[Congressional Record Volume 161, Number 68 (Wednesday, May 6, 2015)]
[Senate]
[Page S2683]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




  STATEMENT IN SUPPORT OF DIVISION M OF THE CONSOLIDATED AND FURTHER 
  CONTINUING APPROPRIATIONS ACT, 2015, THE EXPATRIATE HEALTH COVERAGE 
                           CLARIFICATION ACT

  Mr. CARPER. Mr. President, I ask unanimous consent that a statement 
in support of Division M of the Consolidated and Further Continuing 
Appropriations Act, 2015, the Expatriate Health Coverage Clarification 
Act be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

 Statement of Senators Carper, Toomey, Coons, and Rubio in support of 
 Division M of the Consolidated and Further Continuing Appropriations 
      Act, 2015, the Expatriate Health Coverage Clarification Act.

       At the end of the last Congress, a bipartisan group of 
     Senators and Members of Congress led by Senators Carper, 
     Toomey, Coons and Rubio, worked together to secure passage of 
     the Expatriate Health Coverage Clarification Act of 2014. 
     That legislation, which was included as Division M of the 
     Consolidated and Further Continuing Appropriations Act, 2015, 
     provides important technical clarifications of how the 
     Patient Protection and Affordable Care Act (ACA) applies to 
     health coverage provided by U.S. insurers to globally mobile 
     employees. It puts those U.S. insurers on equal footing with 
     their foreign counterparts and protects jobs in this country.
       As the Administration prepares to begin the rulemaking 
     process to implement the Expatriate Health Coverage 
     Clarification Act, we want to ensure Congressional intent is 
     clear so the Act is implemented properly. We are aware the 
     Congressional Record already contains two statements that 
     reflect Congressional intent on certain elements of the 
     Expatriate Health Coverage Clarification Act, but further 
     explanation will aid the Administration in its implementation 
     efforts.
       The issues that we seek to clarify today are: relief from 
     the ACA's health insurer fee, the effective date of the 
     Expatriate Health Coverage Clarification Act, treatment of 
     groups of similarly situated individuals (including student 
     and religious missionary groups), who to take into account 
     when determining enrollment in expatriate health insurance 
     plans, locations where expatriate plans must provide coverage 
     for qualified expatriates assigned or transferred to the 
     United States, actuarial value, and reporting requirements.
       One important clarification relates to the application of 
     the health insurer fee established in section 9010 of the ACA 
     to expatriate health insurance plans. Under the Expatriate 
     Health Coverage Clarification Act, premiums with respect to 
     persons covered by qualified expatriate health insurance 
     plans are not included in the calculation of the amount of 
     that issuer's share of the health insurance fee. To make 
     certain that the intent of that provision is abundantly 
     clear, we want to iterate that no health insurer fee will be 
     owed with respect to expatriate health insurance plans for 
     2016 and beyond.
       Additionally, in implementing the special rule related to 
     the health insurer fee for 2014 and 2015, it is the intent of 
     Congress that the Internal Revenue Service (IRS) assess less 
     than the full ``applicable amount'' otherwise specified in 
     ACA section 9010 for 2014 and 2015, and that it refund or 
     credit any excess funds already paid by expatriate health 
     insurance issuers for 2014.
       In addition to those important clarifications, we believe 
     additional clarifications will further ensure appropriate 
     implementation of the Expatriate Health Coverage 
     Clarification Act.
       The Expatriate Health Coverage Clarification Act became law 
     on December 16, 2014. The legislative language provides that 
     the Act takes effect upon enactment and applies to expatriate 
     health plans issued or renewed on or after July 1, 2015, 
     unless otherwise specified. It is important to clarify that 
     Congressional intent is to provide immediate relief to U.S. 
     issuers of expatriate health insurance plans effective on the 
     date of enactment, and for the additional requirements 
     imposed by the Act to apply only to plans issued or renewed 
     on or after July 1, 2015, to give the Administration time to 
     issue guidance on these new requirements.
       Another clarification relates to the treatment of ``groups 
     of similarly situated individuals,'' which includes student 
     and religious missionary groups, under the Expatriate Health 
     Coverage Clarification Act. Congress does not intend every 
     student or religious missionary or other similarly situated 
     group to have to endure a lengthy approval process through 
     which the Secretary of Health and Human Services, the 
     Secretary of the Treasury and the Secretary of Labor 
     determine that international health care coverage is 
     appropriate for the group. Rather, if a health plan meets the 
     requirements of being an expatriate health plan and a group 
     of similarly situated individuals meets the requirements of 
     eligibility to purchase such a plan, we expect that these 
     groups can purchase plans as expeditiously as possible. We 
     expect the Secretaries will issue guidance on this matter 
     that is consistent with the language of the Expatriate Health 
     Coverage Clarification Act for these groups to access health 
     insurance and other related services and support in multiple 
     countries.
       The Expatriate Health Coverage Clarification Act limits its 
     relief to expatriate health plans that meet the standards 
     established in the law. One of those standards is that 
     ``[s]ubstantially all of the primary enrollees in such plan 
     or coverage are qualified expatriates . . . .'' It is 
     important to clarify that Congress does not intend for 
     individuals who are enrolled in COBRA or other continuation 
     coverage under the plan to be taken into account when 
     determining whether substantially all of the primary 
     enrollees are qualified expatriates.
       Another standard is that where an expatriate health plan 
     provides coverage for qualified expatriates who are 
     transferred or assigned to the United States, the plan must 
     provide certain coverages in ``. . . 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 (after taking into account 
     the barriers and prohibitions to providing health care 
     services in the countries as designated).'' It is important 
     to clarify that Congress does not intend that expatriates in 
     foreign countries receive duplicate or unnecessary health 
     insurance coverage. Instead, the Secretaries should 
     promulgate guidance establishing that, by virtue of having 
     U.S.-issued expatriate health coverage, qualified expatriates 
     need the full benefits and protections of the Expatriate 
     Health Coverage Clarification Act in such locations as are 
     necessary for the individual to perform his/her job 
     responsibilities.
       The Expatriate Health Coverage Clarification Act says that 
     plan sponsors must reasonably believe that ``the benefits 
     provided by the expatriate health plan satisfy a standard at 
     least actuarially equivalent to the level provided for in 
     section 36B(c)(2)(C)(ii) of the Internal Revenue Code.'' The 
     intent of Congress is to require expatriate health coverage 
     to meet the minimum-value as it is delineated in the Internal 
     Revenue Code 36B(c)(2)(C)(ii). We believe the law allows for 
     employers and issuers to retain the flexibility to design and 
     offer plans with a higher value as they may determine 
     necessary and appropriate to meet the needs and circumstances 
     of their covered population.
       Finally, there is the issue of reporting requirements. The 
     ACA added section 6055 to the Internal Revenue Code, which 
     provides that every provider of minimum essential coverage 
     will report coverage information by filing an informational 
     return with the IRS and furnishing a statement to 
     individuals. The information is used by the IRS to 
     administer, and individuals to show compliance with, the 
     ACA's individual shared responsibility provision. It is 
     Congress's intent that any additional reporting that may be 
     required as a result of the Expatriate Health Coverage 
     Clarification Act or related guidance should be kept as 
     minimal as possible, recognize the unique nature of 
     expatriate health plans, and be incorporated into the 
     existing requirements under section 6055. Should future laws 
     or regulations streamline the reporting requirements for 
     domestic health plans, we expect that this relief be provided 
     equally to expatriate health plans.
       We believe these are important clarifications that will 
     ensure the Expatriate Health Coverage Clarification Act is 
     implemented consistent with Congressional intent and will 
     permit U.S.-based expatriate health insurance issuers to 
     compete with their foreign counterparts.

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