[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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