[Congressional Record (Bound Edition), Volume 160 (2014), Part 5]
[House]
[Pages 6351-6361]
[From the U.S. 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

[[Page 6352]]

     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.
       (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

[[Page 6353]]

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 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.

[[Page 6354]]

  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 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.

[[Page 6355]]

  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 American 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 for 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 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

[[Page 6356]]

     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 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

[[Page 6357]]

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 
     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,

[[Page 6358]]

     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 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

[[Page 6359]]

     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 Hincapie,
                                               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 
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

[[Page 6360]]

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.
  Mr. VAN HOLLEN. Mr. Speaker, I rise today in opposition to the latest 
version of H.R. 4414, the Expatriate Health Coverage Clarification Act 
of 2014. I want to commend my colleague John Carney on his efforts to 
address the needs of expatriate health care plans and to ensure that 
the jobs created by managing these plans remain in the United States. 
However, the bill, in its current form, would create more problems than 
it resolves. As you know, the Affordable Care Act established new 
coverage standards and protections for millions of Americans, including 
that they cannot be denied coverage for preexisting conditions nor have 
their benefits capped at arbitrary annual and lifetime limits. 
Unfortunately, the bill contains potential loopholes that could weaken 
coverage for many families and immigrant workers who live in the United 
States. While I do believe the text of the bill has been improved since 
its initial consideration, there is still more work to be done. 
According to the Statement of Administration Policy, the Administration 
echoes our concerns and it remains willing to work with Congress to 
find a reasonable solution. I hope my colleagues in the Senate will 
make the necessary changes in order to resolve this matter as quickly 
as possible.
  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
     Gutierrez
     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
     Cardenas
     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)
     Lujan, 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
     Sanchez, Linda T.
     Sanchez, Loretta
     Sanford
     Sarbanes
     Schakowsky
     Schiff
     Scott (VA)
     Serrano
     Shea-Porter
     Sherman
     Slaughter
     Smith (WA)
     Speier

[[Page 6361]]


     Swalwell (CA)
     Takano
     Thompson (MS)
     Tierney
     Titus
     Tonko
     Tsongas
     Van Hollen
     Veasey
     Vela
     Velazquez
     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

                              {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.''

                          ____________________