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YucaLandia

Jul 1, 2012, 1:52 PM

Post #1 of 12 (3840 views)

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Affordable Care Act (ACA - Obamacare) Updates for Expats

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Now that the Supreme Court has made Obamacare official, it seemed time to report on how it (might) work.

If interested, check out these 2 reports:
ACA – Obamacare’s Effects on American Expats Living Abroadhttp://yucalandia.wordpress.com/...xpats-living-abroad/

and

ACA “Obamacare”: Necessary Change or “Bigger must be Better”http://yucalandia.wordpress.com/...e-or-make-it-bigger/

We look forward to comments to help keep things current and targeted to US visitors and residents in Mexico.
steve
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Read-on MacDuff
E-visit at http://yucalandia.com

Aaron+

Jul 25, 2012, 5:12 PM

Post #2 of 12 (3234 views)

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Re: [YucaLandia] Affordable Care Act (ACA - Obamacare) Updates for Expats

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(Political comments deleted.)

As for the effect on expats, there is at least one big fork in the road, expats employed by a U.S. company, and the rest of us. The Council of Insurance Agents and Brokers believes that for the first category, and for empoyers with more than 50 employees, that the law's effects appear predictable:
http://www.ciab.com/...adAsset.aspx?id=2102 Cigna takes an opposing stance, and notes that qualify for the foreign income exclusion of the tax code, one needs to be a full 12 months in one given country. It also questions how coverage from non-US insurers will be evaluated. See http://www.cigna.com/...Health_Plans_v8F.pdf

As for the rest of us, those not employed by a US firm and living here, the more I read on the subject, the less I know, because at this point it is all conjecture until the final regulations are written. And those regs could be subject to necessary changes based on any legislation that Congress might actually pass in the next session!

As for US citizens who work on their own here in Mexico for US firms via the Internet, chuckle, you may need a US compliant health care plan or pay the fine/tax for not doing so. But that is not clear either.

(This post was edited by Rolly on Jul 25, 2012, 7:35 PM)

Rolly

Jul 25, 2012, 7:38 PM

Post #3 of 12 (3191 views)

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Re: Affordable Care Act (ACA - Obamacare) Updates for Expats

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Let's stay focused on how the law impacts those of us living in México and avoid the politics of the law.

Rolly Pirate

stevebrtx

Jul 25, 2012, 7:52 PM

Post #4 of 12 (3184 views)

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Re: [Aaron+] Affordable Care Act (ACA - Obamacare) Updates for Expats

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You seem quite informed on this subject, so my question to you as an authority is: Just when should we expect the "regulations" to be completed and published for consumption?

Also, I have this flowchart produced by a member of Congress, can you tell if it's still current?http://chapalaweather.net/ocare.jpg
http://www.chapalaweather.net

(This post was edited by stevebrtx on Jul 25, 2012, 8:07 PM)

Aaron+

Jul 25, 2012, 9:05 PM

Post #5 of 12 (3158 views)

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Re: [stevebrtx] Affordable Care Act (ACA - Obamacare) Updates for Expats

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I did not claim to be an authority on the subject. I'd have to be either a poor to moderately paid legislative assistant, or a well heeled lobbyist, or salaried employee of an insurance company or hospital chain dedicating full time to the process to claim authority status. Instead I am living on a small pension and trying to make sense of the world about me.

The chart you point to is an amusing creature coming from a PPACA opponent. I have charted far more complicated pathways for computer programs I used to be involved with. One could draw a fairly complicated chart for the existing system, which leaves up to 50 million persons uninsured. But it does not get us any further to answering the question, how will the Patient Protection and Affordable Care Act (ACA) affect us living outside the USA.

As to when the regs will come out, that is a good question. Perhaps we should both address our congress person to ask HHS for their estimate. Let me just note that the Mexican INM is taking a long long time to work out regulations for the new immigration law here, which is a lot simpler than reforming health care provision in the USA. There are a lot of special interests that INM may be listening to, and we sure know that the insurance companies, pharmaceutical companies, and major health care operations are all dipping their oars in PPACA.

stevebrtx

Jul 26, 2012, 6:43 AM

Post #6 of 12 (3116 views)

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Re: [Aaron+] Affordable Care Act (ACA - Obamacare) Updates for Expats

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Ok, let's see if I understand, you're not an authority, you don't know when the regs will be written (so we have no idea what they are, or what impact they will, or won't, have) and you seem to dismiss the chart I referenced. Do you have one that I can study created by the authors of the bill? - or has there ever actually been one created for public consumption by the unnamed, unknown authors of the bill?

With all due respect, it seems a bit meaningless to attempt to "discuss" the impact, or none impact, on us here in MX when no one can yet speculate on what will transpire NOB and things are changing daily. You referenced software, then you can relate to "vaporware" and I would proffer this to be "vaporcare", extremely expensive vaporcare, but none the less undefined and any "discussion" at this point is pure conjecture and speculation.
http://www.chapalaweather.net

YucaLandia

Jul 26, 2012, 7:51 AM

Post #7 of 12 (3092 views)

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Re: [stevebrtx] Affordable Care Act (ACA - Obamacare) Updates for Expats

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Aaron makes some good points. Not every post on a topic is a dialogue or discussion. Many useful posts simply identify the current status and characteristics of what exists, and describe what remains to be addressed.

It is very useful to identify the areas that still need clarification and the areas that need work. Aaron points to real, current, significant problems and gaps in our knowledge on the ACA ("Obamacare"), which makes good first steps in solving complex multi-layered problems. He proposes that he and Texas Steve write letters to the appropriate officials to ask for details and what the time frames are for promulgating the regs.

We don't have to be authorities on something to make valid, useful, or insightful comments.
Ordinary people sometimes have the best insights, especially when the problems directly affect them.

Identify the real remaining issues, propose positive practical solutions and efforts that we on Mexconnect can do, and encourage others to make those efforts. Is this really an unreasonable set of approaches, warranting snarky personal retorts?

I agree with Aaron that we should be contacting our State and Federal govt. officials to find out what's going on, and encourage reasonable actions on these issues. As a former Washington DC resident with regular contacts with Govt. officials, and a contractor to the Federal Govt.: It is very clear that well-considered, well-crafted letters to Senators, Congressional Reps, and Govt. officials do make a difference. Democracy works, but it takes more than complaining, it takes the efforts of dedicated citizens. Liberty and freedom do come at a price: the efforts of an informed and active citizenry.
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Read-on MacDuff
E-visit at http://yucalandia.com

(This post was edited by YucaLandia on Jul 26, 2012, 8:00 AM)

stevebrtx

Jul 26, 2012, 8:35 AM

Post #8 of 12 (3078 views)

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Re: [YucaLandia] Affordable Care Act (ACA - Obamacare) Updates for Expats

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Steve, I love your sense of humor, contact our elected reps? - ha, that's rich, and get back the usual form letter? Come on, I'm sure you're much more informed than that. First we're not even in the US, so they could care less, next they don't have a clue either and we're in an election cycle where all they care about is getting reelected.

I use the word "discuss" because that is what the mod said we were supposed to do. My point is that there is so little known and so much unknown in this that any, and all of it, is speculation. The election is in 102 days and will dramatically change things no matter what the outcome.

Something that's been nagging at me for some time, don't laws usually define what is going to happen before they're passed? To me it seems this one was essentially a license for nameless, faceless, non-elected bureaucrats to, after the fact, write what ever they want to do - essentially a "license to steal". The bill said healthcare for all and we're going to pay for it by taxing X, Y & Z, but it never came close to actually detailing how it would work, or did I miss something?

Things here in MX are much the same, "oh, we're changing the immigration laws" - pass the bill, so they did and here we are a year later with a new administration coming in and still no idea really what it means.

I wouldn't know what to say, or ask my representatives if I wrote to them other than "wazzup dude"?

PS Steve: "Not every post on a topic is a dialogue or discussion. Many useful posts simply identify the current status and characteristics of what exists, and describe what remains to be addressed" - those are the ones pinned at the top, somehow I doubt MexCon wants to take ownership of this subject. Although you did call one right "remains to be addressed" which I believe pretty much covers the entire subject.
http://www.chapalaweather.net

(This post was edited by stevebrtx on Jul 26, 2012, 10:59 AM)

Aaron+

Jul 26, 2012, 11:44 AM

Post #9 of 12 (3050 views)

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Re: [stevebrtx] Affordable Care Act (ACA - Obamacare) Updates for Expats

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Stevebrtx, sorry your experience with your elected officials has been dismal. I have had a number of occasions to contact my US Senators, to meet them, and likewise with US Representatives in Congress. I have also written and talked with their legislative assistants. Obviously, I got more than a form letter when I had an action request rather than just a statement of opinion. What to ask? Ask if they could keep me/you informed as to when the operative regulations for PPACA are printed for comments in the Federal Register (if it has not happened already), and then an estimate as to when they will be put into place subject to the comment period. There, that was easy.

Oh, though here in Mexico, I do vote in the USA, by absentee ballot if need be.

Yes, we no the outlines of what was signed into law. As the old expression rightly or wrongly goes, the devil is in the details.

(This post was edited by Aaron+ on Jul 26, 2012, 11:47 AM)

stevebrtx

Jul 26, 2012, 11:56 AM

Post #10 of 12 (3046 views)

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Re: [Aaron+] Affordable Care Act (ACA - Obamacare) Updates for Expats

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Tell you what, I'll make you a deal, you write a letter, PM it to me, I'll copy it and send it to every Rep and Senator representing me and I'll share with you the responses and we'll see what comes of it.
http://www.chapalaweather.net

YucaLandia

Jul 26, 2012, 4:49 PM

Post #11 of 12 (3006 views)

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Re: [stevebrtx] Affordable Care Act (ACA - Obamacare) Updates for Expats

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Good idea.

I suggest we tweak Aaron's language enough that this does not appear to be some cut and paste spamming effort. Each of us can give it your own person touches. Including the appropriate HHS contact info would also be helpful.

The US Government can and does work sometimes.
e.g. I got a piece of the SBA regulations completely rewritten to better fit the reality of the consulting, environmental and public health industries. It took 2 years of occasional efforts on my part to get it through public comments and promulgation, but the process was effective and appropriate. I had to do the research to prove my points, but once proven, the SBA took the data and proposals, and ran with them. I did have to go the government officials who had the power to do it, and I had to humbly ask how a private citizen could get a regulation changed. They gave me step-by-step instructions, and with the support of my Congressional Rep's advocate for citizens, one section of the SBA regs are changed (permanently).
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Read-on MacDuff
E-visit at http://yucalandia.com

stevebrtx

Aug 4, 2012, 9:38 AM

Post #12 of 12 (2658 views)

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Re: [YucaLandia] Affordable Care Act (ACA - Obamacare) Updates for Expats

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I would love to "tweak" Aaron's letter - when I receive it? What happened to our letter writing campaign? I was all ready to demand some answers.
http://www.chapalaweather.net