[Congressional Record Volume 143, Number 87 (Friday, June 20, 1997)]
[Senate]
[Pages S6042-S6043]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. D'AMATO:
  S. 944. A bill to require the Secretary of Housing and Urban 
Development to establish procedures for requesting waivers on behalf of 
qualified international medical graduates of the 2-year foreign 
residency requirement; to the Committee on the Judiciary.


              THE COMMUNITY HEALTH CARE ACCESS ACT OF 1997

 Mr. D'AMATO. Mr. President, I introduce the Community Health 
Care Access Act of 1997. This act will help ensure that the residents 
of our inner-city and rural areas, in New York and across the Nation, 
will have increased access to affordable health care. This legislation 
will establish a procedure within the Department of Housing and Urban 
Development [HUD] for foreign medical students, who are granted 
temporary residency status in order to complete their medical 
education, to retain their legal status in exchange for practicing in 
areas with serious physician shortages.
  Mr. President, throughout my home State of New York, there are 
numerous inner-city and rural communities which face a real crisis in 
the availability of qualified physicians. Too often, these communities 
face enormous difficulty attracting physicians to help serve the needs 
of their residents. Physicians are desperately needed to help cope with 
the growing incidence of drug-resistant tuberculosis, HIV, and other 
infectious diseases, as well as other critical health care needs such 
as pre-natal and neo-natal care.
  The act I am introducing today will help address this crisis by 
requiring the Secretary of the Department of Housing and Urban 
Development to request a J-1 visa waiver for any qualified medical 
professional who agrees to practice in an underserved area. This bill 
will allow hundreds of qualified doctors who are willing and able to 
serve in these communities to partner with existing health care 
facilities in order to serve needy populations who lack access to 
affordable health care.
  This legislation will help hospitals which are located in areas which 
are designated by the Department of Health and Human Services [HHS] as 
``Health Professional Shortage Areas'' to draw upon a pool of doctors 
who are among the best and the brightest in the world. Currently, there 
is a severe shortage of U.S. medical residents who are willing to serve 
in these areas. These urban and rural areas often have large uninsured 
populations with a variety of critical unmet health needs.
  In a nation with the greatest health care system in the world, there 
exist communities which are unfairly denied access to affordable 
quality health care. This disparity can be seen both in isolated rural 
areas and in the high-impact urban cores of some of our largest cities. 
Too often, the members of these communities have been left out of the 
American dream. It is intolerable that certain parts of many American 
cities are experiencing higher infant mortality rates than many third-
world countries.
  The costs of providing health care increase as hospitals struggle to 
attract qualified physicians. As costs rise, the unmet health care 
needs of local residents are exacerbated. Thus, the supply shortage of 
qualified physicians creates a vicious cycle in which local residents 
are trapped.
  My legislation will help break this cycle by increasing the 
availability of doctors in underserved areas while reducing health care 
costs.

  Let me briefly provide some background information. Under the J-1 
visa program, foreign medical students are temporarily admitted to the 
United States in order to complete their medical education and clinical 
training. Upon completion of their education, these students are 
required to leave the United States for a minimum of 2 years before 
they can become eligible for an extension of their legal residency 
status. However, current law provides an exception to this 2-year 
foreign residency requirement if the medical graduate agrees to 
practice in a designated ``Health Professional Shortage Area.''
  Congress reaffirmed its commitment to the J-1 program, as well as to 
the waiver of the 2-year foreign residency requirement for 
international medical graduates who agree to practice in underserved 
areas, when it passed the Illegal Immigration Reform and Immigrant 
Responsibility Act of 1996--Public Law 104-208. This Act was signed 
into law on September 30, 1996.
  Mr. President, in December 1996, the General Accounting Office [GAO] 
released a report assessing the J-1 visa waiver program. This report, 
entitled ``Foreign Physicians: Exchange Visitor Program Becoming Major 
Route to Practicing in U.S. Underserved Areas'' noted the growing use 
of the visa waiver process and made several recommendations for 
improvement.
  In conjunction with the reforms enacted last year as part of the 
Immigration Reform Act, the legislation I introduce today will 
effectively implement several of the recommendations made by the GAO. 
As noted in the report, last year's Immigration Reform Act required 
Federal agencies to utilize the same criteria for approval that 
previously applied to State health departments seeking such waivers. 
These new safeguards required physicians to: First, agree to work for 
at least 3 years for the health facility named in the application; 
second, work in an area designated by the Secretary of HHS as having a 
shortage of health care professionals; third, commence work within 90 
days of receipt of the waiver; and fourth, maintain a nonimmigrant 
status until the completion of the 3-year commitment term. In addition, 
physicians who fail to comply with the terms of their agreements would 
face a termination of their residency status and a loss of eligibility 
to apply for legal immigrant status in the future.
  This legislation would further improve compliance with the waiver 
requirements. This act will address the GAO report's finding that 
Federal agencies need to improve coordination in granting waivers. The 
act requires HUD to report to HHS on the number and location of 
physicians requesting waivers. I fully expect the Department of Health 
and Human Services to utilize this information in its annual 
designations of physician underserved areas. In addition, the 
legislation would require the sponsoring hospitals to provide HUD with 
periodic notices as to the compliance of physicians with the terms of 
the waiver agreements. Hospitals will also be required to provide HUD 
with immediate notice of the termination or cessation of compliance 
with these terms.
  The addition of these reforms will ensure the effective continuation 
of this vital program. The GAO noted that, as of January 1, 1996, there 
were approximately 1,374 physicians admitted to practice in underserved 
areas through the J-1 visa waiver program. These physicians served in 
49 States and the District of Columbia. According to a survey conducted 
by the General Accounting Office, approximately 40 percent of these 
physicians served in nonprofit community or migrant health care 
centers. Almost all of these physicians were practicing in primary care 
specialties. More than half were practicing in internal medicine. The 
other major specialties were pediatrics and family practice.

  Mr. President, it is important to note the outstanding caliber and 
the unique qualifications of the doctors participating in this program. 
In order to receive a J-1 visa, many of the participants were accepted 
into medical universities and world-renowned teaching hospitals with 
rigorous acceptance standards. In some cases, the admitted physicians 
are often specifically recruited by particular health facilities on the 
basis of their superior foreign language skills and cultural 
familiarity. For instance, the GAO cited a migrant health center in 
eastern Washington which actively recruited native-Spanish speakers for 
its program.
  HUD plays a critical role in the reduction of health care costs. The 
agency operates a number of programs which benefit hospitals, nursing 
homes, and other health care organizations. The role played by HUD's 
hospital insurance program, for instance, is absolutely essential for 
many health care institutions in obtaining private market financing for 
hospital construction, renovation, and modernization. The credit 
enhancement provided by this program results in a tangible reduction in 
health care costs at little or no cost to the taxpayer.
  I believe it is essential for Congress to continue to act 
expeditiously to address the valid concerns raised by the

[[Page S6043]]

GAO. At the same time, we must remain cognizant of the basic soundness 
of the waiver program and strive to improve and reform it. The waiver 
process has made basic health care available to many communities with 
desperate needs.
  Mr. President, in conclusion I would emphasize the hardships which 
face many of our Nation's urban and rural residents as a result of the 
crisis in health care availability. The J-1 visa waiver program is an 
important tool to address these needs. The reforms to the current 
waiver process are also critical to ensuring that any noncompliance 
within the program is eradicated. I urge my colleagues to support the 
Community Health Care Access Act of 1997 in order to ensure that the 
waiver program remains a viable option in addressing our country's 
local health care needs for years to come.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 944

       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 ``Community Health Care Access 
     Act of 1997''.

     SEC. 2. PROCEDURES.

       (a) Establishment.--Pursuant to section 212(e) and section 
     214(l) of the Immigration and Nationality Act (8 U.S.C. 
     1182(e) and 8 U.S.C. 1184(l)), the Secretary shall establish 
     procedures under which an individual may apply to the 
     Secretary to request the Director of the United States 
     Information Agency to recommend a waiver of the foreign 
     residence requirement under section 212(e) of the Immigration 
     and Nationality Act (8 U.S.C. 1182(e)) for that individual.
       (b) Requirements.--The procedures under subsection (a) 
     shall require the Secretary to issue a request on behalf of 
     an applicant whenever the applicant--
       (1) meets the requirements under section 214(l) (8 U.S.C. 
     1184(l)) of the Immigration and Nationality Act; and
       (2) meets such other terms and conditions established by 
     the Secretary, which may include a requirement for the 
     applicant to include as part of the waiver application a 
     written agreement on the part of the health facility or 
     health care organization named in the application to provide 
     the Secretary with--
       (A) periodic notification of the applicant's continued 
     employment; and
       (B) immediate notification of a failure on the part of the 
     applicant to comply with the terms of the contract between 
     the applicant and the health facility or health care 
     organization.

     SEC. 3. HHS REPORTING REQUIREMENT.

       At least biannually, the Secretary shall submit a report to 
     the Secretary of Health and Human Services setting forth the 
     number of requests issued under section 2 and identifying the 
     geographic areas in which aliens serve under those requests.

     SEC. 4. IMPLEMENTATION.

       Not later than 90 days after the date of enactment of this 
     Act, the Secretary shall issue final regulations to implement 
     the provisions of the Act. Such regulations shall be issued 
     only after notice and opportunity for public comment pursuant 
     to the provisions of section 553 of title 5, United States 
     Code, regarding notice or opportunity for comment.

     SEC. 5. DEFINITIONS.

       In this Act:
       (1) Applicant.--The term ``applicant'' means an alien as 
     described in clause (iii) of section 212(e) of the 
     Immigration and Nationality Act (8 U.S.C. 1182(e)).
       (2) Secretary.--The term ``Secretary'' means the Secretary 
     of the Department of Housing and Urban Development.
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