[Congressional Record: June 25, 2002 (Senate)]
[Page S6015-S6029]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
[DOCID:cr25jn02-177]                        




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. BROWNBACK (for himself and Mr. Conrad):
  S. 2674. A bill to improve access to health care medically
underserved areas; to the Committee on the Judiciary.
  Mr. CONRAD. Mr. President, today I join Senator Brownback in
introducing important legislation aimed at ensuring that a piece of the
puzzle regarding adequate physician services in underserved communities
is preserved.
  By all accounts, the Conrad State 20 J-1 Visa Waiver program has been
a great success at bringing crucially-needed doctors to medically-
underserved areas. It has served as a wonderful resource for my State
and for other States across our Nation. The bill we are introducing
today eliminates the program's sunset date, thereby making sure that
this much-needed program remains available.
  I created the Conrad State 20 program in 1994 to deal with the
reality that many areas of the country, especially rural communities,
have a very difficult time recruiting American doctors. These health
facilities have had no other choice but to turn to foreign medical
graduates to fill their needs. J-1 visa waivers allow foreign
physicians to practice in medically-underserved communities after their
J-1 status has expired without first returning to their home countries.
These waivers allow foreign physicians to receive nonimmigrant, H-1B
status, temporary worker in specialty occupation, for 3 years. In order
to receive the waiver, the physician must agree to serve the medically-
underserved community for the full three years. If he or she fails to
fulfill that commitment, the physician is subject to immediate
deportation.
  Prior to the creation of my State 20 program, J-1 visa waiver
exclusively involved finding an ``interested Federal agency'' to
coordinate the request. This was found to be a long, cumbersome, and
bureaucratic process. By allowing States to directly participate in the
process of obtaining waivers, my program relieves some of the burdens
on participating Federal agencies and allows decisions regarding a
State's health care needs to be made at the State level by the people
who know best.
  I have shepherded the Conrad State 20 program from its creation in
1994 through a subsequent reauthorization and other improvements over
the years. By now removing the program's sunset date, the bill that
Senator Brownback and I are introducing today will ensure that this
important program remains a part of a State's tool belt in dealing with
physician-shortages in medically-underserved areas.
  Our bill also provides for a modest increase from 20 allowable Conrad
State 20 visa waivers per State per year to 30. For some time, a number
of States have been bumping up against the State 20 ceiling, and my
hope is that this increase will help additional medically underserved
communities throughout the country procure the physician services they
need.
  I urge my colleagues to support this legislation.

[Congressional Record: June 25, 2002 (House)]
[Page H3867-H3871]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
[DOCID:cr25jn02-72]                        




     IMPROVING ACCESS TO PHYSICIANS IN MEDICALLY UNDERSERVED AREAS

  Mr. SENSENBRENNER. Mr. Speaker, I move to suspend the rules and pass
the bill (H.R. 4858) to improve access to physicians in medically
underserved areas.
  The Clerk read as follows:

                               H.R. 4858

       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) Increase in Numerical Limitation on Waivers Requested
     by States.--Section 214(l)(1)(B) of the Immigration and
     Nationality Act (8 U.S.C. 1184(l)(1)(B)) is amended by
     striking ``20;'' and inserting ``30;''.
       (b) Extension of Deadline.--Section 220(c) of the
     Immigration and Nationality Technical Corrections Act of 1994
     (8 U.S.C. 1182 note) is amended by striking ``2002.'' and
     inserting ``2004.''.
       (c) Technical Correction.--Section 212(e) of the
     Immigration and Nationality Act (8 U.S.C. 1182(e)) is amended
     by striking ``214(k):'' and inserting ``214(l):''.
       (d) Effective Date.--The amendments made by this section
     shall take effect as if this Act were enacted on May 31,
     2002.

                              {time}  1215

  The SPEAKER pro tempore (Mr. Quinn). Pursuant to the rule, the
gentleman from Wisconsin (Mr. Sensenbrenner) and the gentlewoman from
Texas (Ms. Jackson-Lee) each will control 20 minutes.
  The Chair recognizes the gentleman from Wisconsin (Mr.
Sensenbrenner).


                             General Leave

  Mr. SENSENBRENNER. Mr. Speaker, I ask unanimous consent that all
Members may have 5 legislative days within which to revise and extend
their remarks on H.R. 4858, the bill currently under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the
gentleman from Wisconsin?
  There was no objection.
  Mr. SENSENBRENNER. Mr. Speaker, I yield myself such time as I may
consume.
  Mr. Speaker, H.R. 4858 extends authority for a visa-requirement
waiver that permits certain foreign medical doctors to practice
medicine in underserved areas without first leaving the United States.
The bill also increases the number of foreign residence waivers from 20
per State to 30 per State.
  Aliens who attend medical school in the United States on ``J'' visas
are required to leave the United States after graduating 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, the 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,
either rural or urban, which are designated by the Secretary of Health
and Human Services as having a shortage of health care professionals.
The waiver limited the number of foreign doctors to 20 per State so
that underserved areas in all States receive doctors. The original
waiver was set to expire on June 1, 1996. The Congress extended the
waiver to June 1, 2002.
  States with underserved medical areas worry 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 that they have more doctors to help keep their clinics open.
  Mr. Speaker, H.R. 4858 increases the numerical limitation on waivers
requested by States from 20 per State per year to 30 per State per
year. It also extends the deadline for the authorization of the waiver
to June 1, 2004. The bill retroactively takes effect May 31, 2002,
prior to the waiver's expiration.
  I urge my colleagues to support this bill so that urgently needed
doctors may continue to practice medicine in areas that are in critical
need of medical care.
  Mr. Speaker, I reserve the balance of my time.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I
may consume.
  I thank the distinguished chairman of the Committee on the Judiciary.
I would like to offer my support for this legislation.
  I offer my support for this legislation with a qualification,
recognizing that this legislation did not come before the Subcommittee
on Immigration and Claims and was marked up in full committee. I
believe the importance of this legislation was such that deviation from
regular order and committee procedures was to be understood. So I rise
in support of this legislation, a bill that will help provide
underserved areas with needed health care providers.
  As my colleagues know, there are many inner city and rural areas in
dire need of doctors, and this program will allow a limited number of
foreign doctors the opportunity to practice in America. In working on
this legislation, I worked with Members and colleagues from both rural
and urban areas, and their advocation for this showed the dire need for
those who are in underserved areas.
  The bill was introduced by the gentleman from Kansas (Mr. Moran); and
many of our colleagues from the rural areas and, as I said, inner city
areas, have asked for this legislation to be in place.
  Mr. Speaker, H.R. 4858 reauthorizes the Conrad 20 program until May
31, 2004. The reauthorization is retroactively effective to May 31,
2002, as that was the date of the expiration of the program and also
noting the ending of the involvement of the USDA. The bill also
includes a modest increase in the number of eligible foreign
physicians. That number goes from 20 to 30 based upon a survey showing
the need.
  Might I note that the Texas Primary Care Office, certainly a State of
which I come from that recognizes the importance of serving in rural
areas and inner city areas, surveyed all 50 States on the use of the J-
1 visa. Upon the USDA announcement that they were ending their
participation, the PCO again surveyed the States and, as a result, the
most recent survey by the PCO, every State but two, indicated that they
are or are intending to put in place a Conrad 20 program, which would
utilize the J-1 visas.
  Under current immigration law, a ``J'' visa is available to foreign
physicians as an exchange visitor if the person meets certain
requirements, including the intention to return to his or her home
country, participation in an exchange visitor program designated by the
U.S. Information Agency, and participation in a program that is
intended to train foreign nationals in a field that can be utilized in
the person's home country, and sufficient funds and fluency in English.
They are limited in the number of visas of a 2-

[[Page H3868]]

year residency requirement available to foreign physicians.
  In particular, a foreign physician may obtain a waiver through a
recommendation issued by an interested State or Federal agency
interested in facilitating the physician's employment in a designated
medically underserved area.
  Until recently, the USDA, as I indicated, participated in this
program. However, back in late February, citing security concerns, the
USDA announced that they were no longer going to act as an interested
government agency in processing J-1 visas. Now the role of recommending
J-1V visas rests primarily with the State agencies.
  I want to ensure, however, that as we work with the INS, that the INS
certainly will be involved in providing assistance as it may be needed.
This is an important aspect of the question of homeland security, and I
would hope this legislation does not in any way suggest to the American
people that we attempt to jeopardize security and/or would not be
concerned in light of the Federal oversight agency, the USDA, no longer
being involved in those programs. Rural communities still need health
care, urban centers still need health care; in fact, Americans need
health care.
  It is interesting to note, Mr. Speaker, the fast pace at which this
legislation has come. Again, I would like to thank the proponents of
the legislation, and they have my support, but certainly I would be
remiss if I did not mention the fact that we are about to address the
question dealing with Medicare and the particular provisions to provide
senior citizens with efforts to give them a Medicare drug benefit.
  I am hoping that as we came together in a bipartisan manner to
support this legislation, as I indicated that I support, that we can
look seriously at the Democratic proposal. That is a serious proposal
that provides a deductible and a $25-a-month premium and provides for
an 80 percent coverage for Medicare benefits for our seniors. This is
the kind of work we should be doing in the House of Representatives.
This is the kind of serious legislation that we should be doing and not
attending to special interests and harming the particular senior
citizens that we are trying to protect.
  So, with that, Mr. Speaker, let me support this legislation and hope
that my colleagues in a bipartisan manner will likewise support this
legislation so that we can have good health care, protected health care
in this country.
  Mr. Speaker, I reserve the balance of my time.
  Mr. SENSENBRENNER. Mr. Speaker, I yield 5 minutes to the gentleman
from Kansas (Mr. Moran), the author of the bill.
  Mr. MORAN of Kansas. Mr. Speaker, I thank the gentleman from
Wisconsin and the gentlewoman from Texas for their remarks earlier
today; and I would like to thank them, as well as the gentleman from
Pennsylvania (Mr. Gekas), the subcommittee chairman, that dealt with
this issue for their prompt attention to an issue that is terribly
important to rural America and urban America as well. It is good to see
us come together, Republicans and Democrats, urban and rural, on behalf
of health care for our citizens.
  Much of our time, in fact, this week much of our time will be spent
on the affordability of health care. How do we help our citizens pay
for it? How do we make health care more affordable? Many of us who live
in regions of the country that are underserved struggle to have access
to health care. How do we keep physicians in our communities? How do we
keep our hospital doors open? How do we have our other health care
providers available for the citizens who happen to live in the urban
core of the city or in a rural community of our country?
  One of the ways that we can help address the issue of physicians in
underserved areas is the J-1 visa program. Clearly, it has been an
opportunity for physicians to remain in the United States and serve in
those underserved areas during the history of the program beginning in
1994. There are 98 physicians in Kansas who were waived under this
program. Of those, 50 are still practicing in our State.
  Mr. Speaker, this is often the only opportunity that a community, a
clinic, or a hospital in a rural or underserved urban area has to
access a physician. I would guess in the 6 years that I have been a
Member of Congress, probably not more than 4 weeks goes by that I do
not have a call or letter or e-mail from a clinic, a community, or a
hospital saying, can you help us locate a physician and can you help us
with the paperwork associated with the J-1 visa.
  These are ways in which our communities are served. Lacrosse, Kansas,
population 1,800 has had a J-1 visa physician in place who is now
retiring. He and his wife are the only physicians in the community.
They are both here on a J-1 visa. For 2 years they have been telling
the community they are retiring. The community has been looking for a
physician and, gratefully, they found a J-1 visa physician.
  They may have been the last J-1 visa granted in the United States.
Back in February of this year, the Department of Agriculture concluded
that it would no longer be an interested government agency for
processing J-1 visas.
  The Rural Health Care Coalition, which I chair with the gentleman
from North Carolina (Mr. McIntyre) and I tried to quickly respond to
this issue. In fact, 56 Members of Congress, including the gentleman
from Nebraska (Mr. Osborne) and the gentleman from Texas (Mr.
Stenholm), who are here today, asked the Bush administration to come
together and to solve the problem. Because there are two ways a J-1
visa can be issued, one through the Federal Government and one through
the State program. Forty-six States in our country has a State program.
Kansas is one that does not, although we are certainly encouraging them
under the current circumstances to create a State program.
  Today, we reauthorized both programs. The Bush administration and the
Department of Agriculture, I am very grateful to them, they responded.
They processed the J-1 applications that were in the works; and they
decided to have an inter-government agency meeting, a set of meetings,
between INS, the State Department, the Department of Agriculture, the
Department of Health and Human Services to figure out how do we
continue the J-1 visa program.
  So this actually is an experience in the 6 years I have been in
Congress in which I thought government responded in a way that it
should to meet the needs of citizens of our Nation.
  So today I am here to support strongly the reauthorization of the J-1
visa program, to continue to encourage the Federal Government to be
engaged in the process of helping us sponsor J-1 visa physicians and to
particularly reauthorize the program for States and to expand the
number of individual physicians that can be admitted under the State
program from 20 a year to 30 a year to meet the needs in the absence of
a Federal interested government agency of rural communities across our
country.
  The program is important. It is the way that health care is delivered
in rural and urban settings across our country. Access to a physician
is so important, and it ought not matter where you live. This program
has worked. Security and other concerns with the program are being
addressed, and we have general support from the Bush administration and
from the INS and from the State Department as we reauthorize this
program, both at the Federal level and at the State level.
  I appreciate the Rural Health Care Coalition and my colleagues in
Congress who care about these issues; and I appreciate the fact that
Republicans, Democrats, and urban and rural Members of Congress came
together on behalf of citizens and the delivery of health care to those
citizens here on the floor this afternoon. I urge my colleagues to
support this legislation. I thank again the chairman and the ranking
members for their continued consideration of this issue and their
promptness in moving it.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself such time as I
may consume.
  I thank the gentleman from Kansas for his leadership on this issue,
and I thank him for the very important statement of having Americans
have access to good health care. That is why I remind my colleagues of
the importance of ensuring that we have an effective Medicare
prescription drug benefit that clearly is fundable and clearly

[[Page H3869]]

is supportable by the seniors who need it very much.
  Mr. Speaker, I am delighted to yield 5 minutes to the distinguished
gentleman from Texas (Mr. Stenholm).
  Mr. STENHOLM. Mr. Speaker, I thank the gentlewoman for yielding me
this time.
  I rise in strong support of H.R. 4858, which I have been pleased to
work on and cosponsor with the gentleman from Kansas (Mr. Moran). I
thank the gentleman from Wisconsin (Mr. Sensenbrenner) for bringing the
bill to the floor today.
  Mr. Speaker, H.R. 4858 reauthorizes and expands the State Conrad 20
program. The 2-year reauthorization allows States to continue to act as
an interested government agency in order to sponsor foreign-born
doctors to practice in medically underserved areas. The number of
doctors that can be sponsored per State is expanded from 20 to 30.
  Since the mid-1990s, 42 States and the District of Columbia have been
using the Conrad 20 program, processing an estimated 595 physicians per
year.

                              {time}  1230

  However, the demand for doctors continues to grow. Despite a
continuing population migration to urban and suburban communities
throughout the State, the vast majority of Texas remains rural, posing
unique challenges to the delivery and accessibility of high-quality
health care. Not only are health care services likely to be unevenly
distributed, but many rural residents do not even have access to a
local doctor, primary care provider, or hospital.
  Regrettably, a doctor would diagnose the health care problems in
rural communities as chronic and persistent. The issues are not new,
and we have tried a variety of medicines to remedy these problems, but
we still have a long way to go before we achieve a healthy rural
America.
  Consider the following state-wide facts: 77 percent of Texas counties
are considered rural, and 88 percent of these are considered medically
underserved; 2.9 million people, or 15 percent of the State's 19.6
million residents, reside in nonmetropolitan counties; 25 rural Texas
counties have no primary care physician; an additional 29 counties have
only one; only 11 percent of licensed primary care physicians practice
in rural areas.
  For other health professionals, the figures are similar: pharmacists,
11.9 percent; physician assistants, 18 percent.
  Access to primary care promotes appropriate entry into the health
system and is vital to ensure the long-term viability of rural health
care delivery. Without access to local health care professionals, rural
residents are frequently forced to leave their communities to receive
necessary treatments. Not only is this a burden to rural residents, who
are often older or lack reliable transportation, but it drains vital
health care dollars from the local community, further straining the
financial well-being of rural communities.
  It is imperative that we identify and expand those programs that
provide physicians, pharmacists, nurses, dentists, and physician
assistants incentives to practice in rural areas. The J-1 visa waiver
program was expanded in 1995, allowing medical exchange graduates in
U.S. residency training to extend their stay for 3 years, provided they
practice in an underserved community.
  For certain rural, as well as urban, areas in the United States, the
J-1 docs have been key providers. Since 1995, Texas alone has received
the services of over 350 J-1 physicians. This represents service to a
population of over 1 million people. One million people have received
health care that they would not otherwise have received, or at least it
would have been more difficult to receive, as a result of this program
that we reauthorize today.
  However, on March 1, 2002, USDA made a unilateral decision to stop
acting as a sponsor for international medical graduates in rural health
services. Everyone involved in this program, starting with the
Department of Public Health of every State, to the health care
facilities who are desperately waiting for their recruited physicians
to start work in their rural communities, to the doctor who needed the
waiver to start work and have legal status, were shocked to learn of
the elimination of this vital program.
  Through the quick efforts of the Rural Health Care Coalition, we were
able to convince USDA at a minimum to process those doctors who already
had an application pending. While I am pleased with USDA's decision to
take a second look at the program, the affected health care facilities
have lost several critical months during which they could have had a
physician filling that void in their community.
  However, I would like to take this opportunity to encourage USDA, the
State Department, and the INS to expedite those pending applications to
the best extent possible, as our rural communities are in dire need and
deserve every opportunity to access medical care. The J-1 waiver
program is considered a lifeline for rural communities all over the
United States.
  In the 17th district of Texas that I have the privilege of
representing, I have three hospitals awaiting approval for a J-1
doctor: Fisher County Hospital in Rotan, North Runnels Hospital in
Winters, and the San Angelo State School in San Angelo. These are
doctors whose applications were pending at the time of the decision to
stop the program.
  Coordination among agencies involved to expeditiously process these
applicants has reached a critical stage in my district, as I am sure it
has in many rural areas across the country. I am hopeful through the
efforts of the Rural Health Care Coalition and the White House task
force formed to look into reinstating the J-1 program, we can develop a
workable plan to meet the ever-growing needs of access to quality
health care in rural America.
  However, until we have an alternative solution at the Federal level,
there is no other sponsorship program that can fill the void for our
rural communities other than the Conrad 20 program. I urge my
colleagues to support H.R. 4858 in an effort to fill that void.
  Mr. SENSENBRENNER. Mr. Speaker, I yield 2 minutes to the gentleman
from Nebraska (Mr. Osborne).
  Mr. OSBORNE. Mr. Speaker, I would like to express my support of H.R.
4858, introduced by my good friend, the gentleman from Kansas (Mr.
Moran).
  I am very pleased to be a cosponsor of this legislation, along with
the gentleman from Kansas and the gentleman from Texas (Mr. Stenholm),
who recently spoke. All of us serve sparsely populated rural areas.
There are a lot of small towns with great distances between these
towns.
  It is very, very difficult in these areas to recruit doctors. Usually
in these types of communities there is only one doctor, and usually
that doctor is the only doctor for many, 30, 40, or 50, miles. So the
problem is that the doctor knows when he goes to that community that
there is not going to be any rotation, and that doctor is always on
call at 2 o'clock in the morning, 6 o'clock in the morning, late at
night, whatever.
  So, number one, it is difficult to find somebody that will answer
that call. Then once you get somebody who will agree, oftentimes it is
even more difficult to recruit that doctor's spouse, because in those
communities there is no shopping center, there is no symphony, there is
no major league sports team in any close proximity. So to get that
combination of a doctor and the spouse that will come to that type of
community is very difficult.
  When a small town loses a doctor, then it loses its hospital and then
begins to lose young people, because young people with children usually
do not want to be in a community where there is no hospital or no
doctor. The community very rapidly begins to unravel.
  By April 15 of this year, 36 physicians were placed in rural Nebraska
communities under the J-1 program. An example of this would be Oshkosh,
Nebraska, which is a county of roughly 1,700 square miles with one
doctor serving 2,500 people. We were able to secure an internist from
Poland on a J-1 visa waiver. This has been critical to the survival of
the hospital and the community.
  So this has been a tremendously important program to rural areas as
well as to urban areas. We like the flexibility of the program. It has
been able to provide some key specialists in certain communities.

[[Page H3870]]

  Mr. Speaker, we urge support of H.R. 4858. I would like to thank the
gentleman from Kansas (Mr. Moran) for his leadership, and I would like
to especially thank the gentleman from Wisconsin (Chairman
Sensenbrenner) for bringing this legislation to the floor.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield myself the balance of
my time.
  Mr. Speaker, in conclusion, let me acknowledge two points that I
thought the previous speakers made very well, but I think it is very
important.
  It is very important that the pending applications be processed
between the INS, the State Department, and the USDA. I think it is also
important to recognize that not having a physician in any community,
whether it be urban or rural, is like not having a school. It is a
vital part of the components of a community, such as access to health
care.
  This particular legislation had the concerns, of course, because it
represented foreign physicians, that there was a question of homeland
security, or a question of security in light of the incidences of
September 11.
  One of the things that we are trying to do as the President moves his
legislation forward is to ensure that, as much as we can, the
lifestyles of Americans and the values of Americans continue. We
recognize that as these individuals come in to share their talents that
this particular visa will give them the authority to work and to give
service, but it also gives the ability for this country to be safe. We
should balance those responsibilities.
  Let me also say, Mr. Speaker, that our previous speakers have
mentioned the fact that access to health care is important, and I
believe that the quality of health care is important. So that is why I
emphasize in my support of this legislation the importance, as well,
for this Congress to support a viable Medicare drug benefit through the
Medicare process, one that will provide the 80 percent coverage, a
premium of $25, and a deductible of $100.
  We must realize that when we do this for our seniors and those that
need access to health care, we provide preventive medicine. What we do
in doing that is to ensure that the usage of Medicare part A and B
hospitalization, emergency surgeries, et cetera, are diminished because
we have the kind of care that our seniors need with respect to a good
Medicare drug benefit for prescription drugs.
  Mr. Speaker, the fight still continues for good health care in
America. When we pass this legislation, we will help our rural and
inner city areas which are underserved, and we will fix some of those
problems; but we will not fix them in totality if we do not pass a
Medicare drug benefit, prescription drug benefit, tied to the Medicare
plan that provides 80 percent coverage and is not one that plays to the
special interests, paying money to pharmaceuticals when that is not
needed.
  We really need to be seriously considering providing good health
care.
  Mr. COSTELLO. Mr. Speaker, I rise today in support of H.R. 4858. The
number of doctors practicing in rural America continues to decline.
Congress needs to find ways to meet the medical needs of all rural
Americans. This important legislation brings us one step closer to
improving access to medical care in rural America by expanding a state
program to recruit physicians.
  The need for this legislation became crucial after the Federal
program used to bring doctors to rural areas was brought to a halt in
February 2002. The U.S. Department of Agriculture announced it would no
longer process J-1 Visa applications for foreign doctors wishing to
practice in underserved areas. This left the state operated program as
the only option for recruiting much-needed doctors to work in medically
underserved areas. However, this program expired on May 31, 2002.
  H.R. 4558 reauthorizes the state program for two years and expands
the program from 20 to 30 doctors per state, in order to accommodate
the increased demands. This year alone, three psychiatrists applying
for the J-1 visa program in Illinois left my state to apply in other
states because Illinois could not provide any additional J-1 Visa
waivers. This legislation would have allowed these psychiatrists to
remain in Illinois where their service is greatly needed. Since 1994,
the J-1 Visa waiver program has brought 338 physicians to Illinois,
many of which currently serve in my district.
  I am committed to ensuring that, to the maximum extent possible,
physicians are available to provide service to medically underserved
areas. J-1 Visa participants can and will help meet these needs once
the program is reauthorized. Mr. Speaker, for these reasons I support
this legislation and urge my colleagues to do the same.
  Mr. TOWNS. Mr. Speaker, I rise today in support of H.R. 4858,
introduced by my colleague Congressman Moran of Kansas. As a co-sponsor
of this legislation, let me stress that it is vital to maintaining
access to health care for the medically underserved, both in urban and
rural areas. This legislation is needed to reauthorize the J1 Visa
waiver program, whose authorization expired on June 1, 2002. The J1
Visa waiver program has been successful in recruiting physicians in
both primary care and specialty areas in both rural and urban medically
underserved communities. Without this critical program many rural
communities would be without access to basic primary care if not for a
physician with a J1 Visa waiver.
  Since its inception in 1994, the J1 Visa program has been successful
as both a Federal and State program, but in late February, the U.S.
Department of Agriculture announced that it was no longer going to act
as the Federal Interested Government Agency (IGA) in processing J1 Visa
applications for physicians wishing to practice 8in rural underserved
areas. The USDA cited security concerns as the issue. However, USDA's
decision caused a major shortage of filling the needs of the medically
underserved. Although, the Administration has formed a task force to
address the Federal J1 program in selecting another IGA to sponsor
candidates, we still need to reauthorize the state program to limit the
disruption in health care services in these communities. Today, I am
pleased that we here in Congress have an opportunity to take a
proactive stand to ensure that the states' J1 Visa program is
continued. I urge my colleagues to support this bill.
  Mr. SIMPSON. Mr. Speaker, I rise to support H.R. 4858, introduced by
my good friend Representative Jerry Moran of Kansas. This legislation
will extend for two years the J-1 visa waiver program for states and
increase each state's allotment from 20 to 30.
  The J-1 visa waiver program allows foreign medical students to remain
practicing in the U.S. without having to return to their home countries
for two years, as the J-1 visa requires. International Medical
Graduates are a thriving part of the physician population in the U.S.
It is estimated that close to 24% of practicing physicians are foreign
nationals. In addition, in 1999 over 2,000 foreign medical graduates
were practicing in health professional shortage areas or medically
underserved areas, where waiver recipients are required to work.
  I am a strong supporter of the J-1 visa waiver program and disagree
with USDA's decision to withdraw as an Interested Government Agency.
Since 1994, California has received 229 J-1 visa waiver physicians to
practice in underserved areas. Five states--Texas, Louisiana, Michigan,
California and Florida account for 45% of USDA J-1 recommendations.
USDA's withdrawal has left states with nowhere else to turn but to the
state waiver programs, often referred to as Conrad-20 programs.
  Since the USDA began its program in 1994, the agency has recommended
over 3,000 physicians for J-1 visa waiver status. As USDA will not
longer make these recommendations, the states now will have to fill
this vital role. Hospitals and clinics needing a foreign doctor that
would have turned to USDA, which did not have a waiver recommendation
limit, will now relay on the states to fulfill their needs.
  However, the states have been limited to only twenty recommendations
per year. Without USDA involvement the 20 slots are simply not enough
to fill the void for most states. I am in support of increasing the
number of slots to 30, as this will help the problem, but I am worried
that this number is insufficient for many states. A recent survey by
the Texas Primary Care office found that 23 states could recommend more
than 20. Although increasing the limit to 30 will help, it will not
address all of the states' needs, especially in California. In this
same survey, 15 states indicated that they could use over 31 waivers.
Seven of those states said they could use more than 51 waivers.
  This J-1 visa waiver program is essential to ensuring that our rural
health clinics and medical practices can remain in business serving our
rural constituencies. These areas cannot attract American doctors
despite aggressive recruitment procedures. Foreign doctors fill this
significant role. I strongly support continuing this important state
program and endorse increasing the number of slots to thirty as a first
step to providing much needed medical personnel in underserved areas
across the country.
  Mr. PALLONE. Mr. Speaker, I rise in support of H.R. 4858, a bill to
improve access to physicians in medically underserved areas. In many
rural areas of the country, we are experiencing an enormous shortage of
qualified

[[Page H3871]]

doctors. For this reason, the J-1 visa waiver program was established
on the State and Federal level.
  This program allowed foreign medical graduates to come to the United
States on a J-1 visa for up to 3 years to train in accredited residency
programs in rural, underserved parts of the country. Mr. Speaker, the
impetus behind accepting physicians from other countries and training
them in American residency positions is to attract physicians to
provide care to the medically underserved who live in rural areas where
doctors trained in the United States do not want to practice.
  The law states that once the residency program is complete, the
doctors are required to return to their country of origin for two
years. However, the Federal government and states have the authority to
waive the requirements if it is in the United States' interest to keep
the physician here. The US Department of Agriculture (USDA) Rural
Development Branch was thrilled by the waiver because it provided the
opportunity to retain medical trainees who would continue to serve in
typically medically underserved communities in rural America. In
addition, individual state agencies could act as an Interested
Government Agency (IGA) and under the Conrad 20 program, could process
up to 20 J-1 doctors on their own.
  Unfortunately, the USDA has indicated an intention to stop granting
permission under the J-1 visa waiver program. National security
concerns have taken hold and new, extensive background checks have put
the USDA in the position of not being able to afford to continue this
program to keep foreign medical graduates. At the same time, the Conrad
20 program which allowed states to process J-1 visa waivers expired on
May 31, 2002.
  I support passage of H.R. 4858, because this legislation would
reauthorize the Conrad 20 program for 2 years and expand the number of
J-1 visa waivers to 30 per state in order to make up for increasing
demands brought on by the termination of the Federal government program
under the USDA.
  I will work to see that this bill is taken up by the other body and
signed into law by the President to ensure that medical care is
available throughout all rural, underserved communities in the United
States.
  Ms. JACKSON-LEE of Texas. Mr. Speaker, I yield back the balance of my
time.
  Mr. SENSENBRENNER. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore (Mr. Quinn). The question is on the motion
offered by the gentleman from Wisconsin (Mr. Sensenbrenner) that the
House suspend the rules and pass the bill, H.R. 4858.
  The question was taken.
  The SPEAKER pro tempore. In the opinion of the Chair, two-thirds of
those present have voted in the affirmative.
  Mr.SENSENBRENNER. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8, rule XX and the
Chair's prior announcement, further proceedings on this motion will be
postponed.

[Congressional Record: June 25, 2002 (House)]
[Page H3865-H3866]
From the Congressional Record Online via GPO Access [wais.access.gpo.gov]
[DOCID:cr25jn02-64]                        




   IMPROVING ACCESS TO PHYSICIANS IN MEDICALLY UNDERSERVED AREAS ACT

  (Mr. GIBBONS asked and was given permission to address the House for
1 minute and to revise and extend his remarks.)
  Mr. GIBBONS. Mr. Speaker, today I rise to support H.R. 4858, the
Improving Access to Physicians in Medically Underserved Areas Act
introduced by my good friend and colleague, the gentleman from Kansas
(Mr. Moran).
  As the representative of the Second District of Nevada, I represent
an area of over 100,000 square miles, including every rural community
in the State, and I know all too well how difficult it is to recruit
doctors and nurses to these areas. One program which has assisted our
State in recruiting doctors to Nevada is the J-1 visa program.
  H.R. 4858 reauthorizes the J-1 visa program and increases the number
of

[[Page H3866]]

visa waivers for international medical graduates that a State may
request from 20 to 30. Rural Americans deserve access to quality health
care, and the J-1 visa program helps to achieve this goal. In fact,
thanks to the J-1 visa program, over 60 doctors have come to Nevada
over the past few years to practice medicine in underserved areas.
  I encourage all of my colleagues to support the successful program
and vote for H.R. 4858.

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