Swiss French: http://www.rts.ch/info/monde/4105523-la-reforme-sante-d-obama-passe-la-rampe-de-la-cour-supreme.html
Here is the text of the SCOTUS ruling: http://www.supremecourt.gov/opinions/11pdf/11-393c3a2.pdf
I don’t have much to say about this yet. I would like to read through the ruling first. I think that universal health care coverage is a good idea (as long as there is some flexibility and freedom of choice, e.g. the Swiss system). However I don’t think that Obamacare should have been introduced in the middle of a recession. FDR did something similar in the 30’s with the introduction of some social programs that homelanders still have access today, but the national debt wasn’t in the 30s what it is today.
As I said elsewhere at Isaac Brock Society, I seem to remember that the final Obamacare bill exempted USPs abroad from the insurance requirement. I believe that insurance companies will no longer be able to discriminate on the basis of pre-existing conditions from (2014?), however I am not sure that this applies to USPs abroad who return (those that really want to after all Unca Sam has done to mess up our lives).
The health insurance companies will make out pretty good. They will now have many more clients since the Federal government is going to subsidize insurance premiums for those people who previously couldn’t afford insurance. Although this now means that they will not be able to deny coverage for pre-existing conditions the truth is that those people who make claims based on a pre-existing condition are not really that significant.
Obama Care is a poor imitation of the one payer health care system that we have in Canada, Singapore and Europe. There will still be millions of uninsured people and these people will be looking exclusively to the government funded programs, of medicare and medicaid, for their care.
In the end the U.S. taxpayer gets hit twice. Through the health insurance companies premiums and government taxation to subsidize private health insurance purchases and al the while paying for the people who will be in the uninsured high risk pool.
Romney Blasts Supreme Court, Calling Healthcare Act ‘Worst Idea I Ever Had’
Vows to Repeal Own Law
@Jefferson, The requirement to have health insurance only applies to people living in the United States (only the states and DC, not the US territories and not abroad), like any kind of taxation should be. Those living in the US, including Americans abroad who return, would have to hold health insurance starting in 2014, and at the same time insurance companies would be prohibited from denying insurance or charging higher premiums for people with pre-existing conditions.
There is a penalty of 2.5% of the person’s income if the person does not have health insurance, starting in 2016. However, the penalty does not apply if the person has not been able to find health insurance that costs less than 8% of the person’s income. There is also an exemption for certain religious groups that oppose paid health care (I wonder what that would be). The health care law also expands current programs like Medicare and Medicaid and provides subsidized insurance for people with low income. To fund this expansion and subsidies, the law increases the Medicare tax, creates an excise tax on “luxury” health insurance, and imposes new fees on the health care industry.
I don’t disagree with public health care as long as it is provided directly by the government, and as long as private health care continues to exist as an alternative. However, the current system in the US where insurance companies dominate the market without competition is probably the worse, and the health care law only strengthens this system. It denies people’s right to pay for health care costs directly if they so choose. Health care costs are inflated in the US because most people have their insurance plans chosen by their employers, don’t pay directly for it, and don’t have to pay almost anything for the use of health care. To most of them, practically all health care seems “free” so they end up using unnecessary services.
In my opinion, a solution to the rising health care costs is not to force everyone to have insurance, but on the contrary, to prohibit employers from offering health insurance to their employees, pay them more salary instead, and allow people to choose whatever health insurance they want, or none, if they prefer to pay for the costs themselves. Or create an entire system of public hospitals and clinics to serve the whole population, charging for its use with maybe some free emergency services or reduced costs for the poor (like religious-affiliated hospitals do). Americans are used to insurance too much and assume it is the only way to pay for health care and many other things.
Yes, non-resident US citizens are excluded, as confirmed in an email exchange I had with ACA today:
‘If you are a bona-fide resident overseas you are excluded from participating in Obamacare in the United States.”
The requirement to have health insurance only applies to those living in the United States (only the states and DC, not the territories and not other countries), starting in 2014. At the same time, health insurance companies will be prohibited from denying coverage or charging higher premiums for people with pre-existing conditions. This applies to anyone in the US, including Americans abroad who return.
If a person does not have health insurance, starting in 2016 there is a penalty of 2.5% of the person’s annual income. There is an exemption from this penalty for religious groups that oppose paid health care (I wonder what that would be), and for those who cannot find health insurance that costs less than 8% of their income. The health care law also expands current programs like Medicare and Medicaid, and provides subsidized health insurance for people with low income. To fund the expansion and subsidies, the law increases Medicare taxes on wages and taxes on investment above a certain amount, creates a tax on “luxury” health insurance, and imposes new fees on the health insurance industry.
The current system in the US where most people have their health insurance chosen by their employers, and don’t pay almost anything when they use health care services, is the main reason why the US has the highest health care costs in the world. To most people in the US, health care is practically “free” so they use many unnecessary services without regard to costs, increasing demand and inflating prices. The health care law only strengthens this system and greatly favors insurance companies and the health care industry by increasing demand for it, often unnecessarily. In my opinion, the solution to the problem is not to force everyone to have health insurance, but on the contrary, to prohibit employers from offering health insurance to their employees, pay them more salary instead, and allow people to choose whatever health insurance they want, or none, if they prefer to pay for the costs themselves. Or create public hospitals and clinics run directly by the government and available to everyone, charging people for its use, with some free emergency services or reduced costs for the poor (like religious-affiliated hospitals do). Americans are used to insurance too much and think that it is the only way to pay for health care and many other things.
Ok, so I’ve never been able to understand what all of the fuss was about with this issue? It seems that the main issue with a proper healthcare system in the US is that it ‘reeks of European socialism’, hence for this reason alone it is bad. In my experience many Americans freely throw around the words communism, socialism, fascism and anarchism and don’t really seem to make any distinction between them (or really get the differences between them) save that all four are foreign and thus un-American. “We didn’t come up with single payer healthcare first so it must be a bad idea” kind of thinking. This law seems to make changes that are so wafer thin that they would be laughable in Europe if proposed as a comprehensive healthcare reform, but in the US its treated like some sort of once in a generation change. Very foreign to me.
@ Don, the problem for us is that the US will be reaching into the pockets of its expats to pay the healthcare bill of Americans resident in the Homeland. Get rid of extra territorial taxation, and I don’t care if they get MacDonalds to run their health care system.
Sorry for the duplicate posts above, I meant to post only one.
The daily funnies…
Andy Borowitz @BorowitzReport
Now that we have healthcare, Clarence Thomas can get his throat checked to see why he hasn’t spoken in 20 years.
How about a world where the doctors guild is forced to release their millenium old stranglehold on us and where we are sovereign over our own bodies and our own lives. A world where we can order any drug or substance without dealing with the doctors-pharma-insurance cartel from anywhere on the planet? Sounds great to me, and I am Swiss. I don’t need the Swiss government deciding with the doctors, administrators, Zurich Versicherung, Helvetia, Roche and Novartis what kind of coverage I will get. Get all of them the FUCK out of my life.
@ConfederateH, I totally agree, but it’s not a millennium-old stronghold, in some developing countries it is still possible to buy most drugs without a prescription. Medical malpractice has caused an increase in restrictions for people to become health practicioners and keep their licenses, increasing their monopoly, but it should have instead made society reevaluate the power it gives them.
*@bubblebustin, and others who wonder: Americans abroad are not EXEMPTED from participation in the health care program. Rather there is a PRESUMPTION written into the law that “Individuals residing outside United States or residents of territories. — Any applicable individual shall be treated as having minimum essential coverage for any month … if such month occurs during any period described in subparagraph (A) ir (B) of section 911(d)(1) which is applicable to the individual,” — as long as you satisfy one of the bona fide residence abroad tests of the IRS. [26 USC 5000A(f)'(4)(A)].
*One objection to Obamacare is cost. Supposedly one of its objectives was to reduce health care expenditures in the US which are already 50% higher per-capita than they are in Switzerland, which is #2 after the US in expenditures for health care. All indications are that it not only will not reduce health care expenditures and costs but will cause them to skyrocket. The overhead and government paperwork seems destined to substantially increase costs.
I am retired and covered by medicare. I take Cumodin, a blood thinner since I had quintuple bypass surgery some 20 years ago. This requires that I be tested every 30 days. It is a test that takes about 2 minutes. But because Medicare does not reimburse my physician for having his nurse perform this test, I must go to the outpatient clinic at a local hospital once per month to have this test performed.
The hospital charge is $187.00. Medicare pays the hospital $48.81 and my private retirement medical supplemental insurance pays $10.81. The hospital writes off the balance.
It would be so much easier to have the physician’s nurse do it, which is what she does for non-Medicare patients, but because Medicare does not reimburse a physician for performing this test, I must go to a hospital, pay $5 for parking and spend an hour of my time every 30 days to have this done. If I did not have supplemental medical insurance through my retirement, I would also have to pay the $10.81 that Medicare does not pay.
And all of the paperwork connected with this simple test is just overwhelming. I receive a statement from Medicare and from my private insurance confirming everything. No wonder medical care is so expensive in the US.
@IntheAlps, I’ll have to get my reading glasses on and give that a read today.
Paul Krugman chimes in on the Obamacare:
@IntheAlps, do you have a link to this?
Patric Hale sent me this email, and gave me his permission to post his observations:
As I understand the SCOTUS decision, particularly Roberts “ju-jitsu” on the issue, changing it from an issue of the commerce clause to it being a tax, he essentially placed Obamacare into the hands of the IRS for administration since that’s who looks after taxes. And, yes, that would make overseas Americans theoretically “liable” to pay for Obamacare, too. After all, if you have real estate in the USA and you sell it – even at a loss – you’d be responsible for the 3.5% “transaction fee” that goes to paying for Obamacare. That overseas Americans don’t pay social security, medicare, or medicaid (unless I’ve been mistaken all these years) I would assume this would fall into the same category. But no one knows where this will go. I presume that Roberts was influenced in reading the bill that it provided for 16,000 additional IRS agents to administer the public mandate, hence his seeing it a a tax.
I’m really quite baffled at how Democrats are celebrating this as a victory. While conservatives rightly don’t like Roberts’ judging it “constitutional”, they are really overlooking the political ramifications of what Roberts actually said. He said in essence: “Democrats, you can’t justify Obamacare and the public mandate based on the commerce clause, which is how your Solicitor General argued it, but you CAN if you actually call it a tax, which is what it is, and is imposed on all Americans in the same way that social security, medicare, and medicaid is.
So the Democrats are celebrating the institution of another new tax on the American people, even though Obama pledged “no new taxes for anyone earning less than $250,000”, AND he claimed that Obamacare wouldn’t raise taxes. This is also the same one who cut “payroll” taxes – that is, contributions to social security – supposedly to help the middle class. Finally, this is the President who has already increased our national debt by over $5 trillion and if re-elected will add another $7 trillion according to his budget. All this adds up to one thing: Even if the economy were to recover to “normal” NONE of the gains will be left for “we, the people” because it will have already been spent by Obama – and the rich simply aren’t rich enough to pay for all of this lolly and folly!
“Beware the naked man who promises to give you the shirt off his back!”
http://www.gpo.gov/fdsys/pkg/PLAW-111publ148/html/PLAW-111publ148.htm to get the public law, then it is Section 1501, which leads to new IRS chapter 48, Section 5000A (f)(4)(A). Section 5000A will be 26 USC 5000A, but the entry does not appear to have been made as yet. If you are by now thoroughly confused, an explanatory page will be posted on the ACA website in the next few days.
Thank you! It’s a given that I’ll be confused but as a mental exercise I’ll give it a view. I look forward to the ACA post!
@all- It may because I am overly tired right now but I don’t understand how Roberts was able to see this as a tax. If it is a tax it is the only tax obligation that a person can satisfy without actually making the tax payment to the government. As long as a person has suitable private medical insurance coverage then there is no PENALTY to remit to the IRS.
Isn’t the idea of a tax that it is levied by the government on all of its citizens? Did justice Roberts resort to the tax argument as a way to avoid the concept of single payer system? Which would have meant a rewriting of the whole bill?
The IRS assures US residents, that it will go easy on enforcement measures of Obamacare. Practitioners express serious doubts.
In the article, Boustany the Chair of the House Ways and Means committee waxes eloquent on the reporting and compliance burden – totalling up the hours and decrying them as useless and unproductive. Too bad that he and his colleagues won’t do the same for the costly, useless and unproductive compliance burdens imposed on those who inherit liability under the oppressive and confiscatory US citizenship-based tax and banking paperwork and penalty regimes cooked up by the US, and punitively enforced by the IRS on all of those born, living and working in other countries.
Grossly hypocritical as always, the US and IRS can justify treating those living inside the US who benefit from US services, and who have US source income, so much differently from those of us abroad – born/naturalized in other countries, and paying tax in full where we actually live. We just barely escaped being forced (and enforced) to pay for this US resident healthcare program. On another thread at IBS, it describes how those of us abroad were originally included, but lobbying efforts by the American Citizens Abroad, AARO and other expat groups finally got us exempted.
This is a fuller and very recent exposition of the current state of Obama’s healthcare provisions re US citizenship-based extraterritorial taxation – there may be tax implications for some expatriates apart from the ‘individual mandate’ which most (but not all) expatriates were (in the end) exempted from.
Particularly see the sections re the: ‘Hospital Insurance Tax’ and ‘
Medicare Tax on Investment Income’
Contrast the efforts with which Boustany raises concerns re IRS and compliance burden on US residents http://boustany.house.gov/112th-congress/boustany-highlights-irs-compliance-of-obamacare-will-take-80-million-man-hours/ and his concern for the DATCA (domestic FATCA) burden on US banks, http://www.accountingtoday.com/news/Congress-Probes-IRS-FATCA-Interest-Regulations-62627-1.html http://www.floridacommercialnews.com/real-estate-finance/updated-fatca-series-post-congressmans-letter-to-treasury-secretary-geithner-on-irs-proposed-control/ with the US political silence re the burden on those of us already paying our taxes in full, with legal post-tax bank accounts where we were born, work and live permanently outside the US.
Badger – That looked interesting, but I couldn’t go to the bother of kludging my way past the “registration.” (Submitting to registration so reminds of submitting to the US.) So I googled instead, and met up with this useful summary. You extraterritorials out there with capital/currency gains socked into your long-held houses – you may get house-hosed by Obamacare! Sauve qui peut.
Get Ready for the New Investment Tax by reading this WSJ story …
@usxcanada; sorry, instead, try googling the title of the Lexology article below
“ObamaCare’s impact on expatriate investment fund partners” by King & Spalding LLP