[Congressional Record Volume 154, Number 151 (Tuesday, September 23, 2008)]
[House]
[Pages H8681-H8682]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




              PHYSICIAN WORKFORCE ENHANCEMENT ACT OF 2008

  Mr. PALLONE. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 2583) to amend title VII of the Public Health Service Act to 
establish a loan program for eligible hospitals to establish residency 
training programs, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 2583

       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 ``Physician Workforce 
     Enhancement Act of 2008''.

     SEC. 2. HOSPITAL RESIDENCY LOAN PROGRAM.

       Subpart 2 of part E of title VII of the Public Health 
     Service Act is amended by adding at the end the following new 
     section:

     ``SEC. 771. HOSPITAL RESIDENCY LOAN PROGRAM.

       ``(a) Establishment.--Not later than October 1, 2010, the 
     Secretary, acting through the Administrator of the Health 
     Resources and Services Administration, shall establish a 
     hospital residency loan program that provides loans to 
     eligible hospitals to establish a residency training program.
       ``(b) Application.--No loan may be provided under this 
     section to an eligible hospital except pursuant to an 
     application that is submitted and approved in a time, manner, 
     and form specified by the Administrator of the Health 
     Resources and Services Administration. A loan under this 
     section shall be on such terms and conditions and meet such 
     requirements as the Administrator determines appropriate, in 
     accordance with the provisions of this section.
       ``(c) Eligibility; Preference for Rural Areas.--
       ``(1) Eligible hospital defined.--For purposes of this 
     section, an `eligible hospital' means, with respect to a loan 
     under this section, a public or non-profit hospital that, as 
     of the date of the submission of an application under 
     subsection (b), meets, to the satisfaction of the 
     Administrator of the Health Resources and Services 
     Administration, each of the following criteria:
       ``(A) The hospital does not operate a residency training 
     program and has not previously operated such a program.
       ``(B) The hospital has secured initial accreditation by the 
     American Council for Graduate Medical Education or the 
     American Osteopathic Association.
       ``(C) The hospital provides assurances to the satisfaction 
     of the Administrator of the Health Resources and Services 
     Administration that such loan shall be used, consistent with 
     subsection (d), only for the purposes of establishing and 
     conducting an allopathic or osteopathic physician residency 
     training program in at least one of the following, or a 
     combination of the following:
       ``(i) Family medicine.
       ``(ii) Internal medicine.
       ``(iii) Obstetrics or gynecology.
       ``(iv) Behavioral or Mental health.
       ``(v) Pediatrics.
       ``(D) The hospital enters into an agreement with the 
     Administrator that certifies the hospital will provide for 
     the repayment of the loan in accordance with subsection (e).
       ``(2) Preference for rural areas.--In making loans under 
     this section, the Administrator of the Health Resources and 
     Services Administration shall create guidelines that give 
     preference to rural areas (as such term is defined in section 
     1886(d)(2)(D) of the Social Security Act).
       ``(d) Permissible Uses of Loan Funds.--A loan provided 
     under this section shall be used, with respect to a residency 
     training program, only for costs directly attributable to the 
     residency training program, except as otherwise provided by 
     the Administrator of the Health Resources and Services 
     Administration.
       ``(e) Repayment of Loans.--
       ``(1) Repayment plans.--For purposes of subsection 
     (c)(1)(D), a repayment plan for an eligible hospital is in 
     accordance with this subsection if it provides for the 
     repayment of the loan amount in installments, in accordance 
     with a schedule that is agreed to by the Administrator of the 
     Health Resources and Services Administration and the hospital 
     and that is in accordance with paragraphs (2), (3), and (4).
       ``(2) Commencement of repayment.--Repayment by an eligible 
     hospital of a loan under this section shall commence not 
     later than the date that is 18 months after the date on which 
     the loan amount is disbursed to such hospital.
       ``(3) Repayment period.--A loan made under this section 
     shall be fully repaid not later than the date that is 24 
     months after the date on which the repayment is required to 
     commence.
       ``(4) Loan payable in full if residency training program 
     canceled.--In the case that an eligible hospital borrows a 
     loan under this section, with respect to a residency training 
     program, and terminates such program before the date on which 
     such loan has been fully repaid in accordance with a plan 
     under paragraph (1), such loan shall be payable by the 
     hospital not later than 45 days after the date of such 
     termination.
       ``(f) No Interest Charged.--The Administrator of the Health 
     Resources and Services Administration may not charge or 
     collect interest on any loan made under this section.
       ``(g) Limitation on Total Amount of Loan.--The cumulative 
     annual dollar amount of a loan made to an eligible hospital 
     under this section may not exceed $250,000.
       ``(h) Penalties.--The Administrator of the Health Resources 
     and Services Administration shall establish penalties to 
     which an eligible hospital receiving a loan under this 
     section would be subject if such hospital is in violation of 
     any of the criteria described in subsection (c)(1). Such 
     penalties shall include the charge or collection of interest, 
     at a rate to be determined by the Administrator of the Health 
     Resources and Services Administration. Except as otherwise 
     provided, penalties collected under this subsection shall be 
     paid to the Administrator of the Health Resources and 
     Services Administration and shall, subject to appropriation 
     Acts, be available until expended for the purpose of 
     enforcing the provisions of this section.
       ``(i) Reports.--Not later than January 1, 2012, and 
     annually thereafter (before January 2, 2014), the 
     Administrator of the Health Resources and Services 
     Administration shall submit to Congress a report on the 
     efficacy of the program under this section in increasing the 
     number of residents practicing in each medical specialty 
     described in subsection (c)(1)(C) during such year and the 
     extent to which the program resulted in an increase in the 
     number of available practitioners in each of such medical 
     specialties that serve medically underserved populations.
       ``(j) Funding.--
       ``(1) Authorization of appropriations.--For the purpose of 
     providing amounts for loans under this section, there are 
     authorized to be appropriated such sums as may be necessary 
     to provide--
       ``(A) $8,000,000 in loans for fiscal year 2010;
       ``(B) $8,400,000 in loans for fiscal year 2011;
       ``(C) $8,820,000 in loans for fiscal year 2012;
       ``(D) $9,261,000 in loans for fiscal year 2013; and
       ``(E) $9,724,050 in loans for fiscal year 2014.
       ``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available until expended.
       ``(k) Termination of Program.--No loan may be made under 
     this section after December 31, 2013.''.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from New 
Jersey (Mr. Pallone) and the gentleman from Texas (Mr. Burgess) each 
will control 20 minutes.
  The Chair recognizes the gentleman from New Jersey.


                             General Leave

  Mr. PALLONE. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days in which to revise and extend their remarks 
and include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from New Jersey?
  There was no objection.
  Mr. PALLONE. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise this evening in support of H.R. 2583, the 
Physician Workforce Enhancement Act of 2008. This legislation seeks to 
address shortages in the physician workforce by creating a loan program 
for rural and

[[Page H8682]]

urban hospitals to start residency training programs.
  Demand for primary care has grown due to an increase in the number of 
people living with chronic diseases and due to the long-term care needs 
of an aging population. However, recent trends show that the growth in 
the physician workforce is not keeping pace with the growth of the 
general population. In fact, there has been a decline in the number of 
medical students and training opportunities for primary care in certain 
areas of practice, including pediatrics, which are expected to have 
more critical shortages in the future.
  H.R. 2583 seeks to address the physician shortage by establishing a 
loan program for eligible hospitals to establish residency training 
programs in allopathic and osteopathic medicine with a preference for 
hospitals located in rural areas.
  Residency training programs are an integral way for rural and small 
urban communities to attract physicians as it encourage doctors to put 
down roots in the community where they completed their residency.
  One important source of funding for residency training programs is 
Medicare. However, the Medicare program caps the number of residents 
and fellows eligible for Medicare reimbursement.

                              {time}  2045

  This can narrow the number of resources available to some smaller 
hospitals that have the greater need for residents that will later 
serve the community as physicians. That cap was implemented at the time 
when it appeared that the physician workforce would enjoy surpluses for 
some time, and that the use of managed care services would reduce the 
demand of medical services. But both trends have significantly reversed 
in recent years, precipitating the need for a new strategy to improve 
the health and vitality of the U.S. physician workforce.
  H.R. 2583 provides such a strategy. This legislation will make great 
strides in attracting new physicians to serve in rural and small urban 
districts that need them most.
  I want to urge my colleagues to support the passage of this bill.
  I reserve the balance of my time.
  Mr. BURGESS. Mr. Speaker, I yield myself such time as I may consume.
  Health care workforce issues are going to be a major and developing 
problem over the next several years, and it's a problem that the 
country really doesn't know a great deal about. In fact, in the next 20 
to 30 years our population is going to age, and it's going to grow. And 
the current trends suggest that we will reach a critical shortage of 
physicians in growing communities, and it'll be especially acute in 
some specialties.
  The problem is complex. The problem is varied, and does not have just 
one solution. But in a modest attempt to spark the discussion on how to 
increase the domestic supply of physicians and provide at least one 
solution, Congressman Matheson and I introduced H.R. 2583 last year.
  H.R. 2583 will assist small hospitals that serve rural or growing 
areas by providing them with financial resources to establish a 
residency training program for certain high need medical specialties.
  While we need to increase the number of doctors, we also need to make 
certain that they practice in areas where they're needed. We need to 
develop new residency training programs away from the major urban 
centers. It is a rule of thumb that most physicians tend to settle and 
start their families and integrate into the community where they 
complete their residency training program. H.R. 2583 will help smaller 
emerging communities attract and retain the medical professionals that 
their communities will need to rely on well into the future.
  H.R. 2583 would establish an interest-free loan program for eligible 
hospitals to establish residency training programs. Over the period of 
its authorization, it should operate at no cost to the American 
taxpayer.
  To qualify, hospitals will need to have secured preliminary 
accreditation from the American Council of Graduate Medical Education 
or the American Osteopathic Association, and have not had a residency 
training program in the past. These loans would go to pay salaries or 
benefits for residents, salaries of faculty and other costs directly 
attributable to the residency training program.
  Mr. Speaker, in response to concerns raised during discussions on 
this bill, House Energy and Commerce staff and Member office staff have 
worked together in a bipartisan manner to address areas of concern. 
This bill represents a modest and an accountable approach to the 
growing problem of physician workforce issues.
  This bill is supported by medical groups, and most notably, the 
American Osteopathic Association. I'm pleased also to have worked with 
Congressman Matheson on this important proposal.
  So, Mr. Speaker, if Members want to help their smaller rural 
communities, and if they want to help attract medical professionals 
that their communities will need in the future, I urge a ``yes'' vote 
on H.R. 2583 today.
  I reserve the balance of my time.
  Mr. MATHESON. Mr. Speaker, I rise today in support of H.R. 2583, the 
``Physician Workforce and Graduate Medical Education Enhancement Act.'' 
I am proud to join Representative Burgess as a lead sponsor of this 
legislation and want to thank him along with Chairman Dingell and the 
Energy and Commerce staff for moving this legislation forward.
  Data shows that physicians typically will practice within 100 miles 
of where they train. While current residency training programs continue 
to excel at producing high quality physicians, they do not adequately 
distribute physicians to communities across the Nation. H.R. 2583 aims 
to create new residency programs in geographic regions that face 
physician shortages, especially those in the South, Southwest, Rocky 
Mountain, and West regions.
  A major obstacle often preventing the establishment of new residency 
training programs are the costs associated with the creation of such 
programs. Under current law, a hospital starting a new residency 
program is not eligible immediately for direct graduate medical 
education or indirect medical education funding. This financing 
arrangement presents challenges for hospitals that operate on narrow 
margins, especially community hospitals that lack adequate reserve 
funds to offset the financial commitments associated with staffing a 
new residency program.
  I believe this legislation provides the appropriate incentives that 
would lead to the creation of new residency training programs in 
geographic areas that lack an adequate supply of physicians, thus 
enhancing the Nation's ability to meet future physician workforce 
needs. If carried out over 10 years, the loan program established by 
the ``Physician Workforce and Graduate Medical Education Enhancement 
Act'' has the potential of assisting in the establishment of up to 50 
new residency programs.
  Thank you and I urge my colleagues to support this piece of 
legislation.
  Mr. PALLONE. Mr. Speaker, I have no further speakers. I urge passage 
of the Physician Workforce and Graduate Medical Education bill, and I 
yield back the balance of my time.
  Mr. BURGESS. I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from New Jersey (Mr. Pallone) that the House suspend the 
rules and pass the bill, H.R. 2583, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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