In the lower chamber, a bipartisan group of eight representatives is working on legislation of their own.
The outlook for the Senate bill is generally good because it has the backing of prominent legislators, including Sens. Charles Schumer (D-N.Y.) and Marco Rubio (R-Fla.), said Mark Kennedy, director of the Graduate School of Political Management at George Washington University. However, it is possible that immigration connections to the recent Boston bombing could affect whether it becomes law. “It still has a strong chance,” Kennedy said.
Hospitals and other providers would need to comply with new electronic immigration status verification system requirements to verify the status of all of their employees within five years. However, employers with more than 5,000 workers would need to use the system, known as E-verify, within two years; employers with more than 500 workers would have three years to begin. The bill also is expected to increase visas and green card access for a broad range of healthcare workers.
“From doctors all the way down to minimum-wage employees, there are provisions in the bill that make it easier for healthcare employers,” said Gregory Siskind, a healthcare immigration lawyer with the firm Siskind Susser in Memphis, Tenn.
The bill would eliminate per-country limits on green cards, which mostly impact physicians looking to emigrate from India. About 30% of international medical graduates who come for U.S. training are from India, but many more from there are waiting in an 8- to 10-year backlog because of a country-specific annual limit. “We'll see an immediate interest in doctors staying in the U.S. because of that one provision,” Siskind said.
Other provisions specifically target increasing the number of physicians who stay in the country after completing their medical training. Although there are no official figures on physician immigrants, Siskind estimated about half of the roughly 7,000 foreign medical school graduates who complete physician residency training every year permanently return to their home countries, in part because of immigration law requirements.
The legislation could have a big impact on providers in rural areas, where about 20% of the population lives, but only 11.4% of physicians practice, according to a 2010 study. Many of its provisions are aimed at bolstering the clinical workforces of hospitals and other providers in rural locations.
The bill would expedite green cards for physicians who serve in HHS-designated shortage areas or qualifying patient populations for five years. It also would expand the immigration options for so-called J waiver physicians, including technical provisions to ease the immigration process for physicians, their employers and graduate medical education programs. A visa program allowing state health departments to recommend 30 J waivers each year would be expanded to include three more slots in each state for service at academic medical centers.
The physician visa provisions drew praise from the American Medical Association. International medical graduates “play an integral part in American medicine, often joining physicians in practices serving patients in rural and low-income urban areas,” AMA President Dr. Jeremy Lazarus said in a statement.
About 80% of physician visa-holders use the J-1 visa, while the rest are admitted through the H-1B program for highly skilled workers, Siskind estimated. The bill would increase the annual cap on all categories of immigrants who qualify under the H1-B program from 65,000 to 110,000, and possibly up to 180,000 a year.
Samantha Burch, vice president of legislation and health information technology at the Federation of American Hospitals, praised the bill for addressing an H1-B visa issue commonly referred to as “cap gap.” The availability of the visas at the Oct. 1 start of the federal fiscal year has caused problems for physicians who complete their training in June and may choose not to stay at the same facility. They fall into the “gap” because they cannot apply for another visa until October. The provision in the Senate bill this week would allow physicians to maintain their H1-B status until they apply for a new one.
A new W visa would make it easier for healthcare employers to hire foreign workers who do not qualify for high-skilled visa categories. The W visas could also help relieve labor shortages in lower-level hospital and nursing home jobs. That's welcome news to the American Health Care Association, which represents nursing facilities, assisted-living facilities and sub-acute providers. Christopher Donnellan, senior director of government relations at AHCA, said these providers face severe staffing, recruitment and retention issues for direct-care workers who change and bathe residents.
“You can't outsource these jobs,” Donnellan said. “Someone has to take care of your grandmother. Someone has to take care of your grandfather.”
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