Before I start writing on my topic for today, let me say in advance that this is a real hot button issue for Americans. I want to remind all readers and participants on LiP to please keep the discussion civil. No name calling. Please, let’s just focus in on how expats are affected, and not the debate of the issue itself.
Health care. It has been a major issue in the United States for decades now. There was a big rush of activity in the early 90’s when President Bill Clinton tried to push through a National Health Care plan, with the effort being headed up by his wife, Hillary. After the proposal was shot down in the early 90’s, the issue of a nationalized health care system kind of faded for a while, although issues like the cost of health care and such continued to be ever present.
With the new administration of President Obama, there has been a renewed push to get a National Health Care system in place in the United States. In the past 24 hours, the U.S. House of Representatives has passed their Health Care Plan by a very slim 220-215 vote. One Republican crossed to vote with the Democrats, so it can hardly be called a bipartisan effort. The debate over health care now shifts to the U.S. Senate, where a bill has yet to be passed. If the Senate passes Health Care legislation, the next step will be for the two houses to meet in a conference session to wrangle out the differences in the two bills that are passed. After that, the final bill would be presented to the President for his signature.
I know what you are thinking…
But, Bob, you don’t live in the United States, why would you really care, and what does it have to do with Living in the Philippines? Why are you writing about this?
Well, as the bill sits right now, it would seem that it might have an impact on expats living anywhere in the world, even in the Philippines. Why? How?
Under the House version of the bill, there is language that says that every American must have health care coverage. In fact, if you do not purchase a health insurance plan, you are subject to a fine of $15,000, and if you do not pay that fine, you can be put in jail. Yes, if the Health Care plan is signed into law as it is now written, you may be put in jail if you do not have Health Insurance.
What about expats?
The bill does not say “All Americans who live in the United States must have coverage.” It says that “All Americans must have health insurance.” So, what if you do not live in the United States? I am an American, but I have not been in the United States for nearly a decade. I do not have any kind of US Health Insurance coverage, because I have no plans to go to the USA for any kind of health care treatment. I feel perfectly safe with the health care that is available to me in the Philippines.
There are only a few (actually I know of only one) Health Insurance plans available in the USA that will cover you for treatment in the Philippines. The one that I am aware of is Tri Care, a plan for US Military Personnel and Retirees. Other plans will cover you for emergency care in the Philippines, but not for regular health care for those who live here. I am not saying that there are no such plans, only that I know of none.
Now, there are health care plans that you can avail of here. If you have a Philippine spouse, you can get PhilHealth, the Philippine Government Insurance plan for your health. It is very inexpensive (P1,200 per year!), but the coverage is also limited. If I have PhilHealth Coverage, I wonder if the US would consider me to be in compliance with the proposed law? I sort of doubt it.
So, will I, and others like me, be required to purchase Health Care Insurance coverage from a US company, even though we don’t live there? If we don’t buy it, will we face a stiff fine, or jail time? Frankly, I think that is crazy. I also think that it is something that has not been considered by those who are considering the law. There are tens of thousands (possibly hundreds of thousands, I’m not sure) of Americans who do not live in the USA, so this is a real issue that needs to be checked out.
So, what do you think? When or if you move to the Philippines, what are your Health Insurance plans? Do you have any plans? Do you plan to self-insure, since health care costs here are actually quite low?
Give me your thoughts, but please remember, let’s only talk about how this legislation affects expats. No name calling, it’s just now what we do here! 😉
Well Bob – Sigh – I have Medicare, A, B, and D. Not sure what my plan is but the one Medicare – Plan A is free. That should take care of the $15,000 fine. At least I hope it does. Early next year I will look at a affordable plan B that I could use in Guam if things got bad for me. Guam is the US of A. Medicare works there. That is my plan for the time I spend in the Philippines. SEE? No bad words, just my plan. 🙂
My guess is that no one has thought about this. If folks are truly interested, there will still be a reconciliation time between the Senate version (forthcoming) and the current HR version. This would be a very good time to email your members of Congress and remind them that not only would it not make sense for Expats, but it is wholly unenforceable.
I refuse to believe such a sweeping action (people permanently living out of the country being required to purchase US Health Care) could possibly become law. However, I have been wrong before. Politicians seem to all suffer with terminal tunnel vision at times.
According to my Google search a few minutes ago, there are over 3 Million Americans permanently living outside the country. Are all of those 3 million people going to willingly subsidize health insurance for the thousands (make that millions) of other people who can't hold a job if you gave it to them on a silver platter.
Painting such a complicated legislation with a broad brush stroke simply will not work in the end. There will have to be exceptions written into the law. The law will probably end up being worded something like: IF you are drawing a wage and paying taxes, you will have to have the health insurance.
And how about the countless Americans who have played the system for generations: never holding a job, living on food stamps and other forms of state and government aid, popping out babies like rabbits so they can get more food stamps? How are they going to pay for that?
American jails are over filled as it is, way over capacity. The threat of a fine and possible jail time is mostly just hot air. How would you impose the fine if there is no money to pay for it and where in the heck would you house the Millions of people who could not comply with the "get the insurance or go to jail" hollow threat?
The Congress passing their proposed version of the bill is just one small step… When the dust settles, the bill, if it continues to pass, and that is a big "IF", will probably not even read like it does today.
–Rich–
Oh yeh, cant wait to get to the PI in a yr. have only ss income at that time and i will get on my wifes philhealth, (the philippine medicare type program) as she is a retired teacher there and has it for life at no cost. anyway the new obama care program wont work well and will probably be changed numerous times in the next 2 yrs. it cuts medicare , uses the threat of the irs intimidation and a few other weird things americans wont like. it is not health care, it is tax care. it would have been better to just put in the public option and use it but then u could not have the (exchange program) u know the required companies to purchase from which they will probably write (derivatives) on top of. remember realestate bubble? anyway it will be modified greatly and when i fill out my taxes online i will put in i have philhealth and then medicare in the future even though i wont owe tax. any govt program including medicare part A should suffice. if not im not coming back to worry about it! i never thought i would promote pubic option being a life long republican but it looks better than this mess. god bless the expats of america. jayho
Hi jayho – I’m not going to debate the Obamacare package… suffice it to say, though, that if somebody does not live in the USA, I personally think they should not have to pay for it.
Hi Tom N – How's it going? Been a while! I hope you are doing well!
I agree with you. I think that the fact that there are Americans who don't live in the USA has not even been considered. But, from what I can tell, the way the legislation is currently written, I would be mandated to buy some kind of US health care policy, or face the penalty!
Hi Bob,
A good topic, and a very vital one, since a majority of expats choosing to live in the Phils. will be past middle age and more liable to suffer from health issues. With my current state of health and fitness, and my lifestyle, I believe that I can reasonably expect to live to around 90+ years old, but sure as day follows night, I am going to need some healthcare during that time, and I will want it good and want it fast. And cheaper as it may be there, I imagine a triple heart bypass, and a hip replacement would still not be met from the petty-cash. So, sure, I am gonna need health insurance, and I'm not going to be wanting to be groaning around on my stretcher straining from angina pain examining the small print on my healthcare insurance.
I'll be watching this topic with avid interest, because the research I've done so far has shown me that the cost of real good healthcare insurance in the Phils. is very expensive indeed, and the information that arises from the responses to this topic could be very significant for us all.
On the subject of your concerns regarding the current healthcare bills before the US senate, I imagine that issues like expats will be exactly the kind of detail to be wrangled over. I guess it wouldn't be the first time a glaring error was made mind you. But just supposing you had a REAL BIG health issue that you felt wouldn't or couldn't be effectively dealt with in the RP, and you felt you had to travel to the states in order to have a chance of staying alive, what would you do? And if you had ticked the "opt out as an expat living permanently overseas" box and were no longer eligible for US healthcare unless you had your dollars in your hand to pay for it, what would you do then? Nothing is clearcut here, is it? Incidentally, for "you" in the preceding sentences, please read "any US citizen)!
Hi, Bob, lucky for me, I may not have to worry about this at this point in time. Anyway, this $15,000 fine for not having a U.S. based health insurance (when this bill becomes law), are you talking about the planned maximum excise tax to be levied to a non-participating family? According to the following link, it's $1,900, not $15,000. But still…
http://www.aca.ch/joomla/index.php?option=com_con…
Hi Bob,
A very interesting, important and timely topic to discuss here on LIP and I for one would like to hear yours and other readers what their plans are. I am planning on moving back to the Philippines in the near future and have no plans on getting any kind of health plans here in the US including enrolling in Medicare when I make my move. My reasons are:
1. There are very few US private health plans that covers treatment and hospitalization in the Philippines and are accepted in very limited hospitals in big cities. Cost is also high.
2. Medicare only covers you if you are living in the US. No coverage outside the US. So why enroll for something you're not going to get.
3. I plan to get private health insurance in the Phil. and enroll in Phil-health. Lower cost.
I am not a Federal employee or member of the US Armed Forces so I don't have Tri-care (you lucky bunch), so #3 is my only option.
I like to hear what others have to say.
Hi John – I read another news article that said that there was a $15,000 penalty or fine for not having a plan. Everything is in flux right now, we'll see how it comes out when the dust settles. Figure this, though… I have a family of 5 US Citizens (and one who is not a US Citizen). Five times $1,900, we are still talking some serious bucks! And, I assume that fine would be every year if you still don't have coverage.
Hi Jun – I'm with you 100% on #3. That's really the only decent option for an expat who has no plans to return to the USA.
Are you a U.S. citizen, Jun? If you are, the concern is over the bill that just passed the House requiring all U.S. citizens to purchase a U.S. based health insurance coverage, or a $15,000 fine, according to Bob. Having the Phil Health Insurance would not exempt you from the U.S. requirement, as it now stands.
Bob–after i got to page 1900 on my reply to this post i saw it was much too large to print here so i will just say " WOW–THEY GOTTA BE KIDDING–GET REAL AMERICA"
Hi John – That's exactly right! If Jun is an American citizen, he may have to buy a plan whether he likes it or not!
Hi James – Ha ha.. you must have been busy at the keyboard, my friend! 😆 And, I don't blame you either! This plan, from an expat view is pure lunacy! We'll see what happens when things fall into place!
Hey, were you in Davao City a couple weeks ago? I thought I saw you, or somebody who looks just like you. I was going to say something, but I was on the other side of the street, and out of reach.
Not me Bob–I am still stuck in Florida trying to get some business settled –i hope to be back in a couple of months and America has seen the last of me then–i am involved in a small fish business in Digos City right now — Nikki is holding down the fort with papa
Hi James – Ha ha… well, it's good that I didn't say anything then! The guy might have thought I was crazy!
Good luck on wrapping things up, and making the move!
Hi
I am Canadian and blessed with having National Health care. It is not a perfect system but NO ONE has to choose food or medicine here.
No one is turned away from ANY hospital and ANY one is able to get a heart transplant for the price of monthly fees of about 50 bucks for a sinlge person and 70 for a family.(of course you have to wait your turn on the transplant list just like anywhere else)
I repeat ….it is NOT a perfect system and as with anything could use some improvement!!!
Yes there are some waiting lists for elective surgeries
BUT
18 months ago my brother woke up feeling odd and called the ambulance
($50.00 per ride covered by his insurance)
wound up in the cardiac care ward and after some tests and had triple bypass surgery the next AM.
the cost $50.00 he had already paid for the month.
If my brother could not have afforded the $50.00 per month due to his poor paying job ….the province gov't would have reduced his fee to……..FREE.
I have heard horror stories about people selling their houses and cars and everything just to afford this kind or any kind of surgery.
It really is inconcievable to us Canadians
Having said that I am VERY sure that the US gov't will have to exempt all citizens living overseas or there would be a worldwide revolt 🙂 🙂
I am also sure that there will be many many discussions about implementation and other needed changes.
Tyleen – I am sorry, my friend, but we are not going to discuss the merits of the Canadian system vs. the current US system. I thought I was kind of clear about it that we are here to discuss the impact of the current US legislation on expats. Please, remain on topic, because this topic will go way out of hand if you don't, and your current comment is off the topic that I laid out.
I don't know how or why you are so sure that US expats would be exempted by the Govt. It would be a first, because US expats currently have to pay for lots of programs that they are not qualified to benefit from. The US is one of the few governments that taxes worldwide income, even if you never go to the USA.
lemme see….social security a government run program…insolvent by 2014. Medicare rife with fraud to the tune of billions per year. Welfare a 11 trillion dollar program (and growing) to end poverty, rife with fraud (estimated to be close to 80% fraudulent claims).
Government run health care??? I’d rather trust it to the local witch doctor than uncle sam.
I have even read Bob (not verified) that you will have to supply the govt. your bank account info. If you don’t have insurance expect a withdrawal from them…nice eh? People are angry over this issue and rightfully so, I fear for our Republic Bob , as much as I hate to say Thomas Jefferson was right, The tree of liberty needs to be watered from time to time. This proposed piece of work would make our fore fathers roll over in their graves!!
So much for "Change you can believe in"….he must have meant thats whats left of our paycheck after uncle sam's takes his cut.
Well Bob..maybe you need to start the process and become a Citizen of the Philipines along with the other members of your family [ I belive you had a topic on this some time back..not sure..but belive so. ] Then if you did…and you live there in the Philipines and you all ready had health insurance for you and your family thru what ever they have there, and you have dual citizenship..then I would think they could not fine you or any of that..because you are insured and you do not live in the USA…
As far as putting people in jail for those the choose not to comply with the new law and choose not to get any….that would be along ways off in the process I think…I think what they would do is get the IRS involved and then you would have them to deal with as far as the fine or what ever goes [ That would not be fun to have the IRS dogging you ]..
Then we would need a new bail out plain to provide the funds to have more law inforcement and more jails and more goverment employees and so forth for all the extra work that will be involved…and on it goes…..like the people back there in Washington think there is some kind of magic piggy back that never runs out of money…[ Hey!, there is..its call the Federal Reserve System!]
The other thing I quess for those the have assets in the USA or bank accounts and etc and did not live there and choose not to go along with the plan…emmmmmmmmm wonder how all of that would be!
So..if this does become law then one more nail in the coffin of the American way of life deteriorating even more…Then we can move on to the next be plan they have back in Washington called Cap and Trade and that if it goes thru will put a few more nails in the coffine of the American way of life deterioration even more…and so it goes……Interesting artical Bob and will be very interesting to see how all of this pans out and if it goes thru what people with do.
Hi Bob – Health Insurance? Don't need it. I'm gonna live forever.
Many of us aging boomers still thing the above sentiment still holds water, though time has caused some of our buckets to crack and leak a little.
While I could use TriCare, I don't plan on it outlivng me. My military retirement health care used to be free – a benefit earned and received for my career in the military service. Then, prescription co-pays magically caught on as a requirement. Then, office-visit co-pays; then an annual bill; and then increased co-pays (services requiring them and amounts needing payment). This courtesy of someone who was "feeling my pain"!
Now, as part of "plan," my annual payment and individual co-payments will increase as my quality of service decreases. (They've already increased the radius of residency from a military base to determine where you get what prod and poke – from a civilian or from a military "medical professional.")
(Other benefits are waning and wilting away – some day I expect the government to say something like, "You want what because you did what kind of career where?" – Only need to be a Congressman for a few years to get a nice health care package!)
If things continue, TriCare will probably disappear. Go ahead and fine me. I don't have the money. Go ahead and put me in jail – while I'm there, don't forget to feed me, clothe me, exercise me, and take care of my medical and dental needs. Give me the cell next to Bernie Madoff! #*((, I spent a career in the military – jail would be a cake walk! 😉
Who says there's no free lunch! 😆
Yes Bob you are right.
I should NOT have written about the Health Care issue.
Thanks for pointing that out to me. I will be more careful in the future!!!! mea culpa
The TV is full of the vote and the discussions about the concerns that special interest groups are having. AARP has just weighed in about your topic of expats and the dicussion on CNN Live is saying RIGHT NOW that it will be an up hill battle to get it passed in the Senate. They are also saying that the concerns of expats living overseas will have to be addressed.
I guess I was so sure that the expats would be exempted as it is so blatantly unfair to make expats pay that I thought the US government would play fair.
I guess Americans will have to stay tuned and wait see what transpires.
Hi brian – The programs that you mention like Medicare and such are things that as an expat you still must pay into, yet are not available for us. For instance, I have a son who would qualify for SSI if we lived in the States. That comes from the taxes that we must all pay. However, because we do not live in the States, he may not receive such payments. I'm not complaining about it, and I really don't want the money anyway, but just pointing out how things work….
Let's keep on the topic of how this affects expats… ok? 😀
Hi Bob;
A camel is nothing but a horse designed by congress. The person, who cannot pay for his or her Health Insurance, can reach right into their back pocket and come up with $15,000.00 for a fine? Okay, so they can’t, then congress will put them in jail, where we the taxpayers will spend $40,000.00 plus to house them every year, and while in jail they’ll receive free health care,it's a Win-Win for all, again on the taxpayer’s dime. That’s why they are voted in every two years, America’s brightest and best!
Hi Paul – The issue of the way that Vets are treated with regard to health care and other Vet issues is a national embarrassment.
Personally, I'd rather enjoy life in Davao that get three squares and bed in a US jail, though! 😉
No probs, Tyleen… let's see how it turns out! By the time it's settled, though, you and I will probably be gray and enjoying a beer together somewhere in the Philippines… or already dead! 😉
Hi Paul – Ha ha… no doubt, my friend! Who said that Politics has to made sense? 😉
Hi Paul – Just want to take the time and thank you in advance for funding my incarceration.
(btw, heatlh care provided by the USPHS in prisons is much better and more timely than that provided military retirees! 😯 )
I'll take "3 hots & a cot" anywhere I can get them! 😆
I always enjoy your posts Paul.
It seems to me to be much ado about very little. The odds of the US Government fining expats in the Philippines for having no insurance are very remote. These guys are unable to catch people like the esteemed Mr.Madoff living on Park Avenue in full view, never mind trying to catch fellow citizens living in places like Mindinao, Luzon and Namibia. I know there is one New Yorker in Namibia that they would like to fine and possible jail for tax evasion and so far——huge sigh—–according to the Daily News—-no luck.LOL
Mind you the efforts involved in fining the millions of American expats for having no health insurance might put millions more back to work. Ya just never know. It is not inconsievable that the Feds might form a special unit and send them overseas trying to chase down the offending expats.
I can imagine them running around Illocos. I guess the occasional guy will turn himself in as you say for the free cot and the three hots that go with it. What a hoot.
Best
Jody
Hi Jody – Don't take me wrong.. I never said they are going to come and hunt you down for not having health care insurance. What they will do, though, I believe, is that the day you land in the airport on US soil, they will arrest you until you pay. That is not only what to expect, I'd bet on it.
Bob as you have stated nothing is etched in stone as of yet. The Senate has to finish its bill, then committee it to death and then the House and Senate versions have to be merged. So none of us know for sure what is going to be the final bill. I just wish that they would slow down and take the pulse of the Amerian people, the reality for all and stop rushing to get a bill passed to just say they passed a bill. This is not health care reform anyway its insurance reform. Its amazing to me that for everyone I talk to only a small percentage like what is happening. You would think Congress would be listening. Expat or not, health care bill or not all Americans are going to be effected by this government. The value of the dollar based on economic policy, the tax burden created for all of us is growing like a Tsunami and I could go on and on. I will just say that the 2010 elections are critical to changing this group making these decisions. Good luck to all of us because I think we need it.
I agree, Ron, that we all need to know what is going on, and look out for our interests whatever they may be. Those living in the USA would have different interests than somebody like me who has not been to the USA in a decade. Here on LiP, we need to look out for the expat consequences on this.
I am a first-time "responder". Although a "cano", I spent most of my childhood in the Davao region and visit often. I have another concern and that is either masive tax increases, or significant inflation / dollar devaluation. I have ideas of retiring at least part-time in the Philippines, and the massive increase in deficit spending concerns me greatly. While the previous administration also deficit spent, the new programs discussed now bring it to a whole new level, raising the risk of significant devaluation of the USD.
Hi Bob – Sorry, I know Medicare doesn't pay outside US soil. That is the reason for the Guam comment. For about $25 per month I could get a Plan B that would pay better then Philhealth. I could also get Tri-Care, my daughter is in the Navy and wants me to enroll. Tri-Care is worth nothing to me in the Philippines. Besides, for it to pay for my medical a person on Tri-Care must have Medicare. Sigh! So no $15,000 fine. Like you Bob most of my health care will be done local. If I would have something big needed then the ticket to Guam is cheap.
I do have a question that maybe someone here can answer for me. I have heard more than once that expats in the Philippines drawing Social Security need to show that they are alive each year. I have been drawing SS since 1995 and Medcare since 1996. I have never be asked if I still live or not. I also have been told that SS will only direct deposit into a single account. The person collecting SS. Until my divorce my SS check was placed in a dual checking account. Go figure..some say one thing..then someone else….The Philippines is worst? How?
Bob
I guess you are on the right track. Government is surely getting more intrusive by the week.
Do the feds have the right to garnish your pension for monies owed .I remember OJ Simpson moved to Florida because his pension could not be touched in that state by the authorities in California.
LOL My wife has just laughed at my question and has informed me that the Feds can do everything that God can do, so I guess that question has been answered. It has been my observation over many years that women from Illocos are very wise and smart in the ways of the world.
Best
Jody
BTW – I was planning on living to be at least 100 years old. At least that old. That is the age Abraham was when he and Sarah had a baby. Me too?
Hi Dave – Those expat plans are expensive, and also not really so much "day to day" stuff from what I've heard. Given the costs of good health care here, a plan like that is not really needed or viable, IMHO. We'll have to see how things flush out. We don't have a law yet, but we do have plenty of bills out there! 😆
Hi Jody – I think that the Feds can garnish your pension, if the situation is right. And, your wife is certainly right… the Feds are the Feds… they make the rules! 😆
Hi John,
Yes, I am a U.S. citizen and if this bill also passes the senate the President will sign this into law. Congress and the Senate are not listening to the people that they should be representing. They had all these town hall meetings and yet nobody listened. They are all so focused with their own agenda. Are we going to vote on it? Of course not. Whoever controls Congress and the Senate will have their way. Fair? I don't know the meaning of that word anymore. Taxation without representation. Jailtime – free meals and health care – looking good. May have to changed my plan in moving to the the Phils. It looks more like San Quentin.
Bob – For me as the father of a seaman (woman) Tri-Care is of little use in the Philippines. I could get a flu shot in Manila and little else. Tri-Care is being stripped of most of what made it good at one time. Meriam has Filihealth (or whatever it is called) and once married she can add me, I think. It is hard when a person has been as sick as me. The US is going the way of Canada for healthcare. So of it will be good and a lot more will be bad. If you are sick then as an senior you wait. The care will go for the younger folks. At least in the RP I can pay my way into a hospital room.
So many things are wrong with the US right now. Nothing has been the same since the oil was shut off. It has been downhill ever since. For a very short while we were the strongest country in the world. Now in healthcare we rank 27th. How did we let that happen? You made the right move Bob. You have missed the worst downfall of any country since Rome. The trouble is that all this pain is far from over. I understand our fearless leader is ready to halt a manned space flight. That will leave China alone on the Moon. Sigh! At the end of this century China and India will be the leaders with the US trailing along with our tail between it's legs. Glad I will not live long enough to see it. Sorry that my children will.
Hi Jun – It's a sad situation!
Hi Gary – Tri Care can offer pretty much full health care coverage here, not just flu shots in Manila. I suppose it depends on what plan is available to you, though. I do know people who get full coverage through Tri Care right here in Davao, though. Now… you do have to pay cash for the services, then file a claim and get reimbursement from Tri Care, but it is fully covered. Like I say, the plan available to you may be different, though.
Kamusta ka Bob,
TO be honest with you Bob, I haven't followed this closely at all, so to me this sounds ridiculous to "make" people buy a health care plan, AND if they don't they are fined or jailed..looks like the police and government will be building prisons and jails instead of funding a good health care program to me.
Again, I haven't followed this at all, but I can't see it affecting US citizens living outside of the country, and I am sure they will have amendments in place when or IF it is ever passed into a law. How could they force you to purchase a health care plan, especially that wouldn't be recognize in your host country.
I guess time will tell….
daghang salamat,
Danny 🙂
Hi Danny – I hope you are right, my friend. However, there are lots of things already in place which we must pay for as expats, yet we are not allowed to use, because we don't live in the USA. So, the health insurance would be no different than other programs that have already been in place for years. We'll see how it flushes out…
Bob:
I think more than likely, the government would use the IRS' long tentacles for enforcement first (Garnishment, liens, etc.). Probably through some form of tax witholding on wages or other gov't benefit payments. That being said, no policy or law is ever made in the States with expats in mind or even remotely in consideration (Except for ways to tax your worldwide earnings… SHEESH!!!). Even if there are over 3 million US expats worldwide, they account for less than 1% of the total US population… insignificant in terms of votes or influence.
More than likely, if this passes, they will catch someone returning to the US and a stink will be made in the press, resulting in some change or ammendment eventually). OR, they may allow foreign plans only for those who file from overseas (Another way to catch tax cheats or those who don't file)… My guess is that this may be what we end up with.
Bob: Also, I'm reasonably certain that the Embassy and Ms kinney's staff would be up to date on expat impact if and when this passes.
Hi John – I was thinking the same thing… health insurance will become equal to "did you pay your taxes?" It will be an enforcement regime for expat taxation. We'll see…
BTW, I totally agree that there will be no "expat consideration" in terms of any debate or legislation. We are too small a group to even be concerned about.
Hi John – I agree that US Embassy will eventually have some guidelines. BTW, not sure if you are aware, but it is my understand that Ambassador Kenney's time is limited. I have been told that she is due to rotate out of the Philippines soon, and I've also heard that she will retire rather than take a new post. Not 100% certain on this, but the source should be reliable.
Bob;
Ugh… This whole topic has given me a headache… Time for a beer, I think.
BTW… I'm near Ipoh in Malaysia, and they grow coffee here. You know if it is decent? I'll stop at the public market, if you want me to look.
Hi Tom – Yeah, who knows what the final bill will be, or even if any bill will ever be passed. But, I'm not betting that things will get better, and there's a good chance they could be worse! 😯 You just never know!
Well, Obama did make a campaign promise that stated all Americans would get health care coverage. What he did not tell you, is that you are going to be mandated to purchase the coverage or get fined or go to jail. If the law passes, then he has made good on his promise. I have found that living here in the Philippines has been advantageous since medical care here is relatively inexpensive. I live on a modest military disability pension I earned after 19 years service, and to make me pay for another mandated program would break the bank.
Hi Michael.M – Thanks for commenting, I believe this is your first time, right? Nice to have you on the site.
You know, I would not have a problem with it if they offered a special policy for expats, priced based on what the medical costs are in the place where you live, and paid out for claims in the part of the world where you resided. That would be fair.
Hello Bob, Yes it is my first time to comment, however I am a regular reader. Keep up the good work.
Hi Bob & John – I'll have to ask Ambassador Kenney about that retirement rumor next time I see her. Her husband is US Ambassador to Columbia (she was previously USAmb to Ecuador), so there might still be a little "State Dept." life ahead, though he's headed for "rotation" as well.
As is, everyone at the Embassy is busy getting ready for the Secretary of State's upcoming impromput visit and "Feeling Your Pain Tour" of typhoon ravaged Manila. They want to get her out a bit – she might come down to Davao as well as making a stop up here.
Honolulu, Hawaii mayor Mufi Hannaman was in town today for a visit. He was making a whirlwind tour of 4-5 municipalities here in Ilocos Norte yesterday and today. Given formal recognition as a "Son of Ilocos," he's here to say thanks, and to invite our governor to visit him in Honolulu.
It's hard keeping one's finger on so many pulses! 😆
Hi Bob,
First of all, I would like to say KUDOS to all Americans for the Health Care Bill. Hoping it will pass the senate too. I do believe that health care should be available to all. KUDOS because now the U.S.A will be at par with all the developed countries that have universal health care.
In terms of coverage, American Law is only valid in American soils ergo no coverage for americans outside U.S. jurisdiction. unless you avail for a travel health insurance. This public option will have different policies in each states and most likely be interpreted and implemented in different ways but nevertheless it is a good thing.
In Canada where health care is provided to all Canadians in Canadian jurisdictions, Canadians do not have to worry about paying or co-paying, almost all medical bills are covered. Annual check-up is free so early detection and prevention can be done. If you have no job, your medication will be given to you by the doctor. If you are a rich Canadians you can go to the states for more expensive hospital suites but you pay it yourself. Some medical services are run by private firms but their main client is the Canadian Government Health Care.
Toting
Bob, You want me to comment without getting nasty or politically angered towards a particular political party????? Wow, thats a tough assignment!
I guess all I can say is that until the average American realizes that ANY social program or entitlement thought of is nothing more than a legal way to pick their pocket by the federal government, we will continue to see our freedoms and bank accounts eroded. My daddy taught me years ago…there is no such thing as a free lunch.
There is a much, much larger issue here that goes beyond medical care, and the meanderings of Congress to pass a health care bill. The current administration is hell-bent on socializing America. The current attempts by the administration to manipulate private business are beyond socialism, the are in fact quite fascist in nature. "Oh, we still want private ownership, we just want to control every aspect of it for the common good. Comply, or we'll put you in jail. ". What's next? The fortunate thing that I'm seeing here right now is that even the morons in this country are starting to figure out that this administration doesn't want just change. They are starting to realize that they want total, dictatorial rule over all aspects of our lives, both private, and public. I don't think we'll see any lasting destructive changes, because I do believe many of these people will be voted out of office. If not, I'll abandon this ship, move overseas and live totally off the grid. All it takes is money.
Hi Spencer – As I asked in the article… please, let's focus on the expat affect. How do you think that the health care plan affects expats?
Hi Paul;
I’ve had a lot of luck with Tri-Care, mostly bad luck, I use it here, but I’ve learned to file claims for reimbursement, one time, I even got a check from them, not bad in 10 years!
I agree with being locked up, is kinda’ like a six month cruise with no liberty port, could do it standing on our heads. I just hope they don’t expect us to work!
Gary;
I could be wrong, and I am a lot! But I believe your daughter would have to have legally support you before you could qualify for Tri-Care. You would have to be listed as her dependent with the Navy, to enroll. Uncle Sam doesn’t give nothin’ away for free!
Forgive me, Bob, I just have to put this in, in response to someone's harangue on how the present administration is "hell-bent" in turning the U.S. into a fascist country.
Opponents of the recently passed House version of the Health Reform Bill received an average of $503,000 from health insurance companies since 1989, while supporters of the bill (219 Democrats and one lone Republican) received an average of $437,00 for the same period. And this is only in the House of Representatives. In the Senate, the disparity is much higher, running into more than a million bucks for those Senators who oppose as against those who support the bill. Now, who are the fascists?
It seems that nobody is following my simple request. I am now going to close comments on this article.
I specifically requested that we have no name calling, and focus on expat affects of the bill.
If we can't stay on topic, I will close the comments on this topic.
Hi Bob,
I was wondering, if in the unlikey event that the U.S. government exempted Americans living abroad from the requirement to purchase healthcare, would it only apply to those with permanent residency or also apply to those living on a tourist visa. I don't have a good feeling about this.
Hi Ron – I suppose that nobody could really say for sure on that, since no final version of the legislation has been settled on. I think, though, that expats will be totally forgotten in the legislative process.
For me, I think that unless somebody has a residence visa in the country where he lives, he should not be exempted. Living abroad on a tourist visa shows no intention of making it permanent, and it just seems too temporary for me. That's just my opinion, though.
Bob, Thanks for this thought provoking article. I think you are absolutely right that the current House bill mandates that all U.S. citizens purchase insurance. Though it is true that a senate version has not yet beeen passed and there will still need to be a conference committee of the two houses to work out a final version, I believe that the mandate will stay in any final bill. I doubt that the question about expats has even been considered because of the complexity of the bill. But since expats are U.S. citizens. I would presume they would be covered under any mandate and would be required to buy some type of insurance.
Another questions for we 'seasoned citizens" is will we be required too buy insurance and the logical choice would then be medicare. This would put us in the box of having to buy medicare but unable to use it where we lived. Maybe that would cause Congress to rethink using medicare in places like the Philippines. Just some thoughts Thanks again.
Richard wilson
Aw, the Canadian National Health Care isn't so bad.
Heck, ask the hundreds of Canadian heart surgery patients flooding through the Cleveland Clinic just across Lake Erie. It's great to have such fine services available at such a reasonable cost! Why, National Health will also help with transportation expenses if the proper paperwork is correctly completed and submitted. 😆
Very interesting topic, Bob. I suppose that a U.S. Expat must either sit & watch as events unfold or contact political representatives & hope that their opinions have some value. A "universal" health care program will be of such complexity, that I would expect the "kinks" to take decades to work out. As the program will be uniquely American, comparisons to the programs of other countries would be speculative as is discussion over whether all U.S. citizens will be required to pay into the system. My slight understanding is that the program has been promoted for the benefit of the 40million who have no coverage? As my own country's health program was of no value to my wife when she spent time in Hospital in RP – both Manila & Davao – One wonders why one would pay into a program that offers no benefit. For an American living in The Philippines, obviously, shelling out a few thousand each year without being able to access the benefits of such a program seems unreasonable. Best of luck with this.
Mike
Hi Richard – Nice to hear from you. I agree that expats has not even been considered, and probably never will be, because it's too small of a group to even think about. We are sort of out there in "limbo land" on this one! 😀
Paul – This is off topic. I have warned others to keep focused on the expat side of the health care debate, and ask you to do the same. I don't want this to turn into a brawl on LiP.
Hey Bob,
This health care bill when passed, will not even take effect until 2013. This will give some time to work out all the kinks (I hope)
Maybe by then the UN will be managing healthcare, and it will be good everywhere.
Hi hudson – It was my understanding that under the house bill the plan would take effect pretty quickly, however the public option would not come in until 2013. I could be mistaken on that, though.
HI Bob –
A valid concern.
Well, you already know where I stand in this & it's not important here. You mentioned this same point during our lunch & I've tried searching the net for answers. Still no clue.
I wonder, what do the other countries with a similar insurance framework do? Or even the British or Canadians? There's got to be a solution somewhere.
In the end, such sweeping rules is hardly enforceable & will most definitely be tweaked (there's still the Senate version THEN the combined version).
This does affect me though since I still have plans to spend at least part of my time in the US.
Hi macky – Nice to hear from you! Hey, isn't it about time for another lunch? Last time I saw you was right at the start of when I got dengue! Luckily, I am feeling much better now, though.
I don't think that the US could get a solution for the expat problem from the Brits or the Canadians, because their system is much different from what is being proposed in the USA. In fact, what they are proposing in the States is that everybody has to buy private insurance. Those other countries have government paid health care, not something where you have to go out and buy a plan. That's a much different animal.
Good to hear from you, macky.
Hi John – You are exactly correct.
Macky
I have never seens a case where a long term expat from Northern Europe is made pay for health care in their native countries.I am not sure what the policies exist in Japan, Taiwan , Singapore ect.
It is worthwhile noting that the US Government collects tax from its own expats.
This is highly unusual as most countries are simply not allowed to tax their citizens overseas.
I only bring up this point to accentuate Bob's initial post which perhaps has some more validity that I had thought.
I think it might be a good idea if the premiums were ultra low for expats.
Best
Jody
Exactly, Jody! 😉
Kuya Bob,
Maybe you should run a spin off site and name it LipBoxing… ;)) Anyway, as for the health care plan. I really don't see them making an exception to the policy on behalf of the citizens that choose not to reside in the states. Looks like our out of pocket expenses will go up again and the insurance will be of no use to the majority. I do have a health care plan that covers me on a reimbursable basis provided by the company. But, I do not work all year long so I will still be required to purchase. I hardly ever pay attention to what is happening in the US. Guess I will have to tune in on this issue.
Still I wonder, how often is the fine assessed??? Ha-ha, maybe it will be cheaper to just pay the fine then provide funds to an agency that does nothing in return.
As most of us (that have lived in the RP) already know, the health care here is affordable, Philhealth is an excellent opportunity and a foreign policy is not only hard to utilize but, in most cases the co-pay portion is higher then the bill itself. If the US approves of this policy it is the same as throwing money into the fire while cooking lechon…
Hi Mike K. – Hmm.. now you have me thinking… do you think that putting dollars in the fire while making lechon would improve the flavor? Wow… that could be a whole new recipe! 😉
Maybe if we expats have been totally forgotten, they will forget about us too when it comes to having to buy the policies! 😆
yea but with my luck they would suddenly remember as I hit the customs counter upon entry!
Maybe we should try the new recipe when I get back…
Hi Bob and John,
We are all speculating here right now.
John, My supplementary health insurance(employer provided) does cover my travels including the Philippines.
I beg to differ Bob about the US taxman can make an arrest in the Philippines. The memorandum of aggreement between the US and the Philippines are only Capital Crimes. Remember Jimenez? he was arrested by Philippine Police Officer but not by Americans then turn over to the US government but not for tax evasion.
Check the extradition treaty here: http://www.lawphil.net/international/treaties/ext…
I am mainly stating a fact that AMERICAN LAWS DOES NOT APPLY TO THE PHILIPPINES.
Expats will have to wait and see how this US Health care be implemented.
You can read more about the bill here:(Lots of reading to do) http://en.wikipedia.org/wiki/United_States_Nation… http://thomas.loc.gov/cgi-bin/query/z?c111:H.R.67… http://thomas.loc.gov/cgi-bin/query/F?c111:1:./te…
The act says that it will be on your taxes so expect higher taxes. If you pay american tax you get it and covers only the U.S. and its territories.
I hope this will clear things.
I do believe this is GOOD to all Americans in US soils. Expats and retirees will have lesser tax increase compared to people like Bob. C'est la vie!
Do not worry it is not as huge as private health insurance.
Toting
Hi Paul – You cannot legally own land here…. 😉
Hi Toting – Every American, regardless of where they live has to pay American tax! I also never said that the US could "arrest you" on Philippines soil. Philippine authorities can arrest you and you may then be extradited to the USA.
By the way, Toting, here is a direct quote from that extradition link that you provided:
So, the link you provided directly and positively says that the Philippines will indeed extradite Americans for tax evasion.
Hi Bob – Ergo, I cannot legally pay property taxes. I'll have to remember that line in January at the Municipal Tax Assessor's office. 😆
Don't think this aspect of living here, or any related one that an expat may have, will amount to a hill of beans with regrard to enforcing and collection of the proposed "fine" (read: tax) for not having government approved health care insurance.
Seriously: Expatriation will not equal immunity!
As far as the USA is concerned, it will (as it does on all issues involving nonresident citizens) all come down to citizenship itself (at least for the paying-in side of the ledger). An approved and recognized renouncing of USA citizenship will most likely be the only way out. Even then they have you coming and going – renouncing one's USA citizenship is only allowed with the permission/approval of the USA government (read: Exit Tax)!
Where expats should pay attention is for any movement to make hard and fast determinations of what is an approved health care insurance policy. Remember, one of the purposes of the current legislation is to cut health care costs for all. The reason for the "fine" amounts to punishing one not doing one's duty to help lower those costs for all. This is not about taking care of one's own. It's about taking care of everyone.
If a budget-bleeding government saw fit to make additional pennies from military retirees, they could state that the various TriCare plans do not meet the specifications of being approved health care insurance scheme, and then enact forced withholding from retirement paychecks to cover the cost of "an approved plan."
An expat could have a gold plated "Cadillac" plan that would cover all expenses and not require any public money be disbursed for the expat. If it doesn't meet government specifications, however, the expat (or anyone having his/her own policy) could very well end up paying for an approved supplemental policy issued by the government.
When you get right down to the core of it: This isn't about paying for your health care expenses, its about paying for everyone's health care expenses.
Welcome to B & P Diner – home of the "free lunch"!
Hi Bob,
Yes, It does state that and also states
"If the extradition request involves a fugitive, it shall be granted only if the remaining sentence to be served is more than six months."
If you owe the US government for the first time $5000 tax evasion, it is only logical that they will just withheld your pension. The chance of an ordinary american citizen being sentence to more that 6 mos for owing the US Government on taxes is a tall order but nevertheless is irrationally possible. It will also cost the tax payers thousands of dollars to chase a retired expat in the Philippines. That is why they will only use extradition treaty to the most heinous or big money crimes for the reason that it will cost so much.
My point here is, Laws can be interpreted and implemented in many different ways, this is also the reason why this article got passionate responses and I would say, your success in writing a good article that touches every Americans.
Universal health care is good for all Americans who are in US soils. It is bad financially for retired expats because they will end up paying more taxes but not as bad as you might be thinking.
My speculation is this Health Care Bill will be implemented like the ones in Canada, U.K., France and Australia. Private health insurance will be relegated to supplementary health insurance, meaning prescription drugs and elected surgery. Taxes will increase but americans in the US who are unfortunate to get a life threatining disease doesn't have to go bankrupt to avail for an expensive cure.
The above countries do pay more taxes but you do not hear someone losing a house to be able to afford the medical cost of the cure.
In a different light, if an expat will have cancer, I pray not, he can come back to the US an be able to get medical treatment for free because he pays for it in his tax and without worrying about the cost.
I really applaud you Bob for writing articles that are good.
Health Insurance in the U.S are so against this bill because they stand to lose billions of dollars.
I would say GOD BLESS AMERICA!!
Toting
Hi Toting – Thank you, I am glad that you enjoy my articles. I agree… God bless America… and the Philippines too!
nice articles bob. more power to your website. 🙂
Saturday, November 21 Update: Do a Google Search for the health care bill and you will trip across this PDF file: Google " 111_ahcaa.pdf ". It is the full 1,990 page searchable House bill H. R. 3962 document.
I searched the document electronically for all the combinations of words I thought would turn up something about Americans living overseas. This is as close as I came to finding an answer, and it does not look good (in this version… remember, this is not a final version, if it passes at all).
I searched the document for the word "residing" and found this:
INDIVIDUALS RESIDING OUTSIDE UNITED
STATES.—Any qualified individual (as defined in
section 911(d)) (and any qualifying child residing
with such individual) shall be treated for purposes of
this section as covered by acceptable coverage during
the period described in subparagraph (A) or (B) of
section 911(d)(1), whichever is applicable.
Sounds like any American living overseas (outside America) will be included in the bill (meaning you pay for it even though you can not use it).
Lets hope I am wrong with this interpretation.
–Rich–
Hi Rich – Thanks for searching out that reference. It will be interesting to see how this develops.
BTW, Rich, are you in Davao now?
Hi, Bob- Actually, the recently-passed House version of the health care reform EXEMPTED Americans who live abroad from having to pay an excise tax for not holding an authorized U.S. health insurance plan, but the bill that is before the Senate that is about to be debated does not.
The Senate version would penalize overseas Americans who choose not to participate in the U.S.-approved health care plans. The penalty is $750 each year and will be tacked on to the tax liability owed IRS, according to the following article:
http://www.rightpundits.com/?p=5028
Hi Bob,
Not yet in Davao … still cleaning up loose ends in Florida. It may be as late as February or March 2010 before I am ready to move. I just got back from visiting my sister in Tennessee and she did everything short of drugging me to convinced me to move back to our hometown. Such a move is simply not going to happen. I see a real need to stay busy – see and experience new things, create a new family. A move to rural Middle Tennessee would be unbearable. Boredom would be the word of every day.
The key to a quicker move may be as simple as "unloading" my 3-bedroom home as opposed to hanging around for some sort of perceived profit a few months down the road. Most of my things I plan to ship are already packed (in anticipation of a quick getaway).
There is another factor that drives me to sell the house quickly — Between now and September of next year, about 3 or 4,000 employees will lose their jobs in this area due to NASA retiring the Shuttle program. I need to get the heck out of Dodge before this area becomes a second Detroit, Michigan, with staggering unemployment.
I'll keep you posted.
–Rich–