[Congressional Record Volume 150, Number 132 (Wednesday, November 17, 2004)]
[House]
[Pages H9857-H9862]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
IMPROVING ACCESS TO PHYSICIANS IN MEDICALLY UNDERSERVED AREAS
Mr. SENSENBRENNER. Mr. Speaker, I move to suspend the rules and pass
the Senate bill (S. 2302) to improve access to physicians in medically
underserved areas.
The Clerk read as follows:
S. 2302
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) Exemptions.--Section 214(l)(1)(D) of the Immigration
and Nationality Act (8 U.S.C. 1184(l)(1)(D)) is further
amended--
(1) by striking ``except that,'' and all that follows 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;
``(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
[[Page H9858]]
located 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 in subparagraph (B)) in
accordance with the conditions of this clause to exceed 5;
and
``(iii) in the case of a request by an interested Federal
agency or by an interested State agency for a waiver for an
alien who agrees to practice specialty medicine in a facility
located in a geographic area so designated by the Secretary
of Health and Human Services, the request shall demonstrate,
based on criteria established by such agency, that there is a
shortage of health care professionals able to provide
services in the appropriate medical specialty to the patients
who will be served by the alien.''.
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 S. 2302, the bill
currently under consideration.
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, I rise in support of S. 2302. This legislation will
extend the program under which alien 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
a ``J'' visa program visa must generally leave the United States after
the completion of their residencies to reside abroad for 2 years. The
intent behind the policy is to encourage American-trained foreign
doctors to return home to improve health conditions that 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 the waiver is limited to 30
per State each year. The waiver has proven to be an important means of
ensuring quality medical care in areas of the United States with
physician shortages.
S. 2302 is substantially similar to H.R. 4453, a bill introduced by
the gentleman from Kansas (Mr. Moran) that this body passed by voice
vote on October 6. It will extend the waiver program to June 2006. It
will 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
waivers to receive H-1B visas regardless of the annual H-1B visa quota.
Finally, the bill clarifies that doctors receiving waivers can practice
specialty medicine. However, when a doctor works in a specialty, there
must exist a shortage of health care professionals able to provide
services in that specialty to the patients he or she will serve.
I urge my colleagues to support this bill.
Mr. Speaker, this time I will insert into the Record an exchange of
jurisdictional letters between the chairman of the Committee on Energy
and Commerce, the gentleman from Texas (Mr. Barton), and myself.
U.S. House of Representatives,
Committee on Energy and Commerce,
Washington, DC, November 16, 2004.
Hon. F. James Sensenbrenner, Jr.,
Chairman, Committee on the Judiciary, U.S. House of
Representatives, Rayburn House Office Building,
Washington, DC.
Dear Chairman Sensenbrenner: This week the House is
scheduled to consider S. 2302 under suspension of the rules.
S. 2302, as passed by the Senate, contains language, which
provides for exemptions to section 214(l)(1)(D) of the
Immigration and Nationality Act, involving the Secretary of
Health and Human Services. As you know, Rule X of the Rules
of the House of Representatives gives the Committee on Energy
and Commerce jurisdiction over public health.
I recognize your desire to bring this legislation before
the House in an expeditious manner. Accordingly, I will not
exercise my Committee's right to a referral. By agreeing to
waive its consideration of the bill, however, the Energy and
Commerce Committee does not waive its jurisdiction over S.
2302. In addition, the Energy and Commerce Committee reserves
its right to seek conferees on any provisions of the bill
that are within its jurisdiction during any House-Senate
conference that may be convened on this legislation. I ask
for your commitment to support any request by the Energy and
Commerce Committee for conferees on S. 2302 or similar
legislation.
I request that you include this letter and your response in
the Record during consideration of the bill. Thank you for
your attention to these matters.
Sincerely,
Joe Barton,
Chairman.
____
U.S. House of Representatives,
Committee on the Judiciary,
Washington, DC, November 17, 2004.
Hon. Joe Barton,
Chairman, Committee on Energy and Commerce, House of
Representatives, Washington, DC.
Dear Chairman Barton: Thank you for your letter regarding
S. 2302, a bill to improve access to physicians in medically
underserved areas. Subsection 1(d) of the bill reduces the
number of slots assigned to underserved areas that are
designated by the Secretary of Health and Human Services. To
the extent they affect duties of the Secretary, these
provisions fall within the Rule X jurisdiction of the
Committee on Energy and Commerce. I appreciate your
willingness to forgo consideration of the bill, and I
acknowledge that by agreeing to waive its consideration of
the bill, the Committee on Energy and Commerce does not waive
its jurisdiction over these provisions.
I will include a copy of your letter and this response in
the Congressional Record during consideration of S. 2032 on
the House floor.
Thank you for your assistance in this matter.
Sincerely,
F. James Sensenbrenner, Jr.,
Chairman.
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 thank the distinguished chairman. This might be the
last time the Subcommittee on Immigration is on the floor, possibly, in
the 108th Congress; and I want to thank the full Committee on the
Judiciary staff, and I want to particularly offer my appreciation to
the Democratic staff of the Committee on the Judiciary for their very
fine work during this Congress and their efforts toward bipartisanship,
and thank Nolan Rappaport on the Subcommittee on Immigration for his
work on this legislation and others dealing with immigration concerns.
Let me share with my colleagues from an Associated Press article
dated August 24: ``Before doctors like Mircea Rachita from Romania
arrived in town, patients in this small town had to wait months for
doctors' appointments. Now, underserved communities are finding good
doctors easy to come by due to a visa waiver program which creates
incentives for foreign-born physicians to work in communities American
doctors may shun.''
Clearly there is room and need for a bill to improve access to
physicians in medically underserved areas, and S. 2302 is the
embodiment of that bill, along with a similar House bill.
The purpose of this bill is to make it possible for foreign doctors
to provide medical services in geographic areas which have been
designated by the Secretary of Health and Human Services as having a
shortage of health care professionals. S. 2302 is almost identical to
H.R. 4453, which I cosponsored with my colleague, the chairman of the
subcommittee, the gentleman from Indiana (Mr. Hostettler).
H.R. 4453 passed the House on October 6 on the Suspension Calendar.
The Senate bill has an additional provision which ensures that
specialists sponsored by Federal and State agencies are placed in areas
that have a shortage in that specialty. The additional provision
requires the sponsoring agency to determine criteria for demonstrating
a specialist shortage and to meet that criteria in order to sponsor the
specialist, a way of broadening access to health care and recognizing
the 44 million uninsured Americans who need access to sometimes public
facilities that utilize these foreign doctors.
[[Page H9859]]
{time} 1730
Aliens who attend medical school in the United States on J exchange
program visas are required to leave the country afterward and reside
abroad for 2 years before they can receive their visas to work here as
physicians.
In 1994, Congress created a new temporary waiver of this 2-year
foreign residence requirement which allowed States as well as Federal
agencies to sponsor the doctors. 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 and created a chasm between the needs of those who
need health care and the regulations of the Federal government. We now
have brought those pieces together.
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
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 the treatment. Now it is available in this county.
The bill will provide a 2-year extension for this waiver program. We
started out with 1 year. I asked for 5 years. We compromised on 2
years. We have made progress.
It will also establish a pilot flexibility program which will allow a
State agency to place a doctor at a location that has not been
designated as underserved if the doctor, nevertheless, will serve
patients from an underserved area. That is a very effective compromise
to ensure that the patients, no matter where they are, get served
whether they are in an underserved area or those patients that reflect
that community.
The exception is limited to five doctors in each State. It targets
rural underserved areas that typically get specialty medical care from
a major medical facility that is not itself located within an
underserved area.
Finally, the doctors who receive a waiver to come here with H-1B
visas will not count toward the H-1B cap.
I urge my colleagues to consider this legislation as a very positive
step for good health care in America and support it enthusiastically.
Mr. Speaker, I reserve the balance of my time.
Mr. SENSENBRENNER. Mr. Speaker, I yield such time as he may consume
to the gentleman from Kansas (Mr. Moran), the author of the House
counterpart to this bill.
Mr. MORAN of Kansas. Mr. Speaker, I thank the chairman for yielding
me time.
I am here only once again in a series, it seems like, of a number of
years in which I have been on the floor to support the provisions
contained in this legislation. I commend the chairman and the ranking
member in the Committee on the Judiciary for their work in getting this
resolved this year.
The J-1 visa program expired on May 31 of this year. It is a program
that is so important to many areas of the country. Once again, I am
here to express my support for the legislation and indicate that in
many places across rural America and the core of our cities, absent
this program, Americans will not be served with a physician. It is
important. It needs to be passed. I thank the chairman for his
leadership in seeing that that occurred.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield such time as he may
consume to the gentleman from Michigan (Mr. Conyers).
Mr. CONYERS. Mr. Speaker, I am so happy that we are working together
on a health care issue. They are critical to the United States where we
have so many people without the ability to get health care. Against
that background and this positive attitude, someone in this body must
say, well, why are we bringing doctors in from out of the country to
the most affluent nation on planet Earth, and they are providing very
important necessary care? I think that is a question that will be taken
up in the following upcoming session, but it is one that is
troublesome.
Right now I join with the gentlewoman from Texas (Ms. Jackson-Lee),
our ranking member, in proudly supporting the work that has taken place
to expand the boards. There are places where, for example, Indian
reservations, technically not within the jurisdiction, will now be able
to receive help. And even more important is the ability now to bring in
specialists, pediatric specialists, diabetes specialists, to work in
areas where, without this intervention, patients would be hundreds and
hundreds of miles away from the proper medical treatment.
This is an excellent bill. It is a product of bipartisan work in the
committee, and I am happy to be a part of it. I thank the gentlewoman
for yielding me time.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield 3 minutes to the
gentleman from North Dakota (Mr. Pomeroy), who I think understands the
need for health care in rural America.
Mr. POMEROY. Mr. Speaker, I thank the gentlewoman for yielding me
time.
I am pleased to associate myself with the ranking member on the
Committee on the Judiciary, the gentleman from Michigan (Mr. Conyers),
as well as my former co-chairman with the Rural Health Care Coalition,
the gentleman from western Kansas (Mr. Moran).
Truly, we have a growing problem relative to the delivery of rural
health care, and that is we do not have enough professionals to deliver
the care required. As we look at the pipeline, those coming along
compared to those nearing the end of their practice years, we realize
that we are working ourselves into a pretty serious problem here and
that is especially so when you consider the aging of the population. So
I agree with the gentleman from Michigan (Mr. Conyers). We need to look
at this systemically, why this is happening, and address it. But in the
near term, we need to take the step that offers a Band-Aid solution but
an important Band-Aid at that, and that is the legislation before us.
North Dakota receives about a dozen doctors a year through this
important visa waiver provision. Twenty-six cities in the State I
represent have participated in this program. We would have a situation
where failure to authorize this would create immediate problems in six
or seven small towns. They would face the departure of critical medical
personnel under the loss of this visa waiver.
With the passage of it, conversely, we will have opportunities to
continue to build capacity. I have one city that has been going through
an incredibly expensive proposition of hiring an anesthesiologist on a
Locum Tenens basis. This is a temporary hire coming in from other parts
of the country, and it costs a fortune. We hope to move through a
resident hire through the application of this visa waiver provision.
So, bottom line, while this is an immigration bill, it is all about
making sure health care services for peoples' needs in rural areas and
underserved communities are available, and I urge its adoption.
Mr. CONYERS. Mr. Speaker, will the gentleman yield?
Mr. POMEROY. I yield to the gentleman from Michigan.
Mr. CONYERS. Mr. Speaker, I want to commend the gentleman, because it
was the senior Senator from North Dakota that put this program together
almost a decade ago, and I commend both of the gentlemen.
Mr. POMEROY. I thank the gentleman very much.
Senator Conrad has done very good work on this, as has the gentleman
from Kansas (Mr. Moran) in the House and others. I am very pleased, as
the gentleman mentioned earlier, a bipartisan moment on health care.
This is a good bill. Let us pass it.
Ms. JACKSON-LEE of Texas. Mr. Speaker, how much time remains?
The SPEAKER pro tempore (Mr. Stearns). The gentlewoman from Texas
(Ms. Jackson-Lee) has 9 minutes.
Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I
may consume.
In conclusion, I am very glad that the point that was made by the
distinguished ranking member and the gentleman from North Dakota (Mr.
Pomeroy) is that this is both a medical
[[Page H9860]]
bill, a health care bill, and it is an immigration bill. And is it not
interesting that we can find an opportunity for bipartisanship around
two very key issues.
I think it is also important to reemphasize the fact that we promote
and encourage the education and training of individuals here in America
in the medical professions, nurses, nurse practitioners, physicians,
physician assistants and others that are the cornerstone of our health
care system. But we know our hospital systems are overburdened. We know
there are many, many people that are underserved. This bill serves a
very valuable purpose.
Might I reemphasize the fact that we will give opportunities to
hospitals that are located or designated as not an underserved area? It
reaches out to serve the underserved, which is something we try to
encourage our teaching hospitals to do, who typically are not in areas
that can be considered that, so that the individuals get high-quality
service. They will be able to utilize this legislation.
Mr. Speaker, in my concluding remarks, I think it is important to
note that we do have before us an immigration bill. I was hoping before
the conclusion of the 108th Congress we might be in a better position
to really attack the question of comprehensive immigration reform. Many
of us have had initiatives that have languished for a very long time. I
cite for this body the Comprehensive Immigration Fairness Reform Act
that really looked at immigration in a very comprehensive manner.
Probably over the next couple of months we will hear a raging debate
on immigration, those for it, those against it. The debate on
immigration can be a very tense and conflicted debate. It raises some
of the most unpleasant aspects of many of those who are pro and con, in
many instances, not being able to find common ground. I would encourage
my colleagues to look at this forthrightly and understand that we can
no longer turn the lights out and close the curtains on this very
important issue.
We can no longer have a temporary guest program, albeit how well-
intentioned this administration may be, the Flat Earth Theory that
allows people to come in for 3 years and then suggest to them that they
must then leave the country in order to, if you will, remain in a
position to possibly have another job again. The guest worker program
proposed by President Vincente Fox and this administration will not
work. You will not get 8 million illegal immigrants in this country to
accept that philosophy. Nor will you get to a point where you would
like to be, a secure America, because we are not focusing on securing
our borders. We are focusing on what I think is misdirected in a
temporary guest worker program.
Comprehensive reform allows us to allow individuals to earn access to
legalization, to document those who are here, and be able to be safe
from terrorists by distinguishing those who have come here for economic
opportunity as opposed to those who have come to do us harm. Why can we
not understand that in a bipartisan way?
Now, let me say also, if we are going to do anything in the last
hours of this session, make sure that we do something that helps legal
immigrants who are here who for years who have been trying to reunite
their families. We have passed out of the House in a bipartisan manner
245-I which would allow legal immigrants to reunite with mothers and
fathers, husbands and wives or children. That would be a fair approach,
and the Senate needs to help us, the other body, if I might say, needs
to help us in that. Any discussion about H-1Bs clearly should be a
discussion in recognizing that we must protect American jobs. We must
protect American jobs in order to have an open and adequate discussion
on immigration.
In conclusion, let me say this, Mr. Speaker, I would hope that our
good friends who are dealing in the conference on issues of immigration
reform would not pursue these in the 9/11 intelligence bill. Allow us
to have a full, comprehensive debate and a full, comprehensive
bipartisan approach to immigration reform that will last and will be
invested in America and will make America work and comply with our
principles of democracy and empowerment and equality.
Putting poison pills on an intelligence bill that deals with fixing
the intelligence system is no way to go forward on a vital question of
how we bring America together and answer the questions of those who
say, what do you do about those illegal immigrants? Are you just going
to affirm them for doing the illegal wrong thing? No, we are not. We
are going to give them the opportunity to earn access to legalization
while they are already here paying taxes, children in school, building
houses and contributing to this economy.
{time} 1745
Let us wake up America and stop the divisive debate on immigration
and stand up for what we believe in.
This country was founded on immigration. How many of us can forget
the early pinnings of this Nation; the turn of the century and the
1900s and immigrants coming from Europe? This is the very same.
Protect the borders, respond to those in Arizona and California and
Texas who are concerned about the constant flow of illegal immigrants
and the large deaths in the deserts. We do that by securing the
borders, working with our friends in South and Central America,
providing economic opportunity there, and working on a real immigration
reform bill.
It saddens me that we come to the close of the 108th Congress when we
could have sat down, looked each other in the eye, sat around the table
and done the right thing.
I can only say that I applaud the J-1 visa legislation, a good sign
of working together. It will help people in America, and I hope it will
help us improve our health care system, but we can also heal a broken
immigration system by doing the very same thing, looking each other in
the eye and sitting around and putting the doctors to work, the
political doctors to work, of good mind and good faith and make this
country what it is, a country that believes in the Statue of Liberty's
words: Bring us your poor and oppressed.
I thank the distinguished Speaker, and I ask my colleagues to support
this legislation, and I hope the charge is that we will face
immigration the way it should be, in a fair, equitable and balanced
way.
Mr. Speaker, I yield back the balance of my time.
Mr. SENSENBRENNER. Mr. Speaker, I yield myself the balance of the
time.
Mr. Speaker, lest anyone be confused as a result of the previous
speaker that this is a wide-ranging, overall immigration bill that
deals with amnesty and guest workers and all of those very contentious
issues, let me lay that impression to rest. This bill does not do that,
and I fear that the previous speaker's statement ends up hurting the
support for this bill that is broad and bipartisan.
All this bill does is allow a foreign national who is a graduate of
an American medical school and who has completed his residency in an
American hospital to practice in a medically-underserved area,
somewhere in the United States, and the request would have to be made
by a State Department of Public Health and limited to no more than 50
doctors per State.
Now, this is not what the gentlewoman from Texas is talking about. We
will deal with that in due course, but let us make sure that this bill
is not confused with the other more broad and contentious bills.
This bill has to pass because it extends a program that expired in
June of this year, and if we vote this legislation down, then we are
not going to have those doctors in the medically-underserved areas.
We should keep the discussion and bills like this confined to what is
in the bill, rather than a wide-ranging overall debate on immigration
policy.
Ms. BORDALLO. Mr. Speaker, I rise today in support of S. 2302, which
would reauthorize the ``Conrad 30 J-1 Visa Waiver Program.''
Reauthorization of this important program will help districts that
experience shortages with respect to health care professionals, such as
Guam, by allowing certain U.S.-trained foreign doctors to remain in the
United States to practice medicine in these underserved areas.
Like many rural and insular areas, Guam experiences great difficulty
attracting and retaining qualified health professionals. The cost of
providing health care is higher in Guam
[[Page H9861]]
than in many areas on the mainland, and incidents of chronic disease
are above national averages. The Conrad 30 J-1 visa Waiver Program is
an important tool that allows poor, rural and insular areas to meet the
health care needs of their communities by permitting International
Medical Graduates to maintain their work visas in the United States if
they agree to remain in areas defined by the Department of Health and
Human Services as Health Professional Shortage Areas or Medically
Underserved Areas or Populations. Normally, these foreign physicians
would have to return to their respective home countries for 2 years
before they could return to the United States to again practice
medicine.
While I believe priority should always be given to American doctors
and health professionals for local hiring, it is clear that there are
simply not enough health care professionals to meet demand in
underserved areas such as Guam. Without the services of skilled foreign
physicians from countries such as the Philippines, it would be
difficult for Guam's public health care system to meet the medical
needs of our community. S. 2302 reauthorizes a program that has been
successful in addressing the issues of recruitment and retention of
qualified health professionals in these areas, and I urge my colleagues
to support its passage.
Mr. DAVIS of Illinois. Mr. Speaker, I rise in support of S. 2302. The
state of health care is one of the most critical issues facing this
Nation. As the world's most powerful and wealthy country, our health
care system is unacceptable. According to the Health Resources and
Services Administration, there are 62 designated Health Professional
Shortage Areas in Cook County, Illinois, alone. It is unacceptable that
49 out of the 102 counties in Illinois lack hospitals with any
obstetrical services. It is unacceptable that 49 of the 102 counties in
Illinois lack hospitals with any psychiatric services. S. 2302 would
help address the Nation's health care crisis by encouraging qualified
medical professionals to serve in medically underserved areas.
Increasing access to primary care providers and specialists would
benefit the citizens of Illinois and the country as a whole.
Therefore, this bill is a step in the right direction. However, much
work remains to be done to reform our health care system as a whole. We
need to ensure that no American is left behind in preventative care. We
need to ensure equal access to medical treatments. We need to ensure
affordable health insurance. We need to erase the vast disparities in
the incidents of illness and death among minorities compared to the
overall U.S. population. African-American and Native-American babies
die at a rate that is 2 to 3 times higher than the rate for white
Americans. African Americans are 1.7 times as likely as white Americans
to have diabetes; Latino Americans are twice as likely to have diabetes
as their white counterparts.
Mr. Speaker, the state of one's health sets the precedent for
everything else in our lives. If we are not in good health, we cannot
perform our jobs well or do well in school. We must work toward making
quality healthcare accessible and available to all regardless of age,
race, or economic status.
Ms. CHRISTENSEN. Mr. Speaker, I rise today to join my fellow
colleagues in support of S. 2302, also known as H.R. 4156. I first
would like to thank Senator Conrad and Congressman Jerry Moran for
sponsoring this important piece of legislation. I would also like to
thank the committees jurisdiction for their quick actions in allowing
this bill to come to the floor.
Mr. Speaker, over the tenure of my congressional career I have come
to the floor repeatedly to demand that Congress act to address the
needs of the medically underserved and to ensure that we do everything
possible to eliminate arbitrary barriers which give rise to healthcare
disparities.
As there is a vast amount of research on the subject of rural
physician recruitment and retention, this bill is by no means a
comprehensive policy. Rather, the purpose is to be a temporary stop gap
measure to allay the crisis of rural health and healthcare providers.
Mr. Speaker, more than 51 million Americans live in areas classified
by the U.S. Office of Management and Budget (OMB) as nonmetropolitan.
They comprise one-fifth of the U.S. population. Rural populations are
found to be older, poorer, sicker, less educated and to have a
perception of worse health status than their urban counterparts.
They also have higher infant mortality and injury-related mortality
rates, fewer hospital beds and physicians per capita, and are much less
likely than urban residents to have private or public health insurance.
Moreover, while the number of individuals living below the poverty line
is disproportionately high in rural areas, the number receiving
Medicaid benefits is disproportionately low.
In a study of the utilization rates of 28 categories of medical
services, found that, with the exception of major surgical procedures,
urban residents received between 20 percent and 30 percent more of each
type of service than did rural residents.
With at least 20 percent of the population living in rural areas,
less than 11 percent of the Nation's physicians are practicing in
nonmetropolitan areas. Today, more than 2,500 physicians were needed in
nonmetropolitan areas to remove all nonmetropolitan health professional
shortage area (HPSA) designations for primary care. More than twice
that number are needed to achieve a 2,000-1 ratio in those HPSAs. This
is the current situation and does not factor in the aging physician
population serving rural areas, nor does it factor in the statistical
designation dealing with counties as the main reference point.
As a medical doctor, I understand that nonmetropolitan physicians
derive a larger share of their gross practice revenue from Medicare and
Medicaid patients than metropolitan physicians. These public programs
pay physicians at lower rates than private insurers. There is a
decreased ability in nonmetropolitan areas to perform economically
enhancing procedures (hospitals with decreasing obstetrical and
surgical units, etc.), which further decreases relative reimbursement
rates. Thus, nonmetropolitan physicians, on average, work more and earn
less than their metropolitan counterparts.
Rural Health Clinics (RHCs), Federally Qualified Health Centers
(FQHCs) in designated HPSAs and medically underserved areas (MUAs), and
differential Medicare payments to qualifying rural areas have helped to
enhance reimbursement. But currently, the mandate that States pay RHCs
and FQHCs their reasonable costs under Medicaid is being phased out.
Medicare managed care program reimbursement to RHCs has threatened to
be lower than the current reimbursement. Both of these payment changes
will put providers in jeopardy.
Mr. Speaker, I along with my Congressional Black Caucus counterparts
have consistently pushed the Congress for more equitable fee
reimbursement and to fully fund Title VII and Title VIII health
profession training program. We have also called for the strengthening,
expansion, and reauthorization of these programs in our minority health
bill H.R. 3459, the Healthcare Equality and Accountability Act, which I
look forward to moving on the 109th Congress.
S. 2302/H.R. 4156 acknowledges that international medical graduates,
through State initiated J-1 visa programs, have initially met some
unmet needs of rural areas. But Mr. Speaker, I would like to highlight
a recent study published by the Council on Graduate Medical Education
that stated that although international medical graduates have made an
important contribution to the provision of medical care in some rural
areas, training these graduates is an inefficient way to expand
physician supply in rural areas. Although many inner city hospitals are
dependent on international medical graduates for providing care to
underserved urban populations, more direct avenues exist for meeting
the needs of these hospitals. The funds would be better targeted to
programs that increase the flow of U.S. health professional graduates
to underserved rural areas.
Therefore, Mr. Speaker while I strongly support the underlying bill,
I again call on Congress to move legislation in the 109th that will do
the following.
Increase ORHP funding for research related to physician recruitment,
retention and networking should be supported and enhanced.
Reevaluate how designation of HPSAs and MUAs are given so the
designated areas accurately reflect underserved status.
Increasing the Title VII funding for AHECs and health education
training centers should be supported and enhanced.
Encourage and mandate that medical schools confront their obligation
to target admissions and training to underserved populations, both
rural and urban, in the primary care professions.
Encourage medical school environments to encourage individuals into
primary care and encourage early and long-term rural exposure to
positive rural physician role models, and such educational programs
should be adequately funded.
Increase scholarship programs to place medical students with
mentoring physicians in rural or remote practices during an elective or
vacation period should be encouraged.
Support medical schools' and residencies' efforts to integrate
community orientation and a team approach to health care. To achieve
the full benefit of this effort, there needs to be further
infrastructure building of rural allied health teams and rural
communities' commitment to meeting the challenges of a changing health
care system.
Encourage family practice residencies to offer rural electives, rural
emphasis and rural training tracks.
Direct the Bureau of Health Professions (BHP) funding for residencies
that are building rural-based programs and funding for those programs
that have a history of producing
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rural physicians should become a staple rather than be at the mercy of
national budget politics. An aggressive plan to increase funding should
be sought.
Increase support by the BHP to primary care residencies to be
continued and enhanced.
Decrease professional isolation by supporting teleinformatics and
outreach education programs of states and by the use of nonphysician
providers.
Increase retention through more appropriately rural-trained
candidates.
Identify care needs at the community level. Use state and federal
funds to assist rural hospitals where access to care would be
threatened by hospital closure and physicians would be further deprived
of opportunities to utilize their professional skills.
Develop and use innovative delivery systems that emphasize
coordination and cooperation among providers, institutions and
communities.
Develop programs allowing rural clinicians to undertake periodic
rotations through academic hospital services (with locum tenens backup)
in order to learn or update procedures.
Provide for those areas that do not qualify for RHC or FQHC status
but still are faced with the disproportionate numbers of Medicare and
Medicaid patients, there should be enhanced Medicare and Medicaid
payments to rural providers.
Evaluate the enhanced reimbursement available through RHC and
Community Health Center designations needs to be adequately maintained
to retain providers and avoid decertification as the area's needs are
met. If the same level of Medicare and Medicaid and uninsured patients
persists and the area is decertified because of an adequate supply of
physicians, a cycle will develop leading to economic unfeasibility,
provider dissatisfaction and lower retention rates.
Mandate the States to pay RHCs and FQHCs reasonable costs under the
State's Medicaid program.
Ensure that Medicare managed care reimbursement must equal or exceed
the RHC and FQHC Medicare reimbursement.
Increase the supply of primary care providers in rural areas by
lessening speciality and geographic differentials in physician income.
Establish relocation grants, especially for remote areas, to defray
the costs of moving and setting up a practice.
Mr. Speaker, in the 109th Congress I will introduce a bill that
codifies these recommendations among others and will hopefully begin
the process of ensuring that we provide healthcare for all Americans
within or close to current expenditures.
Mr. SENSENBRENNER. Mr. Speaker, I yield back the balance of my time.
The SPEAKER pro tempore (Mr. Stearns). The question is on the motion
offered by the gentleman from Wisconsin (Mr. Sensenbrenner) that the
House suspend the rules and pass the Senate bill, S. 2302.
The question was taken.
The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of
those present have voted in the affirmative.
Mr. SENSENBRENNER. Mr. Speaker, on that I demand the yeas and nays.
The yeas and nays were ordered.
The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the
Chair's prior announcement, further proceedings on this motion will be
postponed.
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