[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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