[Congressional Record (Bound Edition), Volume 154 (2008), Part 7]
[House]
[Pages 9661-9663]
[From the U.S. Government Publishing Office, www.gpo.gov]




   EXTENDING PROGRAM RELATING TO WAIVER OF FOREIGN COUNTRY RESIDENCE 
      REQUIREMENT WITH RESPECT TO INTERNATIONAL MEDICAL GRADUATES

  Mr. SCOTT of Virginia. Mr. Speaker, I move to suspend the rules and 
pass the bill (H.R. 5571) to extend for 5 years the program relating to 
waiver of the foreign country residence requirement with respect to 
international medical graduates, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 5571

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

     SECTION 1. EXTENSION OF WAIVER PROGRAM.

       Section 220(c) of the Immigration and Nationality Technical 
     Corrections Act of 1994 (8 U.S.C. 1182 note) is amended by 
     striking ``June 1, 2008'' and inserting ``June 1, 2013''.

     SEC. 2. EXPANDING THE FLEXIBILITY OF THE CONRAD STATE 30 
                   PROGRAM.

       Section 214(l)(1)(D)(ii) of the Immigration and Nationality 
     Act (8 U.S.C. 1184(l)(1)(D)(ii)) is amended by striking ``5'' 
     and inserting ``10''.

     SEC. 3. SENSE OF CONGRESS.

       It is the sense of the Congress that--
       (1) Federal programs waiving the 2-year foreign residence 
     requirement under section 212(e) of the Immigration and 
     Nationality Act (8 U.S.C. 1182(e)) for physicians are 
     generally designed to promote the delivery of critically 
     needed medical services to people in the United States 
     lacking adequate access to physician care; and
       (2) when determining the qualification of a location for 
     designation as a health professional shortage area, the 
     Secretary of Health and Human Services should consider the 
     needs of vulnerable populations in low-income and 
     impoverished communities, communities with high infant 
     mortality rates, and communities exhibiting other signs of a 
     lack of necessary physician services.

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from 
Virginia (Mr. Scott) and the gentleman from Iowa (Mr. King) each will 
control 20 minutes.
  The Chair recognizes the gentleman from Virginia.


                             General Leave

  Mr. SCOTT of Virginia. Mr. Speaker, I ask unanimous consent that all 
Members have 5 legislative days to revise and extend their remarks and 
to include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Virginia?
  There was no objection.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield myself such time as I may 
consume.
  Today we take urgent action to prevent a critically important 
immigration program from expiring.
  No one disputes that there is a health care crisis in this country. 
With our population aging, there can be no doubt that the demand for 
health care will only increase.
  The problem is made worse by the fact that many people in communities 
across America lack access to health care because of a shortage of 
medical professionals, including doctors. H.R. 5571 will reauthorize 
the program, the Conrad 30 J Waiver program, that has been successful 
in helping medically underserved communities attract highly skilled 
physicians. If Congress does not act, the Conrad program will expire on 
June 1, 2008.
  And how important is this program? Well, to take just one example, a 
little more than a year ago, in early May 2007, a powerful tornado tore 
through a Kansas prairie, destroying 95 percent of the town of 
Greensburg and killing 11 people. Because of the Conrad 30 program, 
doctors were available in Greensburg to serve this community in need. 
The Conrad 30 program allows States, like Kansas, to recommend that 
doctors who have received medical training in the United States on a J-
1 visa and who now want to work in medically underserved areas receive 
waivers from the general requirement that doctors first return to their 
home countries for 2 years. This is too important a program to let 
expire.
  I want to commend the gentlewoman from California (Ms. Zoe Lofgren), 
the Chair of the Immigration Subcommittee, for her leadership on this 
issue. I also want to thank the ranking member of the full committee, 
the gentleman from Texas (Mr. Smith); and the gentlewoman from Texas 
(Ms. Jackson-Lee) for their efforts to make sure that this bill came to 
the floor.
  I urge my colleagues to support this important legislation.
  Mr. Speaker, I reserve the balance of my time.
  Mr. KING of Iowa. Mr. Speaker, I yield myself such time as I may 
consume.
  Mr. Speaker, aliens who participate in medical residencies in the 
United States on J exchange program visas must generally leave the U.S. 
at the conclusion of their residencies to reside abroad for 2 years 
before they can be eligible for permanent residence or status as H-1B 
or L visa nonimmigrants. The intent behind this policy to encourage 
American-trained foreign doctors to return home to improve health 
conditions and advance the medical professions in their native 
countries.
  In 1994 Congress created a waiver of the 2-year foreign residence 
requirement. The waiver was available if requested by State departments 
of public health for foreign doctors who committed to practice medicine 
for no less

[[Page 9662]]

than 3 years in a geographic area or areas designated by the Secretary 
of Health and Human Services as having a shortage of health care 
professionals. The number of foreign doctors who could receive the 
waiver was limited to 20 per State.
  Congress has extended this waiver on multiple occasions and has also 
expanded the numerical limitation on waivers to 30 per State. The 
waiver is set to expire on June 1 of this year. In fiscal year 2007, 
768 foreign doctors received waivers.
  H.R. 5571 will further extend the waiver until June 1, 2013. I 
support this bill. The waiver program assists people in rural and 
inner-city communities in getting good quality and accessible medical 
care. As I look at the problem of access to health care and the way we 
have addressed it in this Congress, it gives me a foreboding feeling to 
see where we will be in 10 years or so. I think it's an important 
piece, a small piece, but an important piece of our health care plan. I 
urge its adoption.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SCOTT of Virginia. 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 rise as well to support the 
legislation, H.R. 5571, and to commend the chairwoman of the 
Subcommittee on Immigration of the House Judiciary Committee for her 
leadership on this issue, Congresswoman Zoe Lofgren. I thank the 
manager of the bill, Mr. Scott, for his leadership; our chairman of the 
full committee; our ranking member of the full committee; and the 
ranking member of the Immigration Subcommittee, Mr. King of Iowa.
  This is an embracing and unifying initiative. Why? Because we all 
understand the necessity of health care in America. We understand the 
importance of providing access to health care no matter where you live. 
And I thank Mr. Blake Chisam and my staff, Mr. Arthur Sidney, for 
working on language that I proposed to emphasize the importance of the 
provision that these doctors receive and should be guided by language 
that indicate that they should be utilized in areas that are 
underserved, that there are doctors that are not serving the area.

                              {time}  1630

  So that foreign doctors who will benefit from the waiver provisions, 
which means eliminating the need for foreign medical doctors to return 
to their native land, will be utilized or encouraged to be utilized in 
areas around the country. The language in particular reads: It is the 
sense of Congress that Federal programs waiving the J-1 home residency 
requirement for physicians are generally designed to promote the 
delivery of critically needed medical services to Americans lacking 
adequate access to physician care, and that when determining the 
qualification of location for a waiver petition, the Department of 
Health and Human Services should always consider the needs of 
vulnerable populations in low-income and impoverished communities, 
communities with high infant mortality rates, rural areas, and 
communities exhibiting other signs of a lack of necessary physician 
services.
  In my State of Texas, we have been fighting for this for a very long 
time. In the rural parts of Texas, we are lacking in medical services 
and physicians. It's very important when these waivers are given that 
these physicians are utilized where they can best serve, and that is in 
vast number of areas that do not have access to health care.
  I support this legislation, H.R. 5571, and I think as it comes to the 
floor, it contains all the elements that suggest a benefit that brings 
about a burden, but not a burden that is negative but a burden to serve 
those who are in desperate need. Many of our country are, and these 
physicians can help them. With that, I believe this is an important 
bill.
  Mr. Speaker, I rise today in support of H.R. 5571, to extend for 5 
years the program relating to waiver of the foreign country residence 
requirement with respect to international medical graduates. The 
purpose of this bill is to extend for 5 years the program relating to a 
waiver of the foreign country residence requirement with respect to 
international medical graduates. I support this bill.
  The Immigration and Nationality Act allows for foreign doctors to 
train in the United States under the ``J-1'' visa program, otherwise 
known as non-immigrants in the ``Exchange Visitor Program.'' This 
Exchange Visitor Program seeks to promote peaceful relations and mutual 
understanding with other countries through educational and cultural 
exchange programs. Accordingly, many exchange visitors, including 
doctors in training, are subject to a requirement that they must return 
to their home country to share with their countrymen the knowledge, 
experience, and impressions gained during their stay in the United 
States. Unless U.S. Customs and Immigration Service approves a waiver 
of this requirement, the exchange visitors must depart from the United 
States and live in their home country for 2 years before they are 
allowed to apply for an immigrant visa, permanent residence, or a new 
non-immigrant status.
  A waiver of the 2 year foreign residency requirement is available for 
doctors who have trained in the United States under the J-1 visa if a 
State or an interested Federal agency sponsors the physician exchange 
visitor to work in a health manpower shortage area within the State for 
3 years as a non-immigrant in H-1B status (temporary worker in 
specialty occupation). The Secretary of Health and Human Services 
determines which areas have a health manpower shortage.
  The availability of this waiver will sunset on June 1, 2008. H.R. 
5571 would extend this waiver for 5 years to ensure that areas in the 
United States with a shortage of doctors have an option to hire a 
doctor with a J-1 visa for 3 years where there is no other doctor 
available to fill the job.
  I worked with Congresswoman Zoe Lofgren to ensure that the foreign 
doctors who will benefit from the waiver provisions, eliminating the 
need for the foreign medical doctors to return to their native land, 
will be required to work in impoverished and underserved inner-city and 
urban communities. I believe that this is important because Americans 
who need access to medical care, the poor and needy, will benefit. This 
would be a tremendous improvement in the U.S. medical system and would 
move us closer to garnering access to healthcare for all.
  Specifically, I worked to include the following language in the bill:

       It is the sense of Congress that Federal programs waiving 
     the J-1 home residency requirement for physicians are 
     generally designed to promote the delivery of critically 
     needed medical services to Americans lacking adequate access 
     to physician care and that when determining the qualification 
     of a location for a waiver petition, the Department of Health 
     and Human Services should always consider the needs of 
     vulnerable populations in low-income and impoverished 
     communities, communities with high infant mortality rates, 
     rural areas, and communities exhibiting other signs of a lack 
     of necessary physician services.

  Across this great Nation the health disparities between minority and 
majority populations are staggering. Most major diseases--diabetes, 
heart disease, prostate cancer, HIV/AIDS, low-birth-weight babies--all 
hit the minority communities harder. Minorities consistently have 
decreased access to care, and receive lower quality care, when they do 
have access. As the economy continues to falter and as the unemployment 
rate spikes, millions of Americans are losing their health insurance. 
That state of affairs will only make the health disparities worse. 
Consider these statistics:
  African-American women are nearly three times as likely to die from 
pregnancy complications and childbirth as White women.
  Native American, African-American and Hispanic women are most likely 
to receive inadequate prenatal care.
  Compared with White women, African American women are twice as likely 
and Hispanic women are nearly three times as likely to be uninsured. 
Furthermore, African Americans and Hispanics are much more likely than 
Whites to lack a usual source of care and to encounter other 
difficulties in obtaining needed care.
  Certain minorities also have much higher rates of diabetes-related 
complications and death, in some instances by as much as 50 percent 
more than the total population. It is truly an epidemic.
  Nearly 31 percent of African American girls in the 4th grade were 
overweight in 2001.
  Thirteen percent of Houston high school students are overweight and 
17 percent are at risk.
  Thirty-four percent of African American women are obese, compared to 
19 percent of White women.
  Forty-four percent of African American women are projected to be 
obese by 2020, and 47 percent by 2040.

[[Page 9663]]

  As of February 2006, African-Americans represented only 13 percent of 
the U.S. population, but accounted for 40 percent of the 944,306 AIDS 
cases diagnosed since the start of the epidemic and approximately half, 
49 percent, of the 42,514 cases diagnosed in 2004 alone.
  African-Americans also account for half of new HIV/AIDS diagnoses in 
the 35 States/areas with confidential name-based reporting.
  The AIDS case rate per 100,000 population among African-American 
adults/adolescents was nearly 10.2 times that of Whites in 2004.
  African-Americans accounted for 55 percent of deaths due to HIV in 
2002 and their survival time after an AIDS diagnosis is lower on 
average than it is for other racial/ethnic groups.
   HIV was the third leading cause of death for African-Americans, ages 
25-34, in 2002 compared to the sixth leading cause of death for Whites 
and Latinos in this age group.
  African-American women account for the majority of new AIDS cases 
among women, 67 percent in 2004; while White women account for 17 
percent and Latinos 15 percent. Among African-Americans, African-
American women represent more than a third, 36 percent, of AIDS cases 
diagnosed in 2004.
  Although African-American teens, ages 13-19, represent only 15 
percent of U.S. teenagers, they accounted for 66 percent of new AIDS 
cases reported among teens in 2003.
  It is my hope that the language that I worked to get included in the 
bill will promote the delivery of critically needed medical services to 
Americans in low-income and impoverished communities, rural areas, and 
communities that are in desperate need of physician services.
  I urge my colleagues to support this bill.
  Mr. KING of Iowa. I have no further speakers, and I will yield myself 
such time as I may consume.
  Mr. Speaker, I rise in support of this bill. I think reauthorizing 
the J visas for access to health care across this Nation, allowing 
people practicing medicine to come in at the rate of 30 per State, and 
look around to see which States utilize that and which ones don't, it 
is easy for us to see those States that need that access to health 
care. This will help. It will help in a lot of the States. In fact, it 
will help in all the States, if they use it.
  I urge its adoption.
  Mr. McHUGH. Mr. Speaker, I rise today in support of H.R. 5571, which 
provides a 5-year extension of the Conrad 30 J Waiver Program. That 
program is of critical importance to my constituents and to our Nation 
as a whole because it provides a mechanism whereby doctors can be 
provided to medically underserved areas.
  I have the privilege of representing New York State's 23rd 
Congressional District, a predominantly rural region which encompasses 
14,739 square miles in 11 counties in northern and central New York. It 
is breathtakingly beautiful and contains national treasures such as 
Lake Champlain, the St. Lawrence River, Lake Ontario, and the 
Adirondack Mountains. However, it has a 13.5 percent poverty rate and 
some have characterized it as remote.
  One of our greatest challenges is recruiting and retaining 
physicians. In fact, given its importance to our economy and quality of 
life, that challenge is almost always raised whenever I meet with the 
fine men and women who serve as local elected officials, business 
community leaders, or health professionals.
  The Conrad 30 J Waiver Program is an invaluable tool in our effort to 
meet that challenge. In fact, since 1996, my office has helped secure 
waivers for 46 doctors, including 7 primary care physicians located in 
6 of the 11 counties I represent. While these doctors have helped 
immensely in our effort to address our physician shortage, I am 
hesitant to imagine a scenario where we did not have the Conrad 30 J 
Waiver Program.
  Accordingly, I greatly appreciate the work the Gentlewoman from 
California (Ms. Lofgren) and the Gentleman from Michigan (Mr. Conyers) 
have done to bring this measure to the floor and look forward to its 
enactment.
  Mr. KING of Iowa. I yield back the balance of my time.
  Mr. SCOTT of Virginia. Mr. Speaker, I yield back the balance of my 
time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Virginia (Mr. Scott) that the House suspend the rules 
and pass the bill, H.R. 5571, as amended.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds 
being in the affirmative, the ayes have it.
  Mr. KING of Iowa. Mr. Speaker, I object to the vote on the ground 
that a quorum is not present and make the point of order that a quorum 
is not present.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX and the 
Chair's prior announcement, further proceedings on this motion will be 
postponed.
  The point of no quorum is considered withdrawn.

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