[House Report 108-730]
[From the U.S. Government Publishing Office]
108th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 108-730
======================================================================
TO IMPROVE ACCESS TO PHYSICIANS IN MEDICALLY UNDERSERVED AREAS
_______
October 5, 2004.--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
[To accompany H.R. 4453]
[Including Committee Cost Estimate]
The Committee on the Judiciary, to whom was referred the bill
(H.R. 4453) to improve access to physicians in medically
underserved areas, having considered the same, reports
favorably thereon with an amendment and recommends that the
bill as amended do pass.
CONTENTS
Page
The Amendment.................................................... 1
Purpose and Summary.............................................. 2
Background and Need for the Legislation.......................... 2
Hearings......................................................... 4
Committee Consideration.......................................... 4
Vote of the Committee............................................ 4
Committee Oversight Findings..................................... 4
New Budget Authority and Tax Expenditures........................ 4
Committee Cost Estimate.......................................... 4
Performance Goals and Objectives................................. 5
Constitutional Authority Statement............................... 5
Section-by-Section Analysis and Discussion....................... 5
Changes in Existing Law Made by the Bill, as Reported............ 6
Markup Transcript................................................ 7
The Amendment
The amendment is as follows:
Strike all after the enacting clause and insert the
following:
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) Exemption From Geographic Limitations.--Section 214(l)(1)(D) of
the Immigration and Nationality Act (8 U.S.C. 1184(l)(1)(D)), as
amended by subsection (c), is further amended--
(1) by striking ``except that,'' and all that follows
through the period at the end 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; and
``(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 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 described in subparagraph (B)) in accordance
with the conditions of this clause to exceed 5.''.
Purpose and Summary
H.R. 4453 would extend and modify the program whereby
aliens who participate in medical residencies in the United
States on exchange program visas (known as ``J'' visas) do not
have to leave the U.S. at the conclusion of their residencies
to reside abroad for 2 years if they agree to practice medicine
for 3 years in an area designated by the Secretary of Health
and Human Services (``HHS'') as having a shortage of health
care professionals.
Background and Need for the Legislation
I. BACKGROUND
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.\1\ 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.
---------------------------------------------------------------------------
\1\ See Immigration and Nationality Act Sec. 212(e)(iii).
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In 1994, Congress created a waiver (until June 1, 1996) of
the 2-year foreign residence requirement when a state
department of public health requested it for a foreign doctors
who committed to practicing medicine for no less than 3 years
in a geographic area or areas designated by the Secretary of
HHS as having a shortage of health care professionals.\2\ The
number of foreign doctors who could receive the waiver was
limited to 20 per state. In 1996, Congress extended the waiver
to June 1, 2002.\3\ In 2002, Congress extended the waiver until
June 1, 2004.\4\ At the same time, the numerical limitation on
waivers was increased to 30 per state.
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\2\ See the Immigration and Nationality Technical Corrections Act,
Pub. L. No. 103-416, Sec. 220 (1994).
\3\ See the Illegal Immigration Reform and Immigrant Responsibility
Act, Pub. L. No. 104-208, Sec. 622 (1996).
\4\ See the 21st Century Department of Justice Appropriations
Authorization Act, Pub. L. No. 107-273, Sec. 11018 (2002). Section
11018 incorporated the language of H.R. 4858, which was reported by the
House Judiciary Committee on June 24, 2002, and passed the House on
June 25, 2002.
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The waiver requirements are as follows: the Secretary of
Homeland Security may authorize a waiver upon the request of an
interested U.S. government agency or a director of a state
department of public health (or its equivalent) as in the
public interest \5\ if:
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\5\ See INA Sec. 212(e).
1) in the case of an alien who is otherwise
contractually obligated to return to a foreign country,
the government of such country furnishes the U.S.
government with a statement in writing that it has no
---------------------------------------------------------------------------
objection to a waiver,
2) the alien demonstrates a bona fide offer of full-
time employment at a health facility or health care
organization and that employment has been determined by
the Secretary of Homeland Security to be in the public
interest,
3) the alien agrees to begin employment within 90 days
of receiving the waiver, and agrees to continue to work
for not less than 3 years (unless the Secretary
determines that extenuating circumstances exist, such
as closure of the facility or hardship to the alien,
which would justify a lesser period of employment at
such facility or organization, in which case the alien
must demonstrate another bona fide offer of employment
at a health care facility or health care organization
for the remainder of the 3 year period), and
4) the alien agrees to practice medicine for the 3 year
period only in the geographic area or areas which are
designated by the Secretary of HHS as having a shortage
of health care professionals (except in the case of a
request by the Department of Veterans Affairs or in the
case of a request by an interested Federal agency to
employ the alien full-time in medical research or
training).\6\
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\6\ See INA Sec. 214(l)(1).
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II. THE BILL AS REPORTED
H.R. 4453 as introduced would have extended the waiver for
a year and continued the practice of allowing foreign doctors
receiving a waiver to receive H-1B nonimmigrant status
regardless of the annual H-1B visa quota.\7\ At the full
Committee markup, Representatives Hostettler and Jackson Lee
offered an amendment in the nature of a substitute that would
extend the program until June 1, 2006, specify that the H-1B
cap exemption would apply to doctors whether they were
sponsored by a state or Federal agency, allow foreign doctors
receiving a waiver to work in medically-underserved areas in
either primary care or specialty medicine, and allow five of
each state's 30 waivers to go to doctors that would practice
medicine in areas not designated by the Secretary of Health and
Human Services as having a shortage of health care
professionals, if the doctors receiving the waivers would
practice in facilities that serve patients who reside in areas
designated by the Secretary as having a shortage of health care
professionals. The Committee adopted the Hostettler-Jackson Lee
amendment in the nature of a substitute, and the bill as
reported reflects that text.
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\7\ See The American Competitiveness in the Twenty-First Century
Act of 2000, Pub L. No. 106-313, Sec. 114 (2000). The H-1B quota is now
65,000 each fiscal year. See INA Sec. 214(g)(1)(A).
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Hearings
No hearings were held in the Committee on the Judiciary on
H.R. 4453.
Committee Consideration
On June 3, 2004, the Subcommittee on Immigration, Border
Security, and Claims met in open session and ordered favorably
reported the bill H.R. 4453, without amendment, by a voice
vote, a quorum being present. On September 30, 2004, the
Committee met in open session and ordered favorably reported
the bill H.R. 4453, with an amendment, by a voice vote, a
quorum being present.
Vote of the Committee
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the Committee notes that there
were no recorded votes during the Committee's consideration of
H.R. 4453.
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.
New Budget Authority and Tax Expenditures
Clause 3(c)(2) of rule XIII of the Rules of the House of
Representatives is inapplicable because this legislation does
not provide new budgetary authority or increased tax
expenditures.
Committee Cost Estimate
In compliance with clause 3(d)(2) of rule XIII of the Rules
of the House of Representatives, the Committee believes that
the bill will have no significant cost for the current fiscal
year, and no significant cost for the next five fiscal years.
The Committee did not receive any estimates of the costs of
this legislation from any other government agency as outlined
in clause 3(d)(2)(B) of rule XIII. The bill does not authorize
programs so the Committee cannot provide a comparison with
relevant programs under current law as outlined in clause
3(d)(2)(C) of rule XIII.
Performance Goals and Objectives
The Committee states that pursuant to clause 3(c)(4) of
rule XIII of the Rules of the House of Representatives, H.R.
4453 would extend and modify the program whereby aliens who
participate in medical residencies in the United States on
``J'' exchange program visas do not have to leave the U.S. at
the conclusion of their residencies to reside abroad for 2
years if they agree to practice medicine for 3 years in an area
designated by the Secretary of Health and Human Services as
having a shortage of health care professionals. This would
increase the availability of doctors in these underserved
areas.
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 I, Sec. 8 of the Constitution.
Section-by-Section Analysis and Discussion
The following discussion describes the bill as reported by
the Committee.
Section 1. Modification of Visa Requirements with Respect to
International Medical Graduates.
Subsection 1(a) would amend Sec. 220(c) of the Immigration
and Nationality Technical Corrections Act of 1994 to extend
until June 1, 2006, the program under which aliens who
participate in medical residencies in the United States on
``J'' exchange program visas do not have to leave the U.S. at
the conclusion of their residencies to reside abroad for 2
years if they agree to practice medicine for 3 years in an area
designated by the Secretary of HHS as having a shortage of
health care professionals. This change shall take effect as if
enacted on May 31, 2004.
Subsection 1(b) would amend Sec. 214(l)(2)(A) of the
Immigration and Nationality Act to provide that the 65,000
annual H-1B visa numerical limitation shall not apply to any
alien who has obtained a waiver of the 2 year foreign residence
requirement upon a request by an interested Federal agency or
an interested state agency.
Subsection 1(c) would amend Sec. 214(l)(1)(D) of the
Immigration and Nationality Act to clarify that an alien
participating in the waiver program can practice primary care
or specialty medicine.
Subsection (d) would amend Sec. 214(l)(1)(D) of the
Immigration and Nationality Act to provide that for up to five
of a state's 30 yearly waivers, the head of an interested state
agency may determine that the alien may practice medicine in a
facility that serves patients who reside in one or more
geographic areas designated by the Secretary of the Department
of HHS as having a shortage of health care professionals
without regard to whether such facility is within such a
designated geographic area.
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):
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, [2004.] 2006.
----------
SECTION 214 OF THE IMMIGRATION AND
NATIONALITY ACT
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) * * *
* * * * * * *
(D) in the case of a request by an interested
Federal agency (other than a request by an interested
Federal agency to employ the alien full-time in medical
research or training) or by an interested State agency,
the alien [agrees to practice medicine] agrees to
practice primary care or specialty medicine in
accordance with paragraph (2) for a total of not less
than 3 years only 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, [except that, 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.] except that--
(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;
and
(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 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
described in subparagraph (B)) in accordance
with the conditions of this clause to exceed 5.
(2)(A) Notwithstanding section 248(2), the Attorney
General may change the status of an alien who qualifies
under this subsection and section 212(e) to that of an
alien described in section 101(a)(15)(H)(i)(b). 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.
* * * * * * *
Markup Transcript
BUSINESS MEETING
THURSDAY, SEPTEMBER 30, 2004
House of Representatives,
Committee on the Judiciary,
Washington, DC.
The Committee met, pursuant to notice, at 10:05 a.m., in
Room 2141, Rayburn House Office Building, Hon. F. James
Sensenbrenner, Jr. [Chairman of the Committee] presiding.
[Intervening business.]
Chairman Sensenbrenner. The next item on the agenda is the
adoption of H.R. 4453, the ``Access to Rural Physicians
Improvement Act of 2004.'' The Chair recognizes the gentleman
from Indiana, Mr. Hostettler, the Chairman of the Subcommittee
on Immigration, Border Security, and Claims for a motion.
Mr. Hostettler. And, Mr. Chairman, the Subcommittee on
Immigration, Border Security, and Claims reports favorably the
bill, H.R. 4453, and moves its favorable recommendation to the
full House.
Chairman Sensenbrenner. Without objection, the bill will be
considered as read and open for amendment at any point. The
Chair recognizes the gentleman from Indiana to strike the last
word.
[The bill, H.R. 4453, follows:]
Mr. Hostettler. Thank you, Mr. Chairman. Today we are
marking up Terry Moran's bill, H.R. 4453, the Access to Rural
Physicians Improvement Act of 2004. Aliens who participate in
medical residencies in the United States on J exchange program
visas must generally leave the U.S. after the completion of
their residencies to reside abroad for 2 years. After this
foreign residency they can be eligible for permanent residence
or status as H-1B or L visa nonimmigrants. The intent behind
the 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. State departments of health, public
health may request a waiver for foreign doctors to commit to
practicing medicine for no less than 3 years in geographic
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.
In 1996, Congress extended the waiver to June 1, 2002. In
2002, Congress extended the waiver until June 2004. At the same
time the numerical limitation on waivers was increased to 30
per State. The waiver has proven to be an important means of
ensuring quality medical care in areas of the United States
with physician shortages.
H.R. 4453, as introduced by Mr. Moran, as approved by the
Immigration, Border Security, and Claims Subcommittee would
extend the waiver until 1 year after the bill's date of
enactment. I plan to have the Subcommittee utilize that time
frame to investigate the impact of foreign students and
residents on comparable Americans before deciding on the longer
term status of the program.
Ms. Jackson Lee and I have agreed to offer a substitute
amendment that will extend the program until June 2006 and give
the Committee a bit more time to consider the issue. A number
of organizations have proposed that States be able to utilize
their waivers in locations not designated as physician shortage
areas by the Department of Health and Human Services. Not
surprisingly, HHS is very much opposed to such proposals. I was
hesitant to eliminate this requirement for all waivers without
a hearing. The substitute that Ms. Jackson Lee and I will offer
will allow each State to place five of the doctors it sponsors
each year in areas not designated by HHS as physician shortage
areas. The Committee will then have a year and a half to
examine this pilot program and decide whether to extend it to
the entire waiver program.
I urge my colleagues to support H.R. 4453 and to support my
and Ms. Jackson Lee's substitute amendment.
Chairman Sensenbrenner. The gentlewoman from Texas, Ms.
Jackson Lee.
Ms. Jackson Lee. I thank the Chairman very much, and I
thank the Chairman of the Subcommittee and his cooperation and
working with me on the upcoming amendment to the Access to
Rural Physicians Improvement Act of 2004, H.R. 4453. In our
hearings of course it was certainly determined and acknowledged
that the utilization of the J-1 visas to assist with physicians
in rural communities is pivotal. In fact, it is a key element
to good health in America. I would not want to say to our rural
communities throughout America today that we were not allowing
good strong professional physicians to be able to come into the
community to provide good health care.
The Chairman and myself have agreed from the beginning that
the J-1 visa waiver program for doctors in underserved areas
should be continued. But we have had, as I have indicated,
significant differences of opinions over the details of
extending the program. I wanted a 5-year program, which Members
of the Senate joined me in, and also greater flexibility in
dealing with the State health departments. I am gratified,
however, that we are willing and collaborating on a compromise
that will provide a 2-year extension and as well give some
flexibility. Aliens who attend medical school in the United
States on J exchange program visas generally must leave the
country afterwards and reside abroad for 2 years before they
can apply for another visa on some other basis such as an H-1B
visa or an L visa.
In 1994, Congress created a temporary waiver of the 2-year
foreign residence requirement. It applied to foreign doctors
who would commit to practicing medicine for no less than 3
years in a geographic area designated by the Secretary of
Health and Human Services as having a shortage of health care
professionals. This program has been successful for 10 years in
bringing highly qualified physicians to medically underserved
areas. It is sunsetting on June 1 of this year.
The first physician recommended for a waiver in Texas was a
doctor Maria Camacho, a pediatric internist. Her services to
the residents of Harlingen in Cameron County provide a level of
health care to children that was previously unable in that
country. It is extremely important that she happens to be of
course bilingual. Additionally, she serves on the faculty of
the Valley Regional Academic Health Center to train new
physicians.
Dr. K.M. Moorthi is a nephrologist who was recommended for
a waiver to serve at a facility in Pecos, Texas in Reeves
County. He works at a brand new dialysis center. Patients
requiring dialysis three times per week in that part of Texas
used to have to travel more than 70 miles each way for
treatments. Now it is available in this area.
Where else throughout the Nation do we find those same
circumstances? The Gateway Community Clinic in Laredo is a
federally qualified health center on the Texas-Mexico border.
It obtained a J-1B waiver for Dr. Garcia-Cavazos. This doctor
is a rheumatologist who provides specialty services to a
patient population without regard to their insurance status or
their ability to pay. The Access to Rural Physicians
Improvement Act would authorize a 1-year extension of the
waiver.
Our amendment, which is in the nature of a substitute,
would provide a 2-year extension. It also has a pilot
flexibility provision which would allow a State agency to place
a doctor in an area that has not been designated as underserved
if the doctor will nevertheless serve patients from an
underserved area. This exception is limited to five doctors in
each State. I would venture to say that every Member of
Congress, House and Senate, would be impacted positively by
this compromise amendment, and I am gratified to be able to
offer it and to support it.
Under the Access to Rural Physicians Improvement Act H-1B
doctors who receive the waiver to serve at a State facility do
not count towards the annual H-1B cap. Our amendment makes the
same provision for H-1B doctors who serve at a Federal
facility. The amendment also permits Federal J-1 visa waivers
to apply to specialists in addition to the primary care
physicians.
I would urge my colleagues to support the underlying
legislation with the amendment, and I would venture to say that
this amendment will contribute to positive health care in
America. With that, I yield back and I thank the Chairman.
Chairman Sensenbrenner. Without objection, all Members'
opening statements will appear in the record at this point.
[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, and Ranking Member,
Subcommittee on Immigration, Border Security, and Claims
I want to thank my distinguished colleague, the gentleman from
Indiana, Mr. Hostettler, for working with me on this amendment to the
Access to Rural Physicians Improvement Act of 2004, H.R. 4453. Although
we have agreed from the beginning that the J-1 visa waiver program for
doctors in underserved areas should be continued, we have had
significant differences of opinion over the details of extending the
program. I appreciate Mr. Hostettler's willingness to negotiate a
compromise that can be moved forward as a bipartisan bill.
Aliens who attend medical school in the United States on J exchange
program visas generally must leave the country afterwards and reside
abroad for two years before they can apply for another visa on some
other basis, such as an H-1B or an L visa. In 1994, Congress created a
temporary waiver of the two-year foreign residence requirement. It
applied to foreign doctors who would commit to practicing medicine for
no less than three years in a geographic area designated by the
Secretary of Health and Human Services as having a shortage of health
care professionals. This program has been successful for ten years in
bringing highly qualified physicians to medically underserved areas. It
sunsetted on June 1st of this year.
The first physician recommended for a waiver in Texas was Dr. Maria
Camacho, a Pediatric Intensivist. Her services to the residents of
Harlingen in Cameron County provide a level of health care to children
that was previously unavailable in that county. Additionally, she
serves on the faculty of the Valley Regional Academic Health Center to
train new physicians.
Dr. K. M. Moorthi is a Nephrologist who was recommended for a
waiver to serve at a facility in Pecos, Texas, in Reeves County. He
works at a brand new dialysis center. Patients requiring dialysis 3
times per week in that part of Texas used to have to travel more than
70 miles each way for the treatments. Now it is available in Pecos.
The Gateway Community Clinic in Laredo is a Federally Qualified
Health Center on the Texas-Mexico border. It obtained a J-1 waiver for
Dr. Rogelio Garcia-Cavazos. This doctor is a Rheumatologist who
provides specialty services to a patient population without regard to
their insurance status or their ability to pay.
The Access to Rural Physicians Improvement Act would authorize a
one-year extension of the waiver. Our amendment, which is in the nature
of a substitute, would provide a two-year extension. It also has a
pilot flexibility provision which would allow a state agency to place a
doctor in an area that has not been designated as underserved if the
doctor will nevertheless serve patients from an underserved area. This
exception is limited to five doctors in each state.
Under the Access to Rural Physicians Improvement Act, H-1B doctors
who receive the waiver to serve at a state facility do not count
towards the annual H-1B cap. Our amendment makes the same provision for
H-1B doctors who serve at a federal facility. The amendment also
permits federal J-1 visa waivers to apply to specialists in addition to
primary care physicians.
I urge you to vote for this amendment. Thank you.
Chairman Sensenbrenner. Are there amendments? The gentleman
from Indiana has the substitute.
Mr. Hostettler. Mr. Chairman, I have a substitute at the
desk.
Chairman Sensenbrenner. The Clerk will report the
substitute.
The Clerk. Amendment in the nature of a substitute to H.R.
4453 offered by Mr. Hostettler of Indiana and Ms. Jackson Lee
of Texas.
[The amendment in the nature of a substitute follows:]
Chairman Sensenbrenner. Without objection, the substitute
is considered as read and open for amendment at any point. The
Chair recognizes the gentleman from Indiana, Mr. Hostettler.
Mr. Hostettler. Mr. Chairman, I thank you, and as we said
earlier, Mr. Chairman, H.R. 4453, introduced by Representative
Moran, extends the J visa for foreign residency waiver program
until 1 year after the bill's date of enactment. On June 3,
2004, the bill was approved by the Subcommittee on Immigration,
Border Security and Claims by a voice vote. This substitute
that Ms. Jackson Lee and I are offering would accomplish the
following:
First, the substitute would extend the waiver until June 1,
2006. This will give the Subcommittee adequate time to fully
explore all the issues involved with foreign medical students
and foreign medical residents.
Second, the substitute would allow foreign doctors
receiving a waiver to receive H-1B status regardless of the
annual H-1B visa quota, whether they are sponsored by a State
or Federal agency.
Third, the substitute would explicitly allow foreign
doctors receiving a waiver to work in medically underserved
areas in either primary care or specialty medicine. A number of
State public health agencies have utilized the waiver program
to meet needs for specialty care providers, and the substitute
recognizes this practice.
Fourth, the substitute will allow five of each States 30
waiver recipients to practice medicine in areas not designated
by the Secretary of Health and Human Services as having a
shortage of health care professional, if the doctors receiving
the waivers will practice in facilities that serve patients who
reside in areas designated by the Secretary as having a
shortage of health care professionals. The Subcommittee will
review the operation of this program to ensure not only that
the goal of the waivers is maintained; that is, serving the
underserved, but also to determine the impact on American
citizens who by very definition, at least 30 in each State, 30
per State spots, slots in medical schools must be, by
definition of the result of this, the presence of this program,
must be denied to American citizens for the purpose of
practicing medicine. And so in the interim time we will not
only be looking at the situation as it seeks to serve those
that are in underserved areas, but obviously the impact on
American citizens and their ability to attend medical school.
On that, Mr. Chairman, I yield back the balance of my time.
Chairman Sensenbrenner. The question is on the adoption.
Ms. Jackson Lee. Chairman.
Chairman Sensenbrenner. The gentlewoman from Texas.
Ms. Jackson Lee. Thank you very much, Mr. Chairman. As the
Chairman mentioned, of the Subcommittee, this is a compromise.
I would simply--I will be including most of my statement into
the record, but I do want to make the point that this is a
very, very well respected program and a well-needed program. I
hope after we have had a successful study of this program in
the 2-year extension we will be able to implement a J-1 visa
program that will allow a 5-year program continuously. These
are physicians who in most instances adhere to their visa time
frame. They will return back to their nation of origin, but
more importantly, they serve a very vital need in the battle
for good health care in America to underserved areas, and I
believe it is crucial that this program continue with a 5-year
program and the flexibility for the States.
The compromise I accept and support, and I ask my
colleagues to support the amendment in the nature of a
substitute of myself and Mr. Hostettler.
I would yield back.
Chairman Sensenbrenner. Are there amendments to the
amendment in the nature of a substitute? If there are none, the
question is on agreeing to the amendment in the nature of a
substitute offered by the gentleman from Indiana, Mr.
Hostettler. Those in favor will say aye. Opposed, no. The ayes
appear to have it. The ayes have it, and the amendment in the
nature of a substitute is agreed to.
A reporting quorum is present. The question occurs on the
motion to report the bill H.R. 4453 favorably, as amended. All
in favor will say aye. Opposed, no. The ayes appear to have it.
The ayes have it and the motion to report favorably is adopted.
Without objection, the bill will be reported favorably to
the House in the form of a single amendment in the nature of a
substitute incorporating the amendment adopted here today.
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 the House
rules in which to submit additional, dissenting, supplemental,
or minority views.