[Congressional Record Volume 156, Number 39 (Wednesday, March 17, 2010)]
[Senate]
[Pages S1671-S1673]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]
By Mr. DURBIN:
S. 3135. A bill to enhance global healthcare cooperation and for
other purposes; to the Committee on the Judiciary.
Mr. DURBIN. Mr. President, I rise today to introduce the Global
Healthcare Cooperation Act of 2010. This legislation takes measured but
important steps to enhance global healthcare cooperation and help
developing countries address public health challenges. The Global
Healthcare Cooperation Act will bolster the ranks of healthcare workers
serving in developing countries by enabling American legal permanent
residents to assist with overseas public health emergencies, and by
responsibly regulating the ``brain drain'' of skilled healthcare
workers from underdeveloped countries to the U.S. I look forward to
working with my colleagues to see these provisions enacted into law.
While many nations are currently experiencing shortages of healthcare
personnel, the lack of doctors, nurses and other healthcare workers in
the world's poorest nations is an urgent crisis. There are many factors
contributing to this crisis, but the massive ``brain drain'' of trained
healthcare workers from the poorest nations to the richest is a central
cause. According to the World Health Organization, Africa loses 20,000
health professionals a year as part of this brain drain. In Ethiopia,
for example, there are only 1,806 doctors serving a population of 80
million. By comparison, there are 5,074 doctors serving the 600,000
residents of Washington D.C., and 17,507 doctors serving the 5.3
million residents of Cook County in my home state of Illinois. The
shortage of healthcare personnel is considered the single biggest
obstacle to fighting HIV/AIDS in Africa. Healthcare worker shortages
are particularly devastating when nations are confronted with natural
disasters and other humanitarian crises, such as the recent Haiti
earthquake.
I again saw this problem first hand during a trip to east Africa that
I took last month with Senator Sherrod Brown. In places such as
Tanzania and Ethiopia the story was the same--in countries already in
desperate need of health workers, many were instead leaving for work in
other countries. Many are being recruited to work in the U.S. and in
other wealthy nations.
We should do what we can here in the U.S. to make sure these talented
health professionals are free to return temporarily to help in
countries with urgent health needs without jeopardizing their
immigration status. We should also ensure they have met all medical
care obligations in their home countries that may have been tied to
their health training.
The Global Healthcare Cooperation Act would take two steps to address
these challenges. The first part of the bill would allow a healthcare
worker who is a legal permanent resident in the U.S. to temporarily
provide healthcare services in a country that is underdeveloped or that
has suffered a disaster or public health emergency without jeopardizing
his or her immigration status in the U.S. Specifically, the bill would
allow legal permanent resident healthcare workers to work in qualifying
countries for up to 36 months without running afoul of the continuous
residency requirement for naturalization. This provision will allow
immigrants in our country to lend their skills to overseas disaster
relief and public health crises while still pursuing their dream of
American citizenship.
The second part of this legislation would require a foreigner who is
petitioning to work in the U.S. as a healthcare worker to attest that
he or she has satisfied any outstanding obligation to his or her home
country
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under which the foreigner received money for medical training in return
for a commitment to work in that country for a period of years. In
exchange for financial support for their education or training, some
foreign doctors, nurses, and other healthcare workers have signed
voluntary bonds or made promises to their governments to remain in
their home countries or to return from their studies abroad and work in
the healthcare profession. The bill provides that the petitioner must
satisfy any outstanding obligation in order to be eligible for
admission into the U.S., though the bill is flexible in allowing the
petitioner to reach agreement with the home country in order to satisfy
his or her commitment. The legislation provides a waiver in cases of
coercion by the home country government or other extraordinary
circumstances. The goal of this provision is to ensure that foreign
countries do not invest money in healthcare workers who then renege on
commitments to work in their country without satisfying their
commitment.
The small but important steps contained within the Global Healthcare
Cooperation Act will help save lives, and will demonstrate America's
leadership in the effort to improve the health of people across the
globe. The provisions in this legislation have previously passed the
Senate twice, as part of the 2006 immigration reform bill and the 2007
Labor-HHS appropriations bill, but have not yet become law. I urge my
colleagues to support the enactment of these important provisions.
Mr. President, I ask unanimous consent that the text of the bill be
printed in the Record.
There being no objection, the text of the bill was ordered to be
printed in the Record, as follows:
S. 3135
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 ``Global Health Care
Cooperation Act''.
SEC. 2. GLOBAL HEALTH CARE COOPERATION.
(a) In General.--Title III of the Immigration and
Nationality Act (8 U.S.C. 1401 et seq.) is amended by
inserting after section 317 the following:
``SEC. 317A. TEMPORARY ABSENCE OF ALIENS PROVIDING HEALTH
CARE IN DEVELOPING COUNTRIES.
``(a) In General.--Notwithstanding any other provision of
this Act, the Secretary of Homeland Security shall allow an
eligible alien and the spouse or child of such alien to
reside in a candidate country during the period that the
eligible alien is working as a physician or other health care
worker in a candidate country. During such period the
eligible alien and such spouse or child shall be considered--
``(1) to be physically present and residing in the United
States for purposes of naturalization under section 316(a);
and
``(2) to meet the continuous residency requirements under
section 316(b).
``(b) Definitions.--In this section:
``(1) Candidate country.--The term `candidate country'
means a country that the Secretary of State determines to
be--
``(A) eligible for assistance from the International
Development Association, in which the per capita income of
the country is equal to or less than the historical ceiling
of the International Development Association for the
applicable fiscal year, as defined by the International Bank
for Reconstruction and Development;
``(B) classified as a lower middle income country in the
then most recent edition of the World Development Report for
Reconstruction and Development published by the International
Bank for Reconstruction and Development and having an income
greater than the historical ceiling for International
Development Association eligibility for the applicable fiscal
year; or
``(C) qualified to be a candidate country due to special
circumstances, including natural disasters or public health
emergencies.
``(2) Eligible alien.--The term `eligible alien' means an
alien who--
``(A) has been lawfully admitted to the United States for
permanent residence; and
``(B) is a physician or other healthcare worker.
``(c) Consultation.--The Secretary of Homeland Security
shall consult with the Secretary of State in carrying out
this section.
``(d) Publication.--The Secretary of State shall publish--
``(1) not later than 180 days after the date of the
enactment of this section, a list of candidate countries;
``(2) an updated version of the list required by paragraph
(1) not less often than once each year; and
``(3) an amendment to the list required by paragraph (1) at
the time any country qualifies as a candidate country due to
special circumstances under subsection (b)(1)(C).''.
(b) Rulemaking.--
(1) Requirement.--Not later than 180 days after the date of
the enactment of this Act, the Secretary of Homeland Security
shall promulgate regulations to carry out the amendments made
by this section.
(2) Content.--The regulations promulgated pursuant to
paragraph (1) shall--
(A) permit an eligible alien (as defined in section 317A of
the Immigration and Nationality Act, as added by subsection
(a)) and the spouse or child of the eligible alien to reside
in a foreign country to work as a physician or other
healthcare worker as described in subsection (a) of such
section 317A for not less than a 12-month period and not more
than a 24-month period, and shall permit the Secretary to
extend such period for an additional period not to exceed 12
months, if the Secretary determines that such country has a
continuing need for such a physician or other healthcare
worker;
(B) provide for the issuance of documents by the Secretary
to such eligible alien, and such spouse or child, if
appropriate, to demonstrate that such eligible alien, and
such spouse or child, if appropriate, is authorized to reside
in such country under such section 317A; and
(C) provide for an expedited process through which the
Secretary shall review applications for such an eligible
alien to reside in a foreign country pursuant to subsection
(a) of such section 317A if the Secretary of State determines
a country is a candidate country pursuant to subsection
(b)(1)(C) of such section 317A.
(c) Technical and Conforming Amendments.--
(1) Definition.--Section 101(a)(13)(C)(ii) of the
Immigration and Nationality Act (8 U.S.C. 1101(a)(13)(C)(ii))
is amended by adding ``except in the case of an eligible
alien, or the spouse or child of such alien, who is
authorized to be absent from the United States under section
317A,'' at the end.
(2) Documentary requirements.--Section 211(b) of such Act
(8 U.S.C. 1181(b)) is amended by inserting ``, including an
eligible alien authorized to reside in a foreign country
under section 317A and the spouse or child of such eligible
alien, if appropriate,'' after ``101(a)(27)(A),''.
(3) Ineligible aliens.--Section 212(a)(7)(A)(i)(I) of such
Act (8 U.S.C. 1182(a)(7)(A)(i)(I)) is amended by inserting
``other than an eligible alien authorized to reside in a
foreign country under section 317A and the spouse or child of
such eligible alien, if appropriate,'' after ``Act,''.
(4) Clerical amendment.--The table of contents of such Act
is amended by inserting after the item relating to section
317 the following:
``Sec. 317A. Temporary absence of aliens providing health care in
developing countries.''.
SEC. 3. ATTESTATION BY HEALTH CARE WORKERS.
(a) Attestation Requirement.--Section 212(a)(5) of the
Immigration and Nationality Act (8 U.S.C. 1182(a)(5)) is
amended by adding at the end the following:
``(E) Health care workers with other obligations.--
``(i) In general.--An alien who seeks to enter the United
States for the purpose of performing labor as a physician or
other health care worker is inadmissible unless the alien
submits to the Secretary of Homeland Security or the
Secretary of State, as appropriate, an attestation that the
alien is not seeking to enter the United States for such
purpose during any period in which the alien has an
outstanding obligation to the government of the alien's
country of origin or the alien's country of residence.
``(ii) Obligation defined.--In this subparagraph, the term
`obligation' means an obligation incurred as part of a valid,
voluntary individual agreement in which the alien received
financial assistance to defray the costs of education or
training to qualify as a physician or other health care
worker in consideration for a commitment to work as a
physician or other health care worker in the alien's country
of origin or the alien's country of residence.
``(iii) Waiver.--The Secretary of Homeland Security may
waive a finding of inadmissibility under clause (i) if the
Secretary determines that--
``(I) the obligation was incurred by coercion or other
improper means;
``(II) the alien and the government of the country to which
the alien has an outstanding obligation have reached a valid,
voluntary agreement, pursuant to which the alien's obligation
has been deemed satisfied, or the alien has shown to the
satisfaction of the Secretary that the alien has been unable
to reach such an agreement because of coercion or other
improper means; or
``(III) the obligation should not be enforced due to other
extraordinary circumstances, including undue hardship that
would be suffered by the alien in the absence of a waiver.''.
(b) Effective Date.--The amendment made by subsection (a)
shall take effect on the date that is 180 days after the date
of the enactment of this Act.
(c) Application.--Not later than the effective date
described in subsection (b), the Secretary of Homeland
Security shall begin to carry out subparagraph (E) of section
212(a)(5) of the Immigration and Nationality Act, as added by
subsection (a), including the requirement for the attestation
and the granting of a waiver described in clause (iii) of
such subparagraph (E), regardless of whether regulations to
implement such subparagraph have been promulgated.
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