[Congressional Record Volume 150, Number 125 (Wednesday, October 6, 2004)]
[House]
[Pages H8237-H8239]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
ACCESS TO RURAL PHYSICIANS IMPROVEMENT ACT OF 2004
Mr. SENSENBRENNER. Mr. Speaker, I move to suspend the rules and pass
the bill (H.R. 4453) to improve access to physicians in medically
underserved areas, as amended.
The Clerk read as follows:
H.R. 4453
Be it enacted by the Senate and House of Representatives of
the United States of America in Congress assembled,
SECTION 1. MODIFICATION OF VISA REQUIREMENTS WITH RESPECT TO
INTERNATIONAL MEDICAL GRADUATES.
(a) Extension of Deadline.--
(1) In general.--Section 220(c) of the Immigration and
Nationality Technical Corrections Act of 1994 (8 U.S.C. 1182
note) (as amended by section 11018 of Public Law 107-273) is
amended by striking ``2004.'' and inserting ``2006.''.
(2) Effective date.--The amendment made by paragraph (1)
shall take effect as if enacted on May 31, 2004.
(b) Exemption From H-1B Numerical Limitations.--Section
214(l)(2)(A) of the Immigration and Nationality Act (8 U.S.C.
1184(l)(2)(A)) is amended by adding at the end the following:
``The numerical limitations contained in subsection (g)(1)(A)
shall not apply to any alien whose status is changed under
the preceding sentence, if the alien obtained a waiver of the
2-year foreign residence requirement upon a request by an
interested Federal agency or an interested State agency.''.
(c) Limitation on Medical Practice Areas.--Section
214(l)(1)(D) of the Immigration and Nationality Act (8 U.S.C.
1184(l)(1)(D)) is amended by striking ``agrees to practice
medicine'' and inserting ``agrees to practice primary care or
specialty medicine''.
(d) Exemption From Geographic Limitations.--Section
214(l)(1)(D) of the Immigration and Nationality Act (8 U.S.C.
1184(l)(1)(D)), as amended by subsection (c), is further
amended--
(1) by striking ``except that,'' and all that follows
through the period at the end and inserting ``except that--
''; and
(2) by adding at the end the following:
``(i) in the case of a request by the Department of
Veterans Affairs, the alien shall not be required to practice
medicine in a geographic area designated by the Secretary;
and
``(ii) in the case of a request by an interested State
agency, the head of such State agency determines that the
alien is to practice medicine under such agreement in a
facility that serves patients who reside in one or more
geographic areas so designated by the Secretary of Health and
Human Services (without regard to whether such facility is
within such a designated geographic area), and the grant of
such waiver would not cause the number of the waivers granted
on behalf of aliens for such State for a fiscal year (within
the limitation described in subparagraph (B)) in accordance
with the conditions of this clause to exceed 5.''.
[[Page H8238]]
The SPEAKER pro tempore. Pursuant to the rule, the gentleman from
Wisconsin (Mr. Sensenbrenner) and the gentlewoman from Texas (Ms.
Jackson-Lee) each will control 20 minutes.
The Chair recognizes the gentleman from Wisconsin (Mr.
Sensenbrenner).
General Leave
Mr. SENSENBRENNER. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days within which to revise and extend
their remarks and include extraneous material on H.R. 4453.
The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Wisconsin?
There was no objection.
Mr. SENSENBRENNER. Mr. Speaker, I yield myself such time as I may
consume.
Mr. Speaker, H.R. 4453, introduced by the gentleman from Kansas (Mr.
Moran), would extend the program under which foreign doctors can avoid
having to return home for 2 years by agreeing to practice in medically
underserved areas here in America.
Aliens who participate in medical residencies in the United States on
the ``J'' exchange program visas must generally leave the U.S. after
the completion of their residencies and reside abroad for at least 2
years. The intent behind the policy is to encourage American-trained
foreign doctors to return home to improve health conditions and advance
the medical profession in their native countries.
In 1994, Congress created a waiver of the 2-year foreign residence
requirement. State departments of public health may request a waiver
for foreign doctors who commit to practicing medicine for no less than
3 years in geographic areas designated by the Secretary of Health and
Human Services as having a shortage of health care professionals. The
number of foreign doctors who can receive this waiver is limited to 30
per State each year.
The waiver program has proven to be an important means of ensuring
quality medical care in areas of the United States with physician
shortages. This bill would extend the program to June 2006. It would
also allow each State to place five of the doctors it sponsors each
year in areas not designated by HHS as physician-shortage areas.
The bill continues the practice of allowing foreign doctors receiving
a waiver to receive an H-1B visa regardless of the H-1B visa quota and
will allow doctors receiving waivers to practice specialty medicine.
I urge my colleagues to support this bill.
Mr. Speaker, I reserve the balance of my time.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, I want to acknowledge again the chairman of the
Committee on the Judiciary and the ranking member, along with the
chairman of my subcommittee, the gentleman from Indiana (Mr.
Hostettler), and also the gentleman from Kansas (Mr. Moran), for the
work on this legislation, and again cite this is an immigration bill.
It is a health care impact bill, but it is a bill that we have been
able to work on from the perspective of benefits again, and I think
that this is truly how we should be approaching this question, to take
away the fear and address the problem and resolve it.
Let me first of all acknowledge that this bill has good support in
the other body. But as we were deliberating on the bill and it came to
a point where we were talking about extensions, frankly, Mr. Speaker, I
wanted to extend this particular bill, that I will begin to detail the
rights of, for physicians to remain in the United States for 5 years.
The proposal was for 1 year.
Interestingly enough, out of that negotiation and in a bipartisan
effort, coming from the Texas Medical Center, being housed in Houston,
knowing the great need of physicians and also the great need of
underserved areas, I thought the 5-year extension would have been the
best. We wound up in a bipartisan effort in negotiations to work on a
2-year extension.
So let me rise to support H.R. 4453, the Access to Rural Physicians
Improvement Act of 2004, which makes it possible for foreign doctors to
provide medical services in a geographic area which has been designated
by the Secretary of Health and Human Services as having a shortage of
health care professionals.
Aliens who attend medical schools in the United States on ``J''
exchange program visas are required to leave the country afterwards and
reside abroad for 2 years before they can receive a visa to work here
as physicians. In 1994, Congress created a temporary waiver of this 2-
year foreign residence requirement. It applied to foreign doctors who
would commit to practicing medicine for no less than 3 years in a
geographic area designated by the Secretary of Health and Human
Services as having a shortage of health care professionals. This
program has been successful for 10 years in bringing highly qualified
physicians to medically underserved areas. It sunsetted on June 1 of
this year.
The first physician recommended for a waiver in Texas was Dr. Maria
Camacho, a pediatric internist. Her services to the residents of
Harlingen in Cameron County provided a level of health care to children
that was previously unavailable in that county.
Dr. K.M. Moorthi is a nephrologist who was recommended for a waiver
to serve at a facility in Pecos, Texas, in Reeves County. He works at a
brand new dialysis center. Patients requiring dialysis three times per
week in that part of Texas used to have to travel more than 70 miles
each way for treatment. Now it is available in Pecos.
The Access to Rural Physicians Improvement Act will provide a 2-year
extension for this waiver program. It also will establish a pilot
flexibility provision which will allow a State agency to place a doctor
in an area that has not been designated as underserved if the doctor
will nevertheless serve patients from an underserved area. This
exception is limited to five doctors in each State. Finally, the
doctors that receive a waiver to come here with H-1B waivers will not
be counted toward the annual H-1B cap.
Mr. Speaker, I ask my colleagues to support this legislation.
The Access to Rural Physicians Improvement Act of 2004, H.R. 4453,
makes it possible for foreign doctors to provide medical services in a
geographic area which has been designated by the Secretary of Health
and Human Services as having a shortage of health care professionals.
Aliens who attend medical school in the United States on J exchange
program visas are required to leave the country afterwards and reside
abroad for 2 years before they can receive a visa to work here as
physicians. In 1994, Congress created a temporary waiver of this two-
year foreign residence requirement. It applied to foreign doctors who
would commit to practicing medicine for no less than three years in a
geographic area designated by the Secretary of Health and Human
Services as having a shortage of health care professionals. This
program has been successful for ten years in bringing highly qualified
physicians to medically underserved areas. It sunsetted on June 1st of
this year.
The first physician recommended for a waiver in Texas was Dr. Maria
Camacho, a Pediatric Intensivist. Her services to the residents of
Harlingen in Cameron County provide a level of health care to children
that was previously unavailable in that county.
Dr. K.M. Moorthi is a Nephrologist who was recommended for a waiver
to serve at a facility in Pecos, Texas, in Reeves County. He works at a
brand new dialysis center. Patients requiring dialysis 3 times per week
in that part of Texas used to have to travel more than 70 miles each
way for the treatments. Now it is available in Pecos.
The Access to Rural Physicians Improvement Act will provide a two-
year extension for this waiver program. It also will establish a pilot
flexibility provision which will allow a State agency to place a doctor
in an area that has not been designated as underserved if the doctor
will nevertheless serve patients from an underserved area. This
exception is limited to five doctors in each state. Finally, the
doctors who receive a waiver to come here with H-1B visas will not
count towards the annual H-1B cap.
I urge you to vote for H.R. 4453.
Mr. Speaker, I reserve the balance of my time.
Mr. SENSENBRENNER. Mr. Speaker, I yield 3 minutes to the gentleman
from Kansas (Mr. Moran), the author of the bill.
Mr. MORAN of Kansas. Mr. Speaker, I thank the gentleman from
Wisconsin (Chairman Sensenbrenner), and I thank the gentlewoman from
Texas for her remarks in support of this legislation.
{time} 1445
It has been adequately described and well-defined.
[[Page H8239]]
This is an important program that serves both rural America and the
core center of cities. It brings rural and urban America together. But
as a Member of Congress from Kansas who cares greatly about the future
of rural communities across my State, I recognize this is a significant
component to meeting the needs, the health care needs of our
communities. I know that should we lose our physicians, should we lose
our hospitals, our doctors, our home health care agencies, the ability
to keep those communities together, to keep our communities alive and
well for the future dissipates quickly.
So this is one way in which we have been successful in Kansas and
many communities across the country in attracting and retaining
physicians.
The good news about the program is, there is a 3-year commitment that
the physician remain in that underserved community for a 3-year period
of time but, in reality, nearly two-thirds of all physicians in Kansas
who participate in this program remain longer. They become an integral
part of the community and an integral part of the health care delivery
system. Jewell County, Kansas, population 3,791, has two J-1 physicians
in their community. They are the only two physicians in the county, Dr.
Kalderon and Dr. Meena. They have brought a breath of fresh air to
Jewell County and to its hospital. Absent physicians, we cannot keep
our hospital doors open, and this program has made it possible for the
citizens, the residents of Jewell County to access health care. The
great news is that these people become so important to not only the
delivery of health care, but components of the community that make a
huge difference in the future of that community.
So once, when there was despair and concern as to whether or not we
would be able to access health care, whether or not the community
hospital would stay alive and well, and whether or not people could be
able to afford to live, because rural folks live in that community,
senior citizens, young families, the question was answered when the J-1
physicians arrived and stayed.
So, Mr. Speaker, this issue is important. It matters to the future of
our country, and it matters especially to the future of rural
communities. I thank the gentlewoman from Wisconsin (Mr. Sensenbrenner)
as well as the gentlewoman from Texas (Ms. Jackson-Lee) for their
support today, and I ask my colleagues in Congress to quickly pass this
bill, let the Senate act quickly and keep this program, this highly-
valuable program, in place.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I
may consume.
Mr. Speaker, but let me just thank the gentleman from Kansas and as
well mention the gentleman from Texas (Mr. Stenholm) who is a strong,
strong supporter of this legislation.
Mr. Speaker, a few years ago, before coming to Congress, I was named
to a committee, appointed by the attorney general of the State of
Texas, talking about the closing of hospitals in the State of Texas,
particularly because of the lack of physicians. So this legislation for
our rural communities is extremely important, primarily because we are
even seeing, today, hospitals and facilities being closed. This
legislation will go a long way, and I particularly want to bring
attention again to the idea that even if a physician goes to a served
area, we have the flexibility now potentially to allow five doctors to
serve in a served area but as well be able to serve in an underserved
area, and that flexibility, I am delighted to indicate, is part of this
legislation.
So you may be at the Texas Medical Center, but you may be able to go
and serve in rural areas at places outside of that particular
jurisdiction.
I rise in strong support of H.R. 4453, which I have been pleased to
work on and cosponsor with the gentleman from Kansas (Mr. Moran). I
thank the gentleman from Wisconsin (Mr. Sensenbrenner) for bringing the
bill to the floor today.
Mr. Speaker, H.R. 4453 reauthorizes and expands the State Conrad 20
program. The 2-year reauthorization allows States to continue to act as
an interested government agency in order to sponsor foreign-born
doctors to practice in medically underserved areas. The number of
doctors that can be sponsored per State is expanded from 20 to 30.
Since the mid-1990s, the J-1 Visa Program has helped numerous rural
counties and underserved communities meet the health care needs of
their community.
Nonetheless, the demand for doctors continues to grow. Despite a
continuing population migration to urban and suburban communities
throughout the State, the vast majority of Texas remains rural, posing
unique challenges to the delivery and accessibility of high-quality
health care. Not only are health care services likely to be unevenly
distributed, but many rural residents do not even have access to a
local doctor, primary care provider, or hospital.
Regrettably, a doctor would diagnose the health care problems in
rural communities as chronic and persistent. The issues are not new,
and we have tried a variety of medicines to remedy these problems, but
we still have a long way to go before we achieve a healthy rural
America.
Access to primary care promotes appropriate entry into the health
system and is vital to ensure the long-term viability of rural health
care delivery.
Without access to local health care professionals, rural residents
are frequently forced to leave their communities to receive necessary
treatments. Not only is this a burden to rural residents, who are often
older or lack reliable transportation, but it drains vital health care
dollars from the local community, further straining the financial well-
being of rural communities.
It is imperative that we identify and expand those programs that
provide physicians, pharmacists, nurses, dentists, and physician
assistants incentives to practice in rural areas.
The J-1 visa waiver program was expanded in 1995, allowing medical
exchange graduates in U.S. residency training to extend their stay for
3 years, provided they practice in an underserved community.
For certain rural--as well as urban--areas in the United States, the
J-1 doctors have been key providers.
In rural West Texas, the area I represent, residents are benefiting
directly from the services of J-1 visa physicians.
The cities of Rotan and Winters, Texas are two communities in my
district that continue to rely on the care of these health care
professionals.
The City of Abilene, Texas intends to use the J-1 Visa Program next
year after they have exhausted all other avenues to pursue a
psychiatrist.
The city is ``medically underserved'' in the area of psychiatry and
faces extreme difficulties in attracting a mental health professional.
The J-1 Visa Program may be their best solution.
Since 1995, Texas alone has received the services of 400 J-1
physicians. This represents service to a population of over 1 million
people. One million people have received health care that they would
not otherwise have received, or at least it would have been more
difficult to receive, as a result of this program that we reauthorize
today.
This isn't the final answer to our health care shortage problems but
it certainly is an important part of that answer and I commend
Congressman Moran for his leadership on this issue.
I urge my colleagues to support H.R. 4453, the Access to Rural
Physicians Improvement Act.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I ask my colleagues to support
this legislation, and I yield back the balance of my time.
Mr. SENSENBRENNER. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Quinn). The question is on the motion
offered by the gentleman from Wisconsin (Mr. Sensenbrenner) that the
House suspend the rules and pass the bill, H.R. 4453, as amended.
The question was taken; and (two-thirds having voted in favor
thereof) the rules were suspended and the bill, as amended, was passed.
A motion to reconsider was laid on the table.
____________________