Congressional Record, Volume 160 Issue 62 (Tuesday, April 29, 2014)

[Congressional Record Volume 160, Number 62 (Tuesday, April 29, 2014)]
[House]
[Pages H3266-H3275]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

EXPATRIATE HEALTH COVERAGE CLARIFICATION ACT OF 2014

Mr. NUNES. Mr. Speaker, pursuant to House Resolution 555, I call up
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, and ask for its
immediate consideration.
The Clerk read the title of the bill.
The SPEAKER pro tempore (Mr. Harris). Pursuant to House Resolution
555, the amendment printed in House Report 113-422 is considered
adopted, and the bill, as amended, is considered read.
The text of the bill, as amended, 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 2010 (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--
(i) also offers a qualifying minimum value 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 qualifying minimum value domestic group health plan
offered by that plan sponsor; or
(ii) does not also offer a qualifying minimum value
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 qualifying minimum value domestic group
health plan.
(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--
(i) 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; and
(ii) offers reimbursements for items or services under such
plan or coverage in more than two currencies.
(G) The plan or coverage, and the plan sponsor or
expatriate health insurance issuer with respect to such plan
or coverage, satisfies the provisions of title XXVII of the
Public Health Service Act (42 U.S.C. 300gg et seq.), chapter
100 of the Internal Revenue Code of 1986, and part 7 of
subtitle B of title I of the Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1181 et seq.), which would
otherwise apply to such a plan or coverage, and sponsor or
issuer, if not for the enactment of the Patient Protection
and Affordable Care Act and title I and subtitle B of title
II of the Health Care and Education Reconciliation Act of
2010.
(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 an alien residing outside the United
States, 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 180 days during any
period of 12 consecutive months.
(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) Qualifying minimum value domestic group health plan.--
The term ``qualifying minimum value domestic group health
plan'' means a group health plan that is offered in the
United States that meets the following requirements:
(A) Substantially all of the primary enrollees in the plan
are not qualified expatriates, with respect to such plan.
(B) 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.
(C) The application of section 36B(c)(2)(C)(ii) of such
Code to such plan would not prevent an employee eligible for
coverage under such plan from being treated as eligible for
minimum essential coverage for purposes of section
36B(c)(2)(B) of such Code.
(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.

[[Page H3267]]

(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. The gentleman from California (Mr. Nunes)
and the gentleman from Michigan (Mr. Levin) each will control 30
minutes.
The Chair recognizes the gentleman from California (Mr. Nunes).

General Leave

Mr. NUNES. Mr. Speaker, I ask unanimous consent that all Members may
have 5 legislative days in which to revise and extend their remarks and
to include extraneous material on H.R. 4414.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from California?
There was no objection.
Mr. NUNES. Mr. Speaker, I yield myself such time as I may consume.
Mr. Speaker, the bill before the House today comes down to one simple
question: Will we allow American companies to offer expatriate plans or
will we force the offshoring of these plans? Will we support employment
in America or stimulate employment overseas?
Mr. Carney and I have worked carefully and in good faith on a
bipartisan basis to craft a bill that is limited in scope while at the
same time remaining true to our commitment to save American jobs.
There have been a few changes to the bill since a bipartisan majority
of the House supported it a few weeks ago. We clarified that an
expatriate plan must be a comprehensive health care health plan and not
a mini-med or other substandard plan.

{time} 1430

We tightened the definition of an expatriate. The bill says that an
expatriate must be abroad for at least 6 months. This is a much tougher
standard, and it will guard against potential abuse.
The bill now also requires an expatriate plan to offer reimbursements
in more than two currencies. Plans meet this requirement today, but the
addition of this provision protects against the possible abuse of the
expatriate exemption in the future.
Finally, Mr. Speaker, the bill now makes explicit that the expatriate
plans must continue to comply with relevant laws enacted prior to ACA,
specifically ERISA and the Public Health Service Act.
Mr. Speaker, this bill is a good bill. It is a bipartisan bill, and I
urge the support of the House.
I reserve the balance of my time.
Mr. LEVIN. Mr. Speaker, I yield myself such time as I shall consume.
There is no doubt about where Democrats stand. We have taken the lead
to make sure there is no offshoring, and there has been a good faith
effort here, up to a point. Surely, that has been true of Mr. Carney in
all of his efforts, working with Mr. Nunes.
But the problem is that there remain some serious shortcomings in
this bill, and unfortunately, we cannot try to remedy it through an
amendment, so the notion there is an open process here isn't correct.
The definition of expatriate has been tightened. I think there remain
some issues, at least one regarding it; but the major problem relates
to the language and how it would impact, potentially, health insurance
for an estimated 13 million legal permanent residents and others who
are lawfully present foreign workers in the U.S.
Let me just give you examples of where the standards remain weak. For
example, under this legislation, expat plans would have dispensation to
be weaker than other employer plans in this country.
They could, for example, impose cost sharing on preventive benefits.
They could impose annual and lifetime limits on coverage. They could
impose unduly long waiting periods.
Indeed, the only ACA provision that would clearly remain in effect
would be that they would have to offer coverage to young adults under
26.
So the bottom line is, unfortunately, that the legislation, in its
present form, could substantially undermine health security for foreign
workers, as well as American dependents who remain in this country.
Also, what it does is provide unprecedented special treatment for
these plans in terms of exempting them from financing mechanisms.
Let me say further, as we found out from the Joint Tax Committee and
CBO, they confirm this bill would cause some employers who would offer
ACA-compliant plans under present law to offer less generous expatriate
plans that are no longer subject to the ACA. This is the reason the
administration issued, I think just today, a Statement of
Administration Policy, and they say they do not support H.R. 4414.
The ACA gives people, it continues, greater control over their health
care; and what they say is that this is not true sufficiently in this
case.
It says, because of the ACA, Americans who have previously been
denied coverage due to a preexisting medical condition now have access
to coverage, and that may well not continue.
So the administration concludes it remains willing to work with
Congress to improve H.R. 4414 to address those issues and to maintain
basic consumer protections for all workers. There are straightforward
changes to the legislation, which we have shared with the Congress,
that would satisfy these goals, and the Congress should pursue a
solution.
Unfortunately, because of this rule, we cannot propose an amendment
which would essentially implement these proposals from the
administration that they have shared with the Congress. That is why I,
unfortunately, have no choice but to suggest a ``no'' vote on the floor
of this House.
Mr. Speaker, I reserve the balance of my time.
Mr. NUNES. Mr. Speaker, at this time, I yield 2 minutes to the
gentleman from Ohio (Mr. Renacci), a member of the Ways and Means
Committee.
Mr. RENACCI. Mr. Speaker, I rise today in support of H.R. 4414, the
Expatriate Health Coverage Clarification Act, a bill introduced by my
good friend, John Carney.
When Mr. Carney and I first came to Congress, we looked around in
search of others who, like us, were interested in finding common
ground. Mr. Carney and I now meet regularly for breakfast with a group
of Members from both sides of the aisle.
We come together to discuss commonsense ways to solve our Nation's
problems that Members on both sides of the aisle can get behind. The
bill that is on the floor today is an example of this type of
commonsense approach to making policy.
The purpose of the bill is to fix a problem created by the
President's health care law. If we don't fix it, 1,200 jobs will be
lost across the country.
Mr. Carney and I may not agree on everything. In fact, the
President's health care law is one thing we disagree on; but we do
agree this specific provision is another example of one of the law's
unintended consequences.
This bill before us today will keep America competitive and save
American jobs. I encourage my colleagues on both sides of the aisle to
support this important legislation.
Mr. LEVIN. Mr. Speaker, I yield 4 minutes to the gentleman from
Delaware (Mr. Carney), a colleague and friend who is a sponsor of this
legislation.
Mr. CARNEY. Mr. Speaker, last week, when I was back home in my
district in Delaware getting a workout at the YMCA in my hometown of
Wilmington, a man came up to me as I was on the exercise bike and said:
Excuse me, do you mind if I interrupt?
I said: Of course not, I work for you. He said: I wanted to see if
you know about the status of H.R. 4414 because I write expatriate
health insurance plans

[[Page H3268]]

for Cigna, and I don't want to lose my job.
Losing even one job like this in my State keeps me up at night. The
prospect of losing 500 jobs is a punch to the gut. That is how many
jobs we will lose in my home State of Delaware if we don't pass this
bill 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 ACA 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 a high-end, robust coverage
to people working outside their home country, giving them access to a
global network of health care providers. Individuals on the plan could
be foreign employees working here in America, Americans working abroad,
or, say, a German working in France.
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. These insurance
companies compete with foreign insurance companies that also sell the
same kind of plan. The issue is these foreign plans don't have to
comply with the ACA.
Forcing U.S. expatriate insurance plans to comply with the ACA
thereby gives their foreign competitors a distinct advantage. As a
result, to stay competitive, a U.S. expatriate insurer will move their
business overseas, taking the jobs with them; and that is why I am here
on the floor today.
The good news is that we have bipartisan legislation here today that
will level the playing field. In fact, the administration has already
provided temporary relief for expatriate 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 without this legislative fix.
Our legislation ensures that American expatriate insurance carriers
are on a level playing field with their foreign competitors, so that
American jobs stay here in America.
Many of you know that this is our second go-round at this
legislation. Over the past few weeks, we have worked painstakingly to
improve our bill, and we have.
We are confident that our original version of the bill wouldn't have
negatively impacted green card holders or create loopholes in the ACA,
but we have worked hard over the past few weeks to address the concerns
we heard.
We heard concerns the bill would let insurance companies create low-
quality plans. Our bill now requires expat plans to meet the same value
standard as any other employer-based plan under the ACA, and if the
plan doesn't meet that standard, the expat can use subsidies to buy
coverage on the exchange, just like any other American.
We heard concerns that the definition of an expat was too broad, that
it could be taken advantage of. We changed that definition, tightened
it up, and it is identical to the HHS regulations today.
We now make explicit that expat plans must follow all ERISA and
Public Health Service Act requirements that were in place before the
ACA.
We have been working on this issue for 3 years. The crafting of this
bill has been a more collaborative bipartisan process than I think this
Chamber has seen in quite a while, and I want to thank my friends and
colleagues on both sides of the aisle for that effort.
This bill isn't perfect. The Affordable Care Act wasn't perfect. No
bill is perfect, but if there was ever a case where the perfect was
being made the enemy of the good, we are hearing it from my colleagues
today.
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. LEVIN. I yield the gentleman an additional minute.
Mr. CARNEY. So if we don't pass this legislation today, people who
have expatriate plans and the companies that offer them will continue
to do so. The question is whether they will do so here in the United
States and keeping those workers here or whether they will move those
operations overseas.
I understand, as well as anyone, that the ACA is a political weapon
in a larger political war on both sides of the aisle. All I am asking
today is that we take actions so that 500 hard-working Americans in my
district don't become collateral damage in that partisan political
fight. Let's call a temporary truce in that battle today to protect
those jobs.
Finally, I want to thank my colleague, Congressman Nunes, and the
Ways and Means staff on both sides of the aisle for their hard work on
this issue, and I want to thank leadership on both sides of the aisle
for recognizing this is a very serious problem that needs fixing.
I ask my colleagues on both sides of the aisle to support us and vote
``yes'' on this legislation today. Vote ``yes'' on H.R. 4414.
Mr. NUNES. Mr. Speaker, at this time, I yield 3 minutes to the
gentleman from Pennsylvania (Mr. Dent).
Mr. DENT. Mr. Speaker, I rise today in strong support of H.R. 4414,
the Expatriate Health Care Coverage Clarification Act.
I do want to point out that the American people do expect us to work
together in a responsible manner to solve real problems, and that is
what this bill we are talking about today does.
I certainly want to thank my colleagues, Representative Carney of
Delaware and Representative Nunes of California, for taking the
initiative to craft this really important piece of legislation.
I also know it is really difficult to look at any bill dealing with
the health care law without considering the broader context of the law.
However, it is also difficult to look at the state of our economy today
and be nonchalant about the fact that 1,200 of our fellow Americans
stand to lose their jobs if we don't act and pass this legislation.
Many of those folks live in the State of Delaware. Many of them live
in the State of Pennsylvania, just over the Delaware State line. So our
constituents are hearing about it, just like the story you heard from
Mr. Carney and he is stopped by his constituents. We are hearing about
this at home.
So that is really what this bill introduced by Mr. Carney and Mr.
Nunes does. It saves jobs, it is that simple, and it does so without
jeopardizing anybody's health care.
No one is going to be affected by this in a negative way. The bill on
the floor today simply allows American companies to continue selling
insurance to people who live and work overseas, many of our neighbors
and friends. That happens to them.

{time} 1445

If we don't pass this bill, the business will go to foreign insurance
companies who will be selling these plans and possibly getting many of
these jobs. Why would we want to do that? More importantly, why would
we even allow that?
So this bill represents a very narrow change to the law and saves
jobs. This bill simply amends the law. It does not end the law. This is
not a partisan bill. This bill is a vote to keep jobs here in America
and Pennsylvania and Delaware and California and other places and would
take sensible steps to fix a law that we all know needs to be fixed.
Again, I know it is difficult, but we need to focus on the trees here
and look past the forest, so to speak, on this bill. We need to take
action and save jobs for American workers. And most important of all,
we need to demonstrate to the American people that we can work together
to solve very specific problems that need to be fixed. That is what we
are doing. That is why everybody, whether you are a Republican or a
Democrat, should stand up and enthusiastically support this bill that
will not harm anyone's health care and will save American jobs.
Mr. LEVIN. It is now my pleasure to yield 4 minutes to the gentleman
from California (Mr. Waxman), the ranking member of the Committee on
Energy and Commerce.
Mr. WAXMAN. I thank the gentleman for yielding to me.
Mr. Speaker, my colleagues, this is a bill that could have been
worked out. This is a bill that could have accomplished the purpose
that I know that our colleague from Delaware wants to see put into
place, and I applaud him

[[Page H3269]]

for working hard to improve the bill under very difficult
circumstances.
In trying to allow the American insurance companies to sell policies
to expats, we could craft a bill that is narrow, but we are not getting
cooperation to get to that point. The reason we are not getting
cooperation is we are told we must pass a bill right away. Well, we
were told that 2 weeks ago when we had the bill under suspension, and
we couldn't consider any amendments under suspension. Now we have the
bill under a rule. Oh, and the rule provides for no amendments either.
There is a bill to be crafted, but this bill before us does not
accomplish the goal in a way that really doesn't hurt some people's
insurance coverage.
There are still two major problems with the legislation before us
today. First, it does not have enough safeguards to guarantee that
these expatriate plans are high quality, and the second issue is the
bill creates problems for millions of other people who are legal
permanent residents here in the United States and others working in
this country who are currently protected by the Affordable Care Act.
On the first issue, the insurers tell us that their expatriate plans
are going to be extremely generous. They say they cover people in
dozens of countries around the world and they have comprehensive
benefits, but we don't see any language to verify that claim.
Supporters of the bill claim to guarantee the plans are as high quality
as the insurers say they are. But it is one thing to say that their
plans will be of high quality; it is another thing to actually require
them to offer comprehensive benefits. As President Reagan used to say,
``Trust, but verify.''
The second issue has nothing to do with the expatriate plans and the
companies that are threatening to shut down their operations here in
the United States. It has to do with millions of other people who are
legal permanent residents and workers on visas who currently benefit
from the ACA's protections. But this bill creates a loophole that could
allow these people to be sold plans here in the United States that do
not meet ACA standards. That is why a lot of people looking at this
legislation are saying--such as major labor unions, immigration
advocacy organizations--that this bill is not one they can support, and
they urge that we vote against it.
So I think we can fix both of those issues. We should have fixed both
of those issues before this bill was brought up on the House floor. But
as it stands, we don't know if the Senate can pass any bill, and I
don't believe the President can sign this bill.
My colleague from Delaware and my other colleagues have already
helped make important improvements for the bill. Changing the
definition of an expatriate to someone who is outside of the country
for 6 months is an important step. We should continue to make progress.
There have been productive negotiations on the legislation in recent
days. We need to reach an agreement, and we should bring that
compromise to the House floor; but without that compromise, I don't
feel I can vote for the bill as it presently stands. There are these
two glaring problems that need to be fixed; and without it, we will not
know if those expatriate plans really are the high quality they claim
to be, and we will not know if legal residents of the United States
will be able to get the kind of high-quality plan that everybody else
in the United States will have.
So I urge a ``no'' vote and suggest that we get back to the
negotiating table.
Mr. NUNES. Mr. Speaker, I yield myself 14 seconds.
Mr. Speaker, we have waited for 4 years. For 4 years, we have been
trying to fix this problem. Four years, time is up. We have got to pass
this bill and send it to the Senate so that it can be signed into law.
I will continue to reserve the balance of my time.
Mr. LEVIN. I now yield 2 minutes to the gentleman from Vermont (Mr.
Welch).
Mr. WELCH. Mr. Speaker, I support this bill.
There are really two issues at stake. One is preserving the integrity
of the ACA, the Obama health care bill. There is huge division in this
Congress as to whether that bill should have been passed. It was
passed. But there is unity of purpose now that where there is an
identified problem, we should fix it rather than just having the
ideological battle about whether the law should have been passed in the
first place. That is actually progress because, as my friend from
Pennsylvania said, there is a legitimate expectation on the part of the
people we represent to solve concrete, discrete problems when, in the
solving of them, we are going to keep 1,200 people working. And that is
the real goal of this.
Is there a way where both sides--those who agree with the health care
bill and those who disagree with it--can come together with a narrow
fix that allows 1,200 people--500 in Delaware and 700 in other parts of
the country--to keep doing their work? And, of course, we can.
There is a second question that has come up, and that is whether this
bill right now goes as far as it needs to go. Is this crafted as well
as it needs to be crafted? And that is debatable. The points that the
gentleman from California (Mr. Waxman) made were heartfelt, but there
has been real progress because there has been engagement.
You have had Mr. Carney and Mr. Nunes working very closely with
colleagues on both of their sides to deal with practical issues that
have come up. You have had the White House meeting with Cigna, and both
sides understood. Cigna understood that the White House had had some
legitimate concerns as proponents of the ACA; the White House
understood that Cigna had real and legitimate concerns about their
business and their jobs.

So the progress is reflected in this bill. There is now a debate
about whether that is enough progress. So we have to make a decision:
Do we wait and try to keep negotiating here or do we move it on to the
Senate?
In my view, we move it on to the Senate, partly because, as Mr. Nunes
said, we have been grappling with this for 3 to 4 years. Second, we
have got ACA supporters--and this gives me comfort--on the Senate side,
Senator Carper and Senator Coons from Delaware, who are committed to
making certain that the fix doesn't compromise the health care bill.
That is important to folks like me who voted for the ACA.
So this is a practical step that we can take, working together in
order to save jobs without compromising the underlying legislation.
Mr. NUNES. Mr. Speaker, I yield myself 21 seconds.
Mr. Speaker, I would like to submit for the Record three letters: one
from the Council for Affordable Health Coverage in support of our bill,
the other from the National Association of Health Underwriters in
support of our bill, and the last one from the Business Roundtable in
support of our bill.

Council for Affordable

Health Coverage,

April 29, 2014.
Hon. John Carney,
Longworth House Office Building,
Washington, DC.
Hon. Devin Nunes,
Longworth House Office Building,
Washington, DC.
Dear Congressmen Carney and Nunes: We write to endorse H.R.
4414, the Expatriate Health Coverage Clarification Act of
2014. We strongly support this modification of the Affordable
Care Act (ACA) because it will prevent Americans workers
abroad and American companies providing health coverage
internationally from being disadvantaged compared to their
foreign counterparts.
Employers are not alone in their concerns about the
application of the ACA to expatriates. The Department of
Labor in a Frequently Asked Questions document stated, ``The
Departments recognize that expatriate health plans may face
special challenges in complying with certain provisions of
the Affordable Care Act. In particular, challenges in
reconciling and coordinating the multiple regulatory regimes
that apply to expatriate health plans might make it
impossible or impracticable to comply with all the relevant
rules at least in the near term.'' The Center Consumer
Information and Insurance Oversight (CCIIO) concurred with
the Department of Labor by posting the same document on their
website.
It is clear that the ACA never envisioned the impact of the
law on expatriate plans. For example, CCIIO and the
Department of Labor used the following example to illustrate
the impracticality of applying the ACA to expatriate plans.
``For example, independent review organizations may not exist
abroad, and it may be difficult for certain preventive
services to be provided, or even be identified as preventive,
when such services are provided outside the United States by
clinical providers that use different code sets

[[Page H3270]]

and medical terminology to identify services.''
Because of the challenges and impracticalities associated
with this aspect of the Affordable Care Act, we urge you to
quickly pass this legislation to protect American workers
abroad and American insurers selling insurance on the
international market.
Sincerely,
Communicating for America;
Council for Affordable Health Coverage;
National Association of Health Underwriters;
National Retail Federation;
Retail Industry Leaders Association;
Small Business & Entrepreneurship Council; and

U.S Chamber of Commerce.
____

National Association of

Health Underwriters,

Washington, DC, April 28, 2014.
Congressman John Carney,
Longworth House Office Building,
Washington, DC.
Dear Congressman Carney: On behalf of the National
Association of Health Underwriters (NAHU), representing
100,000 licensed agents and brokers who are engaged in the
sale and service of health insurance and other ancillary
products and serving employers and consumers around the
country, I want to commend you on your efforts to pass the
Expatriate Health Coverage Clarification Act as amended.
NAHU members work to help millions of employers of all
sizes finance administer and utilize their group health
benefit plans on a daily basis. Expatriate health insurance
plans offer high-end, robust coverage to executives and
others working outside their home country, giving them access
to a global network of health care providers.
U.S. insurance companies compete with foreign insurance
companies that also sell expatriate health insurance plans,
but these foreign carriers are not required to comply with
the Affordable Care Act (ACA). This imbalance gives foreign
competitors an unfair advantage. The bill narrowly clarifies
that the Affordable Care Act does not apply to expatriate
health insurance plans.
Since the legislation's original introduction, it has been
amended and now requires an expatriate plan to meet minimum
value requirements as defined under the ACA (60 percent
actuarial value). This is the same standard all other
employer-provided plans must meet in order to comply with the
laws employer shared responsibility provisions. Should an
expatriate plan offered under this bill fail to meet minimum
value requirements, an employee would be eligible to seek
coverage on the exchange and could be eligible for income-
based subsidies.
Further, the amended bill tightens the definition of an
expatriate. It says that an expatriate must be abroad for at
least six months. The previous version of the bill said that
an expatriate only had to be abroad for three months, or
travel outside the country 15 times in a year. This bill
requires a much tougher standard that will guard against
potential abuse. Finally, the amended bill explicitly states
that expatriate plans must continue to comply with relevant
laws enacted prior to the ACA--specifically the Employee
Retirement Income Security Act and the Public Health Service
Act.
We appreciate your leadership on this important issue for
businesses and their employees so that the law can help all
Americans get quality health insurance. We look forward to
working with you and your colleagues in enacting this
bipartisan legislation this year.
Best regards,
Janet Trautwein,
Executive Vice President and CEO.
____

Business Roundtable,

Washington, DC, April 28, 2014.
Hon. Harry Reid,
Majority Leader, U.S. Senate,
Washington, DC.
Hon. Mitch McConnell,
Minority Leader, U.S. Senate,
Washington, DC.
Hon. John Boehner,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Leaders: The Business Roundtable encourages you to
support legislation that does not apply Affordable Care Act
(ACA) requirements upon employer-sponsored health care
coverage for those employees and their families who work
outside of the United States. Business Roundtable is an
association of chief executive officers of leading U.S.
companies with $7.4 trillion in annual revenues and more than
16 million employees.
Business Roundtable companies provide health coverage to
over 40 million Americans around the globe. We consider our
employees to be among our strongest competitive assets and
are committed to a benefits strategy that enhances their
health, well-being, and sense of security wherever they may
be. We have also advocated for reforms that will improve
quality and make health care more affordable and more
efficient.
As companies expand operations internationally, we face
challenges in a global competitive environment, one of which
is the application of ACA requirements to our globally mobile
employees and their families. As currently interpreted, the
complex and prescriptive requirements of the ACA apply to
U.S.-based expatriate plans, which means U.S.-based
international plans must comply with the domestic law's
requirements in all parts of the world and for all employees
outside the United States covered on those plans, regardless
of their citizenship and work location. Many of these
requirements are difficult to implement in other countries
and may not be relevant in other locations.
For example, the Summary of Benefit Coverage notification
uses terminology and data that is specifically tailored to
types of benefits, costs, and care offered in the United
States. This form is not relevant to those who live outside
the country. There are numerous examples of these types of
requirements in the law that are unique to our health care
system and should not be applied to benefits offered to
employees who are residing outside of the United States.
Expatriate health care benefits are highly valued by our
employees and ensure they can continue to benefit from an
American health care option. This, in turn, assures the
competitiveness of U.S. jobs in the global market. For these
reasons, we urge Congress to pass narrow, common sense relief
that provides certainty and clarity for multinational
corporations and their ability to continue providing
comprehensive health benefits for those employees outside the
United States.
Sincerely,
Gary Loveman,
Chairman, Chief Executive Officer and President, Caesars
Entertainment Corporation; Chair, Health and Retirement
Committee, Business Roundtable.

Mr. NUNES. I will continue to reserve the balance of my time.
Mr. LEVIN. I now yield 4 minutes to the gentleman from California
(Mr. Becerra), a member of our committee and also the chair of our
Caucus.
Mr. BECERRA. I thank the gentleman for yielding me the time.
Mr. Speaker, let me say in advance that I appreciate the work that
has been done by any number of Members with regard to this legislation.
Many people have engaged in a good faith effort to try to find an
acceptable solution that resolves issues which are legitimate and have
raised a concern for a lot of us with regard to how we move forward
with the Affordable Care Act and make sure that not only Americans are
covered, but that our companies can continue to offer insurance
coverage for those Americans that are not only affordable but have high
quality.
And many of us have recognized that in the case of Americans who are
out of the country for more time than they are in the country in a
year, that we may have to make some exceptions for them so that the
company that is offering them health insurance can offer a policy that
is competitive. We don't want to price out our American companies that
offer health insurance coverage simply because they are trying to meet
domestic care standards for health care that are required as a result
of the Affordable Care Act but that may not work as well abroad.
So you take a look at the name of this bill, the Expatriate Health
Coverage Clarification Act of 2014. You think, okay, that is what we
are trying to do. We are trying to help expatriates, Americans who work
abroad more time than they are here at home. But when you take a close
look at the bill, that is not what it does.
We are told by the Congressional Research Service that there are
probably about 285,000 Americans who have expatriate health care
coverage. This bill wouldn't impact just those 285,000 Americans. This
bill impacts millions because it impacts U.S. citizens who are here in
the country, not abroad for more than half of the time, and it could
have an impact on every single legal immigrant who is in this country.
So I think all of us agree. We want to make sure that the Affordable
Care Act and its patient protections work, and if we could tweak things
to make it work better, we should. But this is not a bill for
expatriates. This is a bill that goes way beyond.
So let's not fool ourselves. We have to take care of trying to deal
with the narrow exception that we are looking at for expatriates, not
create a giant loophole by which we can now remove the protection
against discrimination for preexisting conditions that right now all
Americans and legal immigrants can now know that they have.
We want to make sure that all of those people who now have protection
from the plans that don't provide coverage after a certain amount of
money, where all of a sudden, boom, you go bankrupt because you didn't
know that your insurance company would only

[[Page H3271]]

cover $50,000 of your health care costs, that protection might be gone.
What we don't want is to create a giant loophole in trying to help a
narrow band of Americans and companies that offer these Americans
health insurance coverage.
The White House has said there is a fix here. And I know the White
House has been trying to work with the proponents of this bill to come
up with a fix. But as they said the last time this was up, this needs
work, and it should not come up for a vote.
But what are they saying now? The administration issued this today:

The administration does not support House passage of H.R.
4414 in its current form because it would reduce consumer
protections and create even more loopholes in the Tax Code.

There is a fix, but this is not it because it goes way beyond. And
what we also have to do is recognize that there are other things
involved.
This bill will cost the American taxpayers money. How much? We are
told by the Congressional Budget Office and Joint Tax Committee, $1.4
billion. Is it paid for? Are the $1.4 billion that we would take away
from--or have to take from other taxpayers covered so that we won't
have to have other Americans pay for this? No. This bill is unpaid for.
And so for any number of reasons, we should sit down and get this
resolved the right way because the White House says there is a fix.
Those of us who oppose this bill say there is a fix. But to create more
loopholes which allow American citizens and immigrants who are lawfully
here, working hard, to all of a sudden be deprived of their
protections----
The SPEAKER pro tempore. The time of the gentleman has expired.
Mr. LEVIN. I yield the gentleman from California an additional 1
minute.
Mr. BECERRA. To deprive American citizens who don't know about this,
to deprive those immigrants who came to this country legally and are
working in this country and today have the same protections to make
sure they are not discriminated against for a preexisting condition,
who also have a chance to get offered a plan that has those protections
against that fine print we used to see in the health policies, to all
of a sudden tell them that they are going to be denied that because we
were trying to fix a problem for Americans who work abroad for more
than a half a year, that is not what we should be doing.
There is a fix. This should not cost the taxpayers more money. And I
believe we could do this pretty quickly because it is a narrow issue.
If we really want to help expats, take out the language in the bill
that talks about legal immigrants who are in the country. It talks
about workers who come to this country to work under worker visa
categories, like in the high-tech field or in agriculture. We can do
this very simply. And I just appeal to my colleagues and friends on
both sides of the aisle: Let's not open up bigger loopholes that cost
the taxpayers money simply to try to fix a narrow version of this that
we know we can do.
So with that, I hope that sanity will prevail before this goes too
far.

{time} 1500

Mr. NUNES. Mr. Speaker, before I yield to my friend from Pennsylvania
again, I just want to say that as someone who used to work in the
fields, I would much prefer an expatriate plan over ObamaCare.
At this time, I will yield 2 minutes to the gentleman from
Pennsylvania (Mr. Dent).
Mr. DENT. Mr. Speaker, just in response to some of the comments I
heard from my colleagues from California, I think it is pretty clear,
the Joint Committee on Taxation, JCT, has been quoted here, but under
this bill, the Joint Committee on Taxation confirms that all plans are
ACA compliant. The JCT also confirms that more U.S. employers--American
employers--will offer employer-sponsored insurance as a result of this
bill.
Further, the Joint Committee on Taxation confirms that the impacts of
this legislation are under 1 million people, closer to 300,000 at best.
That is what we are talking about here.
Let's be very clear. The Nunes amendment that was offered to this
bill actually does help solve many of the problems I believe that have
been raised here in the last few minutes. Mr. Waxman from California
also raised his concerns. But I must say that if we don't move on this
bill, we are not going to have to worry about any of this, because
Americans working overseas as expats will be buying insurance from
German insurance companies or British or some other European concern.
These Americans may be working in places like Ghana, Ethiopia, or
Poland. Frankly, the ACA, the health care law, really has no standing
in those countries.
So, please, this is a very targeted piece of legislation. These
Americans will have good, quality health care as they are working
overseas in countries that really don't recognize the health care law.
So it is a commonsense proposal. The JCT, the Joint Committee on
Taxation, confirms that this is going to affect fewer than 300,000
people. We know that all these plans are ACA compliant, and we know
that more U.S. employers are going to offer employer-sponsored health
insurance as a result of passing this bill.
I say vote for the bill, do the right thing, get the bill to the
Senate and ultimately to the President's desk.
Mr. LEVIN. I now yield 2 minutes to the gentleman from California
(Mr. Costa).
Mr. COSTA. Mr. Speaker, I thank the ranking member, Mr. Levin, for
the 2 minutes.
I rise today to speak in favor of H.R. 4414, the Expatriate Health
Coverage Clarification Act. I am a cosponsor of this bill because I
think it provides a targeted fix to the unintended consequences of the
Affordable Care Act. It is too bad, though, that we cannot work
together in fixing other flaws in the ACA instead of trying to repeal
it over 50 times over the last 2 years.
I think, though, this bill will save American jobs, including many in
the San Joaquin Valley. There have been some concerns that this bill
would negatively impact green card holders and other immigrants to our
country. I think this bill does provide safeguards to ensure that that
will not happen.
An expat plan, by its nature, offers robust benefits across the
globe. No one should be concerned that this bill will somehow erode
coverage or quality for non-Americans living here in the U.S. or for
Americans living abroad, for that matter.
With more than 1,000 jobs at stake, passing this bill will signal to
the American people that, yes, on occasion Congress can work together
and that we do care about more than business as usual.
I am pleased to join my colleagues, Mr. Carney and Mr. Nunes, in
standing up for this effort to protect some American jobs. But let's
remind ourselves that it is a work in progress and the author knows
that this legislation, I suspect, would not be signed into law in its
current form. But it is a work in progress. We move it along, we work
with the Senate and get the concerns addressed the administration has
raised. That is what it takes working together on a bipartisan basis to
get legislation done.
I urge my colleagues to vote ``yes'' on the bill when it comes up for
a vote today.
Mr. NUNES. Mr. Speaker, at this time, I yield myself 15 seconds.
Mr. Speaker, I would like to submit a letter from the American
Benefits Council, a letter from the U.S. Chamber of Commerce, and also
a letter from CHCC, Corporate Health Care Coalition.

American Benefits Council,

Washington, DC, April 8, 2014.
Re Support for H.R. 4414--Expatriate Health Coverage
Clarification Act.

Hon. John Boehner,
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

[[Page H3272]]

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 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.
____

Chamber of Commerce of the

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.
____

Corporate Health Care Coalition,

Washington, DC, April 28, 2014.
Hon. John Boehner,
Speaker, House of Representatives,
Washington, DC.
Hon. Nancy Pelosi,
Minority Leader, House of Representatives,
Washington, DC.
Dear Speaker Boehner and Leader Pelosi: The Corporate
Health Care Coalition is writing to convey its support for
H.R. 4414, ``The Expatriate Health Coverage Clarification Act
of 2014.'' CHCC is a public policy organization comprised of
leading companies from varying industries that compete in the
global marketplace and sponsor health plans for the benefit
of eligible employees and dependents located in every state
in the nation and across the globe.
CHCC members are leaders in providing high quality health
benefits in an efficient and effective manner. A healthy
workforce is critical to our competitiveness both
domestically and globally. Expatriate health plans play a
particularly vital role in recruiting and retaining a
productive, globally mobile workforce, by ensuring that the
health care needs of employees and their families are met
while overseas.
The Expatriate Health Coverage Clarification Act of 2014
would provide needed clarification with respect to the
Affordable Care Act's application to expatriate health plans,
thereby preserving these plans as a viable means of providing
health coverage to employees who reside outside of the United
States. Therefore, CHCC urges Congress to pass the Expatriate
Health Coverage Clarification Act of 2014.
Sincerely,
Kate Hull,
Executive Director.

Mr. NUNES. I continue to reserve the balance of my time.
Mr. LEVIN. I now yield 3 minutes to the gentleman from Wisconsin (Mr.
Kind), another member of our committee.
Mr. KIND. Mr. Speaker, I thank my friend and colleague for yielding
me this time.
Mr. Speaker, I rise in support of this legislation before us today
not because I believe it is a perfect answer to a problem that needs to
be fixed but in order to make sure that the process moves forward. I
want to commend my colleagues who have worked tirelessly over the
ensuing weeks to try to address the concerns--legitimate concerns, I
view--of some of the shortcomings of the legislation before us, Mr.
Nunes and my good friend, Mr. Carney from Delaware.
This is, I think, emblematic of how we should be addressing reform
within the health care system, having the wisdom as a body to recognize
what is working with health care reform and what isn't working and then
try to deal with that with fixes and needed adjustments along the way.
This was an unintended consequence affecting expat health insurance
plans. In my view, there are competitiveness issues from those
insurance plans offering expat coverage compared to what other foreign
plans are offering, but also the ability of people to be able to work
and live effectively abroad.
Even the administration has admitted in their Statement of
Administration Policy that there is a problem that needs to be
addressed. They have identified certain shortcomings of this
legislation, from consumer protections to issues affecting the Tax
Code, but I am sure that as we move forward today, hopefully with
bipartisan support, the Senate will have an opportunity to address many
of these concerns, and we will have to continue to work with the
administration with the legitimate concerns that they continue to
raise.
Again, this is, I think, an approach that we should be taking as a
nation right now, having the wisdom to understand what is working and
also dealing with the unintended consequences of health care reform,
which affects one-fifth of the entire U.S. economy. You are not going
to change that overnight. If you try, you are going to introduce shocks
to the system that aren't going to work for people.
I think this is an honest approach done in a bipartisan fashion with
a lot of listening on both sides and a lot of vetting of issues that I
think are legitimately being raised right now in order to address one
of those small, unintended consequences of the health care reform.
I think, clearly, everyone recognizes more work needs to go into this
legislative package in order to allay some of the concerns. The Senate,
again, will have an opportunity to address and will continue to engage
the administration in order to address some of the concerns that they
are raising, as well. But this is a good, I think, first honest
approach in order to find that solution so we don't see the detrimental
job impact occurring right here in the United

[[Page H3273]]

States and that we do allow affordable and quality health care coverage
for those workers overseas.
Again, I commend my friends, Mr. Carney and Mr. Nunes, for the
outreach and the work that they have put into this legislation. I
encourage my colleagues to support this legislation as it moves
forward.
Mr. NUNES. Mr. Speaker, I will continue to reserve the balance of my
time.
Mr. LEVIN. Can I ask my colleague, are you ready to close?
Mr. NUNES. Yes, I am ready to close.
Mr. LEVIN. So I will do the same.
I would like to place in the Record a letter of opposition to this
bill as presently formulated from the AFL-CIO, the American Federation
of State, County and Municipal Employees, the American Federation of
Teachers, Farmworker Justice, the UAW, the National Council of La Raza,
the National Education Association, the National Immigration Law
Center, the Service Employees International Union, the UNITE HERE, the
United Farm Workers, and the United Food and Commercial Workers
International Union.

April 28, 2014.
Dear Representative: We write today regarding the
Expatriate Health Coverage Clarification Act (H.R. 4414),
scheduled for floor debate on Tuesday. Although negotiations
are apparently occurring behind closed doors on a final
version of the bill, it is our understanding that these
discussions are unlikely to address major shortcomings of the
bill. Barring substantial revisions to the bill, we urge you
to oppose it.
As you know, the bill is intended to accommodate health
plans providing coverage for workers that work in multiple
countries, and it is reasonable to grant these plans some
flexibility to pursue this role. We understand that these
``expatriate'' health care plans currently cover fewer than
300,000 workers. However, the current draft of the bill could
impact a much wider population, resulting in a lower standard
of health care coverage for 13 million lawful permanent
residents (LPRs or green card holders), as well as
individuals with visas for more highly skilled work and
people in dozens of other nonimmigrant categories.
It is important that these workers, who live and work
beside other U.S. workers, enjoy the same coverage
protections provided by the Affordable Care Act (ACA). It
would simply be unfair to provide them a lower level of
protection, and it would exert downward pressure on the
benefits offered to all other workers.
We do believe it is possible to accommodate the needs of
expatriate health plans while avoiding this impact on
millions of workers. First, the Department of Health and
Human Services (HHS) can continue its work developing
regulatory approaches to easing the administrative burdens
faced by these plans. Second, more work can be done on a
legislative approach that appropriately reduces the burden
faced by legitimate expatriate health plans, without creating
a loophole that could be exploited by plans seeking to skirt
the coverage standards of the ACA.
The bill has been improved in some ways since it was first
considered on the House floor. U.S. citizens may only be
included in the plans if they travel out of the country for
more than 180 days a year, and a benchmark has been added to
encourage employers to offer coverage with an actuarial value
of 60 percent or higher.
It remains imperative, however, to ensure that LPRs and
individuals in nonimmigrant visa categories are not exposed
to a gap in ACA coverage protections. More must be done to
exclude these groups from the populations covered by this
bill. Additional employer reporting and enforcement
provisions would help ensure that employers would not stretch
the definition of expatriate employees to offer substandard
coverage to workers.
We welcome the opportunity to help improve this legislation
to address the concerns of the expatriate health plans
without having a negative impact on workers who live and work
in the U.S. It is unlikely that H.R. 4414 will be amended to
meet these goals before the scheduled floor vote, however,
and we urge you to vote against the bill.
Sincerely,
AFL-CIO,
American Federation of State, County and Municipal
Employees (AFSCME);
American Federation of Teachers;
Farmworker Justice;
International Union, United Automobile, Aerospace and
Agricultural Implement Workers of America (UAW);
National Council of La Raza (NCLR);
National Education Association (NEA);
National Immigration Law Center;
Service Employees International Union (SEIU);
UNITE HERE;
United Farm Workers;
United Food and Commercial Workers International Union
(UFCW).

Mr. LEVIN. Also, I submit for the Record a letter in opposition to
this bill as presently formed from the National Immigration Law Center.

National Immigration Law Center,

Los Angeles, CA, April 30, 2014.
Dear Speaker Boehner and Democratic Leader Pelosi: As the
House of Representatives considers the Expatriate Health
Coverage Clarification Act (H.R. 4414) again today, we urge
you to oppose it. Already defeated in the House on April 9,
2014, this bill, absent key changes, will lead to an erosion
of Affordable Care Act (ACA) standards and lower quality
health coverage for immigrants who are unreasonably and
mistakenly classified as expatriates under the legislation.
Supporters of the bill claim that the problems contained in
the original bill have been adequately addressed. This is
simply not true. While some positive changes have been made,
the most egregious provisions remain firmly in place,
including those with broad implications for low-income
immigrants living and working in the U.S. These remaining
problems leave the bill vulnerable to legal challenges.
H.R. 4414 would eliminate the ACA's group plan consumer
protections for ``expatriate health insurance plans,''
including for U.S.-regulated issuers, provided to individuals
who travel ``abroad.'' This blanket exemption alone should be
cause for concern. However, what is far more troubling is
that the bill uses a broad definition for ``expatriate'' that
includes many immigrants who live in the U.S. permanently and
do not travel abroad for work. This definition extends far
beyond the purported objectives of the legislation and must
be fixed.
Specifically, the definition of ``expatriate'' in H.R. 4414
includes lawful permanent residents (LPRs or green card
holders), most of whom spend the vast majority of their time
in the United States. These individuals reside in the U.S.,
are on a path to citizenship, and have built their lives in
the U.S. Simply put, they should not be defined as
``expatriates'' if they do not travel outside of the United
States for work for extended periods. Instead, their health
insurance plans should have the same consumer protections
codified by the ACA as others who live and work in the U.S.
This bill would create a loophole that could lead to inferior
coverage for these individuals.
H.R. 4414 would have an unintentional, disastrous impact on
LPRs and other low-wage immigrant workers. 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 Hincapiee,
Executive Director.

Mr. LEVIN. Finally, I submit into the Record the Statement of
Administration Policy from the Obama administration.

Statement of Administration Policy

H.R. 4414--Expatriate Health Coverage Clarification Act

(Rep. Carney, D-Delaware, and 24 cosponsors)

The Administration does not support House passage of H.R.
4414, the Expatriate Health Coverage Clarification Act, in
its current form, because it would reduce consumer
protections and create even more loopholes in the tax code.
The Affordable Care Act gives people greater control over
their own health care. Since October 1, eight million have
signed up for private insurance and millions more have been
enrolled in Medicaid. Because of the Affordable Care Act,
Americans who have previously been denied coverage due to a
pre-existing medical condition now have access to coverage.
Additionally, the law helps millions of Americans stay on
their parents' plans until age 26, and helps provide access
to free preventive care like cancer screenings that catch
illness early on.
The Administration remains willing to work with the
Congress to improve H.R. 4144 to address these issues and to
maintain basic consumer protections for all workers. There
are straightforward changes to the legislation, which we have
shared with the Congress, that would satisfy these goals, and
the Congress should pursue a solution.

Mr. LEVIN. So let me close, and I yield myself such time as I may
consume.
I think it is regrettable that we are here in this predicament when
we don't need to be. I think we do need to fix the expat issue, but not
by unfixing health care reform for millions of people. This is more
than about 300,000 people. We are talking about the health care
protections and provisions applicable to 13 million people in this
country who are here legally.
It has been said, and I very much respect this, it has taken 3 years
to try to fix this problem, and Mr. Carney and others have truly been
working, and Mr. Nunes, and there have been bipartisan discussions.
But here is the problem: If we are really going to continue
effectively to work together when there is an outstanding issue, when
there has been this aura of good faith, the majority should have let
the minority place on the floor an amendment to the bill and let us
debate it.
In fact, it only works against bipartisanship in this kind of
circumstance to say it is essentially a closed rule. What is there to
fear? The only thing to fear is that we would have discussion that

[[Page H3274]]

might make this a still more bipartisan bill. So instead of getting a
likely minority of members on the Democratic side, we would have, I
think, an overwhelming majority on both sides determined to keep jobs
here, but not at a price of undoing necessary protections in terms of
the health of millions and millions of Americans.
So that is where we are here and essentially so for so many of us
placed in a situation where we say we must do better, we shouldn't
simply leave it to the other body, we have the abilities within this
House with true bipartisanship to continue working, and after 3 years,
it might take another week or 2, that would be worth it in terms of
trying to restore the reality of bipartisanship that really works.
Mr. Speaker, I yield back the balance of my time.
Mr. NUNES. Mr. Speaker, I will close, and I yield myself such time as
I may consume.
The need for this bill wasn't conceived by opponents of the
Affordable Care Act or ObamaCare. The Obama administration and the army
of regulators acknowledged there is a problem and have come to the
Congress to fix it. Treasury, HHS, and Labor have all accepted the fact
that expat plans should not be regulated the same way domestic plans
are regulated.
After 4 years of examining this issue, as I said earlier, the
administration issued limited and temporary regulatory relief for expat
plans. This bill is necessary because despite the administration's
limited and temporary fixes, thousands of jobs are on the chopping
block. American businesses can't compete based on the promise of
limited and temporary relief.
Mr. Speaker, I want to also remind my colleagues that Mr. Carney and
I have worked on this for many years, and we have worked not only in a
bipartisan way in the House of Representatives, we have also worked
with our Senate counterparts where we have bipartisan support in the
United States Senate.
So, the Obama administration has said they have concerns, but we
don't know what the concerns are and they did not issue a veto threat.
So I think that more level heads will prevail. This bill will pass
today. It will go to the Senate, it will pass, and I would urge, then,
President Obama to sign it into law so that we can save these jobs.
With that, Mr. Speaker, I yield back the balance of my time.
Mr. DeFAZIO. Mr. Speaker, the amended version of H.R. 4414 that was
brought up today is a marked improvement over the previous version of
the bill that was brought up earlier this month. I again commend
Representative Carney for proposing fixes to the Affordable Care Act. I
also commend him for trying to work with House leadership and the
Administration to come to an agreement on how to properly treat
expatriate plans under the Affordable Care Act. Unfortunately the bill
on the House floor today does not have the Administration's support.
The potential of lawful permanent residents and other visa holders in
the United States to erroneously be considered expatriates under H.R.
4414 still exists. I expect the Senate to fix this potential loophole
and look forward to supporting final passage of the bill after the
Senate has made targeted changes.
The SPEAKER pro tempore (Mr. Stewart). All time for debate has
expired.
Pursuant to House Resolution 555, the previous question is ordered on
the bill, as amended.
The question is on the engrossment and third reading of the bill.
The bill was ordered to be engrossed and read a third time, and was
read the third time.
The SPEAKER pro tempore. The question is on the passage of the bill.
The question was taken; and the Speaker pro tempore announced that
the ayes appeared to have it.
Mr. LEVIN. 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, this 15-
minute vote on passage of the bill will be followed by a 5-minute vote
on the motion to suspend the rules and pass H.R. 627.
The vote was taken by electronic device, and there were--yeas 268,
nays 150, not voting 13, as follows:

[Roll No. 182]

YEAS--268

Aderholt
Amodei
Bachmann
Bachus
Barber
Barletta
Barr
Barrow (GA)
Barton
Benishek
Bentivolio
Bera (CA)
Bilirakis
Bishop (NY)
Bishop (UT)
Black
Blackburn
Boustany
Brady (TX)
Bridenstine
Brooks (AL)
Brooks (IN)
Buchanan
Bucshon
Burgess
Bustos
Byrne
Calvert
Camp
Cantor
Capito
Carney
Carson (IN)
Carter
Cassidy
Chabot
Chaffetz
Clay
Cleaver
Coble
Coffman
Cole
Collins (GA)
Collins (NY)
Conaway
Connolly
Cook
Cooper
Costa
Cotton
Courtney
Cramer
Crawford
Crenshaw
Cuellar
Culberson
Daines
Davis, Rodney
Delaney
DelBene
Denham
Dent
DeSantis
Diaz-Balart
Duckworth
Duffy
Duncan (TN)
Engel
Enyart
Esty
Farenthold
Fattah
Fincher
Fitzpatrick
Fleischmann
Fleming
Flores
Forbes
Fortenberry
Foster
Foxx
Franks (AZ)
Frelinghuysen
Gabbard
Gardner
Garrett
Gerlach
Gibbs
Gibson
Gingrey (GA)
Gowdy
Granger
Graves (GA)
Graves (MO)
Griffith (VA)
Grimm
Guthrie
Gutieerrez
Hall
Hanabusa
Hanna
Harper
Hartzler
Hastings (WA)
Heck (NV)
Herrera Beutler
Higgins
Himes
Holding
Hudson
Huizenga (MI)
Hultgren
Hunter
Hurt
Issa
Jenkins
Johnson (OH)
Johnson, Sam
Jolly
Jones
Joyce
Kelly (PA)
Kilmer
Kind
King (IA)
King (NY)
Kingston
Kinzinger (IL)
Kirkpatrick
Kline
Kuster
LaMalfa
Lamborn
Lance
Lankford
Larsen (WA)
Larson (CT)
Latham
Latta
Lipinski
LoBiondo
Long
Lucas
Luetkemeyer
Lummis
Maloney, Carolyn
Maloney, Sean
Marchant
Marino
Matheson
McAllister
McCarthy (CA)
McCarthy (NY)
McCaul
McClintock
McHenry
McIntyre
McKinley
McMorris Rodgers
Meadows
Meehan
Messer
Mica
Miller (FL)
Miller (MI)
Moran
Mullin
Mulvaney
Murphy (FL)
Neal
Neugebauer
Noem
Nugent
Nunes
Nunnelee
Olson
Owens
Palazzo
Paulsen
Pearce
Perlmutter
Perry
Peters (CA)
Peters (MI)
Peterson
Petri
Pittenger
Pitts
Poe (TX)
Polis
Pompeo
Posey
Price (GA)
Quigley
Rahall
Reed
Reichert
Renacci
Ribble
Rice (SC)
Rigell
Roby
Rogers (AL)
Rogers (KY)
Rogers (MI)
Rohrabacher
Rokita
Rooney
Ros-Lehtinen
Roskam
Ross
Rothfus
Royce
Runyan
Ruppersberger
Ryan (WI)
Scalise
Schneider
Schock
Schrader
Schweikert
Scott, Austin
Scott, David
Sensenbrenner
Sessions
Sewell (AL)
Shimkus
Shuster
Simpson
Sinema
Sires
Smith (MO)
Smith (NE)
Smith (NJ)
Smith (TX)
Southerland
Stewart
Stivers
Stockman
Stutzman
Terry
Thompson (CA)
Thompson (PA)
Thornberry
Tiberi
Tipton
Turner
Upton
Valadao
Vargas
Wagner
Walberg
Walden
Walorski
Weber (TX)
Webster (FL)
Welch
Wenstrup
Westmoreland
Williams
Wilson (SC)
Wittman
Wolf
Womack
Woodall
Yoder
Young (AK)
Young (IN)

NAYS--150

Amash
Bass
Beatty
Becerra
Bishop (GA)
Blumenauer
Bonamici
Brady (PA)
Braley (IA)
Broun (GA)
Brownley (CA)
Butterfield
Capps
Capuano
Caardenas
Cartwright
Castor (FL)
Castro (TX)
Chu
Cicilline
Clark (MA)
Clarke (NY)
Clyburn
Cohen
Conyers
Crowley
Cummings
Davis (CA)
Davis, Danny
DeFazio
DeGette
DeLauro
DesJarlais
Deutch
Dingell
Doggett
Doyle
Duncan (SC)
Edwards
Ellison
Ellmers
Eshoo
Frankel (FL)
Fudge
Gallego
Garamendi
Garcia
Gohmert
Gosar
Grayson
Green, Al
Green, Gene
Grijalva
Hahn
Harris
Hastings (FL)
Heck (WA)
Hensarling
Hinojosa
Holt
Honda
Horsford
Hoyer
Huelskamp
Huffman
Israel
Jackson Lee
Jeffries
Johnson (GA)
Johnson, E. B.
Jordan
Kaptur
Keating
Kelly (IL)
Kennedy
Kildee
Labrador
Langevin
Lee (CA)
Levin
Loebsack
Lofgren
Lowenthal
Lowey
Lujan Grisham (NM)
Lujaan, Ben Ray (NM)
Lynch
Maffei
Massie
Matsui
McCollum
McDermott
McGovern
McNerney
Meeks
Meng
Michaud
Miller, George
Moore
Nadler
Napolitano
Negrete McLeod
Nolan
O'Rourke
Pallone
Pascrell
Pastor (AZ)
Payne
Pelosi
Pingree (ME)
Pocan
Price (NC)
Rangel
Roe (TN)
Roybal-Allard
Ruiz
Rush
Ryan (OH)
Salmon
Saanchez, Linda T.
Sanchez, Loretta
Sanford
Sarbanes
Schakowsky
Schiff
Scott (VA)
Serrano
Shea-Porter
Sherman
Slaughter
Smith (WA)
Speier
Swalwell (CA)
Takano
Thompson (MS)
Tierney
Titus
Tonko
Tsongas
Van Hollen
Veasey
Vela
Velaazquez
Visclosky
Walz
Waters
Waxman
Wilson (FL)
Yarmuth
Yoho

NOT VOTING--13

Brown (FL)
Campbell
Farr
Goodlatte
Griffin (AR)
Lewis
McKeon
Miller, Gary
Murphy (PA)
Richmond
Schwartz
Wasserman Schultz
Whitfield

[[Page H3275]]

{time} 1543

Ms. SHEA-PORTER, Messrs. YOHO, MASSIE, SANFORD, and AMASH changed
their vote from ``yea'' to ``nay.''
Ms. KUSTER, Messrs. MORAN and SCHOCK changed their vote from ``nay''
to ``yea.''
So the bill was passed.
The result of the vote was announced as above recorded.
A motion to reconsider was laid on the table.
Stated against:
Mr. FARR. Mr. Speaker, on rollcall No. 182, I would have voted
``nay'' had the Speaker allowed me to vote at the well. Had I been
present, I would have voted ``nay.''

____________________