[Congressional Record (Bound Edition), Volume 145 (1999), Part 8]
[House]
[Pages 10544-10549]
[From the U.S. Government Publishing Office, www.gpo.gov]



           NURSING RELIEF FOR DISADVANTAGED AREAS ACT OF 1999

  Mr. ROGAN. Mr. Speaker, I move to suspend the rules and pass the bill 
(H.R. 441) to amend the Immigration and Nationality Act with respect to 
the requirements for the admission of nonimmigrant nurses who will 
practice in health professional shortage areas.
  The Clerk read as follows:

                                H.R. 441

       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 Act of 1999''.

     SEC. 2. REQUIREMENTS FOR ADMISSION OF NONIMMIGRANT NURSES IN 
                   HEALTH PROFESSIONAL SHORTAGE AREAS DURING 4-
                   YEAR PERIOD.

       (a) Establishment of a New Nonimmigrant Classification for 
     Nonimmigrant Nurses in Health Professional Shortage Areas.--
     Section 101(a)(15)(H)(i) of the Immigration and Nationality 
     Act (8 U.S.C. 1101(a)(15)(H)(i)) is amended by striking ``; 
     or'' at the end and inserting the following: ``, or (c) who 
     is coming temporarily

[[Page 10545]]

     to the United States to perform services as a registered 
     nurse, who meets the qualifications described in section 
     212(m)(1), and with respect to whom the Secretary of Labor 
     determines and certifies to the Attorney General that an 
     unexpired attestation is on file and in effect under section 
     212(m)(2) for the facility (as defined in section 212(m)(6)) 
     for which the alien will perform the services; or''.
       (b) Requirements.--Section 212(m) of the Immigration and 
     Nationality Act (8 U.S.C. 1182(m)) is amended to read as 
     follows:
       ``(m)(1) The qualifications referred to in section 
     101(a)(15)(H)(i)(c), with respect to an alien who is coming 
     to the United States to perform nursing services for a 
     facility, are that the alien--
       ``(A) has obtained a full and unrestricted license to 
     practice professional nursing in the country where the alien 
     obtained nursing education or has received nursing education 
     in the United States;
       ``(B) has passed an appropriate examination (recognized in 
     regulations promulgated in consultation with the Secretary of 
     Health and Human Services) or has a full and unrestricted 
     license under State law to practice professional nursing in 
     the State of intended employment; and
       ``(C) is fully qualified and eligible under the laws 
     (including such temporary or interim licensing requirements 
     which authorize the nurse to be employed) governing the place 
     of intended employment to engage in the practice of 
     professional nursing as a registered nurse immediately upon 
     admission to the United States and is authorized under such 
     laws to be employed by the facility.
       ``(2)(A) The attestation referred to in section 
     101(a)(15)(H)(i)(c), with respect to a facility for which an 
     alien will perform services, is an attestation as to the 
     following:
       ``(i) The facility meets all the requirements of paragraph 
     (6).
       ``(ii) The employment of the alien will not adversely 
     affect the wages and working conditions of registered nurses 
     similarly employed.
       ``(iii) The alien employed by the facility will be paid the 
     wage rate for registered nurses similarly employed by the 
     facility.
       ``(iv) The facility has taken and is taking timely and 
     significant steps designed to recruit and retain sufficient 
     registered nurses who are United States citizens or 
     immigrants who are authorized to perform nursing services, in 
     order to remove as quickly as reasonably possible the 
     dependence of the facility on nonimmigrant registered nurses.
       ``(v) There is not a strike or lockout in the course of a 
     labor dispute, the facility did not lay off and will not lay 
     off a registered nurse employed by the facility within the 
     period beginning 90 days before and ending 90 days after the 
     date of filing of any visa petition, and the employment of 
     such an alien is not intended or designed to influence an 
     election for a bargaining representative for registered 
     nurses of the facility.
       ``(vi) At the time of the filing of the petition for 
     registered nurses under section 101(a)(15)(H)(i)(c), notice 
     of the filing has been provided by the facility to the 
     bargaining representative of the registered nurses at the 
     facility or, where there is no such bargaining 
     representative, notice of the filing has been provided to the 
     registered nurses employed at the facility through posting in 
     conspicuous locations.
       ``(vii) The facility will not, at any time, employ a number 
     of aliens issued visas or otherwise provided nonimmigrant 
     status under section 101(a)(15)(H)(i)(c) that exceeds 33 
     percent of the total number of registered nurses employed by 
     the facility.
       ``(viii) The facility will not, with respect to any alien 
     issued a visa or otherwise provided nonimmigrant status under 
     section 101(a)(15)(H)(i)(c)--
       ``(I) authorize the alien to perform nursing services at 
     any worksite other than a worksite controlled by the 
     facility; or
       ``(II) transfer the place of employment of the alien from 
     one worksite to another.
     Nothing in clause (iv) shall be construed as requiring a 
     facility to have taken significant steps described in such 
     clause before the date of the enactment of the Nursing Relief 
     for Disadvantaged Areas Act of 1999. A copy of the 
     attestation shall be provided, within 30 days of the date of 
     filing, to registered nurses employed at the facility on the 
     date of filing.
       ``(B) For purposes of subparagraph (A)(iv), each of the 
     following shall be considered a significant step reasonably 
     designed to recruit and retain registered nurses:
       ``(i) Operating a training program for registered nurses at 
     the facility or financing (or providing participation in) a 
     training program for registered nurses elsewhere.
       ``(ii) Providing career development programs and other 
     methods of facilitating health care workers to become 
     registered nurses.
       ``(iii) Paying registered nurses wages at a rate higher 
     than currently being paid to registered nurses similarly 
     employed in the geographic area.
       ``(iv) Providing reasonable opportunities for meaningful 
     salary advancement by registered nurses.

     The steps described in this subparagraph shall not be 
     considered to be an exclusive list of the significant steps 
     that may be taken to meet the conditions of subparagraph 
     (A)(iv). Nothing in this subparagraph shall require a 
     facility to take more than one step if the facility can 
     demonstrate that taking a second step is not reasonable.
       ``(C) Subject to subparagraph (E), an attestation under 
     subparagraph (A)--
       ``(i) shall expire on the date that is the later of--
       ``(I) the end of the one-year period beginning on the date 
     of its filing with the Secretary of Labor; or
       ``(II) the end of the period of admission under section 
     101(a)(15)(H)(i)(c) of the last alien with respect to whose 
     admission it was applied (in accordance with clause (ii)); 
     and
       ``(ii) shall apply to petitions filed during the one-year 
     period beginning on the date of its filing with the Secretary 
     of Labor if the facility states in each such petition that it 
     continues to comply with the conditions in the attestation.
       ``(D) A facility may meet the requirements under this 
     paragraph with respect to more than one registered nurse in a 
     single petition.
       ``(E)(i) The Secretary of Labor shall compile and make 
     available for public examination in a timely manner in 
     Washington, D.C., a list identifying facilities which have 
     filed petitions for nonimmigrants under section 
     101(a)(15)(H)(i)(c) and, for each such facility, a copy of 
     the facility's attestation under subparagraph (A) (and 
     accompanying documentation) and each such petition filed by 
     the facility.
       ``(ii) The Secretary of Labor shall establish a process, 
     including reasonable time limits, for the receipt, 
     investigation, and disposition of complaints respecting a 
     facility's failure to meet conditions attested to or a 
     facility's misrepresentation of a material fact in an 
     attestation. Complaints may be filed by any aggrieved person 
     or organization (including bargaining representatives, 
     associations deemed appropriate by the Secretary, and other 
     aggrieved parties as determined under regulations of the 
     Secretary). The Secretary shall conduct an investigation 
     under this clause if there is reasonable cause to believe 
     that a facility fails to meet conditions attested to. Subject 
     to the time limits established under this clause, this 
     subparagraph shall apply regardless of whether an attestation 
     is expired or unexpired at the time a complaint is filed.
       ``(iii) Under such process, the Secretary shall provide, 
     within 180 days after the date such a complaint is filed, for 
     a determination as to whether or not a basis exists to make a 
     finding described in clause (iv). If the Secretary determines 
     that such a basis exists, the Secretary shall provide for 
     notice of such determination to the interested parties and an 
     opportunity for a hearing on the complaint within 60 days of 
     the date of the determination.
       ``(iv) If the Secretary of Labor finds, after notice and 
     opportunity for a hearing, that a facility (for which an 
     attestation is made) has failed to meet a condition attested 
     to or that there was a misrepresentation of material fact in 
     the attestation, the Secretary shall notify the Attorney 
     General of such finding and may, in addition, impose such 
     other administrative remedies (including civil monetary 
     penalties in an amount not to exceed $1,000 per nurse per 
     violation, with the total penalty not to exceed $10,000 per 
     violation) as the Secretary determines to be appropriate. 
     Upon receipt of such notice, the Attorney General shall not 
     approve petitions filed with respect to a facility during a 
     period of at least one year for nurses to be employed by the 
     facility.
       ``(v) In addition to the sanctions provided for under 
     clause (iv), if the Secretary of Labor finds, after notice 
     and an opportunity for a hearing, that a facility has 
     violated the condition attested to under subparagraph 
     (A)(iii) (relating to payment of registered nurses at the 
     prevailing wage rate), the Secretary shall order the facility 
     to provide for payment of such amounts of back pay as may be 
     required to comply with such condition.
       ``(F)(i) The Secretary of Labor shall impose on a facility 
     filing an attestation under subparagraph (A) a filing fee, in 
     an amount prescribed by the Secretary based on the costs of 
     carrying out the Secretary's duties under this subsection, 
     but not exceeding $250.
       ``(ii) Fees collected under this subparagraph shall be 
     deposited in a fund established for this purpose in the 
     Treasury of the United States.
       ``(iii) The collected fees in the fund shall be available 
     to the Secretary of Labor, to the extent and in such amounts 
     as may be provided in appropriations Acts, to cover the costs 
     described in clause (i), in addition to any other funds that 
     are available to the Secretary to cover such costs.
       ``(3) The period of admission of an alien under section 
     101(a)(15)(H)(i)(c) shall be 3 years.
       ``(4) The total number of nonimmigrant visas issued 
     pursuant to petitions granted under section 
     101(a)(15)(H)(i)(c) in each fiscal year shall not exceed 500. 
     The number of such visas issued for employment in each State 
     in each fiscal year shall not exceed the following:
       ``(A) For States with populations of less than 9,000,000, 
     based upon the 1990 decennial census of population, 25 visas.

[[Page 10546]]

       ``(B) For States with populations of 9,000,000 or more, 
     based upon the 1990 decennial census of population, 50 visas.
       ``(C) If the total number of visas available under this 
     paragraph for a fiscal year quarter exceeds the number of 
     qualified nonimmigrants who may be issued such visas during 
     those quarters, the visas made available under this paragraph 
     shall be issued without regard to the numerical limitation 
     under subparagraph (A) or (B) of this paragraph during the 
     last fiscal year quarter.
       ``(5) A facility that has filed a petition under section 
     101(a)(15)(H)(i)(c) to employ a nonimmigrant to perform 
     nursing services for the facility--
       ``(A) shall provide the nonimmigrant a wage rate and 
     working conditions commensurate with those of nurses 
     similarly employed by the facility;
       ``(B) shall require the nonimmigrant to work hours 
     commensurate with those of nurses similarly employed by the 
     facility; and
       ``(C) shall not interfere with the right of the 
     nonimmigrant to join or organize a union.
       ``(6) For purposes of this subsection and section 
     101(a)(15)(H)(i)(c), the term `facility' means a subsection 
     (d) hospital (as defined in section 1886(d)(1)(B) of the 
     Social Security Act (42 U.S.C. 1395ww(d)(1)(B))) that meets 
     the following requirements:
       ``(A) As of March 31, 1997, the hospital was located in a 
     health professional shortage area (as defined in section 332 
     of the Public Health Service Act (42 U.S.C. 254e)).
       ``(B) Based on its settled cost report filed under title 
     XVIII of the Social Security Act for its cost reporting 
     period beginning during fiscal year 1994--
       ``(i) the hospital has not less than 190 licensed acute 
     care beds;
       ``(ii) the number of the hospital's inpatient days for such 
     period which were made up of patients who (for such days) 
     were entitled to benefits under part A of such title is not 
     less than 35 percent of the total number of such hospital's 
     acute care inpatient days for such period; and
       ``(iii) the number of the hospital's inpatient days for 
     such period which were made up of patients who (for such 
     days) were eligible for medical assistance under a State plan 
     approved under title XIX of the Social Security Act, is not 
     less than 28 percent of the total number of such hospital's 
     acute care inpatient days for such period.
       ``(7) For purposes of paragraph (2)(A)(v), the term `lay 
     off', with respect to a worker--
       ``(A) means to cause the worker's loss of employment, other 
     than through a discharge for inadequate performance, 
     violation of workplace rules, cause, voluntary departure, 
     voluntary retirement, or the expiration of a grant or 
     contract; but
       ``(B) does not include any situation in which the worker is 
     offered, as an alternative to such loss of employment, a 
     similar employment opportunity with the same employer at 
     equivalent or higher compensation and benefits than the 
     position from which the employee was discharged, regardless 
     of whether or not the employee accepts the offer.

     Nothing in this paragraph is intended to limit an employee's 
     or an employer's rights under a collective bargaining 
     agreement or other employment contract.''.
       (c) Repealer.--Clause (i) of section 101(a)(15)(H) of the 
     Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(H)(i)) 
     is amended by striking subclause (a).
       (d) Implementation.--Not later than 90 days after the date 
     of enactment of this Act, the Secretary of Labor (in 
     consultation, to the extent required, with the Secretary of 
     Health and Human Services) and the Attorney General shall 
     promulgate final or interim final regulations to carry out 
     section 212(m) of the Immigration and Nationality Act (as 
     amended by subsection (b)).
       (e) Limiting Application of Nonimmigrant Changes to 4-Year 
     Period.--The amendments made by this section shall apply to 
     classification petitions filed for nonimmigrant status only 
     during the 4-year period beginning on the date that interim 
     or final regulations are first promulgated under subsection 
     (d).

     SEC. 3. RECOMMENDATIONS FOR ALTERNATIVE REMEDY FOR NURSING 
                   SHORTAGE.

       Not later than the last day of the 4-year period described 
     in section 2(e), the Secretary of Health and Human Services 
     and the Secretary of Labor shall jointly submit to the 
     Congress recommendations (including legislative 
     specifications) with respect to the following:
       (1) A program to eliminate the dependence of facilities 
     described in section 212(m)(6) of the Immigration and 
     Nationality Act (as amended by section 2(b)) on nonimmigrant 
     registered nurses by providing for a permanent solution to 
     the shortage of registered nurses who are United States 
     citizens or aliens lawfully admitted for permanent residence.
       (2) A method of enforcing the requirements imposed on 
     facilities under sections 101(a)(15)(H)(i)(c) and 212(m) of 
     the Immigration and Nationality Act (as amended by section 2) 
     that would be more effective than the process described in 
     section 212(m)(2)(E) of such Act (as so amended).

     SEC. 4. CERTIFICATION FOR CERTAIN ALIEN NURSES.

       (a) In General.--
       (1) Section 212 of the Immigration and Nationality Act (8 
     U.S.C. 1182) is amended by adding at the end the following 
     new subsection:
       ``(r) Subsection (a)(5)(C) shall not apply to an alien who 
     seeks to enter the United States for the purpose of 
     performing labor as a nurse who presents to the consular 
     officer (or in the case of an adjustment of status, the 
     Attorney General) a certified statement from the Commission 
     on Graduates of Foreign Nursing Schools (or an equivalent 
     independent credentialing organization approved for the 
     certification of nurses under subsection (a)(5)(C) by the 
     Attorney General in consultation with the Secretary of Health 
     and Human Services) that--
       ``(1) the alien has a valid and unrestricted license as a 
     nurse in a State where the alien intends to be employed and 
     such State verifies that the foreign licenses of alien nurses 
     are authentic and unencumbered;
       ``(2) the alien has passed the National Council Licensure 
     Examination (NCLEX);
       ``(3) the alien is a graduate of a nursing program--
       ``(A) in which the language of instruction was English;
       ``(B) located in a country--
       ``(i) designated by such commission not later than 30 days 
     after the date of the enactment of the Nursing Relief for 
     Disadvantaged Areas Act of 1999, based on such commission's 
     assessment that the quality of nursing education in that 
     country, and the English language proficiency of those who 
     complete such programs in that country, justify the country's 
     designation; or
       ``(ii) designated on the basis of such an assessment by 
     unanimous agreement of such commission and any equivalent 
     credentialing organizations which have been approved under 
     subsection (a)(5)(C) for the certification of nurses under 
     this subsection; and
       ``(C)(i) which was in operation on or before the date of 
     the enactment of the Nursing Relief for Disadvantaged Areas 
     Act of 1999; or
       ``(ii) has been approved by unanimous agreement of such 
     commission and any equivalent credentialing organizations 
     which have been approved under subsection (a)(5)(C) for the 
     certification of nurses under this subsection.''.
       (2) Section 212(a)(5)(C) of the Immigration and Nationality 
     Act (8 U.S.C. 1182(a)(5)(C)) is amended by striking ``Any 
     alien who seeks'' and inserting ``Subject to subsection (r), 
     any alien who seeks''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall take effect on the date of the enactment of this Act, 
     without regard to whether or not final regulations to carry 
     out such amendments have been promulgated by such date.
       (c) Issuance of Certified Statements.--The Commission on 
     Graduates of Foreign Nursing Schools, or any approved 
     equivalent independent credentialing organization, shall 
     issue certified statements pursuant to the amendment under 
     subsection (a) not more than 35 days after the receipt of a 
     complete application for such a statement.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
California (Mr. Rogan) and the gentleman from Guam (Mr. Underwood) each 
will control 20 minutes.
  The Chair recognizes the gentleman from California (Mr. Rogan).


                             General Leave

  Mr. ROGAN. Mr. Speaker, I ask unanimous consent that all Members may 
have 5 legislative days within which to revise and extend their remarks 
on H.R. 441.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from California?
  There was no objection.
  Mr. ROGAN. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, because of a shortage of nurses in the late 1980's, 
Congress passed the Immigration Nursing Relief Act of 1989. That act 
created for a period of 5 years the H-1A temporary visa program for 
registered nurses. When the H-1A program sunset, the House of 
Representatives decided against extending it.
  There does not appear to be a national nursing shortage today, so 
there is no need to revise the H-1A program. However, a number of 
hospitals with unique circumstances are still experiencing great 
difficulty in attracting American nurses. Hospitals serving mostly poor 
patients in inner-cities have special difficulties. So do certain 
hospitals in rural areas.
  H.R. 441, the Nursing Relief for Disadvantaged Areas Act of 1999, 
introduced by the gentleman from Illinois (Mr. Rush), has been drafted 
very narrowly to help precisely these kind of hospitals. It will create 
a new temporary registered nurse visa program designated H-1C that 
would provide up

[[Page 10547]]

to 500 visas a year and that would sunset in 4 years.
  To be able to petition for an alien, an employer would have to meet 4 
conditions: First, the employer would have to be located in a health 
professional shortage area as designated by the Department of Health 
and Human Services. Second, the employer would have to have at least 
190 acute care beds. Third, a certain percentage of the employer's 
patients would have to be Medicare patients. Finally, a certain 
percentage of patients would have to be Medicaid patients.
  The H-1C program created by this bill would adopt those protections 
for American nurses contained in the expired H-1A program. For 
instance, for a hospital to be eligible for H-1C nurses, it would have 
to agree to take timely and significant steps to recruit American 
nurses. Also H-1C nurses would have to be paid the prevailing wage.
  Additional protections have also been added. H-1C nurses cannot be 
able to comprise more than 33 percent of a hospital's workforce of 
registered nurses and a hospital cannot contract H-1C nurses to work at 
another facility.
  Our goal should be that set out by the Immigration Nursing Relief 
Advisory Committee created by the Immigration Nursing Relief Act of 
1989. We need to balance both the continuing need for foreign nurses in 
certain specialties and localities for which there are not adequate 
domestic registered nurses and the need to continue to lessen 
employers' dependence on foreign registered nurses and protect the 
wages and working conditions of U.S. registered nurses.
  Mr. Speaker, I believe this bill successfully balances both these 
needs. Because it is so narrowly drafted it is not opposed by the 
American Nurses Association. I urge my colleagues to support the bill.
  Mr. Speaker, I reserve the balance of my time.
  Mr. UNDERWOOD. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, I rise in support of this legislation introduced by the 
gentleman from Illinois (Mr. Rush) which addresses a pressing need for 
nurses at low income inner-city hospitals. When similar legislation was 
proposed last Congress, I expressed my concerns that it did not include 
adequate safeguards to protect American workers. Fortunately, this 
legislation was amended to specify that the relief was only temporary 
and to allow us to move more firmly in the direction of developing a 
more permanent solution to this problem that will utilize nurses from 
the American workforce instead of continuing to rely on foreign labor. 
I supported the revised bill, which passed the committee in the House 
last year before we ran out of time in the Senate.
  The legislation being considered today is nearly identical to the 
legislation the House approved last Congress. It would allow up to 500 
fully qualified foreign nurses to enter the United States each year to 
work for 3 year periods at hospitals that have not been able to hire 
enough nurses from the American workforce.
  Since we are facing a temporary shortage of workers, the legislation 
sunsets in 4 years. The bill also provides for a determination to be 
made on whether the hospitals are taking reasonable steps to recruit 
and retain nurses from the American workforce. In addition, the 
Department of Labor and the Department of Health and Human Services 
would be required to conduct a study to establish ways for these 
American hospitals to meet their staffing needs with nurses from the 
American workforce instead of continuing to rely on foreign labor.
  Finally, the legislation also includes a provision creating an 
abbreviated certification process for foreign nurses who meet specified 
qualification standards. This change is needed to eliminate unnecessary 
and inappropriate steps in the certification process for ensuring the 
qualifications of these nurses to work in the United States.
  I am a proud cosponsor of this bill, and I would certainly like to 
congratulate the work of the gentleman from Illinois (Mr. Rush), the 
gentleman from Illinois (Mr. Hyde), the gentleman from Michigan (Mr. 
Conyers), and, of course, the gentlewoman from Texas (Ms. Jackson-Lee) 
on H.R. 441.
  On a note relating to Guam, Guam, unfortunately, does not qualify 
because of a certain threshold here on hospital beds, but certainly I 
hope we will be able to work that out at some time along in the process 
or perhaps with different legislation.
  Mr. Speaker, I yield such time as she may consume to the gentlewoman 
from Texas (Ms. Jackson-Lee).
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I thank the distinguished 
gentleman from Guam, one, for his cosponsorship and leadership, and 
certainly I appreciate his effort on our behalf with respect to 
managing the time on this legislation.
  The distinguished gentleman from California (Mr. Rogan) and, of 
course, the distinguished gentleman from Texas (Mr. Smith), the 
chairman of this committee, and myself are delighted to bring H.R. 441 
to the floor of the House. We want to congratulate and applaud the 
gentleman from Illinois (Mr. Rush), who had the insight and leadership 
to bring this legislation forward.
  I would like to take the time, Mr. Speaker, to read into the record 
the words and comments of the American Nurses Association, and will 
subsequently have this letter submitted into the Record.
  I read the letter primarily because I think this is also, this 
legislation, an affirmation of the importance of nurses in our Nation. 
We want to thank them. The American Nurses Association stands as the 
longstanding organization, the only full service professional nursing 
organization in the country, along with, of course, other organizations 
that have organized themselves around nursing.
  The letter begins, ``Dear Congresswoman Lee, the American Nurses 
Association appreciates the opportunity to comment on H.R. 441, the 
Nursing Relief Act for Disadvantaged Areas of 1999.'' They again state 
that they are the only full service professional nursing organization. 
``We have a longstanding interest in the development of nursing 
workforce policy.''
  ``Overall, the ANA 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 over 
reliance on foreign educated nurses by the hospital industry serves 
only to postpone real efforts to address the nursing workforce needs of 
the United States.''
  However, they remain neutral, and state they will ``look forward to 
ongoing discussions with the committee to address this complex issue.''
  Mr. Speaker, I include the letter for the Record.
                                      American Nurses Association,


                                      600 Maryland Avenue, SW,

                                   Washington, DC, March 18, 1999.
     Hon. Sheila Jackson Lee,
     Ranking Minority Member, Subcommittee on Immigration and 
         Claims, Washington, DC
       Dear Congresswoman Lee: The American Nurses Association 
     (ANA) appreciates the opportunity to comment on H.R. 441, the 
     Nursing Relief for Disadvantaged Areas Act of 1999. As the 
     only full-service professional nursing organization, we have 
     a long-standing interest in the development of nursing 
     workforce policy.
       Overall, ANA 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 over reliance on foreign educated nurses by 
     the hospital industry serves only to postpone real efforts to 
     address the nursing workforce needs of the United States.
       With regard to H.R. 441, ANA has taken a position of 
     neutrality. However, ANA will adamantly oppose any amendments 
     which seek to broaden the application of this visa or would 
     lessen the protections afforded registered nurses under this 
     measure.
       ANA looks forward to opportunities for ongoing discussions 
     with the Committee as they seek to address this complex 
     issue.
       Sincerely,
                            Beverly L. Malone, PhD, RN, President.

  Mr. Speaker, they too recognize the importance of addressing the 
question of the shortage of nurses. I want to thank them for their 
responsible letter that says that they will not oppose this legislation 
and will work along with us.

[[Page 10548]]

  They have worked with us during this process to ensure that the 
process would be limited and, I believe, with the leadership of the 
gentleman from Illinois (Mr. Rush) and the gentleman from Texas 
(Chairman Smith), that we have come to a point where all of us can 
agree on this legislation.
  The Registered Nurse Temporary Visa Program was created by the 
Immigration Nursing Relief Act of 1989 and expired in 1997. The 
Immigration Nursing Relief Act was enacted in response to a nationwide 
shortage of nurses sufficient to disrupt the delivery of services to 
patients in some of our health care institutions and to potentially 
place patients in jeopardy.
  The program allowed health care institutions who attested there would 
be a substantial disruption in the provision of health care services 
without the help of the alien nurses to essentially sponsor such a 
nurse.
  Nurses admitted under the program were permitted to stay in the 
United States for an initial period of 3 years, but that period was 
subject to a possible extension up to a total of 5 years. The New York 
City, Chicago, Houston, Los Angeles and Miami areas accounted for two-
thirds of all petitions filed because of the enormous need in these 
communities.
  I support H.R. 441 because it creates a new registered nurse 
temporary visa program that would sunset after 5 years in collaboration 
with the insight provided for us by the American Nurses Association. It 
would limit the number of visas that can be issued to 50 a year and 
hospitals would be able to petition for an alien nurse to those in 
need. H.R. 441 would serve to decrease the nursing shortage in the 
United States and set up a new H-1C visa program.
  I would also like to note, as I indicated earlier again, that the 
American Nurses Association has offered themselves to work and 
collaborate with us on stabilizing the nursing profession. There is no 
greater asset to our hospital and health profession industry, if you 
will, or the nurturing of Americans that does not include our nursing 
professionals, whether it is in home care, whether it is in our 
community clinics, or whether it is in our hospitals. They are an 
important aspect of our medical system in this Nation.

                              {time}  1515

  So I am delighted that they are not opposing this legislation.
  I also want to close, simply, Mr. Speaker, by acknowledging again the 
gentleman from Illinois (Mr. Rush) who has worked on this legislation 
for now two sessions, and we are delighted that we are able to bring it 
to the floor of the House.
  I know that the gentleman from Illinois (Mr. Rush) was en route, but 
all of us has found ourselves struggling with the air traffic today. I 
know that he will want to submit his statement into the Record. I want 
to congratulate him.
  Mr. UNDERWOOD. Mr. Speaker, I certainly would like to again reiterate 
our congratulations to the gentleman from Illinois (Mr. Rush) for his 
diligence in this, and I thank the majority for their cooperation.
  Mr. Speaker, I yield back the balance of my time.
  Mr. RUSH. Mr. Speaker, I rise today to encourage my colleagues to 
vote for H.R. 441, the Nursing Relief for Disadvantaged Areas Act of 
1999.
  My reason for introducing and encouraging support for this 
legislation is simple--it will assist the underserved communities of 
this nation by providing adequate health care for their residents.
  Today, there are some areas in this country which experience a 
scarcity of health professionals, even though numbers indicate that no 
nursing shortage exists nationally. Such an area 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.
  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. St. Bernard's Hospital utilized the H1-A program to 
maintain an adequate nursing staff level. The H1-A program was vital to 
St. Bernard's continued existence. Prior to this program, St. Bernard 
hired temporary nurses. As a result, the hospital's nursing 
expenditures increased by approximately $2 million in an effort to 
provide health care to its patients in 1992. This additional cost 
brought St. Bernard's close to closing its doors. The H1-A visa program 
expired on September 30 1997. Currently, no program exists that would 
assist hospitals such as St. Bernards in their effort to retain 
qualified nurses.
  My legislation merely seeks to close the gap created by the 
expiration of the H1-A program. H.R. 441, 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%; and (4) have a Medicaid population of at least 28%.
  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 sets a cap on the number of new visas that may 
be issued each year. The legislation 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.
  Mr. HYDE. Mr. Speaker, I am pleased that we are returning today to 
some unfinished business from the 105th Congress--noncontroversial 
legislation that provides short-term relief to hospitals with critical 
needs that cannot recruit and retain adequate numbers of registered 
nurses. H.R. 441, the ``Nursing Relief for Disadvantaged Areas Act of 
1999,'' is designed in response to a crisis facing some large hospitals 
with high percentages of Medicare and Medicaid patients in areas where 
there are shortages of health care professionals. The viability of 
essential health care for large numbers of people is threatened when 
certain acute care facilities in medically underserved, impoverished 
communities are unable to meet their requirements.
  H.R. 441 provides such hospitals relief in compelling circumstances 
by facilitating the temporary admission to the United States of 
registered nurses in an H-1C nonimmigrant visa category--subject to a 
nationwide ceiling of 500 visas issued annually and limits of 50 or 25 
(depending on a state's population) on the numbers of nurses who can 
receive visas each year for employment by hospitals in any one state. 
The legislation includes an exception from per state limits to 
facilitate the potential use of otherwise unused visas--as long as the 
annual nationwide ceiling is not breached.
  This narrowly focused program for nurses, which will sunset after a 
four period, addresses urgent needs that cannot be met in any other 
way. The House bill was introduced by our colleague from Illinois, Mr. 
Rush, with my cosponsorship--and its Senate counterpart was introduced 
by Senator Durbin with Senator Hutchison's cosponsorship.
  I became involved in this effort to enact remedial legislation when 
Saint Bernard Hospital, located in the Englewood Community in Chicago, 
brought its precarious situation with regard to nursing shortages to my 
attention during the last Congress. Because I knew the continued 
functioning of Saint Bernard Hospital would be so essential to the 
residents of the Englewood Community, I decided to endorse an 
appropriately limited legislative remedy.
  H.R. 441, like the bill that passed the House last year, clearly 
merits bipartisan congressional support. It provides relief to 
particularly vulnerable hospitals and incorporates many safeguards 
designed to protect American jobs.
  I commend the gentleman from Texas [Lamar Smith], Chairman of the 
Subcommittee on Immigration and Claims, and the gentleman form Michigan 
[John Conyers], Ranking Minority Member of our full committee, for 
their important contributions to this carefully crafted legislation. 
Because the language of the bill in its current form reflects a 
consensus among House and Senate members of both parties, I am hopeful 
that it can be enacted

[[Page 10549]]

into law expeditiously. I urge my colleagues to support it.
  Mr. CONYERS. Mr. Speaker, I rise in support of this legislation, 
introduced by Mr. Rush, which addresses a pressing need for nurses at 
low income, inter-city hospitals.
  When similar legislation was proposed last Congress, I expressed my 
concerns that it did not include adequate safeguards to protect 
American workers. Fortunately, the legislation was amended to specify 
that the relief was only temporary and to allow us to move firmly in 
the direction of developing a more permanent solution to this problem 
that will utilize nurses from the American work force instead of 
continuing to rely on foreign labor. I supported the revised bill which 
passed the committee and the House last year, before we ran out of time 
in the Senate.
  The legislation being considered today is nearly identical to the 
legislation the House approved last Congress. It would allow up to 500 
fully qualified foreign nurses to enter the United States each year to 
work for three-year periods at hospitals that have not been able to 
hire enough nurses from the American work force. Since we are facing a 
temporary shortage of workers, the legislation sunsets in four years.
  The bill also provides for a determination to be made on whether the 
hospitals are taking reasonable steps to recruit and retain nurses from 
the American work force. In addition, the Department of Labor and the 
Department of Health and Human Services would be required to conduct a 
study to establish ways for these hospitals to meet their staffing 
needs with nurses from the American work force instead of continuing to 
rely on foreign labor.
  Finally, the legislation also includes a provision creating an 
abbreviated certification process for foreign nurses who meet specified 
qualification standards. This change is needed to eliminate unnecessary 
and inappropriate steps in the certification process for ensuring the 
qualifications of these nurses to work in the United States.
  Mr. ROGAN. Mr. Speaker, I thank my colleagues for their comments.
  Mr. Speaker, I have no further requests for time, and I yield back 
the balance of my time.
  The SPEAKER pro tempore (Mr. Pease). The question is on the motion 
offered by the gentleman from California (Mr. Rogan) that the House 
suspend the rules and pass the bill, H.R. 441.
  The question was taken; and (two-thirds having voted in favor 
thereof) the rules were suspended and the bill was passed.
  A motion to reconsider was laid on the table.

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