Obamacare and the American Migrant

When I was in the U.S. last month I went to see the staff at the district office of one of my senators.  While I was waiting for the meeting to start I saw a flyer about the new American national health care program known as 'Obamacare' (The Patient Protection and Affordable Care Act).  As I read all kinds of questions popped into my mind about how this program will work for American migrants - those living abroad and those who might choose to return to the U.S.  After my meeting I spent a few minutes talking to another staff member and she was able to answer a few basic inquiries like:  If someone lives abroad for 20 years and has a pre-existing medical condition can he/she get health insurance in the U.S. if he/she wishes to return?  Her answer was an unequivocal 'yes'.  Under the new program insurance companies will not be able to deny coverage.  However, when I asked what 'reasonably priced" meant and what level of coverage one might expect, she couldn't answer and suggested that I got to a website to find out more.  I followed up that question by explaining my circumstances.  After hearing me out she admitted that the coverage would probably not be as comprehensive (or as inexpensive) as what I receive in France.  I'll be looking into this further and I'll post more when I have better information.

I'm not the only one with questions.  I know a couple of Americans here in the Paris area with long-term life-threatening health conditions.  One case I know of personally is someone who is very ill and on permanent disability here in France.  They have long considered the lack of national health insurance in the U.S. to be an impediment to ever returning there to live.  Going home to die or to end up on the streets isn't very appealing.  Under Obamacare has that changed?

Not easy to answer that question.  The few sites I looked at this morning were oriented toward what Obamacare means for Americans living in the U.S.  I could find nothing that specifically addresses Americans abroad (6 million+ U.S. citizens) or Americans who will return or who have returned to the U.S. to live.

Case in point - on the blog Iris sans frontières a woman who returned to the U.S. with her husband after living many years in Paris is concerned about Obamacare and her private French insurance.  Under the new healthcare law everyone must have a minimum level of insurance or pay a fine.

The situation worrying me for the past year as an American expatriate now residing in the U.S. is the possibility that my medical insurance might not qualify for Obamacare, that it might fall through the cracks.

To make matters even more interesting she and her husband are enrolled in the national health insurance program for retirees called Medicare but only Part A (hospitalization) and not Part B (doctors, scans and so on).  They did not elect to join Part B because they already had their private French insurance.  This system has worked reasonably well for them for 18 years - they pay the local doctor when they receive service and then they send the bills to France to be reimbursed.  But now with Obamacare she sees a problem because "I appear, like a good number of Americans, to have no insurance."

Furthermore, because they did not join Medicare Part B when they became eligible, there is penalty for late enrollment:

10% for each full 12-month period one could have had Part B but did not. I am 18 years overdue. Every Social Security representative I’ve talked with sees no way out of my paying the penalty if I were to enroll now.

After many phone calls and lengthy explanations she was able to get some answers from the Healthcare Insurance Marketplace Advanced Resolution Center.  They were able to confirm that their existing French insurance does qualify as "minimum essential insurance coverage" so the American system will recognize that  coverage and not charge them a fine.

However, if they ever lose their French insurance and have to apply for Medicare Part B, it looks like they will have to pay that penalty to join.  That doesn't seem right.  Does that mean that an American abroad who wishes to return home in his 70's will have to pay extra to get enrolled in Medicare, the national healthcare program for retirees (people on fixed incomes)?

It would be good to get some clarity on all this.  We know that Americans abroad are exempt from Obamacare but what about all the issues around re-insertion into the homeland healthcare system?

If you have any information that would be helpful to Iris or to Americans abroad who are contemplating a return to the U.S., please feel free to leave a comment here or on her blog.

I must say however, that this all seems much trickier than I had imagine and it is yet another example of how the American diaspora is something of an afterthought when it comes to homeland legislation.  All the more reason to push hard for a Commission on Americans Living Abroad.