote:
Originally posted by DavidE
Pescador, the US needs more good doctors and nurses. A good doctor isn't in the trade because it only leaves him a two hundred thousand dollar a year income after taxes and liability insurance.

Everybody wants to be "The Hunt Brothers" and have their own cartel. Their own monopoly. Just ducky. Vitamins are now priced about ten times higher versus the cost of living then they were in the sixties and seventies. Repair shops demand a hundred dollars an hour. People buy and sell commodities and reap huge profits while doing absolutely zero (that's 0.000000000000000000000000000) toward productivity or research and development, while they sit behind a desk. Everybody wants to be a billionaire and China is just kicking our burro, because of this stupidity.

It's already starting to come crashing down. Greedy politicians, greedy market manipulators, greedy banks, and a weary public. Common sense is dead. America is screwing itself right into the ground.


Well, that is a pretty good fallacy. I had a lot of doctors as personal clients and for the most part any of those doctors who accepted Medicare Clients and were on the Major PPO's like Blue Cross Blue Shield, were barely able to scrape out 75K a year and for that they get to be on call, spend an inordinate amount of time filing claims with insurance companies and the Fed. that do not get paid, work about 100 hours a week with on-call demands, and are forced to operate in a real "cover your ass" kind of environment.
I think most people are not that greedy but want to get paid what they are worth. I thought I worked long and hard hours until I started to spend time with my Doctor clients and they maid me look like a part timer.
I am a firm believer in the idea of the Free Enterprise System and those that want to succeed should have the opportunity to do so without having to spend half their time and money to comply with the wastefullness and stupidity of big government wasting and throwing away their money.
China may be kicking our burro because they understand that some jobs only pay a few cents an hour but it is a start, they do not waste untold dollars on wacko environmentalists and stupid regulations that choke and strangle the small start up businesses, and they do a pretty good job of letting us do the Research and Development and they just rip off the ideas and make the finished product a lot cheaper than we are able to do.
I know it is very popular to think that the problem with our economy is the few who are making big dollars, but the reality is that never bothered me at all. If they are free to do that in an honest, ethical, and legal way, then it means I can do the very same thing if I want to get off of my butt and make it happen.
Anyway, if I had some medical care that was imminent and needed some attention, I would be looking at getting it done sooner than later as I see some real shortages happening in the not too distant future.

DavidE - 6-30-2012 at 06:52 PM

Agreed, not all doctors are greedy. The guy who operated on my arm spends 14 hours a day in his specialist's facility and then walks next door to the hospital. 75K a year doctors? Divide that by the number of working days, then hours, then patients then charge per patient. My last internal medicine doctor said he was scheduled to see 5 patients per hour. Eight hours a day and let's be kind; 200 work days a year. Two hundred times forty = 8,000. At a hundred bucks a pop. Eight hundred thousand dollars gross, seventy five thousand net. I wonder how he affords that new Range Rover? The base problem with our country is that one almost certainly needs to be a failed attorney to win office. Reminds me of the kind of brilliance that would require a grade school teacher to be a convicted child molester.

Pescador, people who do NOTHING, have no skill whatsoever are sucking the life out of the United States. They contribute ZERO. The have their own imperatives and legitimacy sanctioned by legislation. They are maggots, leaches and suckers on the branches of citizens who contribute. They hoard basic commodities, and then demand every dime they can get out of the transaction. This is screwing America right into the ground. The poor DO NOT HAVE ENOUGH POWER to affect the standard of living. Leeches who buy oil for thirty dollars a barrel and then demand a hundred twenty dollars a barrel for it are one example. You cannot shout to me "OIL COSTS NINETY DOLLARS A BARREL!" It does not! Ask Mexico, Saudi Arabia, Venezuela, or Kenya WHAT THEY GET PAID FOR DELIVERING A BARREL OF OIL TO A SUPERTANKER! It's a epidemic. NIKE hires four dollar a day workers, adds six dollars worth of material and makes two hundred dollars sneakers. That's fine amigo, I don't freakin' need sneakers. I don't need a two hundred inch television. But when a drug SALESMAN pulls up to my Rheumatologist's office in an eighty thousand dollar BMW 733-i and brings in samples of medicine that sets me back four dollars a dose, that sort of gets me excited. So does paying four dollars a gallon gasoline, so some speculator's wife can go nuts trying to decide whether to Winter in Mallorca, or Dubai.

Free Enterprise is crucial. The epitome of free enterprise happened to me on a visit to a friend's house in Morelia Michoacan:

10PM...knock,knock,knock,knock on the door. Eduardo opens it. "Buenas noches seņor, we came to say that this barrio is no longer safe. We have decided to arm ourselves and protect everyone. This is going to cost two hundred pesos semanal (weekly). Your family is worth it, no?"

"Do you know those guys Eduardo?"

"I've never seen them before in my life. But they had rifles and pistolas".

Free enterprise! Nine dollar a gallon gasoline with ZERO increase in exploration and refining. Free Enterprise! A dollar an apple, natural gas which is next to worthless as far as a scarce commodity, but two hundred dollars a month to heat a poor person's home.

SUB PRIME LOANS were pushed, prodded and propelled by greed. Points earned, bonuses and commissions. Bernie Madoff screwed the very people who were screwing others.

It's all going to collapse folks. Want to know why? There is no trust. ZERO. No confidence. Welcome to the Big Depression.

Hook - 7-1-2012 at 12:38 AM

Jim, the problem with our economy is that the few who make the big dollars have increased their bottom lines by shipping jobs overseas to people who willingly work for peanuts, because of the inequalities in the cost of goods and services between the countries. These are jobs that only a generation ago paid good wages in the US.

That same free enterprise spirit that you extoll, did what came natural; found the cheapest way to make a product or provide a service by shipping it overseas and ignoring things like environmental laws, job benefits like health care, retirement programs, etc.

Once politicians opened up markets to allow corporations to ship jobs to places like India, China and Mexico where "wacko environmental laws" and benefits are non-existent, it was inevitable. Tax laws encourage this.

Unfortunately, the savings in the cost of the goods they sell back to this country is not enough to offset the lost wages. Hmmm.......I wonder where the difference is going? Hmmm......I wonder how politicians were convinced to do this?

I think it naive to think that free enterprise can provide a decent wage for a significant percentage of the people in the US in the 21st Century. At least not while corporate officers and top employees can draw tremendous wages even when the corporation is floundering. And while corporations can sit on piles of cash and don't distribute it to shareholders, fairly.

Technology also plays a big role in reducing good paying jobs. I really cant say if the dollar value of jobs created by technology outweighs the value of jobs lost to technology. But, it is what it is. We cant turn our backs on technology.

There are large elements of the free enterprise system that work in opposition to the financial health of a large number of people in the US, nowadays.

It ain't the early 20th Century anymore..............when free enterprise COULD solve most problems. Wealth is collecting and sitting with the beneficiaries of the cheap labor markets in other countries.

I dont know what the answer is. But unchecked free enterprise is an antiquated idea, IMO. The world has changed. Overseas markets like India and China have HUGE advantages in competitiveness that go way beyond true free enterprise. Their costs are low due to incentives their government provides that would be illegal in the US and their currencies values are artificially set to provide another competitive advantage.

I think how this all will affect health care is how it HAS been affecting health care............a lot of it will go overseas. It's only natural. We cant create enough doctors and we cant force down the wages of the best doctors. It will go overseas. It's already been happening.

[Edited on 7-1-2012 by Hook]

BigWooo - 7-1-2012 at 06:19 AM

I read yesterday that in 2014, even though they are saying that health insurance will be mandatory...you can still opt not to purchase health insurance... but you will be paying an additional 1% in federal taxes as a penalty for not having health insurance.

Although it sucks to pay the additional 1%, if your happy with your Mexican insurance and care, 1% extra Fed tax is most likely cheaper than buying an insurance policy you won't use.

Either way you will be paying extra.

Santiago - 7-1-2012 at 07:47 AM

Since this is a thread regarding ex-pats with local health insurance but none in the USA, I'm guessing the far majority would be retirees between the ages of 55 and 64, right? You sell your primary residance, your small rental you've repainted after every stoopid renter moved out, and bought a nice place in Guadalajara, settled in, joined the best Mexican health plan, canceled your US insurance and see doctors in Mexico, figuring that when you're 65, you'll join Medicare, just in case you get something bad. And since your world view is similar to DavidE's, you cashed in all your 401Ks/IRAs, paid the freeking tax, bought gold on the Australian Exchange so that when the good ol' USofA goes over the cliff you're OK. (Don't laugh, I KNOW guys who have done this)
Let's say you travel to the USA once or twice each year and during one of those travels a hit and run driver hits you while you are in a crosswalk; the driver is never found. You have a broken pelvis, lots of internal organ injuries etc etc. You'e not going anywhere for 6 months at the very least. As much as some of us would like to, we will not let you die; you will go to the nearest Trauma Center and spend a good half a million dollars.
Gee, I wonder what the changes are for the private business in the USA that supplied all the care to you to actaully get paid BY YOU. Slim and none, and slim just left.
So if the rest of us who actually live here ask you to please, carry some kind of insurance so that if the above does happen the system doesn't have to cover you and you refuse to do so, well, yeah, we are going to tax your sorry a**. Get over it.

Hook - 7-1-2012 at 08:02 AM

My insurance DOES cover accidents like you describe in the US. And we do travel the US a couple times a year. I just cant go to the US for treatment of something discovered. Well, I could get insurance that allows me to do that from the company I'm with but it would be too expensive.

There are lots of insurance companies that write policies that exclude getting treated in the US because it's so expensive to be treated there. The company doesnt want to pay for the treatment and the insured cant afford the premium.

Maybe this will qualify for coverage in the US and exempt us from the 1% tax in 2014.

Santiago - 7-1-2012 at 08:29 AM

In any large and difficult omnibus legislation, the way the program ends up is far different from the the way it was first enacted; the ACA will be no exception if it survives the first few years. It will get tweeked as things that don't work well are removed and those that do are pushed to the forefront. I don't think a year goes by that SS, Medicare, Farm Bill etc gets modified in some way.
I suspect in putting the bill together, no one thought of Hook's particular situation, it must be a small subset of Americans. I think Hook has covered his bases and agree that he shouldn't be subject to the fee/penalty/premuim/tax, whatever you want to call it. I will go weed-diving today and see if I can come up with something.
Do Canadians ever have these discussions?????

Santiago - 7-1-2012 at 08:35 AM

Ridge, really, you've just wiped out everyone's monitor. Again.

DavidE - 7-1-2012 at 09:39 AM

"Paid By Someone Else" Like me $103,000+ in federal taxes 1981 alone.

Like me, 1991, $645,000 in liquidated assets to pay hospital bill because insurance said I had "moved from Nevada to California" disqualifying me".

Like me, paying $200,000+ since then until Medicare kicked in.

Got neeewwwsss for you. Had I not had Medicare + supplemental insurance a year ago, a hospital would have set my broken arm / hand and NOT had to have to install a titanium plate or reconstruct surgery. Unless of course you would like to argue this with the California health care system to see what is and what isn't covered by a "Get in an accident and it's all free" medical treatment. The hospital releases you when it can be proven in a court of law that by doing so, it has not put your life in danger. People that go to the emergency room with sniffles, are shunted OUT, quickly, and the public hospital charges full-bore as a write-off. The FIRST thing they ask is DO YOU HAVE INSURANCE? This determines the level of treatment. Want to go after a fight? Go after a constitutional amendment that repeals the notion that a child of undocumented residents AUTOMATICALLY gains US citizenship which shields the family from deportation. Hundreds of babies are born every day at public expense, and the undocumented know the citizenship law by heart. They count on it. They pray over it. The women get pregnant with a vengeance over it. But, the effort will never go there. It will remain rooted like a hog in slop over a piddly-ass issue of sharing health care expense. I do not know how many of you were alive and worked in the 50's and 60's when the USA had REAL income taxes? I cannot believe how spoiled and self-centered young people have gotten. We old farts worked our ass off, got taxed all to hell, the infrastructure got built, like freeways and hospitals, and the next generation comes and says, "Oh hell no! There is no way we are going to do the same thing as the generation before us and think about the elderly!"

Health care is a quagmire, because politicians run it. Oh hell yes, let's all pay attention to the fire and forget about the arsonist.

The system, like the standard of living is being BLED TO DEATH by elements that suck all the money out without contributing a damned thing. Of course you wouldn't THINK about how many tens of billions of dollars our congressional royalty enjoys in unique, and gold-plated federal health care programs they enjoy, now would you? You can't get it, only they have it. And they decide what works for their constituents. No! Oh hell no! Let's argue about health care for us!

Sonny, it's all about hypothesis and taxes until you need it. Health care that is.