[Congressional Record Volume 152, Number 80 (Tuesday, June 20, 2006)]
[House]
[Pages H4237-H4239]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




   NURSING RELIEF FOR DISADVANTAGED AREAS REAUTHORIZATION ACT OF 2005

  Mr. SENSENBRENNER. Mr. Speaker, I move to suspend the rules and pass 
the bill (H.R. 1285) to amend the Nursing Relief for Disadvantaged 
Areas Act of 1999 to remove the limitation for nonimmigrant 
classification for nurses in health professional shortage areas, as 
amended.
  The Clerk read as follows:

                               H.R. 1285

       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 ``Nursing Relief for 
     Disadvantaged Areas Reauthorization Act of 2005''.

     SEC. 2. 3-YEAR EXTENSION FOR CHANGES TO REQUIREMENTS FOR 
                   ADMISSION OF NONIMMIGRANT NURSES IN HEALTH 
                   PROFESSIONAL SHORTAGE AREAS.

       Section 2 of the Nursing Relief for Disadvantaged Areas Act 
     of 1999 (8 U.S.C. 1182 note) is amended--
       (1) in the section heading, by striking ``4-YEAR'' and 
     inserting ``SPECIFIED''; and
       (2) by amending subsection (e) to read as follows:
       ``(e) Limiting Application of Nonimmigrant Changes to 
     Specified Period.--The amendments made by this section shall 
     apply to classification petitions filed for nonimmigrant 
     status only during the period--
       ``(1) beginning on the date that interim or final 
     regulations are first promulgated under subsection (d); and
       ``(2) ending on the date that is 3 years after the date of 
     the enactment of the Nursing Relief for Disadvantaged Areas 
     Reauthorization Act of 2005.''.

     SEC. 3. EXEMPTION FROM ADMINISTRATIVE PROCEDURE ACT.

       The requirements of chapter 5 of title 5, United States 
     Code (commonly referred to as the `Administrative Procedure 
     Act') or any other law relating to rulemaking, information 
     collection or publication in the Federal Register, shall not 
     apply to any action to implement the amendments made by 
     section 2 to the extent the Secretary Homeland of Security, 
     the Secretary of Labor, or the Secretary of Health and Human 
     Services determines that compliance with any such requirement 
     would impede the expeditious implementation of such 
     amendments.

  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.


                             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 materials on H.R. 1285 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 H.R. 1285, to extend for 3 years 
the Nursing Relief For Disadvantaged Areas Act of 1999 which provides 
nonimmigrant visas for nurses in health professionals shortage areas.
  A number of hospitals are experiencing great difficulty in attracting 
American nurses, particularly hospitals serving mostly poor patients in 
inner-city neighborhoods and those serving rural areas. For example, 
St. Bernard Hospital in Chicago is the only remaining hospital in an 
area of over 100,000 people and has a patient base composed entirely of 
individuals in poverty. St. Bernard almost closed its doors in 1992, 
primarily because of its inability to attract registered nurses.
  In 1999, Congress passed the Nursing Relief for Disadvantaged Areas 
Act to help precisely these kinds of hospitals. This legislation 
created a new H-1C temporary registered nurse visa program with 500 
visas available a year. To be eligible to petition for an alien nurse, 
the employer must, one, be located in a health professional shortage 
area as designated by the Department of Health and Human Services; two, 
have at least 190 acute care beds; three, have a certain percentage of 
Medicare patients; and, four, have a certain percentage of Medicaid 
patients.
  The H-1C program adopted protections for American nurses contained in 
the expired H-1A nursing visa program. For instance, for a hospital to 
be eligible for H-1C nurses, it has to agree to take timely and 
significant steps to recruit American nurses, then H-1C nurses have to 
be paid the prevailing wage. The program also contained new protections 
such as the requirement that H-1C nurses cannot comprise more than 33 
percent of the hospital's workforce of registered nurses, and that a 
hospital cannot contract out H-1C nurses to work at other facilities. 
This bill would reauthorize the H-1C program for an additional 3 years.
  Our goal in creating the H-1C program was set out in the Immigration 
Nursing Relief Advisory Committee which recognized the necessity to 
``balance both the continuing need for foreign nurses in certain 
specialties and localities for which there are not adequate domestic 
registered nurses, and then the need to continue to lessen employers 
dependence on foreign registered nurses and protect the wages and 
working condition of U.S. registered nurses.''
  The H-1C program reflects this balance. I urge my colleagues to 
support this reauthorizing legislation.

[[Page H4238]]

  Mr. Speaker, I reserve the balance of my time.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I ask to address the House for 
such time as I might consume.
  Mr. Speaker, I rise to support the Nursing Relief for Disadvantaged 
Areas Reauthorization Act of 2005, H.R. 1285. And I offer my 
appreciation for the distinguished gentleman from Illinois (Mr. Rush), 
who is en route. And I would ask, as I know that the Chairman will ask, 
but I ask specifically that Mr. Rush's statement subsequently can be 
entered into the Record.

                              {time}  1300

  I do appreciate the fact that we have worked with Mr. Rush for a 
number of years, and I am reminded of the passage of this legislation 
in 1999; so it is a long time that we have been focusing on this great 
need.
  The original Nursing Relief for Disadvantaged Areas Act was a 
temporary visa program that expired at the end of September 20, 2004. 
H.R. 1285 would reauthorize and extend it for years.
  Let me cite for my colleagues some important information. According 
to a report released by the American Hospital Association, April 2006, 
U.S. hospitals need approximately 118,000 registered nurses to fill 
vacant positions nationwide. This translates into a national RN vacancy 
rate of 8.5 percent. The report titled ``The State of America's 
Hospitals: Taking the Pulse'' also found that 49 percent of hospital 
CEOs had more difficulty recruiting RNs in 2005 than in 2004. Since the 
origins of this bill, Mr. Speaker, we are going downward, if you will.
  According to the latest projections from the U.S. Bureau of Labor 
Statistics published in the November of 2005 Monthly Labor Review, more 
than 1.2 million new and replacement nurses will be needed by 2014. 
Government analysts project that more than 703,000 new RN positions 
will be created through 2014, which will account for two-fifths of all 
new jobs in the health care center.
  This is a wake-up call for America. This legislation is attempting to 
respond to this crisis, but this is, frankly, a wake-up call for 
America. Where are the nursing schools? Where are the recruits? Where 
are the students, and how can we assist?
  I rose in support of the original Nursing Relief for Disadvantaged 
Areas Act 5 years ago, and I support this. I had hoped, however, at 
that time that the nursing shortage would be temporary. Unfortunately, 
the shortage of nurses in the United States has gotten worse since 
then. As indicated, 5 years ago the U.S. Department of Health and Human 
Services reported on the results of a survey which indicated that there 
were roughly at that time 1.89 million nurses in the United States, but 
that we needed 2 million. Unfortunately, as I have said, we are 
spiraling downward.
  I hope this debate on the floor of the House will ignite nursing 
schools, States, and this Congress across America. As this legislation 
has been so diligently offered by our colleague from Illinois, who sees 
the nursing shortage and who has asked us to extend the time for this 
particular provision to bring in nurses, let us have a wake-up call to 
begin to train nurses out of America's high schools around the country.
  According to projections from the U.S. Bureau of Labor Statistics 
that were published in November 2005, I indicated that we need 1.2 
million new and replacement nurses, as stated earlier, in 2014. We need 
a growing enrollment in America's nursing schools. Part of the problem 
is that a shortage of nursing school facilities is restricting nursing 
program enrollments. According to the American Association of Colleges 
of Nursing's report on 2005-2006 Enrollment and Graduations in 
Baccalaureate and Graduate Programs in Nursing, U.S. nursing schools 
turned away 41,683 qualified applicants in 2005 due to insufficient 
faculty, clinical sites, classroom space, and budget constraints.
  Let me read to you just a paragraph from the American Nursing 
Association. My mother having been a nurse, I know many Members of 
Congress having come from the nursing profession and maybe our 
colleagues as well knowing nurses or working with nurses: ``Overall, 
the ANA,'' and this is back in 1999, ``believes that we need to address 
the root causes for the instability of the nursing workforce that has 
led to swings in the supply and demand of registered nurses. It is 
clear that overreliance on foreign-educated nurses by the hospital 
industry serves only to postpone real efforts to address the nursing 
workforce needs of the United States.''
  This is not a criticism of this legislation. This is support for this 
legislation. But what it says is, as we welcome the nurses who will 
help our disadvantaged areas, let us track their great service, as we 
do with the J-1 visa that helps us in rural and urban areas with 
doctors who will serve in underserved areas who are coming into our 
country. Let us work to address this critical shortage. The Nursing 
Relief for Disadvantaged Areas Act would provide more nurses in the 
disadvantaged areas, which is where the shortage is most critical. I 
support that enthusiastically.
  I urge Members to vote for H.R. 1285 because it is needed. It is 
needed now. I urge Members to vote to reauthorize and extend the 
Nursing Relief for Disadvantaged Areas Act for another 3 years so that 
disadvantaged communities in our Nation do not suffer from lack of 
health care.
  I rise in support of the Nursing Relief for Disadvantaged Areas 
Reauthorization Act of 2005, H.R. 1285. The original Nursing Relief for 
Disadvantaged Areas Act was a temporary visa program that expired at 
the end of September 20, 2004. H.R. 1285 would reauthorize and extend 
it for 3 years.
  When I rose in support of the original Nursing Relief for 
Disadvantaged Areas Act 5 years ago, I hoped that the nursing shortage 
would be temporary. Unfortunately, the shortage of nurses in the United 
States has gotten worse since then. Five years ago, the U.S. Department 
of Health and Human Services reported on the results of a survey which 
indicated that there were roughly 1.89 million nurses in the United 
States, but that we needed 2 million.
  According to projections from the U.S. Bureau of Labor Statistics 
that were published in the November 2005 Monthly Labor Review, more 
than 1.2 million new and replacement nurses will be needed by 2014. 
Enrollment in American nursing schools is not growing quickly enough to 
meet this demand.
  Part of the problem is that a shortage of nursing school facilities 
is restricting nursing program enrollments. According to the American 
Association of Colleges of Nursing's report on 2005-2006 Enrollment and 
Graduations in Baccalaureate and Graduate Programs in Nursing, U.S. 
Nursing schools turned away 41,683 qualified applicants in 2005 due to 
insufficient faculty, clinical sites, classroom space, and budget 
constraints.
  The Nursing Relief for Disadvantaged Areas Act would provide more 
nurses in disadvantaged areas, which is where the shortage is most 
critical. I urge you to vote for H.R. 1285 to reauthorize and extend 
the Nursing Relief for Disadvantaged Areas Act for another 3 years.
  Mr. Speaker, I am pleased to yield 3 minutes to the distinguished 
gentleman from Maryland (Mr. Cummings), who is on our Government Reform 
Committee and has worked very hard on these issues dealing with 
disadvantaged neighborhoods.
  Mr. CUMMINGS. Mr. Speaker, I thank the gentlewoman for yielding.
  I stand in support of this legislation, but I do want to emphasize 
something that is very important, and I think Ms. Jackson-Lee alluded 
to it just a moment ago.
  In my district in Baltimore, we have one Johns Hopkins, we have the 
University of Maryland, we have a small black college called Coppin 
State. Coppin State University has a nursing school, and most of its 
applicants come from the inner city of Baltimore, in our region. These 
are kids that have worked very hard to get through school and have done 
very well. But for every one applicant that we admit into Coppin, five 
are not able to come. These are people who are qualified. It is 
incredible to me that young people who work hard, play by the rules, 
give it everything they have got, and then they get to the point of 
being able to go to college, they cannot go to Coppin's nursing school 
because of two main things: one, faculty, a lack of faculty; and, 
second, a lack of space. And it is so incredibly sad when I think about 
their standing on the sidelines of life and not being able to pursue 
goals that are their life dreams.
  In some kind of way we have got to turn this around. I mean, it is 
wonderful to do what we have to do to go across the shores, but what 
about the

[[Page H4239]]

young people in our country? What about them? What about the ones who 
simply want to grow up to help other people? What about the ones who 
have to defer their dreams? What about the ones who have to arrest 
their dreams and not be able to pursue them?
  We spend just a phenomenal amount of time talking about No Child Left 
Behind, talking about educating our children, using our State and local 
and Federal funds to educate them, and then when they get to the point 
where they are qualified to go to nursing school, there are not enough 
resources for them.
  The other thing I might add is that Coppin State has like a 99 
percent passage on the State exam, 99 percent. So what that means is 
definitely we have five not going to nursing school, one going, and, 
again, those folks being left on the sidelines.
  So I hope that the committee will continue to work on this because I 
want these young people to fulfill their dreams.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I 
may consume.
  I thank the distinguished gentleman Mr. Cummings.
  Let me conclude by thanking Congressman Bobby Rush, who has been a 
strong advocate for providing and helping with nursing in underserved 
areas.
  And let me also conclude by indicating again my support by saying, 
Mr. Speaker, we have to balance what we do as we provide these valuable 
nurses through the extension of this bill in our areas, but we must 
also reach out and find a way to ensure that every young person, every 
individual, seeking an opportunity in our medical schools for 
physicians and as well nursing has that opportunity to serve America.
  With that, again, I ask for support of H.R. 1285.
  Mr. RUSH. Mr. Speaker, I rise today in support of H.R. 1285, a bill 
to amend the Nursing Relief for Disadvantaged Areas Act of 1999. In 
1999, I sponsored the Nursing Relief for Disadvantaged Areas Act, 
formerly H.R. 441-P. L. No.: 106-95, to address an immediate nursing 
shortage in my district, the First Congressional District of Illinois. 
This legislation sunset last year in June of 2005.
  Today, there are many areas in this country which are experiencing a 
scarcity of health professionals, some areas more than others. In 1999 
when I sponsored this legislation there were only pocket areas that 
experienced a shortage of nurses, now there exists, a national 
shortage. This shortage unfortunately, exists in my district, the First 
Congressional District of Illinois.
  The Englewood community, a poor, urban neighborhood with a high 
incidence of crime, is primarily served by St. Bernard's Hospital. This 
small community hospital's emergency room averages approximately 31,000 
visits per year; 50% of their patients are Medicaid recipients and 35% 
receive Medicare.
  Prior to the creation of a non-immigrant visa (H1-C) St. Bernard 
could not attract nurses into the Englewood area and was forced to hire 
temporary nurses to service its patients. This resulted in St. Bernard 
nursing expenditures to increase in the millions. The Immigration 
Nursing Relief Act of 1989 created the H-1A visa program in order to 
allow foreign educated nurses to work in the United States. The 
rationale for the H1-A program, as acknowledged by the AFL-CIO, the 
American Nurses Association and others, was to address spot shortage 
areas.
  My legislation merely seeks to close the gap created by the 
expiration of the H1-A program. H.R. 1285 simply extends the sunset 
provision in the Nursing Relief for Disadvantaged Areas Act to three 
years. It does not substantively change any language in the law, it 
still prescribes that any hospital which seeks to hire foreign nurses 
under these provisions must meet the following criteria: (1) be located 
in a Health Professional Shortage Area; (2) have at least 190 acute 
care beds; (3) have a medicare population of 35 percemt; and (4) have a 
Medicaid population of at least 28 percent.
  As one who has always fought for the American worker, I can assure 
you that this proposal does not have a detrimental effect on American 
nurses. My legislation continues the cap on the number of new visas 
that may be issued each year. It also includes processing requirements 
that require employers to attest that the hiring of foreign nurses will 
not adversely affect the wages and working conditions of registered 
nurses. The Secretary of Labor will oversee this process and provide 
penalties for non-compliance.
  Health care is a basic human right. The hallmarks of civilized 
nations are health care, education, and democracy.
  The state of health care is a grave concern in my district. Hospitals 
have closed. City health clinics are closing. Payments for Medicare and 
Medicaid have been cut back.
  The legislation we must pass today is aimed at helping hospitals, 
like St. Bernard's, keep their doors open to the communities they 
serve. That said I would like to thank my colleagues Congressman 
Sensenbrenner, Congressman Hostettler, Congressman Hyde, Congressman 
Conyers and Congresswoman Sheila Jackson-Lee for their support and for 
recognizing the national and local importance of this bill. Again, I 
urge my colleagues on both sides of the aisle to support this 
legislation.
  Mr. CASE. Mr. Speaker, I rise in strong support of H.R. 1285, which 
would amend the Nursing Relief for Disadvantaged Areas Act of 1999 by 
repealing a provision limiting the nonimmigrant classification for 
nurses working in health professional shortage areas.
  Nursing shortages continue to plague our country, especially our 
underserved areas like much of my district. A report released by the 
American Hospital Association (AHA) in April 2006 indicated that U.S. 
hospitals need approximately 118,000 Registered Nurses (RNs) just to 
fill current vacant positions. This is, nationwide, a vacancy rate of 
8.5 percent. In November 2005, the U.S. Bureau of Labor Statistics, 
Monthly Labor Review, stated that more than 1.2 million new and 
replacement nurses will be needed by 2014. Even worse, the Health 
Resources and Services Administration (HRSA) reported that 
approximately 30 states had RN shortages in 2000.
  In my state of Hawaii, the University of Hawaii (UH) reported in 2000 
that we faced a nursing shortage of more than 1,000 registered nurses; 
this shortage is projected to increase to approximately 2,000 by 2010. 
Like most states, UH found Hawaii's nursing workforce tired and burnt 
out due to incredible stress, understaffing issues, and increased 
overtime without adequate support staff. What is clear from the data 
already collected coupled with existing information regarding retention 
is that a worsening shortage of nurses means a worsening shortage of 
quality care for patients.
  These statistics and the trends and conclusions they reflect are 
nothing new, but what do we do about it? As one valuable initiative, in 
1999 President Clinton signed into law P.L. 106-96, the Nursing Relief 
for Disadvantaged Areas Act. This law provided for foreign nurses to 
obtain temporary work visas to come to the U.S. and work in places 
experiencing a shortage of health professionals. By allowing 
experienced health professionals, particularly nurses, from countries 
such as the Philippines into medically shortage underserved 
communities, the law has contributed greatly to keeping hospitals open 
and, more importantly, providing quality care to patients who otherwise 
would have no other place to seek treatment.
  Mr. Speaker, I fully support the goal of H.R. 1285 to extend this 
important legislation, the Nursing Relief for Disadvantaged Areas Act 
of 1999, for an additional three years. I look forward to working with 
my colleagues on this and other initiatives to ensure that Americans 
continue to receive the health care they deserve.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, 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. Duncan). 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. 1285, 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.
  The title of the bill was amended so as to read: ``A bill to extend 
for 3 years changes to requirements for admission of nonimmigrant 
nurses in health professional shortage areas made by the Nursing Relief 
for Disadvantaged Areas Act of 1999.''.
  A motion to reconsider was laid on the table.

                          ____________________