[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.

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