[House Report 107-528]
[From the U.S. Government Publishing Office]



107th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     107-528

======================================================================



 
     TO IMPROVE ACCESS TO PHYSICIANS IN MEDICALLY UNDERSERVED AREAS

                                _______
                                

 June 24, 2002.--Committed to the Committee of the Whole House on the 
              State of the Union and ordered to be printed

                                _______
                                

 Mr. Sensenbrenner, from the Committee on the Judiciary, submitted the 
                               following

                              R E P O R T

                             together with

                            ADDITIONAL VIEWS

                        [To accompany H.R. 4858]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on the Judiciary, to whom was referred the 
bill (H.R. 4858) to improve access to physicians in medically 
underserved areas, having considered the same, reports 
favorably thereon without amendment and recommends that the 
bill do pass.

                                CONTENTS

                                                                   Page
Purpose and Summary..............................................     2
Background and Need for the Legislation..........................     2
Hearings.........................................................     2
Committee Consideration..........................................     2
Vote of the Committee............................................     2
Committee Oversight Findings.....................................     2
Performance Goals and Objectives.................................     3
New Budget Authority and Tax Expenditures........................     3
Congressional Budget Office Cost Estimate........................     3
Constitutional Authority Statement...............................     4
Section-by-Section Analysis and Discussion.......................     4
Changes in Existing Law Made by the Bill, as Reported............     4
Markup Transcript................................................     6
Additional Views.................................................    17

                          Purpose and Summary

    H.R. 4858 would extend authority for a waiver to permit 
certain foreign medical doctors to practice medicine in 
underserved areas without first leaving the United States and 
increase the number of foreign residence waivers to 30 per 
State.

                Background and Need for the Legislation

    Aliens who attend medical school in the United States on 
``J'' visas must leave the United States after school to reside 
abroad for 2 years before they may practice medicine in the 
United States. The intent behind this policy is to encourage 
American-trained foreign doctors to return home to improve 
health conditions and advance the medical profession in their 
native countries.
    In 1994, Congress created a waiver of the 2-year foreign 
residence requirement for foreign doctors who commit to 
practicing medicine for no less than 3 years in the geographic 
area or areas which are designated by the Secretary of Health 
and Human Services as having a shortage of health care 
professionals.\1\ The waiver limited the number of foreign 
doctors to 20 per State so that underserved areas in all States 
receive doctors under the program. The original waiver was set 
to expire June 1, 1996, but Congress extended the waiver to 
June 1, 2002.\2\
---------------------------------------------------------------------------
    \1\ Immigration and Nationality Technical Corrections Act, Pub. L. 
No. 103-416, Sec. 220, 108 Stat. 4319 (1994).
    \2\ Illegal Immigration Reform and Immigrant Responsibility Act, 
Pub. L. No. 104-208, Sec. 622, 110 Stat. 3009-695 (1996).
---------------------------------------------------------------------------
    States with underserved medical areas claim that health 
facilities in such areas will have to close down if the 
authority for these medical waivers is not extended. The States 
have also requested additional waivers so they may have more 
doctors to help keep their clinics open.

                                Hearings

    No hearings were held on H.R. 4858.

                        Committee Consideration

    On June 19, 2002, the Committee met in open session and 
ordered favorably reported the bill H.R. 4858 without amendment 
by voice vote, a quorum being present.

                         Vote of the Committee

    There were no recorded votes on H.R. 4858.

                      Committee Oversight Findings

    In compliance with clause 3(c)(1) of rule XIII of the Rules 
of the House of Representatives, the Committee reports that the 
findings and recommendations of the Committee, based on 
oversight activities under clause 2(b)(1) of rule X of the 
Rules of the House of Representatives, are incorporated in the 
descriptive portions of this report.

                    Performance Goals and Objectives

    H.R. 4858 does not authorize funding. Therefore, clause 
3(c) of rule XIII of the Rules of the House of Representatives 
is inapplicable.

               New Budget Authority and Tax Expenditures

    Clause 3(c)(2) of House rule XIII is inapplicable because 
this legislation does not provide new budgetary authority or 
increased tax expenditures.

               Congressional Budget Office Cost Estimate

    In compliance with clause 3(c)(3) of rule XIII of the Rules 
of the House of Representatives, the Committee sets forth, with 
respect to the bill, H.R. 4858, the following estimate and 
comparison prepared by the Director of the Congressional Budget 
Office under section 402 of the Congressional Budget Act of 
1974:

                                     U.S. Congress,
                               Congressional Budget Office,
                                     Washington, DC, June 21, 2002.
Hon. F. James Sensenbrenner, Jr., Chairman,
Committee on the Judiciary,
House of Representatives, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for H.R. 4858, a bill to 
improve access to physicians in medically underserved areas.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Mark 
Grabowicz, who can be reached at 226-2860.
            Sincerely,
                                  Dan L. Crippen, Director.

Enclosure

cc:
        Honorable John Conyers, Jr.
        Ranking Member
H.R. 4858--A bill to improve access to physicians in medically 
        underserved areas.
    CBO estimates that implementing H.R. 4858 would result in 
no significant net cost to the Federal Government. The bill 
would affect direct spending, so pay-as-you-go procedures would 
apply, but we estimate that any effects would be insignificant. 
H.R. 4858 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act and 
would impose no costs on State, local, or tribal governments.
    Until June 1, 2002, foreign students attending medical 
school in the United States were permitted to remain here after 
graduation if they agreed to work in rural areas for at least 3 
years or accepted employment with certain Federal agencies. 
This program was limited to 20 individuals a year for each 
state that participated in the program. Currently such 
individuals must return to their native countries. H.R. 4858 
would reestablish this program through June 1, 2004, and would 
increase the limit on the number of participants to 30 for each 
state.
    Based on the participation of foreign medical students in 
these employment programs in recent years, CBO expects that the 
bill's provisions would affect about 1,500 persons annually. 
The Immigration and Naturalization Service (INS) would collect 
fees to provide work permits for these individuals. The agency 
is authorized to spend such fees without further appropriation, 
so the net impact on INS spending would be insignificant. INS 
fees are classified as offsetting receipts (a credit against 
direct spending).
    The CBO staff contact for this estimate is Mark Grabowicz, 
who can be reached at 226-2860. This estimate was approved by 
Peter H. Fontaine, Deputy Assistant Director for Budget 
Analysis.

                   Constitutional Authority Statement

    Pursuant to clause 3(d)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee finds the authority for 
this legislation in article 1, section 8, clause 4 of the 
Constitution.

               Section-by-Section Analysis and Discussion

Sec. 1. Waiver of Foreign Country Residence Requirement with Respect to 
        International Medical Graduates.
    Section 1 of the bill increases the numerical limitation on 
waivers requested by States from 20 per State to 30 per State. 
It also extends the deadline for the authorization of the 
waiver to June 1, 2004. The effective date of the bill is 
retroactive and is written as enacted on May 31, 2002, the day 
the program expired.

         Changes in Existing Law Made by the Bill, as Reported

    In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italics, existing law in which no change 
is proposed is shown in roman):

                    IMMIGRATION AND NATIONALITY ACT

           *       *       *       *       *       *       *


                        TITLE II--IMMIGRATION

           *       *       *       *       *       *       *


 Chapter 2--Qualifications for Admission of Aliens; Travel Control of 
                         Citizens and Aliens

           *       *       *       *       *       *       *


 GENERAL CLASSES OF ALIENS INELIGIBLE TO RECEIVE VISAS AND INELIGIBLE 
               FOR ADMISSION; WAIVERS OF INADMISSIBILITY

      Sec. 212. (a)  * * *

           *       *       *       *       *       *       *

      (e) No person admitted under section 101(a)(15)(J) or 
acquiring such status after admission (i) whose participation 
in the program for which he came to the United States was 
financed in whole or in part, directly or indirectly, by an 
agency of the Government of the United States or by the 
government of the country of his nationality or his last 
residence, (ii) who at the time of admission or acquisition of 
status under section 101(a)(15)(J) was a national or resident 
of a country which the Director of the United States 
Information Agency pursuant to regulations prescribed by him, 
had designated as clearly requiring the services of persons 
engaged in the field of specialized knowledge or skill in which 
the alien was engaged, or (iii) who came to the United States 
or acquired such status in order to receive graduate medical 
education or training, shall be eligible to apply for an 
immigrant visa, or for permanent residence, or for a 
nonimmigrant visa under section 101(a)(15)(H) or section 
101(a)(15)(L) until it is established that such person has 
resided and been physically present in the country of his 
nationality or his last residence for an aggregate of a least 
two years following departure from the United States: Provided, 
That upon the favorable recommendation of the Director, 
pursuant to the request of an interested United States 
Government agency (or, in the case of an alien described in 
clause (iii), pursuant to the request of a State Department of 
Public Health, or its equivalent), or in the case of a waiver 
requested by an interested United States Government agency on 
behalf of an alien described in clause (iii), or of the 
Commissioner of Immigration and Naturalization after he has 
determined that departure from the United States would impose 
exceptional hardship upon the alien's spouse or child (if such 
spouse or child is a citizen of the United States or a lawfully 
resident alien), or that the alien cannot return to the country 
of his nationality or last residence because he would be 
subject to persecution on account of race, religion, or 
political opinion, the Attorney General may waive the 
requirement of such two-year foreign residence abroad in the 
case of any alien whose admission to the United States is found 
by the Attorney General to be in the public interest except 
that in the case of a waiver requested by a State Department of 
Public Health, or its equivalent, or in the case of a waiver 
requested by an interested United States Government agency on 
behalf of an alien described in clause (iii), the waiver shall 
be subject to the requirements of section [214(k):] 214(l): And 
provided further, That, except in the case of an alien 
described in clause (iii), the Attorney General may, upon the 
favorable recommendation of the Director, waive such two-year 
foreign residence requirement in any case in which the foreign 
country of the alien's nationality or last residence has 
furnished the Director a statement in writing that it has no 
objection to such waiver in the case of such alien.

           *       *       *       *       *       *       *


                       ADMISSION OF NONIMMIGRANTS

      Sec. 214. (a)  * * *

           *       *       *       *       *       *       *

      (l)(1) In the case of a request by an interested State 
agency, or by an interested Federal agency, for a waiver of the 
2-year foreign residence requirement under section 212(e) on 
behalf of an alien described in clause (iii) of such section, 
the Attorney General shall not grant such waiver unless--
            (A)  * * *
            (B) in the case of a request by an interested State 
        agency, the grant of such waiver would not cause the 
        number of waivers allotted for that State for that 
        fiscal year to exceed [20;] 30;

           *       *       *       *       *       *       *

                              ----------                              


 SECTION 220 OF THE IMMIGRATION AND NATIONALITY TECHNICAL CORRECTIONS 
                              ACT OF 1994

SEC. 220. WAIVER OF FOREIGN COUNTRY RESIDENCE REQUIREMENT WITH RESPECT 
                    TO INTERNATIONAL MEDICAL GRADUATES.

    (a)  * * *

           *       *       *       *       *       *       *

    (c) Effective Date.--The amendments made by this section 
shall apply to aliens admitted to the United States under 
section 101(a)(15)(J) of the Immigration and Nationality Act, 
or acquiring such status after admission to the United States, 
before, on, or after the date of enactment of this Act and 
before June 1, [2002.] 2004.

                           Markup Transcript



                            BUSINESS MEETING

                        WEDNESDAY, JUNE 19, 2002

                  House of Representatives,
                                Committee on the Judiciary,
                                                    Washington, DC.
    The Committee met, pursuant to notice, at 10:29 a.m., in 
Room 2141, Rayburn House Office Building, Hon. F. James 
Sensenbrenner, Jr. [Chairman of the Committee] presiding.
    Chairman Sensenbrenner. The Committee will be in order. A 
working quorum is present.

           *         *         *         *         *

    Pursuant to notice, I now call up the bill H.R. 4858, a 
bill to improve access to physicians in medically underserved 
areas, for purposes of markup and move its favorable 
recommendation to the House.
    Without objection, the bill will considered as read and 
open for amendment at any point.
    [The bill, H.R. 4858, follows:]
    
    
    Chairman Sensenbrenner. The Chair recognizes the Chairman 
of the Subcommittee on Immigration, Border Security, and 
Claims, Mr. Gekas, for 5 minutes to explain the bill.
    Mr. Gekas. I thank the Chair.
    This bill extends an authorization that has been applied 
for several years now. We allow, as a society, we allow foreign 
students to come in to become doctors in our own land here, 
with the condition that says that once they complete their 
medical education here in the United States, they would have to 
return to their own nation for a period of 3 years so that the 
overall purpose of the program--namely to train doctors in our 
land to help in health conditions in their land--be fulfilled.
    But in the past, we have authorized a waiver of that 
provision if the doctors who are trained in the United States 
agree to act as doctors and serve as doctors in rural and 
underserved areas for a period of 2 years. The current waiver 
of that system expires as of June 1st of this year. It has 
already expired. What we're doing is extending that 
modification, that waiver, for another 2 years, starting June 
1st of this current year.
    That's the extent of this legislation. It's a mere 
extension of a waiver that previously has been adopted by the 
Congress of the United States.
    Chairman Sensenbrenner. The gentlewoman from California, 
Ms. Lofgren.
    Ms. Lofgren. I move to strike the last word. I have several 
questions about----
    Chairman Sensenbrenner. Without objection, all Members may 
submit opening statements, which will appear at this point in 
the record.
    [The prepared statement of Ms. Jackson Lee follows:]
       Prepared Statement of the Honorable Sheila Jackson Lee, a 
           Representative in Congress From the State of Texas


    Chairman Sensenbrenner. And the gentlewoman is recognized 
for 5 minutes.
    Ms. Lofgren. Thank you, Mr. Chairman.
    First, it is not clear to me whether the State Department 
has provided a report to the Committee on this measure. And I 
know that in past efforts to review the J visa program, the 
State Department has had very strong views about blanket 
waivers, because they feel it is contrary to the agreements 
made with foreign governments relevant to the J program 
overall.
    Can the Chairman provide me with information as to the 
State Department's report on this measure?
    Mr. Gekas. [Presiding.] If the lady would yield----
    Ms. Lofgren. I would yield.
    Mr. Gekas.--the Chair would simply outline that we are 
aware of no stated position like the one to which the lady 
alludes.
    Ms. Lofgren. Have we asked the State Department?
    Mr. Gekas. Actually, we just agreed, on the basis of 
request by the State Department, to----
    Ms. Lofgren. The State Department has requested--the State 
Department has requested this bill?
    Mr. Gekas. Not the State Department itself. What I'm saying 
to you is that this came to us through legislation offered by 
the gentleman from Kansas, Mr. Moran. We have not received 
objections from the State Department or anyplace else----
    Ms. Lofgren. Reclaiming my time----
    Mr. Gekas. An existing waiver program----
    Ms. Lofgren. Reclaiming my time, I think made most of the 
Immigration Subcommittee meetings, but I do not recall the 
Subcommittee marking this bill up. Did I just miss the meeting 
or did we have a markup on this?
    Mr. Gekas. The lady is correct.
    What we're responding to is the expiration of the waiver 
period and to bring it to the attention of the Judiciary 
Committee on what I would consider a routine matter of 
extending that waiver for the stated purposes.
    Ms. Lofgren. Reclaiming my time, I do have a concern about 
moving forward on this bill without a Subcommittee markup for 
several reasons.
    First, the limitation of 20 per State is discriminatory 
against those States that are larger. It may work very well in 
the State of Kansas--and I, frankly, on the merits have no 
objection to helping the State of Kansas. But this will--to 
limit to the number of 20 will certainly not assist the State 
of Texas. It will not assist the State of California and some 
of the other larger States that have the same problems with 
medically underserved rural areas as does Kansas.
    Secondarily, there are the identical issues in medically 
underserved areas in urban areas that have not been addressed. 
And I think that we might have been able to deal with that 
issue had we had a Subcommittee markup, which we have not had.
    Finally, I do have a concern--I can recall in the '96 act 
proposing that we give wider discretion to our immigration 
service to waive the 2-year residency requirement under the 
entire J program when it is advantageous to America. And there 
was objection made, and strong objection made, by the State 
Department because they thought it would actually pose a threat 
to the viability of the J program overall. I think it would be 
a mistake to proceed without soliciting the input of the State 
Department on this issue. And for all we know, they may not 
even be aware that we are marking this bill up.
    So while, in the end, I might support this bill later on, I 
cannot support it today without a markup. And I'd be willing to 
have a markup on Friday so as to get the right information so 
as not to hold it up. But I just think it's very poor practice 
to proceed in this way without dealing with the urban issues, 
without dealing with the larger States, and without getting the 
testimony or at least the written agreement of the State 
Department before proceeding.
    And I reluctantly cannot support the bill at this time for 
those reasons. And I would yield back the balance of my time.
    Chairman Sensenbrenner. [Presiding.] Are there amendments?
    The gentlewoman from California.
    Ms. Waters. I move to strike the last word.
    I, too, have questions.
    Chairman Sensenbrenner. The gentlewoman is recognized.
    Ms. Waters. Am I to understand that this is strictly for 
rural areas and that urban areas are not included in this, Mr. 
Chairman? Mr. Gekas?
    Mr. Gekas. Would the lady yield?
    Ms. Waters. Yes. Yes, I yield to Mr. Gekas.
    Mr. Gekas. It is my understanding that this legislation 
only extends a concept which we have adopted in the Congress 
for underserved areas. That, in my judgment, brings to mind 
immediately rural areas of our country. That does not mean that 
it is restricted to rural areas. The description is 
``underserved.''
    Ms. Waters. Okay. Okay.
    Mr. Gekas. So if a case can be made that somewhere in the 
United States, even in an urban setting, there is a population 
that is underserved, then that would apply as well.
    Ms. Waters. Reclaiming my time, am I to understand that 
these are for foreigners that receive their medical education 
in the United States?
    Mr. Gekas. If the lady would yield?
    Ms. Waters. Yes, I yield.
    Mr. Gekas. That's correct. That's correct.
    Ms. Waters. And further, I would like to ask, in reviewing 
this so that it may continue, have you built in any of the 
security concerns that appear to be so prevalent as we deal 
with all of the issues of public policy in the Government? Have 
we taken a look at any questions that may be raised about 
security concerns? And do we do anything different or special? 
Or do we just do it the way we've done it in the past?
    Mr. Gekas. If the lady would yield further----
    Ms. Waters. Yes, I do yield.
    Mr. Gekas. I would state that the security concerns and the 
screening that has been applied by the State Department in the 
past on issuing this special type of visa still remains. I 
probably would be wise and prudent to add that increased 
security, as we have now imposed on many of our visas, will 
also apply.
    Ms. Waters. Reclaiming my time----
    Mr. Gekas. So this is----
    Ms. Waters. Reclaiming my time, thank you. Thank you very 
much. I get your answer.
    And the three things that I've asked you are still not 
clear to me. I don't know what's in the original law. You refer 
to ``rural,'' and then you refer to ``disadvantaged'' or 
``needed areas'' or something. And we really do need to 
understand what is in law now, what are we reauthorizing.
    And thirdly, while you will assume that there are 
additional security measures that have been built in by the 
State Department, since we've had no hearing, we really don't 
know that.
    I think perhaps it would be unwise to move with this at 
this time, until we at least figure two of the things that some 
of us are concerned about:
    Whether or not, if we are going to give special waivers, 
will it be designed for one sector of our society; will it in 
fact cover those areas in need? What does the original 
legislation say?
    And number two, whether or not the State Department can 
represent to us that they built in additional security 
concerns.
    Without that information, I'd be unable to support the 
bill. I yield back the balance of my time.
    Chairman Sensenbrenner. Are there amendments? Are there 
amendments?
    For what purpose does the gentleman from North Carolina 
seek recognition?
    Mr. Watt. I move to strike the last word.
    Chairman Sensenbrenner. The gentleman is recognized for 5 
minutes.
    Mr. Watt. Thank you, Mr. Chairman.
    I note that this waiver program apparently expired on May 
31 of 2002, and that a number of people have raised concerns 
about it, about the extension--not so much objections as 
questions. A further question that is always raised in this 
context and one that, as I recall from my time as Ranking 
Member on the Immigration Subcommittee, was this whole waiver 
program has been carefully balanced to take into account the 
fact that sometimes you want to encourage physicians who have 
been trained here in the United States to return to the 
countries that they have come from, because those countries 
need medical services. They are a lot more underserved than 
some of the areas in our country.
    The reason--I mean, I think this is a good program. And I'm 
wondering whether the gentleman might consider maybe instead of 
extending the program for 2 years to 2004, maybe extending it 
to 2003, so that we could get some input from the State 
Department and try to answer some of these questions. It just 
seems like there are a number of unanswered questions. And 
we're doing a 2-year extension as opposed to a 1-year 
extension. That might be a little bit better.
    And I'm proposing that in a constructive way, not because I 
oppose the legislation. But because I share some of the same 
concerns that--some of the same questions, not concerns but 
questions, that really need to be answered and ought to have 
been answered in the Subcommittee before this bill ever got to 
this point, if this bill had been considered in the 
Subcommittee.
    Mr. Gekas. Will the gentleman yield?
    Mr. Watt. I'll yield to Mr. Gekas, and maybe he might----
    Mr. Gekas. I considered this, when it came to my desk, as a 
routine matter, based on the previous actions of the Judiciary 
Committee and the Congress as a whole, in a program which found 
great support and which has, we believe, borne sufficient 
dividends to allow it to be continued. And that's they way I'm 
treating it.
    Now, this Committee and the Congress many times continues a 
program without debate and without over-concern, shall we say, 
about the value of the program. I have no reason to believe 
that this program has not continued to be valued by the State 
Department and by the medical profession, and by the society as 
a whole. And so I believe that we should approve it here. And 
if we find that there are differences that have to be brought 
out, we can do that between now and the time of floor action. 
And definitely floor action will be able to bring to the 
concerns that the gentleman has articulated here today.
    I would ask for approval now, based on the fact that it has 
worked before. And I consider it, really, a routine matter.
    Mr. Watt. I yield to the gentlelady from California. Maybe 
she would have a perspective on the 1-year extension also.
    Ms. Lofgren. Clearly, a 1-year extension would be a stopgap 
measure. But I just--you know, each of us commits to working 
through these items on the full Committee, but also each of us, 
and we do it by seniority and we do it carefully, agrees to 
serve on a Subcommittee. And that is where the detail work is 
done for this Committee, to make sure that all the i's are 
dotted and the t's are crossed. And I have been on the 
Immigration Subcommittee now for many, many years, and it's 
something I take very seriously. And I guess--I understand you 
think there's not a problem. And hopefully you're right.
    But the problem here is that we haven't had the 
Subcommittee to look at it. There are issues here that need to 
be explored.
    I am disappointed that this--you know, it is not as if 
we've met every day in the Subcommittee. I mean, we could have 
had--we've had ample opportunity to meet and take this up. And 
I just think it's a mistake. And it's really not fair to the 
Congress and to the Committee----
    Chairman Sensenbrenner. The time of the gentleman has 
expired.
    Ms. Lofgren.--to proceed.
    Mr. Frank. Mr. Chairman?
    Chairman Sensenbrenner. The Chair recognizes himself for 5 
minutes.
    There has been ample time to take this up. The program 
expired on June 1st. On June 4th, a bipartisan group of 
Members, representing both urban and rural areas, introduced 
the bill for the extension: Mr. Moran of Kansas, a rural 
district; Mr. Towns of New York, Brooklyn or Queens; Mr. 
Stenholm of Texas, a rural area; Mr. McIntyre of North 
Carolina, a kind of mixed urban-rural area; and Mr. Houghton of 
New York, who has got some very large cities as well as some 
rural areas.
    The fact is that they won't be able to get the doctors into 
these areas unless this program is extended.
    Now, why the bill wasn't introduced until June 4th, I don't 
know. But this Committee has had this bill now for 15 days. 
Today is June 19th. It deals with an extension of an expired 
program for 2 years and an increase in the number of visas that 
can be authorized by State from 20 to 30. These are all in 
medically underserved areas--rural areas, urban areas, maybe 
some suburban areas.
    It seems to me, to keep the doctors practicing there, we 
ought to deal with this today, get it on the floor next week, 
send it over to the other body. Otherwise, you're going to be 
seeing the INS, if they ever get around to it, tapping some of 
these doctors on the shoulder and saying, ``You've got to go 
home.''
    I yield back the balance of my time.
    Mr. Frank. Mr. Chairman?
    Chairman Sensenbrenner. The gentleman from Massachusetts.
    Mr. Frank. Mr. Chairman, I'm inclined to agree with you. 
Obviously, somebody should have introduced the bill earlier, 
but we don't always all get things done on time.
    But I did want to note one aspect of this. Apparently, I 
infer from what you said, I would ask this question, some of 
this applies to doctors who are already here and will now be--
and who have been for 3 weeks temporarily out of status. And I 
want to say that I feel vindicated now in having voted for the 
extension of 245(i). This shows the importance--I mean, if we 
were in fact to apply immigration law I guess totally strictly, 
some of these doctors would have had to leave the country and, 
if we pass the bill, then reapply for admission. That would 
seem to me--I'd yield to the gentleman.
    Chairman Sensenbrenner. Well, if the gentleman would yield, 
both Mr. Gekas and I voted for 245(i), too.
    Mr. Frank. I agree. I was----
    Chairman Sensenbrenner. It's our bill.
    Mr. Frank. I was being supportive, Mr. Chairman. I'm 
agreeing with you, and I was noting--I know that 245(i) was not 
universally improved.
    But I think 245(i) was misunderstood. This is an example of 
it; 245(i) deals in part with this sort of a circumstance, 
where through some lapse, some very honest, very valuable 
citizens find themselves temporarily out of status, and this is 
an example. It would be ridiculous to make these doctors who 
are serving and are obviously very much wanted in the areas to 
have to leave.
    So I mean to say this in support of what the Committee has 
been doing. And I am in favor of the bill.
    Chairman Sensenbrenner. Are there amendments?
    If there are no amendments, the Chair notes the presence of 
a----
    Ms. Jackson Lee. Excuse me? Thank you. I'd like to strike 
the last word.
    Chairman Sensenbrenner. The gentlewoman from Texas.
    Ms. Jackson Lee. Mr. Chairman, I have heard a little bit of 
the debate that has ensued. And let me acknowledge the concerns 
of my colleagues, particularly with my attention to the 
prerogative and process of Committee review. I have always 
argued for that, and I am sympathetic the positions that I 
believe have been, if you will, offered.
    This, however, is legislation that I am supporting, and 
recognize that we have not had the opportunity for oversight by 
the Subcommittee or the Committee in general. But the 
reauthorization is key, and it is key because it goes to the 
issue of underserved areas.
    I would like to have had 245 in place, and I am still 
pushing for that to occur. But these physicians come under a 
limited number of waivers of the 2-year foreign residency 
requirement available to foreign physicians. And in particular, 
a foreign physician may obtain a waiver through recommendation 
issued by an interested State or Federal agency interested in 
facilitating the physician's employment in a designated 
medically underserved area.
    This impacts urban areas as well as rural areas. And our 
colleague Ed Towns has a great interest in this issue, 
primarily because of the community in which he serves.
    I would ask my colleagues to recognize that there is a long 
agenda that we have to pursue as it relates to immigration 
issues. My commitment to Committee oversight--but in light of 
the necessity of this legislation, I would ask my colleagues to 
support the passage of H.R. 4858, which allows for the 
reauthorization retroactively to be effective May 31, 2002, as 
that was the date of the expiration of the program.
    I would consider this an emergency, and I would ask my 
colleagues to support this legislation.
    I yield back.
    Chairman Sensenbrenner. Does the gentlewoman yield back?
    The Chair notes the presence of a reporting quorum. The 
question is on the motion to report H.R. 4858 favorably.
    Those in favor will say aye.
    Opposed, no.
    The ayes have it, and the motion to report favorably is 
adopted.
    Without objection, the Chairman is authorized to move to go 
to conference pursuant to House rules. Without objection, the 
staff is directed to make any technical and conforming changes. 
And all Members will be given 2 days, as provided by House 
rules, in which to submit additional, dissenting, supplemental, 
or minority views.
                            Additional Views

    HR 4858 was brought to markup in the full committee without 
any consideration by the Subcommittee on Immigration, Border 
Security and Claims. HR 4858 was never vetted in a hearing at 
the subcommittee level nor was it scrutinized in subcommittee 
markup. We have received no reports from the State Department 
or the INS or other agencies about the need or impact that 
additional physicians may have in underserved areas. In fact we 
have no way of knowing whether the addition of a nominal number 
of physicians per state will resolve the problems of medically 
underserved communities. Lastly, I am very concerned about the 
unfairness that the ``same size fits all'' formula has for 
larger states like California and Texas.
    This bill was introduced late, but I would expect the 
Chairman of the subcommittee to keep track of the visa programs 
that are part of American law, to anticipate problems and not 
merely react.

                                   Zoe Lofgren

                                  
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