The House Immigration Subcommittee has marked up H.R. 4533, a stripped down version of H.R. 4156, a bill that extends the Conrad 30 J-1 waiver program which allows international physicians to remain in the US after completing residency training in exchange for committing to work in physician shortage areas on H-1B visas for three years.

H.R. 4156, introduced by Kansas Republican Jerry Moran, would have extended the ten year old Conrad program by five years, exempted Conrad doctors from the J-1 cap and allowed state health agencies to designate certain facilities as eligible for waivers even if they don’t meet federal shortage area criteria. H.R. 4533 only extends the program for a year and contains no state health agency flexibility language.

Congresswoman Sheila Jackson Lee attempted to introduce amendments that would have made H.R. 4533 identical to H.R. 4156, but committee Chairman Hostettler (R-IN) adamantly rejected the move. The amendment language was rejected on party lines by a vote of 4 to 3.

According to the National Journal, the Department of Health and Human Services opposes states having the ability to designate facilities for fear of local politics coming into play. However, the argument drew raised eyebrows from critics who point out that on most issues, Republicans argue that states should have the right to determine their own policies. Similar arguments could be made regarding any policy area including education, welfare benefits and even programs like Medicaid.

Congresswoman Jackson Lee noted with respect to the extension period that the Conrad program has "been successful for 10 years in bringing highly qualified

physicians to work in rural and urban medically underserved areas. We do

not have to be so tentative about extending it."

According to the National Journal, Hostettler said he wanted to limit the program's renewal to one year for two reasons. First, he said, several local groups are pressing for states to be able to use their waivers to assign the doctors to locations "not designated as shortage areas by HHS." He noted that the Bush administration is "very much opposed" to that idea.

Hostettler did not elaborate on who specifically in the Bush Administration has said the Administration is against the idea or why they would be against the idea. Advocates of the clause point out that the current shortage area designation criteria only measure shortages in an immediately surrounding area and do not account for the regional patient-bases of many hospitals. Also, the shortage designations are based on primary care physician shortages even though state waivers can be for specialty physicians.

Hostettler also made the odd argument that the Conrad doctors were somehow threatening to take positions from Americans wishing to go to medical school. However, Conrad waivers are for physicians coming to the US after medical school and not FOR medical school. Furthermore, all American medical school graduates are guaranteed residency slots before international medical graduates can seek any of the extra 25% of slots available. Advocates of the program also point out that the US is facing a dire physician shortage that has not been disputed by anti-immigration advocates.

The bill next moves on to the House Judiciary Committee for further markup. A bill matching H.R. 4156 is due to be marked up in the Senate soon.