[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.
____________________