I think I found the answer to my question about whether or not expats would be screwed over by having to buy health insurance under the new health care reform bill. The answer, although not athoritative, is no. It’s not explicitly stated in the bill but it’s a combination of the new law and a new IRS regulation.
The health care reform law says you must meet a minimum level of coverage requirement, and a new IRS regulation says that expats are assumed to have the minimum level of coverage requirement for tax purposes. There appears to be no requirement to prove it and just as well since what would that mean? Expats who live full time in another country take care of their medical care expenses in a variety of ways. It would make no sense to impose U.S. coverage requirements on expats since the costs are completely different.
Expats may achieve adequate coverage from a variety of insurance or membership plans or be self-insured which is to say no coverage at all but just pay out of pocket. That’s the usual case here in Thailand. Top quality care at the private hospitals is a fraction of the cost of U.S. care so many people just pay out of pocket. The total costs for things like major surgery are often less than a single year of premiums in the U.S.
Many of the hospitals offer a sort of membership plan that entitles you to discounts on medical care. It’s sort of like an insurance plan but specific to that hospital. Those memberships can be a good deal under certain circumstances. For example, the Bangkok Hospital Group has a plan that costs around 20,000 baht that offers discounts on doctor visits and inpatient care, as well as free health screenings for three years. If you like that hospital and are definitely planning to do your checkup there every year then it more than pays for itself in the health screenings alone, and the discounts on other treatments are a sort of insurance policy. Sort of, because it doesn’t pay a significant fraction of a major medical bill.
So for now at least expats aren’t going to get screwed over by the new health care law. Just Americans who still live in the U.S.