[Congressional Record (Bound Edition), Volume 150 (2004), Part 17]
[Senate]
[Pages 23344-23346]
[From the U.S. Government Publishing Office, www.gpo.gov]




     IMPROVING ACCESS TO PHYSICIANS IN MEDICALLY UNDERSERVED AREAS

  Mr. SESSIONS. I ask unanimous consent that the Senate proceed to the 
immediate consideration of Calendar No. 775, S. 2302.
  The PRESIDING OFFICER. The clerk will report the bill by title.
  The assistant legislative clerk read as follows:

       A bill (S. 2302) to improve access to physicians in 
     medically underserved areas.

  There being no objection, the Senate proceeded to consider the bill 
which had been reported from the Committee on the Judiciary, with an 
amendment to strike all after the enacting clause and insert in lieu 
thereof the following:
  [Strike the part in black brackets and insert in lieu thereof the 
part printed in italic.]

                                S. 2302

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     [SECTION 1. WAIVER OF FOREIGN COUNTRY RESIDENCE REQUIREMENT 
                   WITH RESPECT TO INTERNATIONAL MEDICAL 
                   GRADUATES.

       [(a) Extension of Deadline.--Section 220(c) of the 
     Immigration and Nationality Technical Corrections Act of 1994 
     (8 U.S.C. 1182 note) (as amended by section 11018 of Public 
     Law 107-273) is amended by striking ``2004.'' and inserting 
     ``2009.''.
       [(b) Designation of Health Professional Shortage Areas by 
     State Agencies.--Section 214(l)(1)(D) of the Immigration and 
     Nationality Act (8 U.S.C. 1184(l)(1)(D)) is amended--
       [(1) by striking ``professionals,'' and inserting 
     ``professionals or in other shortage locations specified by a 
     State department of public health (or its equivalent),''; and
       [(2) by striking ``in a geographic area designated by the 
     Secretary.'' and inserting ``in such a geographic area or 
     other shortage location.''.
       [(c) Exemption From H-1B Numerical Limitations.--Section 
     214(l)(2)(A) of the Immigration and Nationality Act (8 U.S.C. 
     1184(l)(2)(A)) is amended by adding at the end the following: 
     ``The numerical limitations contained in subsection (g)(1)(A) 
     shall not apply to any alien whose status is changed under 
     the preceding sentence, if the alien obtained a waiver of the 
     2-year foreign residence requirement upon a request by an 
     interested State agency.''.]

     SECTION 1. MODIFICATION OF VISA REQUIREMENTS WITH RESPECT TO 
                   INTERNATIONAL MEDICAL GRADUATES.

       (a) Extension of Deadline.--
       (1) In general.--Section 220(c) of the Immigration and 
     Nationality Technical Corrections Act of 1994 (8 U.S.C. 1182 
     note) (as amended by section 11018 of Public Law 107-273) is 
     amended by striking ``2004.'' and inserting ``2006.''.
       (2) Effective date.--The amendment made by paragraph (1) 
     shall take effect as if enacted on May 31, 2004.
       (b) Exemption From H-1B Numerical Limitations.--Section 
     214(l)(2)(A) of the Immigration and Nationality Act (8 U.S.C. 
     1184(l)(2)(A)) is amended by adding at the end the following: 
     ``The numerical limitations contained in subsection (g)(1)(A) 
     shall not apply to any alien whose status is changed under 
     the preceding sentence, if the alien obtained a waiver of the 
     2-year foreign residence requirement upon a request by an 
     interested Federal agency or an interested State agency.''.
       (c) Limitation on Medical Practice Areas.--Section 
     214(l)(1)(D) of the Immigration and Nationality Act (8 U.S.C. 
     1184(l)(1)(D)) is amended by striking ``agrees to practice 
     medicine'' and inserting ``agrees to practice primary care or 
     specialty medicine''.
       (d) Exemptions.--Section 214(l)(1)(D) of the Immigration 
     and Nationality Act (8 U.S.C. 1184(l)(1)(D)) is further 
     amended--
       (1) by striking ``except that,'' and all that follows and 
     inserting ``except that--''; and
       (2) by adding at the end the following:
       ``(i) in the case of a request by the Department of 
     Veterans Affairs, the alien shall not be required to practice 
     medicine in a geographic area designated by the Secretary;
       ``(ii) in the case of a request by an interested State 
     agency, the head of such State agency determines that the 
     alien is to practice medicine under such agreement in a 
     facility that serves patients who reside in one or more 
     geographic areas so designated by the Secretary of Health and 
     Human Services (without regard to whether such facility is 
     located within such a designated geographic area), and the 
     grant of such waiver would not cause the number of the 
     waivers granted on behalf of aliens for such State for a 
     fiscal year (within the limitation in subparagraph (B)) in 
     accordance with the conditions of this clause to exceed 5; 
     and
       ``(iii) in the case of a request by an interested Federal 
     agency or by an interested State agency for a waiver for an 
     alien who agrees to practice specialty medicine in a facility 
     located in a geographic area so designated by the Secretary 
     of Health and Human Services, the request shall demonstrate, 
     based on criteria established by such agency, that there is a 
     shortage of health care professionals able to provide 
     services in the appropriate medical specialty to the patients 
     who will be served by the alien.''.

  Mr. SESSIONS. I ask unanimous consent that the committee substitute 
amendment be agreed to, the bill, as amended, be read a third time and 
passed, the motions to reconsider be laid upon the table, with no 
intervening action or debate, and any statements relating to the bill 
be printed in the Record.
  The PRESIDING OFFICER. Without objection, it is so ordered.
  The committee amendment in the nature of a substitute was agreed to.

[[Page 23345]]

  The bill (S. 2302), as amended, was read the third time and passed.
  Mr. SESSIONS. Madam President, I believe that is all I have. I yield 
the floor.
  The PRESIDING OFFICER. The Senator from Maryland.
  Mr. SARBANES. Madam President, I was struck by the fact that when my 
colleague from Alabama presented his chart on economic growth, it 
stopped at the end of last year and did not carry forward into this 
year. Of course, had it carried forward into this year, it would have 
shown a declining trend in economic growth and that is a matter, 
obviously, of very deep concern. In fact, there was a story last week, 
a Reuters news story last week, that said:

       Top U.S. executives are pessimistic about next year's U.S. 
     economy. About 70 percent of the chief executives surveyed by 
     the Business Council projected flat to 2 percent U.S. 
     economic growth. More bearish than forecasts by major 
     economists, the Business Council survey, often seen as a 
     gauge of corporate sentiment, was released ahead of a meeting 
     of the group's members, about 125 CEOs from companies . . .

  Then they cite a number of the large companies in the country, saying 
generally CEOs are a bit more pessimistic, referring to the difference 
of opinion between executives and economists.
  The U.S. economy actually grew at a 3.3 percent annual rate in the 
second quarter of this year. Now these chief executives are projecting 
a flat to 2-percent growth. My colleagues on the other side, if you 
bring these uncomfortable facts to their attention, they say, well, you 
are talking doom and gloom. But how are we going to realistically deal 
with our problems if we do not face what our problems are?
  I want to address one question, because the previous presentation 
talked as though the only relevant factor is economic growth. It never 
addressed job growth. It only addressed job growth in the sense of 
saying if you had economic growth, you would have job growth. If you 
didn't have economic growth, you would have job loss. But the problem 
is more complicated than that, the problem we are confronting right 
now. I want to point out a couple of factors in that regard.
  This chart shows how unemployment has moved in previous postwar 
recoveries, and how it is moving in this one. What it shows: Of course, 
you obviously get a downward trend in employment as you go into a 
recession. Then you try to come out of a recession. Of course, 
recessions are measured by economic growth figures. In the average of 
postwar recoveries, this is what has happened with respect to 
employment. We have had this kind of growth. So we have had a good, 
rising trend in employment.
  In this recession, this is what has happened to employment. There is 
a huge gap here in terms of the recovery with respect to jobs. That is 
why we are so concerned about jobs. That is why we continuously stress 
that point.
  This figure was underscored earlier in the conversation we had about 
the number of long-term unemployed, which has jumped so substantially. 
One question becomes, Why are we not getting the jobs? I think one 
answer to that is to be found in these two charts. What we see in 
recent years is a sharp increase in productivity. In other words, that 
is what a worker can produce for each hour of work. But we do not see 
an increase in worker wages. Productivity is growing much faster than 
worker wages. The workers who are producing more for each hour worked 
are, in effect, not sharing in the benefits and their wages are running 
virtually constant.
  One might ask, What happened in other recessions? What usually 
happens is that worker wages, as you come out of the recession, rise 
commensurate with their share of the economy, which is about two-
thirds. But here is what is happening this time. The worker wages are 
not rising, but the corporate profits are rising 65 percent. So most of 
the benefit from the economic growth in this partial recovery is not 
going to the workers, but it is going to corporate profits. This is in 
marked contrast with previous recoveries. I want to underscore that 
point. This is a very different pattern than we have seen in the past. 
Of course, part of the reason for that is the policies of this 
administration.
  Then the counterargument is made on the other side: If you give the 
corporation these profits, they will invest them and therefore 
strengthen the economy, build the economy and create jobs. But here is 
what has happened in this Bush administration. These are the growth 
rates of plant and equipment investment by U.S. corporations. As you 
can see, it actually is down, negative during this Bush administration, 
compared with previous administrations in which it was a positive 
figure. So what is happening is the benefits are being skewed away from 
the workers, but those receiving the benefits are not investing them in 
the economy in order to build businesses and create jobs. That, of 
course, explains in part, in my view, why there is such a tremendous 
lag in this recovery in terms of producing jobs. There is no way you 
can get around the fact.
  I listened earlier. No one actually challenged any of the figures or 
facts about the employment situation. There is no way you can get 
around the fact that this is the first administration in 75 years not 
to have a net gain of jobs in the course of the administration. They 
are still down 825,000 jobs from where they were when they came into 
office. They are down 1.6 million jobs in the private sector and they 
are down 2.7 million manufacturing jobs.
  My colleague from Alabama says we have produced this year a gain of 
93,000 jobs. He says that is a good thing. It is a good thing in the 
sense that we want to be positive in producing manufacturing jobs. It 
is not such a good thing if you put it in the context of the fact that 
we have lost 2.7 million jobs since January of 2001. If you put the 
figure in context, I am relieved that we gained a few manufacturing 
jobs this year. That is certainly better than losing them. But if you 
are looking at the record of this administration, the fact is in the 
course of this administration they have lost 2.7 million manufacturing 
jobs.
  You can come to the floor and say we gained 93,000 manufacturing jobs 
this year, and that is a good thing. As far as that statement goes, it 
is a good thing. But it is in the context of the fact that we lost 2.7 
million jobs over this time period, over the entire time period. That 
also relates, of course, to the points that are being made now about 
the gain in jobs that has taken place--well, the month that is usually 
used by my colleagues on the other side is, I think, August of 2003. I 
am pleased and relieved that we have gained some jobs. But the fact 
remains these job gains have tailed off in recent months.
  The other side would have a story to tell if they had sustained job 
gains. They might have gotten out of the hole and actually produced 
more jobs, a net gain of jobs in the course of their administration. 
The Treasury Secretary was projecting it would create a huge number of 
jobs. It has not happened.
  As this chart indicates, we are on a descending line month to month 
in terms of job creation going back to the beginning of this year. That 
is the concern about jobs.
  It is fine and good to come to the floor and show economic growth 
charts, although one would have hoped that the chart would have carried 
out into this year and not stopped at the end of last year.
  Second, one has to take into account what people are now saying about 
what to expect on economic growth, and particularly the story from last 
week about the Business Council meeting. The leading U.S. corporation 
chief executives met in Irving, TX, where the top U.S. chief executives 
said they are pessimistic about next year's economy. About 70 percent 
of the chief executives surveyed by the Business Council projected flat 
to 2 percent U.S. economic growth.
  That is why we are concerned. That is why the public is concerned. 
That is why working people are concerned. They feel it.
  You may come to the floor and say everything is a rosy scenario. But 
if you are long-term unemployed, you know it is not a rosy scenario. 
Long-term unemployed now as a share of the unemployed is at the highest 
figure it has been--over 20 percent now for 24 straight months.

[[Page 23346]]

  Trying to portray a rosy scenario is not going to take care of the 
problem of the long-term unemployed. We tried to do something about 
that in the Senate. We tried to extend the unemployment benefits, but 
that was beaten back, regrettably. People who exhaust their benefits 
and aren't able to find a job find themselves in dire circumstances in 
terms of meeting the needs of their families.
  I think we have a serious job unemployment situation. I think we need 
to face it. I don't think it helps to simply try to brush it away, 
paper it over. These trend lines, regrettably, are not working in the 
right direction.
  Now, with this forecast from these top U.S. executives of the 
Business Council, we can see that we face an even greater challenge as 
we move towards 2005.
  I simply close with the observation that this administration has not 
produced a net gain of jobs in the course of its tenure. You have to go 
all the way back to Herbert Hoover to find an administration, whether 
Democrat or Republican, through that period that failed to produce a 
net gain of jobs in the course of that administration. That, of course, 
is one of the very key reasons this election that comes before us on 
November 2 is so important for the future of our country.
  I yield the floor.
  The PRESIDING OFFICER. The Senator from Alabama is recognized.
  Mr. SESSIONS. Madam President, I thank the distinguished Senator from 
Maryland. I know he is very skilled in his knowledge of these issues. I 
don't know how the President can be blamed for this or that, or how any 
President can be.
  I will just say this: When President Bush took office this economy 
was in trouble. In the first quarter he inherited there was negative 
growth; the second quarter was negative growth; the third quarter was 
9/11. In the third quarter of former President Clinton's last year in 
office there was substantial negative growth, and one-half of the value 
of the NASDAQ stock exchange had been lost by the time President Bush 
took office. I will just say that he inherited a problem. And in the 
last 12 to 15 months, 1.9 million jobs have been created in this 
country. We had growth as high as 8 percent late last year for the 
third quarter, which is the highest growth in 20 years.
  Yes. We have challenges. Five and four-tenths percent unemployment is 
too high for me. It is a lot better than Europe. It is a lot better 
than most countries in the world. But it is not good enough.
  But I note this: The 5.4 percent unemployment rate that we have 
today, which we are working to improve, is better than the average 
unemployment rate of the 1970s, 1980s, or 1990s.
  I hope we will continue to work on it here together in Congress, the 
President and everyone, to see what we can do to continue to help grow 
the economy. Certainly, if we don't have a growing economy we will not 
create jobs.
  Mr. SARBANES. Madam President, will the Senator yield for a question?
  Mr. SESSIONS. Yes.
  Mr. SARBANES. Was the Senator disappointed by the jobs figures for 
the month of September of 96,000?
  Mr. SESSIONS. I have not been disappointed for the last 6 months of 
job figures. There have been some tremendous numbers. What was the 
highest month we had this year? There were 300,000 or 400,000 jobs 
created in 1 month, and there was 1 where it was 100,000. I would like 
to see it stay at 200,000 or 300,000. Sure. The unemployment rate today 
is stable. But we did add jobs.
  Mr. SARBANES. The Senator has to go back to March of this year to get 
the kind of job figures he is talking about.
  Mr. SESSIONS. March of this year was just a few months ago. It is not 
as if it were 5 years ago.
  Mr. SARBANES. The concern is that these job figures are coming down 
like this. It seems to me that the Senator has to face the fact that 
this is where the job figures have been trending over the last 6 
months.
  Mr. SESSIONS. We had--how many was it? I believe 240,000 jobs were 
created last month.
  Mr. SARBANES. No.
  Mr. SESSIONS. The month before last?
  I reclaim the floor, Madam President. I was going to speak on another 
subject.
  The PRESIDING OFFICER. The Senator from Alabama has the floor.
  Mr. SARBANES. I would like to answer the question he just put to me.
  Mr. SESSIONS. Maybe the Senator could read the last 3 or 4 months in 
job creation. Does he have them? There have been some pretty good 
months in there.
  Mr. SARBANES. Not in the last 3 or 4 months, earlier in the year. 
Employment, again for the last 4 months, totaled 400,000 in the last 4 
months. So it has averaged about 100,000 a month.
  Mr. SESSIONS. It is better than what President Bush inherited from 
President Clinton.
  Mr. SARBANES. He inherited a very strong economy in terms of the 
number of people who were working. And participation in the labor force 
was up very high. We broke records in terms of job production in the 
1990s in the number of people we put to work.
  Mr. SESSIONS. All right. Madam President, I will just say this: The 
economy was sinking when President Bush took office from President 
Clinton. And a sinking economy inevitably means you are going to have 
job losses, and that is what occurred. The President has turned this 
economy around. We have seen some robust growth in the last year. And 
we have created 2 million new jobs, as the Senator well knows, and we 
can debate that round and round forever. I think the glass is at least 
half full. I guess the Senator is seeing it half empty.

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