Providing for consideration of 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.

Mr. Speaker, I yield myself such time as I shall consume.

There is no doubt about where Democrats stand. We have taken the lead to make sure there is no offshoring, and there has been a good faith effort here, up to a point. Surely, that has been true of Mr. Carney in all of his efforts, working with Mr. Nunes.

But the problem is that there remain some serious shortcomings in this bill, and unfortunately, we cannot try to remedy it through an amendment, so the notion there is an open process here isn't correct.

The definition of expatriate has been tightened. I think there remain some issues, at least one regarding it; but the major problem relates to the language and how it would impact, potentially, health insurance for an estimated 13 million legal permanent residents and others who are lawfully present foreign workers in the U.S.

Let me just give you examples of where the standards remain weak. For example, under this legislation, expat plans would have dispensation to be weaker than other employer plans in this country.

They could, for example, impose cost sharing on preventive benefits. They could impose annual and lifetime limits on coverage. They could impose unduly long waiting periods.

Indeed, the only ACA provision that would clearly remain in effect would be that they would have to offer coverage to young adults under 26.

So the bottom line is, unfortunately, that the legislation, in its present form, could substantially undermine health security for foreign workers, as well as American dependents who remain in this country.

Also, what it does is provide unprecedented special treatment for these plans in terms of exempting them from financing mechanisms.

Let me say further, as we found out from the Joint Tax Committee and CBO, they confirm this bill would cause some employers who would offer ACA-compliant plans under present law to offer less generous expatriate plans that are no longer subject to the ACA. This is the reason the administration issued, I think just today, a Statement of Administration Policy, and they say they do not support H.R. 4414.

The ACA gives people, it continues, greater control over their health care; and what they say is that this is not true sufficiently in this case.

It says, because of the ACA, Americans who have previously been denied coverage due to a preexisting medical condition now have access to coverage, and that may well not continue.

So the administration concludes it remains willing to work with Congress to improve H.R. 4414 to address those issues and to maintain basic consumer protections for all workers. There are straightforward changes to the legislation, which we have shared with the Congress, that would satisfy these goals, and the Congress should pursue a solution.

Unfortunately, because of this rule, we cannot propose an amendment which would essentially implement these proposals from the administration that they have shared with the Congress. That is why I, unfortunately, have no choice but to suggest a ``no'' vote on the floor of this House.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield 4 minutes to the gentleman from Delaware (Mr. Carney), a colleague and friend who is a sponsor of this legislation.

I yield the gentleman an additional minute.

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.

I now yield 2 minutes to the gentleman from Vermont (Mr. Welch).

I now yield 4 minutes to the gentleman from California (Mr. Becerra), a member of our committee and also the chair of our Caucus.

I yield the gentleman from California an additional 1 minute.

I now yield 2 minutes to the gentleman from California (Mr. Costa).

I now yield 3 minutes to the gentleman from Wisconsin (Mr. Kind), another member of our committee.

Can I ask my colleague, are you ready to close?

So I will do the same.

I would like to place in the Record a letter of opposition to this bill as presently formulated from the AFL-CIO, the American Federation of State, County and Municipal Employees, the American Federation of Teachers, Farmworker Justice, the UAW, the National Council of La Raza, the National Education Association, the National Immigration Law Center, the Service Employees International Union, the UNITE HERE, the United Farm Workers, and the United Food and Commercial Workers International Union.

April 28, 2014.

Dear Representative: We write today regarding the

Expatriate Health Coverage Clarification Act (H.R. 4414),

scheduled for floor debate on Tuesday. Although negotiations

are apparently occurring behind closed doors on a final

version of the bill, it is our understanding that these

discussions are unlikely to address major shortcomings of the

bill. Barring substantial revisions to the bill, we urge you

to oppose it.

As you know, the bill is intended to accommodate health

plans providing coverage for workers that work in multiple

countries, and it is reasonable to grant these plans some

flexibility to pursue this role. We understand that these

``expatriate'' health care plans currently cover fewer than

300,000 workers. However, the current draft of the bill could

impact a much wider population, resulting in a lower standard

of health care coverage for 13 million lawful permanent

residents (LPRs or green card holders), as well as

individuals with visas for more highly skilled work and

people in dozens of other nonimmigrant categories.

It is important that these workers, who live and work

beside other U.S. workers, enjoy the same coverage

protections provided by the Affordable Care Act (ACA). It

would simply be unfair to provide them a lower level of

protection, and it would exert downward pressure on the

benefits offered to all other workers.

We do believe it is possible to accommodate the needs of

expatriate health plans while avoiding this impact on

millions of workers. First, the Department of Health and

Human Services (HHS) can continue its work developing

regulatory approaches to easing the administrative burdens

faced by these plans. Second, more work can be done on a

legislative approach that appropriately reduces the burden

faced by legitimate expatriate health plans, without creating

a loophole that could be exploited by plans seeking to skirt

the coverage standards of the ACA.

The bill has been improved in some ways since it was first

considered on the House floor. U.S. citizens may only be

included in the plans if they travel out of the country for

more than 180 days a year, and a benchmark has been added to

encourage employers to offer coverage with an actuarial value

of 60 percent or higher.

It remains imperative, however, to ensure that LPRs and

individuals in nonimmigrant visa categories are not exposed

to a gap in ACA coverage protections. More must be done to

exclude these groups from the populations covered by this

bill. Additional employer reporting and enforcement

provisions would help ensure that employers would not stretch

the definition of expatriate employees to offer substandard

coverage to workers.

We welcome the opportunity to help improve this legislation

to address the concerns of the expatriate health plans

without having a negative impact on workers who live and work

in the U.S. It is unlikely that H.R. 4414 will be amended to

meet these goals before the scheduled floor vote, however,

and we urge you to vote against the bill.

Sincerely,

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

National Immigration Law Center,

Los Angeles, CA, April 30, 2014.

Dear Speaker Boehner and Democratic Leader Pelosi: As the

House of Representatives considers the Expatriate Health

Coverage Clarification Act (H.R. 4414) again today, we urge

you to oppose it. Already defeated in the House on April 9,

2014, this bill, absent key changes, will lead to an erosion

of Affordable Care Act (ACA) standards and lower quality

health coverage for immigrants who are unreasonably and

mistakenly classified as expatriates under the legislation.

Supporters of the bill claim that the problems contained in

the original bill have been adequately addressed. This is

simply not true. While some positive changes have been made,

the most egregious provisions remain firmly in place,

including those with broad implications for low-income

immigrants living and working in the U.S. These remaining

problems leave the bill vulnerable to legal challenges.

H.R. 4414 would eliminate the ACA's group plan consumer

protections for ``expatriate health insurance plans,''

including for U.S.-regulated issuers, provided to individuals

who travel ``abroad.'' This blanket exemption alone should be

cause for concern. However, what is far more troubling is

that the bill uses a broad definition for ``expatriate'' that

includes many immigrants who live in the U.S. permanently and

do not travel abroad for work. This definition extends far

beyond the purported objectives of the legislation and must

be fixed.

Specifically, the definition of ``expatriate'' in H.R. 4414

includes lawful permanent residents (LPRs or green card

holders), most of whom spend the vast majority of their time

in the United States. These individuals reside in the U.S.,

are on a path to citizenship, and have built their lives in

the U.S. Simply put, they should not be defined as

``expatriates'' if they do not travel outside of the United

States for work for extended periods. Instead, their health

insurance plans should have the same consumer protections

codified by the ACA as others who live and work in the U.S.

This bill would create a loophole that could lead to inferior

coverage for these individuals.

H.R. 4414 would have an unintentional, disastrous impact on

LPRs and other low-wage immigrant workers. We urge you to

oppose the bill, and we look forward to working with members

of Congress to close its loopholes and find workable

solutions.

Sincerely,

Marielena Hincapiee,

Executive Director.

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.

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. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I want to thank the gentleman from Texas (Mr. Burgess) for yielding me the customary 30 minutes.

Mr. Speaker, I yield myself such time as I may consume.

(Mr. McGOVERN asked and was given permission to revise and extend his remarks.)

I voted for the Affordable Care Act, I support the Affordable Care Act, and I believe in the Affordable Care Act. I believe every person in this country ought to have health care. I don't think that is a radical idea, but my friends on the other side of the aisle apparently do. I think everybody in this country is entitled to good, quality health insurance. I think when they get sick they ought to know they will be taken care of and not have to worry about whether they are going to get covered or not because of preexisting conditions or whether they are going to meet some sort of lifetime cap and be excluded from coverage.

That is what the Affordable Care Act is all about. That is what this big controversy that my friends on the other side of the aisle have decided to make on this issue is all about. So I am making sure that everybody in this country has health care. Boy, what a radical idea, what a radical idea.

I will also say that having supported the Affordable Care Act, it is not a perfect piece of legislation. I have never seen a perfect piece of legislation ever come out of Congress. Legislation, especially legislation that covers a subject as wide as this, at times will be tweaked. There will be unintended consequences that we will come and we will try to fix. That is what legislation is supposed to do: to try to fix the problems.

Democrats have said that from the beginning, that we want to make this bill work, work as well as it possibly can. We said we would be willing to work with Republicans and the administration to address the problems that have come about as a result of the implementation of this law. By no means does that mean that we should repeal the Affordable Care Act, which is something my Republican friends are obsessed with. To the contrary, we need to do everything we can to fix any challenges that this law may have to make sure that every American gets the benefit of the Affordable Care Act.

H.R. 4414, the Expatriate Health Coverage Clarification Act, is trying to fix one problem with the law. My friend from Delaware (Mr. Carney) and others are attempting to try to fix a provision in the law that causes some problems with the ways that expatriates are treated under the ACA.

This is one example of how we--Democrats and Republicans--should be able to work together. This is one example of how we--supporters and opponents of the ACA--should be able to lay those differences aside as we try to find solutions and move our country forward.

It is my understanding, Mr. Speaker, that House and Senate Democrats and Republicans have been working with the White House to come up with a solution that can pass both Houses of Congress and be signed by the President. It is also my understanding that discussions were ongoing as late as yesterday afternoon when the House majority decided to go with the version before us today instead of waiting to continue negotiations in a bipartisan, bicameral way so that we can get a bill moved expeditiously through both Houses and signed into law by the President of the United States.

I am more than a little disappointed, Mr. Speaker, because I want to work with the majority to fix this problem. I am concerned that this bill, the bill before us that we are talking about right now, creates other problems, namely excluding green card holders and nonimmigrant workers from most of the coverage protections provided by the ACA. I am disappointed that this process was closed down even though negotiations were still ongoing.

Quite frankly, Mr. Speaker, the gentleman from Texas literally took my breath away when he talked about that this represents the Speaker's pledge to let the House work its will. This issue first came up under a suspension, which was totally closed, and it is coming to the floor today under a closed rule. Those of us who have some ideas on how we might be able to make this more palatable to address some of the concerns that we have will not have that opportunity. They have closed the process down. I hardly think that that can be described as an open process or as a transparent process. This is yet another closed rule, another closed rule.

Mr. Speaker, this process was flawed and this process could have been better. There are many of us on my side of the aisle who believe that we need to fix this flaw that the gentleman from Delaware (Mr. Carney) has brought to our attention, but we need to do it in the right way, and this is not the right way to do it.

I think what is going to happen here is--my friends on the other side of the aisle control most of the votes here so they will probably pass this bill--but what will happen then is that the Senate will then have negotiations with the White House and try to figure out how to fix this problem. They will pass it, then it will have to come back to the House again, and then we will have to deal with it separately.

I regret very much that my friends have decided to go this way. If they had waited a few more days we probably could have gotten a solution to this that could have received unanimous support. Instead, we are back at the same old-same old, where it is attack the ACA, attack the ACA, and pretend to try to fix it by addressing a legitimate concern, but adding to that a whole bunch of extraneous stuff that creates other problems.

I would urge my colleagues to vote ``no'' on the rule and to vote ``no'' on the bill. Let's wait until the Senate gets it right with the White House and we can revisit this issue.

With that, I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

What we are considering right now before the full House is very clear.

One, a closed rule. What a closed rule means is that you can't offer any amendments. So some of the concerns that have been raised about the underlying bill we can't fix. For the life of me, I don't understand why, if the gentleman claims that the Republican majority is committed to an open, transparent process where the House can work its will, I don't understand why you would approve a closed rule on this.

Let's be honest about this. It is not like my friends on the other side of the aisle are doing anything else. We have had multiple repeals of the Affordable Care Act before us. We have had lots of message issues that their pollsters say poll well, but the Republican majority hasn't really done very much to help the American people in any way, shape, or form. So it is not like the time doesn't exist to maybe have a little bit more debate on an issue like this and be able to perfect this bill. This is a closed rule. This is a closed rule, this is a closed process, and this has become a closed House.

Again, I urge my colleagues to vote ``no'' on this closed rule, reject this closed process, reject the underlying bill, and I reserve the balance of my time.

Mr. Speaker, I yield myself such time as I may consume.

I remind the gentleman that the Speaker of the House said when the Republicans won the majority that they were going to conduct proceedings here in the most open way possible--this will be the most open and transparent House ever. And it has become the most closed House ever.

Because the gentleman brought up the Affordable Care Act, I want to make sure he understands the facts. While the bill we are talking about right now received 20 minutes of debate under suspension, let me read you the facts about the Affordable Care Act, in case my friend forgot.

The House held nearly 100 hours of hearings and 83 hours of committee markups. The House heard from 181 witnesses, both Democrats and Republicans. 239 amendments were considered in the three committees of jurisdiction, 121 of which were adopted. The bill was available for 72 hours before Members were asked to vote on it on the floor.

The process was just as open in the Senate. The Senate Finance Committee held more than 53 hearings. The Finance Committee also spent 8 days marking up the legislation, the longest markup in 22 years for the committee. The Senate Health Committee held 47 bipartisan hearings, roundtables, and walk-throughs on health care reform. The Patient Protection and Affordable Care Act may have started out with a different bill number, but the fact remains hundreds of hours of hearings on the Affordable Care Act, hundreds of witnesses, hundreds of amendments considered in the committee, and countless hours of townhall meetings.

My friend on the other side of the aisle likes to say, well, there was a different bill number when we voted here on the floor, but as he knows, the process of using a different bill number is very common around here. In fact, the Republican majority has done it several times in the past 3 years. But regardless of the bill number, the work that went into forming this legislation was one of the most open processes in the history of Congress.

That is the facts on that.

But let me also make one other point. The problem my friends on the other side of the aisle have with the Affordable Care Act is not with the process. It is just they don't believe that people ought to have affordable health care in this country. They have spent countless hours on this floor trying to repeal a bill that eliminates preexisting conditions as a way to deny people insurance.

They have been fighting against a bill that helps senior citizens get free preventive care coverage, that helps close that doughnut hole in the Medicare prescription drug bill. They are fighting against a bill that has brought millions and millions and millions of more people into a process where they can afford health care. So they have been against this from the very beginning.

I think the American people have a very different view. Their view is that they want this bill to work. My friends on the other side of the aisle have just spent countless hours, countless days, countless weeks, countless months just trying to repeal it. It is just Johnny One Note: repeal, repeal, repeal.

This idea that everybody should have affordable health care is such a controversy in the Republican Congress, I can't quite understand why. Why is it such a bad idea that everybody in this Congress has access to good quality health care? Why is that an idea that causes such resentment on the other side of the aisle? I don't get it.

We ought to make sure that this law gets implemented properly, and we ought to do this the right way. My friends don't want to do it the right way, so we are going to have to wait for the Senate to work it out with the administration and then send it back to us. There really should be a better way to do this.

With that, I reserve the balance of my time.

Does the gentleman have any other speakers?

I yield myself the balance of my time.

Mr. Speaker, I am going to urge my colleagues to vote ``no'' on the previous question.

If we defeat the previous question, I will offer an amendment to the rule that would allow the House to consider the Fair Minimum Wage Act. This week, the Senate will vote to raise the minimum wage to $10.10 an hour. Now is the time for the House to act and to honor our commitment to the middle class by giving hard-working Americans fair pay.

Mr. Speaker, I ask unanimous consent to insert the text of the amendment in the Record, along with extraneous material, immediately prior to the vote on the previous question.

Again, I would urge my colleagues on the other side of the aisle, who like to talk about how the Republican majority is committed to allowing the House to work its will and is committed to an open and transparent process, to vote with us on this.

We have been trying to get the minimum wage bill to the floor forever, and we can't even get it up for a vote so that every Member has an opportunity to vote up or down. This is that opportunity so that we can have that vote, a vote to help lift people out of poverty and to help give people an opportunity to live better lives.

There are millions of workers in this country who are working full time--who are working hard at minimum wage jobs--and they are still stuck in poverty. There are millions and millions of people in this country who work hard full time at minimum wage jobs, but who earn so little that they still qualify for SNAP, and they rely on that program to put food on their tables because their paychecks don't provide enough.

This is an important issue, and I hope that my colleagues will support me on this. I urge all of my colleagues to vote ``no'' and defeat the previous question, and I urge a ``no'' vote on the rule.

I yield back the balance of my time.

Mr. Speaker, on that I demand the yeas and nays.

Mr. Speaker, I demand a recorded vote.

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.

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.

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.

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. Speaker, at this time, I yield 2 minutes to the gentleman from Ohio (Mr. Renacci), a member of the Ways and Means Committee.

Mr. Speaker, at this time, I yield 3 minutes to the gentleman from Pennsylvania (Mr. Dent).

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. Speaker, I yield myself 21 seconds.

Mr. Speaker, I would like to submit for the Record three letters: one from the Council for Affordable Health Coverage in support of our bill, the other from the National Association of Health Underwriters in support of our bill, and the last one from the Business Roundtable in support of our bill.

Council for Affordable

Health Coverage,

April 29, 2014.

Hon. John Carney,

Longworth House Office Building,

Washington, DC.

Hon. Devin Nunes,

Longworth House Office Building,

Washington, DC.

Dear Congressmen Carney and Nunes: We write to endorse H.R.

4414, the Expatriate Health Coverage Clarification Act of

2014. We strongly support this modification of the Affordable

Care Act (ACA) because it will prevent Americans workers

abroad and American companies providing health coverage

internationally from being disadvantaged compared to their

foreign counterparts.

Employers are not alone in their concerns about the

application of the ACA to expatriates. The Department of

Labor in a Frequently Asked Questions document stated, ``The

Departments recognize that expatriate health plans may face

special challenges in complying with certain provisions of

the Affordable Care Act. In particular, challenges in

reconciling and coordinating the multiple regulatory regimes

that apply to expatriate health plans might make it

impossible or impracticable to comply with all the relevant

rules at least in the near term.'' The Center Consumer

Information and Insurance Oversight (CCIIO) concurred with

the Department of Labor by posting the same document on their

website.

It is clear that the ACA never envisioned the impact of the

law on expatriate plans. For example, CCIIO and the

Department of Labor used the following example to illustrate

the impracticality of applying the ACA to expatriate plans.

``For example, independent review organizations may not exist

abroad, and it may be difficult for certain preventive

services to be provided, or even be identified as preventive,

when such services are provided outside the United States by

clinical providers that use different code sets

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.

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. 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.

I continue to reserve the balance of my time.

Mr. Speaker, I will continue to reserve the balance of my time.

Yes, I am ready to close.

Mr. Speaker, I will close, and I yield myself such time as I may consume.

The need for this bill wasn't conceived by opponents of the Affordable Care Act or ObamaCare. The Obama administration and the army of regulators acknowledged there is a problem and have come to the Congress to fix it. Treasury, HHS, and Labor have all accepted the fact that expat plans should not be regulated the same way domestic plans are regulated.

After 4 years of examining this issue, as I said earlier, the administration issued limited and temporary regulatory relief for expat plans. This bill is necessary because despite the administration's limited and temporary fixes, thousands of jobs are on the chopping block. American businesses can't compete based on the promise of limited and temporary relief.

Mr. Speaker, I want to also remind my colleagues that Mr. Carney and I have worked on this for many years, and we have worked not only in a bipartisan way in the House of Representatives, we have also worked with our Senate counterparts where we have bipartisan support in the United States Senate.

So, the Obama administration has said they have concerns, but we don't know what the concerns are and they did not issue a veto threat. So I think that more level heads will prevail. This bill will pass today. It will go to the Senate, it will pass, and I would urge, then, President Obama to sign it into law so that we can save these jobs.

With that, Mr. Speaker, I yield back the balance of my time.

Mr. Speaker, by direction of the Committee on Rules, I call up House Resolution 555 and ask for its immediate consideration.

Mr. Speaker, for the purpose of debate only, I yield the customary 30 minutes to the gentleman from Massachusetts (Mr. McGovern), pending which I yield myself such time as I may consume. During consideration of this resolution, all time yielded is for the purpose of debate only.

General Leave

Mr. Speaker, I ask unanimous consent that all Members may have 5 legislative days to revise and extend their remarks on the resolution.

Mr. Speaker, House Resolution 555 provides for the consideration to fix yet another flaw that has to be corrected in the Affordable Care Act due to the rushed process by which the bill was passed in March of 2010.

As a direct result of the hasty legislation, experts have estimated that over 1,000 Americans will lose their jobs unless Congress takes immediate action to correct and clarify the Affordable Care Act's impact on expatriate health care plans.

This bill before us today will do just that, putting Americans above partisan politics and helping yet another subset of people in our country who currently are being harmed by the President's takeover of our health care system.

The rule before us today provides for one full hour of debate equally divided and controlled by the chair and the ranking minority member on the Committee on Ways and Means. Further, the rule provides for the adoption of an amendment by the bill's authors, Representatives Nunes from California and Carney from Delaware, which addresses a number of concerns the minority expressed during debate of this legislation several weeks ago.

True to the Speaker's commitment of letting the House work its will, Republicans listened to those concerns and crafted a bipartisan amendment to improve the legislation. In addition, the rule provides the minority the standard motion to recommit.

H.R. 4414, the Expatriate Health Coverage Clarification Act of 2014, addresses the problem caused by the Affordable Care Act, which could result in those Americans who live abroad for a substantial portion of the year, those individuals referred to as expatriates, that could cause them to lose their health care coverage because of the one-size- fits-all approach to our health care system, which was employed by the wizards who wrote the Affordable Care Act.

Expatriate health care providers have traditionally offered tailored, specialized insurance plans to meet the needs of Americans who spend their time overseas. These citizens simply cannot rely on a local general practitioner or neighborhood clinic because, so often, they are far away from home.

However, the Affordable Care Act does not provide an avenue by which these plans can continue to be offered. Instead, Senator Reid, Kathleen Sebelius, and Barack Obama decided it was up to them to decide how Americans' health insurance plans should be structured.

The legislation before us today is a clear example of why a top-down Federal approach to health care does not work. Consumers should be in the driver's seat deciding what works best for them, what works best for themselves and their families, not someone sitting in Washington,

Mr. Speaker, I yield myself 1 minute.

This bill was brought to the floor under suspension of the rules prior to the Easter recess. So it has been available for consideration, for staff work to occur, for some period of time. The fact of the matter is that it is an imminent problem facing people who are working

outside of the country, and for that reason it was important to get it solved.

If the gentleman feels that more work should have been done prior to that time, perhaps they should have worked with the majority prior to it being brought up under suspension. I don't know the answer to that. But I do know where we are today is that this is a problem that needs to be fixed, and the Republican majority is seeing to it that it is fixed, bringing it to the floor under a rule. The minority will have an opportunity to amend during a motion to recommit, and I certainly look forward to a lively discussion during that time.

I reserve the balance of my time.

Mr. Speaker, I yield myself 1 minute.

This, this was brought to the House floor as a closed rule in March of 2010. This coercive, partisan piece of legislation which is going to affect health care in this country for every man, woman, and child for the next three generations, this was brought under a closed rule.

We are trying to fix one very narrow problem contained within these pages. It seems to me that there has been ample discussion. A bill was debated under suspension. It did not receive the required two-thirds vote, so it is being brought back today under a rule, and the minority will have an opportunity to offer an amendment during the motion to recommit. This was a closed rule which was very damaging to the country. Today's closed rule is simply to fix one of the many problems contained herein.

I reserve the balance of my time.

Mr. Speaker, I reserve the balance of my time.

Mr. Speaker, I yield myself 30 seconds.

As much as I would like to continue this lively back-and-forth, we both know each other's positions on this extremely well.

No, I have no other speakers.

I reserve the balance of my time.

I yield myself the balance of my time.

Mr. Speaker, today's rule provides for the consideration of a critical bill to ensure Americans who are being hurt by the Affordable Care Act can have some relief.

Americans and their families who live abroad for part of the year face losing this specialized health insurance coverage on which they have come to rely. In addition, the men and women who operate on these health care plans face having their jobs outsourced overseas in order for companies to comply with regulations from the Department of Health and Human Services.

I certainly want to thank Mr. Nunes and Mr. Carney for their thoughtful legislation. For that reason, I urge my colleagues to support both the rule and the underlying bill.

I yield back the balance of my time, and I move the previous question on the resolution.

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----

To deprive American citizens who don't know about this, to deprive those immigrants who came to this country legally and are working in this country and today have the same protections to make sure they are not discriminated against for a preexisting condition, who also have a chance to get offered a plan that has those protections against that fine print we used to see in the health policies, to all of a sudden tell them that they are going to be denied that because we were trying to fix a problem for Americans who work abroad for more than a half a year, that is not what we should be doing.

There is a fix. This should not cost the taxpayers more money. And I believe we could do this pretty quickly because it is a narrow issue.

If we really want to help expats, take out the language in the bill that talks about legal immigrants who are in the country. It talks about workers who come to this country to work under worker visa categories, like in the high-tech field or in agriculture. We can do this very simply. And I just appeal to my colleagues and friends on both sides of the aisle: Let's not open up bigger loopholes that cost the taxpayers money simply to try to fix a narrow version of this that we know we can do.

So with that, I hope that sanity will prevail before this goes too far.