H.R. 1368: No Healthcare Subsidies for Foreign Diplomats Act of 2015

Posted: 12:12 am EDT
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Following the 2013 report that Russian diplomats were charged with alleged widespread Medicaid fraud between 2004 to 2013 at an approximate cost of $1,500,000 in fraudulently received benefits (see 49 Russian Diplomats/Spouses Charged With Picking Uncle Sam’s Pocket in Medicaid Scam), Congress investigated (Congress Seeks Information on Obamacare Coverage of Foreign Diplomats).

On March 17, the House Committee on Foreign Affairs announced  that U.S. Rep. Ed Royce (R-CA), Chairman of the House Foreign Affairs Committee, and U.S. Rep. Paul Ryan (R-WI), Chairman of the House Ways and Means Committee, introduced H.R. 1368, the No Healthcare Subsidies for Foreign Diplomats Act of 2015, legislation to prevent foreign diplomats from receiving subsidized health coverage under the Affordable Care Act (ACA).  According to the Department of Health and Human Services, foreign diplomats and United Nations employees in the United States are currently eligible to obtain American taxpayer-funded subsidies under the ACA, such as premium tax credits and cost-sharing reductions, just like American citizens and lawful permanent residents.  By contrast, U.S. diplomats overseas do not depend on foreign taxpayers for health care coverage, relying instead on domestic health insurance plans that provide overseas coverage.

Chairman Royce said: “After a year-long investigation, the Obama Administration finally came clean about the fact that foreign diplomats are eligible for taxpayer-funded health care subsidies.  This is unacceptable.   Americans’ tax dollars should not be used to foot the bill for foreign diplomats’ health care coverage.  I am pleased to reintroduce this legislation and look forward to working with Chairman Ryan to pass this commonsense reform.”

H.R. 1368:

  • Expresses the sense of Congress that foreign diplomats should be allowed to purchase health insurance coverage in the U.S., but the cost of that coverage should be borne by their sending States;
  • Expresses the sense of Congress that U.S. taxpayers should not subsidize the health insurance expenses of foreign diplomats;
  • Amends the Internal Revenue Code to make foreign diplomats ineligible for health insurance premium tax credits and cost-sharing reductions under the ACA;
  • Requires the Secretary of HHS to certify to Congress that no foreign diplomats are receiving such benefits under the ACA; and
  • Requires the Secretary of State to notify all foreign missions in the U.S. that their personnel are ineligible for these benefits under the ACA.

The Committee says that initially, it sent a letter to Secretary Kerry requesting information on the arrest and the eligibility of foreign diplomats receiving government-funded medical benefits.  In January and April of 2014, the Committee also sent letters to the Secretary of Health and Human Services regarding foreign diplomats’ eligibility to receive Obamacare.  In a response on September 30, 2014, HHS confirmed foreign diplomats’ eligibility for government subsidized healthcare.  In October of 2014, Chairman Royce and former Chairman Camp wrote to IRS Commissioner John Koskinen seeking information about how many foreign diplomats have enrolled in the Affordable Care Act and have received subsidies.

The HHS response to the eligibility of foreign diplomats under Obamacare notes the following:

[F]oreign diplomats’ eligibility to participate in the Health Insurance Marketplaces is governed by the Affordable Care Act, which specifies that, in order to enroll in a qualified health plan (QHP) through the Marketplace, an individual must: (I) reside in the state that established the Marketplace; (2) not be incarcerated, other than pending the disposition of charges; and (3) be a United States’ citizen or national, or a non-citizen who is lawfully present and reasonably expected to remain so for the entire period for which enrollment is sought. Non-immigrant, non-citizens in the “A” and “G” visa classifications are lawfully present for this purpose, if they have not violated the terms of the status under which they were admitted or to which they have changed after admission. Accordingly, to the extent that a foreign diplomat who is a non-immigrant under an “A” or “G” visa classification and who has not violated the terms of the status under which he or she was admitted or to which he or she has changed after admission resides in the state that established the Marketplace and is not incarcerated other than pending the disposition of charges, he or she would be eligible for enrollment in a QHP through the Marketplace. The Department does not collect data on the number of foreign diplomats who participate in the Marketplace.

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Congress Seeks Information on Obamacare Coverage of Foreign Diplomats

— Domani Spero
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On October 29, 2014,  the House Foreign Affairs Committee Chairman Ed Royce (R-CA) and Ways and Means Committee Chairman Dave Camp (R-MI) wrote to IRS Commissioner John Koskinen seeking information after learning that foreign diplomats working in the United States are eligible for subsidized health coverage under the Affordable Care Act (ACA). Excerpt from their letter:

The Committees on Foreign Affairs and Ways and Means are investigating the extent to which these diplomats receive taxpayer-subsidized premium tax credits and cost-sharing subsidies under the Affordable Care Act.  We are seeking to determine how many such individuals participate in these programs and the total cost of such benefits.  As the agency principally responsible for administering health coverage tax credits, we request that you provide this information as soon as possible.

According to the Department of Health and Human Services, foreign diplomats holding “A” or “G” visas are eligible to participate in an array of medical programs administered by the federal government, including participation in Health Insurance Marketplaces governed by the Affordable Care Act (ACA). The Secretary of Health and Human Services has informed the Committee on Foreign Affairs that, if they meet basic ACA requirements, “a foreign diplomat could satisfy the statutory criteria to be eligible for a premium tax credit and cost-sharing reductions.”  The State Department has gone so far as to advertise to Foreign Missions, Permanent Missions to the United Nations, and the United Nations Secretariat that health care exchanges and “the benefits of the United States Affordable Care Act are available” to them.

The Foreign Affairs Committee has sought to determine the number of diplomats receiving coverage and subsides under the ACA.  Unfortunately, the State Department has informed the Foreign Affairs Committee that it “is not involved in the process through which foreign diplomats obtain government-funded benefits” and cannot provide that data.  The Department of Health and Human Services is likewise unable to provide this information.  Specifically, it noted that “[t]he Department does not collect data that identify whether individuals receiving services through our medical programs have diplomatic status.”  Similarly, “the Department does not collect data that identifies whether individuals receiving tax credits and/or cost sharing reductions have diplomatic status.”  Copies of these letters are attached for your reference.

We fully support the ability of foreign diplomats to purchase health care coverage in the United States.  We do not, however, believe that American taxpayers should subsidize these services.  To assist with our oversight of this matter, we ask that you please provide the following information as soon as possible, but not later than 5:00 p.m. on November 12, 2014.

  1. The total number, including from which country, of all non-immigrant, non-citizen “A” and “G” visa holders who are eligible for, and who have received, premium tax credits for qualified health plans under the Affordable Care Act;
  1. The total number, including from which country, of all non-immigrant, non-citizen “A” and “G” visa holders who are eligible for, and who have received, cost-sharing reductions for qualified health plans under the Affordable Care Act; and
  1. The total cost, and cost per individual, of all subsidies provided to the individuals above.

The signed letter and referenced attachments are available here.

Did you know about this? Do you know the rationale for this?  International relations is based on reciprocity, are our American diplomats eligible for healthcare subsidies in countries that avail of Obamacare subsidies here? Since the State Department is “is not involved in the process through which foreign diplomats obtain government-funded benefits,” in the United States, how is it supposed to press countries for reciprocal treatment on behalf of our diplomats?

According to a notice circulated (pdf) by the State Department in February 2014, individuals who are lawfully present in the United States, including U.S. citizens, permanent residents (green card holders), and “A” and “G” visa holders (principal or dependent), may purchase coverage through the health insurance marketplace/exchange. Additionally, the notice states that “Those Permanent Missions whose employees do not receive health and medical insurance benefits through the sending state, or Permanent Missions who have not entered into a health and medical insurance plan with a private insurance provider, may find the benefits provided by the ACA a cost effective way to insure their employees against high physician, hospital, and prescription drug costs.”

Note that A-1 – 2 visas are for foreign government diplomats and officials and their immediate family members while G-1 – 4 visas are for international organization officials and employees and their immediate family members.

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