[Congressional Record Volume 160, Number 58 (Wednesday, April 9, 2014)]
[House]
[Pages H3067-H3072]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




          EXPATRIATE HEALTH COVERAGE CLARIFICATION ACT OF 2014

  Mr. NUNES. Madam Speaker, I move to suspend the rules and pass the 
bill (H.R. 4414) to clarify the treatment under the Patient Protection 
and Affordable Care Act of health plans in which expatriates are the 
primary enrollees, and for other purposes.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 4414

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Expatriate Health Coverage 
     Clarification Act of 2014''.

     SEC. 2. TREATMENT OF EXPATRIATE HEALTH PLANS UNDER ACA.

       (a) In General.--Subject to subsection (b), the provisions 
     of (including any amendment made by) the Patient Protection 
     and Affordable Care Act (Public Law 111-148) and of title I 
     and subtitle B of title II of the Health Care and Education 
     Reconciliation Act of 2011 (Public Law 111-152) shall not 
     apply with respect to--
       (1) expatriate health plans;
       (2) employers with respect to any such plans for which such 
     employers are acting as plan sponsors; or
       (3) expatriate health insurance issuers with respect to 
     coverage offered by such issuers under such plans.
       (b) Minimum Essential Coverage and Eligible Employer-
     Sponsored Plan.--For purposes of section 5000A(f) of the 
     Internal Revenue Code of 1986, and any other section of the 
     Internal Revenue Code of 1986 that incorporates the 
     definition of minimum essential coverage provided under such 
     section 5000A(f) by reference, coverage under an expatriate 
     health plan shall be deemed to be minimum essential coverage 
     under an eligible employer-sponsored plan as defined in 
     paragraph (2) of such section.
       (c) Qualified Expatriates and Dependents Not United States 
     Health Risk.--
       (1) In general.--For purposes of section 9010 of the 
     Patient Protection and Affordable Care Act (26 U.S.C. 4001 
     note prec.), for calendar years after 2014, a qualified 
     expatriate (and any dependent of such individual) enrolled in 
     an expatriate health plan shall not be considered a United 
     States health risk.
       (2) Special rule for 2014.--The fee under section 9010 of 
     such Act for calendar year 2014 with respect to any 
     expatriate health insurance issuer shall be the amount which 
     bears the same ratio to the fee amount determined by the 
     Secretary of the Treasury with respect to such issuer under 
     such section for such year (determined without regard to this 
     paragraph) as--
       (A) the amount of premiums taken into account under such 
     section with respect to such issuer for such year, less the 
     amount of premiums for expatriate health plans taken into 
     account under such section with respect to such issuer for 
     such year, bears to
       (B) the amount of premiums taken into account under such 
     section with respect to such issuer for such year.
       (d) Definitions.--In this section:
       (1) Expatriate health insurance issuer.--The term 
     ``expatriate health insurance issuer'' means a health 
     insurance issuer that issues expatriate health plans.
       (2) Expatriate health plan.--The term ``expatriate health 
     plan'' means a group health plan, health insurance coverage 
     offered in connection with a group health plan, or health 
     insurance coverage offered to a group of individuals 
     described in paragraph (3)(B) (which may include dependents 
     of such individuals) that meets each of the following 
     standards:
       (A) Substantially all of the primary enrollees in such plan 
     or coverage are qualified expatriates, with respect to such 
     plan or coverage. In applying the previous sentence, an 
     individual shall not be taken into account as a primary 
     enrollee if the individual is not a national of the United 
     States and resides in the country of which the individual is 
     a citizen.
       (B) Substantially all of the benefits provided under the 
     plan or coverage are not excepted benefits described in 
     section 9832(c) of the Internal Revenue Code of 1986.
       (C) The plan or coverage provides benefits for items and 
     services, in excess of emergency care, furnished by health 
     care providers--
       (i) in the case of individuals described in paragraph 
     (3)(A), in the country or countries in which the individual 
     is present in connection with the individual's employment, 
     and such other country or countries as the Secretary of 
     Health and Human Services, in consultation with the Secretary 
     of the Treasury and the Secretary of Labor, may designate; or
       (ii) in the case of individuals described in paragraph 
     (3)(B), in the country or countries as the Secretary of 
     Health and Human Services, in consultation with the Secretary 
     of the Treasury and the Secretary of Labor, may designate.
       (D) In the case of an expatriate health plan that is a 
     group health plan offered by a plan sponsor that also offers 
     a domestic group health plan, the plan sponsor reasonably 
     believes that the benefits provided by the expatriate health 
     plan are actuarially similar to, or better than, the benefits 
     provided under a domestic group health plan offered by that 
     plan sponsor. 
       (E) If the plan or coverage provides dependent coverage of 
     children, the plan or coverage makes such dependent coverage 
     available for adult children until the adult child turns 26 
     years of age, unless such individual is the child of a child 
     receiving dependent coverage.
       (F) The plan or coverage is issued by an expatriate health 
     plan issuer, or administered by an administrator, that 
     maintains, with respect to such plan or coverage--
       (i) network provider agreements with health care providers 
     that are outside of the United States; and
       (ii) call centers in more than one country and accepts 
     calls from customers in multiple languages.
       (3) Qualified expatriate.--The term ``qualified 
     expatriate'' means any of the following individuals:
       (A) Workers.--An individual who is a participant in a group 
     health plan, who is a national of the United States, lawful 
     permanent resident, or nonimmigrant for whom there is a good 
     faith expectation by the plan sponsor of the plan that, in 
     connection with the individual's employment, the individual 
     is abroad for a total of not less than 90 days during any 
     period of 12 consecutive months of enrollment in the group 
     health plan, or travels abroad on not less than 15 occasions 
     during such a 12-month period.
       (B) Other individuals abroad.--An individual, such as a 
     student or religious missionary, who is abroad, and who is a 
     member of a group determined appropriate by the Secretary of 
     Health and Human Services, in consultation with the Secretary 
     of the Treasury and the Secretary of Labor.
       (4) Domestic group health plan.--The term ``domestic group 
     health plan'' means a group health plan that is offered in 
     the United States and in which substantially all of the 
     primary enrollees are not qualified expatriates, with respect 
     to such plan, and substantially all of the benefits provided 
     under the plan are not excepted benefits described in section 
     9832(c) of the Internal Revenue Code of 1986.
       (5) Abroad.--
       (A) United states nationals.--
       (i) In general.--Except as provided in clause (ii), for 
     purposes of applying paragraph (3) to a national of the 
     United States, the term ``abroad'' means outside the 50 
     States, the District of Columbia, and Puerto Rico.
       (ii) Special rule.--For purposes of applying paragraph (3) 
     to a national of the United States who resides in the United 
     States Virgin Islands, the Commonwealth of the Northern 
     Mariana Islands, American Samoa, or Guam, the term ``abroad'' 
     means outside of the 50 States, the District of Columbia, 
     Puerto Rico, and such territory or possession.
       (B) Foreign citizens.--For purposes of applying paragraph 
     (3) to an individual who is not a national of the United 
     States, the term ``abroad'' means outside of the country of 
     which that individual is a citizen.
       (6) United states.--The term ``United States'' means the 50 
     States, the District of Columbia, Puerto Rico, the United 
     States Virgin Islands, the Commonwealth of the Northern 
     Mariana Islands, American Samoa, and Guam.
       (7) Miscellaneous terms.--
       (A) Group health plan; health insurance coverage; health 
     insurance issuer; plan sponsor.--The terms ``group health 
     plan'', ``health insurance coverage'', ``health insurance 
     issuer'', and ``plan sponsor'' have the meanings given those 
     terms in section 2791 of the Public Health Service Act (42 
     U.S.C. 300gg-91), except that in applying such terms under 
     this section the term ``health insurance issuer'' includes a 
     foreign corporation which is predominantly engaged in an 
     insurance business and which would be subject to tax under 
     subchapter L of chapter 1 of the Internal Revenue Code of 
     1986 if it were a domestic corporation.
       (B) Foreign state; national of the united states; 
     nonimmigrant; reside; lawful permanent resident.--The terms 
     ``national of the United States'', and ``nonimmigrant'' have 
     the meaning given such terms in section 101(a) of the 
     Immigration and Nationality Act (8 U.S.C. 1101(a)), the term 
     ``reside'' means having a residence (within the meaning of 
     such term in such section), and the term ``lawful permanent 
     resident'' means an alien lawfully admitted for permanent 
     residence (as defined in such section).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Nunes) and the gentleman from Washington (Mr. 
McDermott) each will control 20 minutes.
  The Chair recognizes the gentleman from California.


                             General Leave

  Mr. NUNES. Madam Speaker, I ask unanimous consent that all Members 
have 5 legislative days in which to revise and extend their remarks and 
to include extraneous material on the subject of the bill under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?

[[Page H3068]]

  There was no objection.
  Mr. NUNES. Madam Speaker, I yield myself such time as I may consume.
  Before I yield to my good friend, who helped coauthor this bill with 
me, I just have a brief statement.
  The Expatriate Health Coverage Clarification Act is a result of close 
bipartisan collaboration and extensive discussions with the Obama 
administration.
  I would like to thank Mr. Carney for his work on this important bill, 
along with our numerous bipartisan cosponsors, our original cosponsors.
  The bottom line is that this is a jobs bill, one that has been 
carefully drafted to address the unique problems related to expat 
health insurance.
  Madam Speaker, I yield 6 minutes to the gentleman from Delaware (Mr. 
Carney).
  Mr. CARNEY. Madam Speaker, I want to thank the gentleman for 
yielding, and thank him for his hard work on this very serious issue 
that affects both our States, Delaware and California.
  Madam Speaker, in a State of 900,000 people, losing 500 jobs is a 
serious blow. That is how many jobs we will lose in my home State of 
Delaware if we don't pass this legislation on the floor today.
  I am a strong supporter of the Affordable Care Act. So are a lot of 
people in my State. But no law is perfect, and in a law as important, 
as complicated, and as technical as the Affordable Care Act, there are 
bound to be a few things that needed to be fixed.
  The Affordable Care Act was unintentionally written in a way that 
subjects U.S. expatriate health insurance plans to all the provisions 
of the ACA, which places a unique burden on these types of plans.
  Expatriate health insurance plans offer high-end, robust coverage to 
people working outside their home country, giving them access to global 
networks of health care providers. Individuals on the plan could be 
foreign employees working here in America, Americans working abroad, 
or, for instance, a German working in France.
  These employees can be NGO and foreign aid workers, pilots, cruise 
ship workers, and contractors sent to support our troops on deployment 
around the globe.
  Expatriate plans ensure that these employees have worldwide access to 
quality health care while working outside their home country.
  Several U.S. health insurance companies, Cigna, MetLife, Aetna, and 
United Health, offer expatriate health insurance plans. The employees 
who write those policies generally work here in the United States and 
make up several thousand U.S. jobs, including 500 in my State.
  These insurance companies compete with foreign insurance companies 
that also sell expatriate health insurance plans. The issue is, these 
foreign plans don't have to comply with the Affordable Care Act.
  Forcing U.S. expatriate insurance plans to comply with the Affordable 
Care Act gives their foreign competitors a distinct advantage. It makes 
plans written in the U.S. more expensive, which gives companies an 
incentive to purchase foreign-based plans instead.
  As a result, it makes more sense for U.S. expatriate insurers to move 
their business overseas, resulting in a potential loss of a few 
thousand jobs. In Delaware, that is going to mean 500 jobs. In 
California, it is 700.
  The good news is that we have bipartisan legislation here today that 
will level the playing field.
  The Obama administration has already recognized that it is burdensome 
and unnecessary to require expatriate insurance plans to comply with 
the Affordable Care Act. In fact, the administration has provided 
temporary regulatory relief for expat plans from nearly every 
Affordable Care Act provision that has gone into effect so far.
  The problem is this relief is only partial and only temporary. The 
administration can't make this relief permanent without a legislative 
fix.
  Our legislation clarifies that the Affordable Care Act does not apply 
to expatriate health insurance plans. It ensures that American 
expatriate insurance carriers are on a level playing field with their 
foreign competitors, so that American jobs stay here in America.
  You may hear on the floor today that this bill is about destroying 
the ACA, or changing our immigration laws, or giving a handout to 
insurance companies.
  But let me assure you, that is not what it is about. It is about 
jobs, pure and simple.
  If we don't pass this legislation today, people who have the 
expatriate plans, and their companies that offer them, will continue to 
do so, the same as they are today. The only difference is that the 
companies will buy these plans from insurance carriers that write the 
plans from abroad.
  That means those insurance jobs will go to foreign workers instead of 
workers in America. They will go to workers based in Singapore instead 
of those based in Delaware.
  I understand as well as anyone that the Affordable Care Act is a 
political weapon in a larger political war on both sides of the aisle. 
But that is not what this bill is about today.
  All I am asking today is that we take action so 500 hardworking 
Americans in my district don't become collateral damage in this 
partisan political fight. Let's call a temporary truce in that battle 
today to protect these jobs.
  I thank Congressman Nunes and Ways and Means staff for their hard 
work on these issues, and I want to thank the leadership on both sides 
of the aisle for recognizing this as a serious problem that needs to be 
fixed.
  I ask my colleagues to vote ``yes'' on H.R. 4414.
  Mr. McDERMOTT. Madam Speaker, I yield myself such time as I may 
consume.
  The Republicans have branded this bill as clarification. But what 
demands clarification is the cold, hard fact that this legislation is a 
bailout for insurance companies.
  This has never had a hearing in the House. It has never been 
discussed. We have never had witnesses. No regular order whatsoever. 
This appeared out of nowhere.
  This bill, pure and simple, is a case of Republicans seeking special 
treatment for certain insurance companies who would like nothing more 
than to avoid the responsibilities under the law and sell inferior 
insurance policies to Americans and foreign workers and their families 
in the United States, which is exactly why the American people are 
fortunate to have the ACA as the law of the land.
  It is currently protecting them from these kinds of intolerable 
insurance company practices.
  Republicans have focused on coming out against bailouts for insurance 
companies in several other ACA contexts, but it is all sound and fury 
because it means nothing.
  With this legislation, however, Republicans want a bailout for a few 
insurance companies that sell so-called expatriate coverage. But why 
should this situation be any different?
  Why do the Republicans get to pick and choose?
  As the Republicans are now in the business of picking and choosing 
winners in this case, the losers are going to be the patients.
  Republicans claim this bill is a simple fix intended to clarify the 
ACA when it comes to expatriate coverage, and perhaps there is a need 
for that. Perhaps there is a need. We might have found it out if we had 
had one hearing.
  The current guidance defines individuals under expat plans as those 
who are out of the country for at least 6 months during the year. The 
theory is that the people are gone more than they are here.
  But this bill overrides current regulations and ignores the comments 
given by the administration to define a covered individual, and it does 
it and says, you are an expat if you are out of the country for as few 
as 90 days, or 15 trips.
  Now, I don't know how many people in Seattle make 15 trips out of the 
country in a year when they are working for Boeing or working for 
Microsoft or all the international companies. I have got those people 
in my district.
  This means that to serve people who move across the border daily, or 
frequent fliers for work, they would be exempt from the enrollees who 
are gone for only a few weeks.
  In addition, the legislation says that all foreigners who are living 
and working in the United States but are outside their own country for 
90 days or 15 trips can also be covered by these plans.

[[Page H3069]]

  As a result, the provisions of this bill would severely undermine 
current H1B visa requirements that level the playing field with 
American workers. If you are bringing people in from the outside and 
they go home, or they are gone for only 90 days, well, you can somehow 
pay them less.
  This legislation will open the door for U.S. employers who wish to 
avoid the ACA to hire foreign workers rather than American citizens. 
That is why the United Farm Workers are against this bill.
  The United Farm Workers do a pretty good job of clarifying this bill 
when they say ``Congress should not pass laws that create an economic 
incentive to hire guest workers over professional U.S. agricultural 
workers.''
  The AFL-CIO is against this bill because it would undermine the 
health security of 13 million green card holders, people with work 
visas, and individuals who are granted visas for humanitarian reasons.

                              {time}  1245

  The National Immigration Law Center is against this bill because it 
eliminates minimum essential standards for ``expatriate health 
insurance plans provided to individuals who travel abroad.'' As a 
result, this bill would deny health coverage security for low-wage 
immigrant workers, including farm workers and caregivers.
  This bill contains too many loopholes that amount to an extraordinary 
bailout for insurance companies. This bill also establishes a precedent 
for employers to hire guest workers. It is being brought here as a 
suspension bill with no opportunity to amend it. It might be that we 
could make it a better bill if it had been through the process, but it 
is being rammed through here by insurance companies who want to get a 
benefit.
  This bill is yet another attempt on the part of the Republicans to 
repeal the Affordable Care Act. They want to drill another hole in the 
bottom of the bill. They are going to keep drilling holes--trying--this 
is number 53.
  I reserve the balance of my time.
  Mr. NUNES. Madam Speaker, just to clarify the Record here, this has 
been worked on in a bipartisan way, including the two Senators from 
Delaware and a Senator from New Jersey, who happen to be Democrats.
  A lot of the language that was in here was worked out so that, in 
fact, this could not only gather bipartisan support in the House, but 
also quickly pass in the Senate because, as my colleague from Delaware 
pointed out, if this doesn't pass and doesn't pass quickly, these jobs 
are going to leave overseas. That is why this is just a clarification.
  At this time, I yield 1 minute to the gentleman from Vermont (Mr. 
Welch), my good friend and former Dairy Caucus cochair.
  Mr. WELCH. I thank the gentleman for yielding.
  Madam Speaker, I am a strong ACA supporter. We have got to improve 
it. We have got to make it work, and that is the reason why I am 
supporting this legislation.
  Some efforts that are brought to the floor about the ACA are about 
unraveling it, but those of us who are the strong supporters--when an 
issue is identified that can help jobs and make some improvements, we 
have the responsibility, in my view, Madam Speaker, to advocate for 
those changes.
  We have the Member from Delaware (Mr. Carney), a strong supporter of 
the ACA, who has identified a specific problem, and I understand the 
concerns of the opponents because many efforts are being made to 
unravel the law, but there has been an acknowledgement that there is a 
problem, and that is what is being addressed by Mr. Carney.
  If the language is not as good as it should be--and part of that may 
be because we didn't have as much time to consider it--we have strong 
allies in the Senate. Senator Carper and Senator Coons are both very 
strong ACA supporters who are willing to make the adjustments over 
there, not to mention the majority leader, Senator Reid.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mr. NUNES. I yield to the gentleman from Vermont an additional 1 
minute.
  Mr. WELCH. So this is not perfect; but we have got a situation here 
where it is acknowledged by both sides, the opponents of this bill and 
the proponents of this bill, that there is an issue because of the 
language in the ACA bill.
  If this Congress were working the way, ideally, it would, when there 
is a problem that we could identify, we would come up with a specific 
solution.
  If we had more time, it might be better language, but the fact that 
we would act here to keep this alive, give some hope to those folks 
that Mr. Carney is concerned about whose jobs are at stake, and then 
work with our colleagues in the Senate to make whatever improvements 
can be made, we could maintain the strength of the Affordable Care Act; 
preserve the jobs that may be lost in Delaware, California, and 
elsewhere; and demonstrate some flexibility to make all our legislation 
that, by definition, is imperfect better.
  That can be done on a bipartisan basis.
  I thank the gentleman from Delaware, and I thank my colleague from 
California.
  Mr. McDERMOTT. Madam Speaker, I yield 4 minutes to the gentleman from 
California (Mr. Waxman).
  Mr. WAXMAN. I thank the gentleman for yielding to me.
  Madam Speaker, I want to say to my friend from Vermont, a member of 
my committee, that this is not the way to pass laws. This is not the 
way to correct problems. Problems should be worked out through narrow 
fixes in a public setting.
  This is a bill for an insurance company that is threatening to fire 
people in Delaware and a little small part of California, so that 
insurance company is saying: well, we are going to fire these people 
unless you correct our problem.
  The Republicans will not correct their problem. They want to put a 
big hole in the Affordable Care Act. Well, you can believe the Senate 
may fix it, but the suspension calendar should not be used for bills 
that have never been considered in an open hearing and that cannot be 
amended on the floor of the House.
  This bill goes far beyond a narrow, sensible fix. It says that 
Americans who are out of this country for a matter of weeks can be sold 
policies with harsh annual limits on their coverage, no minimum quality 
standards, and it says the families of these Americans--who may not 
even be overseas, but be living here--will get a plan that would be of 
lower quality than other Americans, even though they live here 365 days 
of the year.
  This bill's supporters say these expatriate plans are of very high 
quality, but the insurers and Republicans refuse to accept a bill that 
subjects the plan even to the most basic standards of quality and 
affordability.
  Why? There is no reason for that, except that they want the ACA to be 
in competition with plans that are of lower quality. This raises real 
concerns.
  Worse yet, this bill goes far beyond its stated goal of addressing 
coverage for Americans who live overseas. It is not that narrow. It 
creates a whole new second class health insurance system for foreign 
workers and legal permanent residents.
  These individuals currently have access to ACA-compliant plans, 
putting them on an even footing with U.S. workers. It would undercut 
current law. It would weaken the rights of immigrants and foreign 
workers. It would create powerful incentives for employers to hire 
foreign workers instead of U.S. workers.
  So this bill isn't about a narrow thing to fix some possible 
unemployment in these two States. That is why this bill is opposed by 
organized labor. It is opposed by immigrant advocacy organizations.
  There were long negotiations in back rooms between Republicans, 
Democrats, the administration, and the insurance companies, but there 
was no agreement on this bill. No one would compromise, and that is 
disappointing. It is mainly because of the intransigence of one 
insurance company and the Republican leadership.
  We should not advance a deeply flawed bill because an insurance 
company is making threats. We shouldn't advance a deeply flawed bill 
with the expectation that somebody else is going to solve the problem. 
That is why we are here in this House, to make sure the legislation is 
as good as it can possibly be.

[[Page H3070]]

  If all parties are ready to act in good faith, they should go back to 
the negotiating table and solve the narrow problem that we can agree 
on, rather than opening a troublesome loophole in the ACA.
  Mr. NUNES. I reserve the balance of my time, Madam Speaker.
  Mr. McDERMOTT. Madam Speaker, I yield 4 minutes to the gentleman from 
California (Mr. Becerra).
  Mr. BECERRA. I thank the gentleman for yielding.
  Madam Speaker, let me first acknowledge the work that has been done 
by so many of our colleagues here bipartisanly, the gentleman from 
Delaware, the gentleman from California, the committees of 
jurisdiction, and leadership, I suspect, on both sides of the aisle. I, 
too, have been involved in trying to deal with this.
  If you take a look at the title of the bill, it tells you what they 
are trying to do. The bill is called the Expatriate Health Coverage 
Clarification Act, so the bill tells us that it is to deal with the 
issue of expatriates.
  Well, who are expatriates, and how are they impacted by the 
Affordable Care Act?
  An expatriate, I think most of us would acknowledge, is an American 
who is told by his or her employer, we need to send you abroad to go 
work--whatever the task is--but I need you to go; so that expatriate, 
now living abroad, will be told that he or she must have an insurance 
policy that abides by the Affordable Care Act's protections for 
Americans who get health care here.
  The insurers will say: well, we may have to deal with different 
standards in that other country, so give us some flexibility.
  That is very fair. We should make sure that any company that has to 
send a worker abroad has the flexibility to make sure that they are 
providing good coverage, but that they are not strapped by the 
regulations that apply to coverage here in the U.S. Everyone agrees 
with that.
  Here is the problem: this bill doesn't do that. It doesn't do that, 
and I say that with all due respect to my colleague from Delaware. It 
doesn't do that.
  Let me ask you this: Is someone who works in this country 365 days of 
the year someone who we would consider an expatriate? Is an American 
who spends most of his time--three-quarters of his time working in the 
U.S. an expatriate?
  Should the family of that American who goes abroad, but the family 
never leaves the U.S., be denied the protections of the Affordable Care 
Act, so that a preexisting condition can now be used to discriminate 
against the child of that American worker?
  That is the difficulty with this bill. This bill talks about 
expatriates, but the reality is a lot of Americans who never leave this 
country and a lot of foreign workers, including green card holders who 
are on their way to becoming citizens, who have every lawful right to 
be here because they have gone about it the right way, they are just 
waiting their time so they can qualify to become U.S. citizens--many of 
them could be denied the protections that we all now have.
  We cannot be discriminated against based on a preexisting condition. 
We must be provided minimal protections. We have a right, now, to make 
sure that an insurance company doesn't use what we are paying in 
premiums to put in the pockets of executives and big salaries. That 
money has to now be spent, by law, on health care coverage.
  This bill would say no, those who are expatriates would qualify for 
different plans that don't have to meet those Affordable Care 
standards.
  Why should more than 13 million people who are in this country 
legally and are on their way to becoming U.S. citizens--who today have 
the same protections you and I have to not be discriminated against for 
preexisting conditions--because this bill that is supposed to be for 
expatriates, now be told no, you might be offered a policy that doesn't 
have to meet the Affordable Care standards?
  Why should an American family that sees one of its breadwinners, 
father or mother, be sent abroad to work for 90 days be told no, we no 
longer have to offer you an Affordable Care health care policy that 
prevents discrimination against your child because he or she has 
asthma?
  If this were a bill to focus on the issue of expatriates who go work 
abroad, where I think it is a legitimate concern of the insurance 
company to not impose upon the insurance company costs that are beyond 
what are paid here, I would agree that this goes well beyond that, and 
I would urge my colleagues to think twice before voting for this bill 
this way.
  Mr. NUNES. I will continue to reserve the balance of my time.
  Mr. McDERMOTT. Madam Speaker, I will yield myself the balance of my 
time to close, having no further requests for time.
  I have been an expat. I was in the State Department. The State 
Department sent me overseas. I lived over there. I came home 1 month a 
year. I would leave. The rest of the time, I was an expat. That is 
pretty clearly an expat.
  My daughter teaches at the King's Academy in Amman, Jordan. She is an 
expat. She lives over there. She comes home in the summertime for a 
month or so. She is an expat. Everybody understands that.
  What this bill says is, if you live in Seattle and you make 15 trips 
a year out of the country, then you are an expat, or you could be 
considered an expat. Now, that is not exactly what I think most people 
think of when they think of an expat--or somebody who works as a 
contractor.
  Suppose you work for the Federal Government for 3 months overseas. 
Are you an expat? According to this, you are. You can easily be put in 
that category and not be offered the protections. That means you don't 
have any protections around the issues of preexisting conditions. You 
can't necessarily put your kids on your insurance up until age 26.
  Your lifetime limits, all of the things that are built into the 
Affordable Care Act, the insurance companies now can say: we don't have 
to offer that to you because you are out of the country 15 times a 
year, or you have worked overseas for 90 days.
  As Mr. Waxman said, you are creating a second class of citizen in 
this country, and Mr. Becerra raised the issue on the reverse side. 
People who come from other countries are expats, right, because they 
came from somewhere else, so they can be put into a plan that does not 
give them the protections of the ACA.

                              {time}  1300

  That is not what I think my friend from Delaware or my friend from 
California really wanted to do. What is missing here is that we did a 
backroom deal. We had Members of Congress sit in a back room somewhere 
with somebody from the White House, talk about something and decide 
something, and here it is, fait accompli, no chance to change it, no 
chance to make it better or make it closer to what people really 
thought.
  And most interestingly for Republicans is you are sending a bill to 
the House and expecting that the Senate is going to fix it. Now, our 
experience here on the floor and in the Congress the last few months, 
expecting the Senate to do something is, well, it is probably--it is 
not like wishing for the tooth fairy, but it is certainly putting your 
trust in a rather weak situation. The House sent over--what?--500 bills 
in the last session and got 12 or 15 back? And you are saying that this 
one is going to be fixed? I doubt it.
  I yield back the balance of my time.

                                     American Federation of State,


                               County and Municipal Employees,

                                    Washington, DC, April 8, 2014.
       Dear Representative: On behalf of the 1.6 million members 
     of the American Federation of State, County and Municipal 
     Employees (AFSCME), I urge you to oppose the Expatriate 
     Health Coverage Clarification Act which is scheduled for a 
     vote tomorrow. While the bill may be intended to address 
     concerns of health plans covering those who work part of the 
     year outside the United States, the reach of the bill is much 
     greater.
       The bill's definition of expatriate workers include 13 
     million individuals who are lawful permanent residents, 
     people with work visas and individuals who were granted visas 
     for humanitarian reasons. The bill exempts employers and 
     insurance plans from meeting Affordable Care Act (ACA) 
     coverage standards for these millions of people living and 
     working in the United States. Instead, the bill would allow 
     these employers to use their own judgment in determining 
     whether coverage is adequate.
       This bill does much more than simply clarify a technical 
     matter of the ACA. It defines a large group of people who 
     will be treated

[[Page H3071]]

     differently by the ACA and afforded weaker protections than 
     others. The bill undermines the premise that all families are 
     entitled to a minimum standard of coverage and could lead to 
     erosion in standards for other groups and eventually all 
     families.
       We urge you to oppose the Expatriate Health Coverage 
     Clarification Act.
           Sincerely,
                                              Charles M. Loveless,
     Director, Federal Government Affairs.
                                  ____



                              National Immigration Law Center,

                                                    April 8, 2014.
     Hon. John Boehner,
     The Speaker, House of Representatives,
     Washington, DC.
     Hon. Nancy Pelosi,
     Democratic Leader,
     Washington, DC.
       Dear Speaker Boehner and Democratic Leader Pelosi: We urge 
     you to oppose H.R. 4414, the Expatriate Health Coverage 
     Clarification Act. Although intended to address the concerns 
     of health plan issuers serving expatriate workers, the bill's 
     impact would be much larger and deny important plan 
     protections for millions of low-wage immigrants and 
     nonimmigrant workers in the U.S.
       H.R. 4414 would eliminate the Affordable Care Act's (ACA)'s 
     minimum essential standards for ``expatriate health insurance 
     plans'' provided to individuals who travel ``abroad.'' The 
     bill defines an ``expatriate'' as anyone who travels 
     ``abroad'' for 90 days or more in the course of 12 months, or 
     who takes 15 or more trips ``abroad'' over 12 months. This 
     overly broad definition would include lawfully present, 
     foreign-born workers living and working in the U.S., 
     including lawful permanent residents (LPRs or green card 
     holders), individuals with work visas for more highly skilled 
     work, and dozens of other nonimmigrant categories. Also, the 
     definition of ``abroad'' in the legislation captures lawfully 
     present noncitizens who are living and working in the U.S.--
     or any country outside of their native country--for this same 
     time period. These definitions are so broad that it leaves 
     the bill vulnerable to legal challenges.
       The U.S. Department of Health and Human Services (HHS) is 
     addressing the expatriate insurance issue and has issued 
     proposed regulations (79 FR 15808) that would relax the 
     onerous administrative burdens imposed by the ACA on 
     expatriate insurance issuers. In contrast to H.R. 4414's 
     overly broad definition of ``expatriate,'' HHS has proposed a 
     more common sense definition which requires workers to be 
     abroad for at least 6 months out of the year.
       H.R. 4414 would have an unintentional, disastrous impact on 
     low-wage immigrant workers, including farm workers and 
     caregivers. We urge you to oppose the bill, and we look 
     forward to working with members of Congress to close its 
     loopholes and find workable solutions.
           Sincerely,
                                               Marielena Hincapie,
     Executive Director.
                                  ____



                                          United Farm Workers,

                                         Keene, CA, April 8, 2014.
       Dear Representative: The United Farm Workers opposes 
     legislation introduced by Congressman Carney and Congressman 
     Nunes, the stated purpose of which is ``To clarify the 
     treatment under the Patient Protection and Affordable Care 
     Act of health plans in which expatriates are the primary 
     enrollees and for other purposes.''
       While the purpose appears to be to clarify the situation of 
     expatriate workers who are working for U.S. corporations 
     abroad, and who are covered under a different health care 
     plan than the corporation's U.S. workers, the definition of 
     qualified expatriate workers is over-broad and would extend 
     to guest workers, and possibly legal permanent residents, 
     working in the United States.
       The legislation as drafted would have the effect of 
     allowing agricultural employers in the United States who hire 
     so-called guest workers to escape the ACA requirements that 
     would apply to professional farm workers currently living in 
     the United States, thus making it cheaper to employ a guest 
     worker than to employ a U.S. citizen or legal permanent 
     resident.
       The position of the UFW is, and always has been, equal pay 
     and benefits for equal work. If two workers are working side 
     by side in a field, and one is an H-2A (or other ``guest'') 
     worker and the other is a worker with US citizenship or Legal 
     Permanent Resident status, then both should be entitled to 
     enroll in the same health care plan. One worker should not 
     receive fewer health care benefits than the other.
       Congress should not pass laws that create an economic 
     incentive to prefer H-2A or other types of ``guest'' workers 
     over professional US workers already working in agriculture.
       Please vote NO on the ``Carney-Nunes'' health care 
     legislation.
           Sincerely,

                                               Giev Kashkooli,

                                   Political/Legislative Director,
     National Vice President.
                                  ____

         American Federation of Labor and Congress of Industrial 
           Organizations,
                                    Washington, DC, April 8, 2014.
       Dear Representative: On behalf of the AFL-CIO, I urge you 
     to vote against the Expatriate Health Coverage Clarification 
     Act. The bill is intended to make adjustments to the 
     Affordable Care Act (ACA) to address the concerns of health 
     plans serving expatriate workers and to retain American jobs, 
     but we are concerned it could create serious gaps in 
     important benefit protections for lawful permanent residents 
     (green card holders) and people with nonimmigrant visas 
     living and working in the United States.
       As you know, this bill is intended to accommodate health 
     plans serving workers who perform their jobs in multiple 
     countries. It is reasonable that some flexibility be granted 
     to these health plans to ensure that compliance with the 
     insurance laws of more than one country does not create 
     unreasonable inefficiencies and new costs.
       Unfortunately, the bill could undermine benefit protections 
     for 13 million green card holders, people with work visas, 
     and individuals who were granted visas for humanitarian 
     reasons. The bill exempts employers and insurers from abiding 
     by ACA insurance coverage standards for these workers, 
     allowing them to employ their own judgment in determining if 
     coverage is adequate. Provisions to limit the exemption to 
     plans solely-focused on covering expatriate workers are 
     inadequate.
       The primary goals of the Affordable Care Act include making 
     major advances toward universal coverage and providing new 
     guarantees of benefit coverage standards. We look forward to 
     working with you to find ways of adjusting the ACA in a 
     manner which preserves the insurance protections it offers to 
     working families.
           Sincerely,

                                               William Samuel,

                                                         Director,
     Government Affairs Department.
                                  ____

                                                 Service Employees


                                          International Union.

       Dear Representative, On behalf of SEIU, I write to ask you 
     to vote against the Expatriate Health Coverage Clarification 
     Act. While the legislation aims to address the treatment of 
     plans that cover, expatriate workers under the Affordable 
     Care Act (ACA), the legislation as drafted could result in 
     insufficient coverage for lawful permanent residents and 
     those with non-immigrant visas working and living in the 
     United States.
       For those plans that truly serve workers who preform jobs 
     in multiple countries, certain accommodations under the law 
     may be appropriate but this legislation is overly broad. The 
     current legislative language allows for employers and 
     insurers to offer coverage that does not include vital ACA 
     protections to millions of lawful permanent residents and 
     non-immigrant visa holders--individuals and families that 
     would not normally be defined as expatriate workers.
       Some of the most popular provisions of the ACA are the 
     consumer protections the law creates, including the end to 
     discriminatory practices by insurers. We want to guarantee 
     that as many people as possible benefit from these important 
     provisions. Unfortunately, the Expatriate Health Coverage 
     Clarification Act is not narrowly tailored to ensure that is 
     the case.
       If you have any questions, please contact Ilene Stein, 
     Assistant Legislative Director.
           Sincerely,
                                                    Steph Serling,
                                             Legislative Director.

  Mr. NUNES. Mr. Speaker, sometimes in this body and with the Senate we 
can sit down for the common good of the American people. Sometimes we 
can sit down with Democrats and Republicans working together not only 
in the House but also in the Senate. And also, sometimes, Mr. Speaker, 
the arguments that are made on the floor are so ridiculous that they 
don't deserve a response.
  I am going to submit for the Record a letter from American Benefits 
Council.

                                    American Benefits Council,

                                    Washington, DC, April 8, 2014.
     Re Support for H.R. 4414--Expatriate Health Coverage 
         Clarification Act
     Hon. John Boehner,
     The Speaker, House of Representatives,
     Washington, DC.
     Hon. Nancy Pelosi,
     Minority Leader, House of Representatives, Washington, DC.
       Dear Speaker Boehner and Leader Pelosi: I write on behalf 
     of the American Benefits Council (``Council'') to express 
     support for H.R. 4414, the Expatriate Health Coverage 
     Clarification Act of 2014 (``Act''). The Act provides 
     important clarification regarding application of the 
     Affordable Care Act (ACA) to health coverage that is provided 
     to globally mobile employees. These are issues of significant 
     concern to multinational employers, their employees and 
     families.
       The Council is a public policy organization representing 
     principally Fortune 500 companies and other organizations 
     that assist employers of all sizes in providing employee 
     benefits. Collectively, our members either sponsor directly 
     or provide services to health and retirement plans that cover 
     more than 100 million Americans both within the United States 
     and abroad.
       Most of our member companies sponsor health coverage for a 
     workforce that includes globally mobile employees. Council 
     members rely on expatriate health plans to provide benefits 
     that meet the unique needs

[[Page H3072]]

     of this employee population and their families. Multinational 
     employers value expatriate health plans for many reasons, 
     including the role they play in recruiting and retaining a 
     productive globally mobile workforce by ensuring coverage of 
     their employees' and families' health care needs while 
     abroad.
       The ACA was intended to reform the U.S. health care system. 
     Its application to expatriate health plans and to the 
     employer sponsors and people covered by such plans, has 
     created compliance uncertainty with respect to the law's 
     individual and employer mandates and certain other health 
     plan requirements. Although some of these matters have been 
     addressed in transition guidance issued by the agencies, the 
     guidance is temporary and does not fully address the 
     outstanding concerns.
       H.R. 4414 provides needed statutory clarification with 
     respect to the application of the ACA to expatriate health 
     plans and the employers, employees and family members that 
     rely on such plans to meet the health benefits needs of a 
     globally mobile workforce.
       We appreciate your consideration of these important issues.
           Sincerely,
                                                   James A. Klein,
                                                        President.

  Mr. NUNES. I will also submit a letter from the U.S. Chamber of 
Commerce, also in support of this clarification.

                                              Chamber of Commerce,


                                     United States of America,

                                    Washington, DC, April 9, 2014.
       To the Members of the U.S. House of Representatives: The 
     U.S. Chamber of Commerce, the world's largest business 
     federation representing the interests of more than three 
     million businesses of all sizes, sectors, and regions, as 
     well as state and local chambers and industry associations, 
     and dedicated to promoting, protecting, and defending 
     America's free enterprise system, strongly supports H.R. 
     4414, ``The Expatriate Health Coverage Clarification Act of 
     2014,'' to preserve the ability of our country's businesses 
     to provide, and our citizens to obtain appropriate health 
     care coverage as they conduct business and live overseas. 
     This important bill protects the ability of American 
     companies to provide and workers to obtain coverage abroad 
     that have historically been offered and valued.
       The PPACA was designed to improve access to coverage and 
     health care services for people in the United States and to 
     strengthen this nation's health care system. Whether it will 
     accomplish these goals remains to be seen. However, it was 
     certainly not intended and must not be misconstrued to 
     disadvantage American companies either operating or employing 
     individuals in other countries or selling products abroad. It 
     is important to ensure that this unintended consequence does 
     not occur. This bill would protect the coverage and 
     opportunities of American workers, American employers, and 
     American products abroad. Congress must pass this bill to 
     explicitly exempt expatriate plans from the myriad of PPACA 
     requirements.
       Applying these new mandates to international plans would 
     not only be extremely difficult and complex from an 
     operations standpoint due to the global nature of this type 
     of coverage but would also be bad policy. They would place 
     American businesses and expatriate American employees at a 
     disadvantage in the global marketplace. Requiring American 
     companies that operate around the globe and their foreign-
     based employees to buy more costly coverage would unfairly 
     benefit foreign competitors and foreign employees. Such 
     PPACA-compliant expatriate plans are not likely to be cost-
     competitive. In many instances, they may not provide global 
     coverage and would in fact not comply with applicable local 
     laws. Because of conflicting requirements between these new 
     mandates and the laws of other countries, an employer may 
     also have to purchase multiple policies with overlapping 
     coverage or risk noncompliance with one or more nations' 
     laws. Congress must protect the ability of American companies 
     and their expatriates to purchase and offer appropriate and 
     valued plans that have long been part of how our country 
     operates in the global marketplace.
       U.S. jobs are at stake. If this legislation does not get 
     enacted, American jobs associated with writing, servicing and 
     administering these plans will be shipped overseas.
       The Chamber continues to champion health care reform that 
     builds on and reinforces the employer-sponsored system while 
     improving access to affordable, quality coverage. The Chamber 
     urges you and your colleagues to support H.R. 2575, and may 
     consider including votes on, or in relation to, this bill in 
     our annual How They Voted scorecard.
           Sincerely,
                                                  R. Bruce Josten.

  Mr. NUNES. I will also submit a rebuttal argument for the Record so 
that people can really get to the bottom of this legislation.
  I want to address some of the misperceptions and concerns that have 
been raised about this bill.
  First, this bill has nothing to do with what type of plan insurers 
can write and sell to expatriates. The question is where they are going 
to write these same plans. Here in the United States, or overseas. The 
same companies are going to purchase the same plans regardless of 
whether this bill passes. The only question is whether or not the U.S. 
jobs associated with these plans will be saved.
  Next, the bill does not allow U.S. employers to escape the ACA and 
offer substandard plans. These plans are incredibly generous by their 
very nature. They offer coverage in multiple countries and 
administration of plans that include multiple currencies, languages, 
and coverage mandates.
  But let me quote from the legislation itself. Page 6, lines 1-6, 
``the plan sponsor [must] reasonably believe that the benefits provided 
by the expatriate health plan are actuarially similar to, or better 
than, the benefits provided under a domestic group health plan offered 
by that plan sponsor.''
  Mr. Speaker, the legislation requires that the expatriate health plan 
be as good as the domestic health plan that is covered by the ACA. Any 
suggestion otherwise does not reflect what the legislation clearly 
states.
  There is an employer mandate in the ACA. Employers are required to 
offer a domestic plan. If they don't, they are fined $2,000 per 
employee. Employers aren't going to drop their current plan for their 
U.S. employees, pay the $2,000 penalty for every employee on their 
payroll, just so they can offer their subset of green card employees a 
substandard plan. That is a completely unrealistic scenario.
  This bill does not allow, as has been suggested, nonimmigrant farm 
workers to be offered substandard plans. Under the scenario envisioned 
by opponents of this bill, a farmer would have to drop his or her own 
plan and that of its U.S. workers to be allowed to offer an expat plan 
that somehow is less than the ACA standard. Who is going to do that? 
That's cutting off your nose to spite your face. But even if they were 
crazy enough to do that--the expat plan would still have to provide 
coverage in countries outside of the United States--they couldn't save 
money by doing this--it would likely cost the farmer more money to 
provide this type of plan.
  Mr. Speaker, the ACA is a complicated piece of legislation, but this 
bill is not. This bill will allow the jobs to stay in the United 
States--and nothing else. This bill does not legally or practically 
make changes beyond this narrow scope which is why there is such strong 
bipartisan support.
  With that, Mr. Speaker, I yield back the balance of my time.
  Mr. DeFAZIO. Mr. Speaker, I commend Representative Carney for 
proposing fixes to the Affordable Care Act. Since the law was passed, I 
have said that parts of the Affordable Care Act need to be improved or 
changed. As Representative Carney has identified, there is no question 
that Congress needs to clarify how the law is applied to expatriate 
plans. The Administration has correctly exempted these plans from some 
ACA requirements that do not make sense for plans used primarily 
overseas, but the Administration is only able to provide temporary 
exemptions without congressional action. I am confident that the Senate 
will be able to make the needed targeted changes to H.R. 4414 so that 
it can pass both houses of Congress and gain the support of the 
Administration. I look forward to working with Representative Carney to 
make sure that legislation providing proper clarity to expatriate plans 
is signed in to law.
  The SPEAKER pro tempore (Mr. Marchant). The question is on the motion 
offered by the gentleman from California (Mr. Nunes) that the House 
suspend the rules and pass the bill, H.R. 4414.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. McDERMOTT. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this motion will be postponed.

                          ____________________