Cynical US Healthcare questions

Old Mar 28th 2010, 6:25 pm
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Default Cynical US Healthcare questions

I started to think about this whole healthcare thing from an immigration perspective.

One reason, ex-pats couldn't bring aged parents over was the cost of healthcare. Now it's "free" (that's cynical part 1), is it now viable to bring over the aged parents, thinking at least they are now covered for "major" emergency stuff - plus the option to send them back to the UK for "competing" aged care homes!

Cynical part 2. Won't this happen more too for people having babies in the USA where they become a USA citizen which guarantees them, when they are 18 at least, the chance to come to the USA, if they want. I can see the volume of this floor going through the roof and being repealed by the next Government.

Cynical? Me?
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Old Mar 28th 2010, 6:46 pm
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Default Re: Cynical US Healthcare questions

That may be an "unintended consequence" of the legislation, depending on how the details work out. Two possibilities could eventually come about:

1. Health requirements increased in order to become a migrant (as already happens in Australia and Canada); and

2. Limitations on parent migration, as Australia has done.

If you're not living in the USA, planning to have a baby born in the USA is logistically difficult.
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Old Mar 28th 2010, 7:24 pm
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Default Re: Cynical US Healthcare questions

How is it 'free' for parents (or anyone else for that matter) There'll still be a premium to be paid and it'll likely reflect the patients history non?
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Old Mar 28th 2010, 9:50 pm
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Default Re: Cynical US Healthcare questions

The Dems plan allows premium discrimination based on age

But the subsidy is dependant it seems on income so there may well be possibilities

At the moment the system is skewed towards parents from countries where there is no coverage so they have nothing to lose, a trip to the ER in the US is better than the current option.
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Old Mar 29th 2010, 1:44 am
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Default Re: Cynical US Healthcare questions

Originally Posted by franc11s View Post
One reason, ex-pats couldn't bring aged parents over was the cost of healthcare. Now it's "free" (that's cynical part 1), is it now viable to bring over the aged parents, thinking at least they are now covered for "major" emergency stuff - plus the option to send them back to the UK for "competing" aged care homes!
I don't think it makes that much difference. Medicare eligibility remains the same and sponsors will still be liable for costs from the public purse. I guess the one advantage is that parents under Medicare age with pre-existing conditions will be able to get insurance, although they won't be eligible for government subsidies regardless of income.
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Old Mar 29th 2010, 2:34 am
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Default Re: Cynical US Healthcare questions

Originally Posted by Giantaxe View Post
I don't think it makes that much difference. Medicare eligibility remains the same and sponsors will still be liable for costs from the public purse. I guess the one advantage is that parents under Medicare age with pre-existing conditions will be able to get insurance, although they won't be eligible for government subsidies regardless of income.
I'm not so sure about that. I think the bill refers to all legal premanent residents as being eligible.
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Old Mar 29th 2010, 4:14 am
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Default Re: Cynical US Healthcare questions

Originally Posted by Michael View Post
I'm not so sure about that. I think the bill refers to all legal premanent residents as being eligible.
I actually agree with Giantaxe, on this one. Even if the bill does have some language about LPRs and eligibility, there's no guarantee that the feds won't take the view that a sponsor's signed contract trumps that.

We've discussed this a couple of times, but have yet to find a definitive answer. The nightmare scenario is, one bunch of feds says "OK, Mr LPR, you're eligible for the subsidy so it's only just that you be subject to the penalty for not having insurance" while another says "OK, Mrs USC, you signed a contract promising to repay any benefits your sponsee claims and the health insurance subsidy is just such a benefit".
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Old Mar 29th 2010, 4:31 am
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Default Re: Cynical US Healthcare questions

The lack of clarity about it all is one of the reasons we're headed back to the UK. We can't risk my need for dialysis/transplant etc in a few years bankrupting us.
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Old Mar 29th 2010, 4:34 am
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Default Re: Cynical US Healthcare questions

Originally Posted by chartreuse View Post
I actually agree with Giantaxe, on this one. Even if the bill does have some language about LPRs and eligibility, there's no guarantee that the feds won't take the view that a sponsor's signed contract trumps that.

We've discussed this a couple of times, but have yet to find a definitive answer. The nightmare scenario is, one bunch of feds says "OK, Mr LPR, you're eligible for the subsidy so it's only just that you be subject to the penalty for not having insurance" while another says "OK, Mrs USC, you signed a contract promising to repay any benefits your sponsee claims and the health insurance subsidy is just such a benefit".
Legal permanent residents (LPRs) are treated similarly to U.S. citizens under all three major health care reform bills. They are mandated to obtain health insurance, are eligible to purchase insurance through the exchange, and are eligible for the premium and cost-sharing subsidies if they meet the other eligibility requirements. This consistency of treatment holds regardless of when they entered the United States or whether they came initially as refugees or asylees.

The proposed policies toward nonimmigrants (i.e., those in the United States temporarily, such as students and temporary workers) are more nuanced in large part because some classes of nonimmigrants reside legally in the United States for extended periods of time, some are employed and taxed as a result of those earnings, and some are on a track to become LPRs.


http://www.hlc.org/Att_3_-_CRS_Report.pdf
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Old Mar 29th 2010, 4:48 am
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Default Re: Cynical US Healthcare questions

Originally Posted by Michael View Post
[B]Legal permanent residents (LPRs) are treated similarly to U.S. citizens under all three major health care reform bills. They are mandated to obtain health insurance, are eligible to purchase insurance through the exchange, and are eligible for the premium and cost-sharing subsidies if they meet the other eligibility requirements. This consistency of treatment holds regardless of when they entered the United States or whether they came initially as refugees or asylees.
Nowhere does that say "And no branch of the federal government will seek to recover any such subsidies from the LPR's sponsor." LPRs are "eligible" for no end of MTBs, in that there is no specific exclusion, which may well be why the recovery provisions are in the sponsorship agreement in the first place.
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Old Mar 29th 2010, 5:04 am
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Default Re: Cynical US Healthcare questions

Originally Posted by chartreuse View Post
Nowhere does that say "And no branch of the federal government will seek to recover any such subsidies from the LPR's sponsor." LPRs are "eligible" for no end of MTBs, in that there is no specific exclusion, which may well be why the recovery provisions are in the sponsorship agreement in the first place.
I think you are looking for something that was not intended. First of all the subsidy based on income is a tax credit and tax credits have never been treated differently between US citizens and LPRs.

I would be extremely surprised if LPRs were not treated the same as US citizens including that the sponsor would not be required to repay the government.

Last edited by Michael; Mar 29th 2010 at 5:10 am.
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Old Mar 29th 2010, 5:55 pm
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Originally Posted by Michael View Post
I think you are looking for something that was not intended. First of all the subsidy based on income is a tax credit and tax credits have never been treated differently between US citizens and LPRs.

I would be extremely surprised if LPRs were not treated the same as US citizens including that the sponsor would not be required to repay the government.
I tend to agree.

LPRs are prohibited from receiving means-tested benefits in their first 5 years as an immigrant.
If they are awarded means-tested benefits, AND the issuing agency chooses to do so, they may be sued (or their sponsor) for repayment of the means-tested benefit.

The easy way to the answer is to ask: Are subsidies considered 'means-tested benefits'? Even though the subsidies are based on income, I'm not sure the answer is 'yes'.
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Old Mar 29th 2010, 6:00 pm
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Default Re: Cynical US Healthcare questions

Originally Posted by meauxna View Post
I tend to agree.

LPRs are prohibited from receiving means-tested benefits in their first 5 years as an immigrant.
If they are awarded means-tested benefits, AND the issuing agency chooses to do so, they may be sued (or their sponsor) for repayment of the means-tested benefit.

The easy way to the answer is to ask: Are subsidies considered 'means-tested benefits'? Even though the subsidies are based on income, I'm not sure the answer is 'yes'.
I hope you're both correct, I just don't trust the govt to play fair when the word "immigrant" comes up in the context of healthcare. In any case, it's somewhat moot for me, as I should have naturalized by the time it takes effect, but there will be plenty of folks who haven't.
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Old Mar 29th 2010, 6:13 pm
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Originally Posted by chartreuse View Post
I hope you're both correct, I just don't trust the govt to play fair when the word "immigrant" comes up in the context of healthcare. In any case, it's somewhat moot for me, as I should have naturalized by the time it takes effect, but there will be plenty of folks who haven't.
I agree we should keep our eyes on it, but not get overly paranoid.
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Old Mar 29th 2010, 6:20 pm
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Default Re: Cynical US Healthcare questions

Originally Posted by chartreuse View Post
I hope you're both correct, I just don't trust the govt to play fair when the word "immigrant" comes up in the context of healthcare. In any case, it's somewhat moot for me, as I should have naturalized by the time it takes effect, but there will be plenty of folks who haven't.
So here's a related issue:- what about an over-65 LPR who doesn't qualify for Medicare; can they get subsidies for health insurance at that age?
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