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Thursday, September 5, 2013

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.


Christophe said...

Hi Victoria,

Hope you're doing great.
So, how did the meeting with your senator staff go. Are you going to write about it?

Christophe said...

I don't have any information regarding Obamacare and Americans abroad.
However, I can comment about how and why it is negatively perceived by middle size and big companies here in the US.
I can tell through the meetings and talks we have each year about heath insurance, that they blame a lot of the cost increases on Obamacare, even if the company is self insured.
You would think that a self insured company would not be impacted. That is not totally true.
Part of the cost increase is due to the requirement of having to accept "kids" up to 26 years old on the company's insurance plan, even if they can get insurance through their own company.
(In the case of spouses for example, it is possible to insure them through our company, but there is a significant premium increase if they can get insurance coverage through their own employer).
This year, they told us that Obamacare is contributing to the increase in cost because it requires a $63 per employee transitional insurance fee. This can add up depending on the size of the company.

Victoria FERAUGE said...

@Christophe, I have the view from my dad too. He has a small consulting practice in Seattle. Their healthcare costs are a real problem and impact their competitiveness internationally.

I have to get my notes together and when I do I will write about it - it was fascinating to actually meet MY reps.

Anonymous said...

I didn't Catch the details about what the penalty for Medcare B is, what it is based on, and etc. Or, at least, a link to those details.

This sounds like strike 2---- that having lived outside of USA is a crime.

From an Anonymous EU parliament visitor!

Tim said...

The easiest answer to this question is whether someone in the position of your friend in Paris would be eligible for Massachusetts Commonwealth Care (aka RomneyCare the MA state level inspiration for Obama care.) RomneyCare is already in place in Massachusetts and all MA residents must have RomneyCare or an alternative plan.

What I am going to try to lookup up is upon arrival in Massachusetts how long does it take to become considered a legal resident eligible for free care(based on income levels) and whether what plans allow to you to get into the expensive and prestigious hospitals such as Massachusetts General(ranked best hospital in the United States).

Note: several states such as Massachusetts, New Hampshire, and Rhode Island have banned insurance companies from using pre-existing conditions to deny coverage. So people in those states with employer coverage have always been able to obtain care.

Tim said...

The link below is for Network Health. They actually administer RomneyCare for the State of Massachusetts and is where you can find the doctor and hospital acceptance locator.

Janet said...

For information on the effects of Obamacare on Americans resident abroad go to
and enter
into the Search field.

Here is some of the information I found:
"Americans who are bona-fide residents overseas are presumed to have minimum essential coverage and as such do not have to pay a tax for not being insured in the US."

"For tax payers below the top Federal Income tax bracket above, the long term rate will remain at 15%, though for individuals earning over $200,000 (single) and $250,000 (married filing jointly) net investment income
which includes: Capital gains (long and short term), interest, dividends, income from partnerships, some
retirement income and some other misc. income will be subject to the additional
3.8% Obamacare tax."