New Hampshire Republican Senator Judd Gregg has posted a letter on his web site in which he urges Senate immigration reform negotiators to deal with nurses. Gregg's letter lacks specifics except to urge giving nurses more points under the new merit-based point system. The problem, however, is that even if nurses qualify under the point system, there could very well be decades-long backlogs for green cards under the new system and nurses would still not get the visas they need to come to the US.

The National Foundation for American Policy, a think tank that concentrates on immigration and trade issues, has released a report entitled "The Impact of the Point System on Foreign Nurses and Other Potential Immigrants". Incidentally, I was interviewed at length for the report and am quoted on page 8.

The State Department is seeking to raise the fee for exchange visitor status changes to $246. Such changes would include, among other things, extensions beyond the maximum duration, change of category, reinstatement and ECFMG sponsorship authorization. The current fee is $198.

New York Newsday reports on the severe shortage of health care workers and why the immigration reform bill may help.

Just as the Senate has reached an impasse (hopefully a temporary one), the stalemate on nurses in that body looks like it may have reached a resolution. The ANA, AHA, and Senators on both sides of the issue have come up with a plan to allow nurses to reclaim the 90,000 or so unused SA 1409. Mr. SCHUMER (for himself and Mrs. HUTCHISON) submitted an amendment intended to be proposed by him to the bill S. 1348, to provide for comprehensive immigration reform and for other purposes; which was ordered to lie on the table; as follows:

On page 281, after line 27, insert the following:

SEC. 509. INCREASING THE DOMESTIC SUPPLY OF NURSES AND PHYSICAL THERAPISTS.

(a) Report.--

(1) IN GENERAL.--Not later than January 1, 2008, the Secretary of Health and Human Services shall submit to Congress a report on the shortage of nurses and physical therapists educated in the United States.

(2) CONTENTS.--The report required by paragraph (1) shall--

(A) include information from the most recent 3 years for which data are available;

(B) provide separate data for each occupation and for each State;

(C) separately identify the nurses and physical therapists receiving initial licenses in each State and the nurses and physical therapists licensed by endorsement from other States;

(D) identify, from among the nurses and physical therapists receiving initial licenses in each year, the number of such nurses and physical therapists who received professional educations in the United States and the number of such nurses and physical therapists who received professional educations outside the United States;

(E) to the extent possible, identify, by State of residence and the country in which each nurse or physical therapist received a professional education, the number of nurses and physical therapists who received professional educations in any of the 5 countries from which the highest number of nurses and physical therapists emigrated to the United States;

(F) identify the barriers to increasing the supply of nursing faculty in the United States, domestically trained nurses, and domestically trained physical therapists;

(G) recommend strategies for Federal and State governments to reduce such barriers, including strategies that address barriers that prevent health care workers, such as home health aides and nurse's assistants, from advancing to become registered nurses;

(H) recommend amendments to Federal law to reduce the barriers identified in subparagraph (F);

(I) recommend Federal grants, loans, and other incentives that would increase the supply of nursing faculty and training facilities for nurses in the United States, and recommend other steps to increase the number of nurses and physical therapists who receive professional educations in the United States;

(J) identify the effects of emigration by nurses on the health care systems in the countries of origin of such nurses;

(K) recommend amendments to Federal law to minimize the effects of shortages of nurses in the countries of origin of nurses who immigrate to the United States; and

(L) report on the level of Federal investment determined under subsection (b)(1) to be necessary to eliminate the shortage of nurses and physical therapists in the United States.

(b) Consultation.--The Secretary of Health and Human Services shall--

(1) enter into a contract with the Institute of Medicine of the National Academies to determine the level of Federal investment under titles VII and VIII of the Public Health Service Act (42 U.S.C. 292 et seq.) that would be necessary to eliminate the shortage of nurses and physical therapists in the United States by January 1, 2015; and

(2) consult with other agencies in working with ministers of health or other appropriate officials of the 5 countries from which the highest number of nurses and physical therapists emigrated, as reported under subsection (a)(2)(E), to--

(A) address shortages of nurses and physical therapists in such countries caused by emigration; and

(B) provide the technical assistance needed to reduce further shortages of nurses and physical therapists in such countries.

(c) Recapture of Unused Employment-Based Immigrant Visas.--

(1) IN GENERAL.--Section 106(d) of the American Competitiveness in the Twenty-first Century Act of 2000 (Public Law 106-313; 8 U.S.C. 1153 note) is amended--

(A) in paragraph (1)--

(i) by inserting ``1996, 1997,'' after ``available in fiscal year''; and

(ii) by inserting ``group I,'' after ``schedule A,'';

(B) in paragraph (2)(A), by inserting ``1996, 1997, and'' after ``available in fiscal years''; and

(C) by adding at the end the following:

``(4) PETITIONS.--The Secretary of Homeland Security shall provide a process for reviewing and acting upon petitions with respect to immigrants described in schedule A not later than 30 days after the date on which a completed petition has been filed.''.

(2) APPLICABILITY.--Notwithstanding any provision of this Act or any amendment made by this Act, section 106(d) of the American Competitiveness in the Twenty-first Century Act of 2000 (Public Law 106-313; 8 U.S.C. 1153 note), as amended by paragraph (1), shall apply to petitions filed on or before the effective date set forth in section 502(d) of this Act for classification under paragraph (1), (2), or (3) of subsection (b), or subsection (d), of section 203 of the the Immigration and Nationality Act (as such section was in effect on the day before the date of the enactment of this Act).



SA 1475. Mr. DURBIN submitted an amendment intended to be proposed to amendment SA 1409 submitted by Mr. SCHUMER (for himself and Mrs. HUTCHISON) and intended to be proposed to the bill S. 1348, to provide for comprehensive immigration reform and for other purposes; which was ordered to lie on the table; as follows:

On page 6, after line 12 of the amendment, insert the following:

(d) Fee for Recapture of Unused Employment-Based Immigrant Visas.--Section 106(d) of the American Competitiveness in the Twenty-first Century Act of 2000 (Public Law 106-313; 8 U.S.C. 1153 note), as amended by subsection (c)(1), is further amended by adding at the end the following:

``(5) FEE FOR RECAPTURE OF UNUSED EMPLOYMENT-BASED IMMIGRANT VISAS.--

``(A) IN GENERAL.--The Secretary of Homeland Security shall impose a fee upon each petitioning employer who uses a visa recaptured from fiscal years 1996 and 1997 under this subsection to provide employment for an alien as a professional nurse, provided that--

``(i) such fee shall be in the amount of $1,500 for each such alien nurse (but not for dependents accompanying or following to join who are not professional nurses); and

``(ii) no fee shall be imposed for the use of such visas if the employer demonstrates to the Secretary that--

``(I) the employer is a health care facility that is located in a county or parish that received individual and public assistance pursuant to Major Disaster Declaration number 1603 or 1607; or

``(II) the employer is a health care facility that has been designated as a Health Professional Shortage Area facility by the Secretary of Health and Human Services as defined in section 332 of the Public Health Service Act (42 U.S.C. 254e).

``(B) FEE COLLECTION.--A fee imposed by the Secretary of Homeland Security pursuant to this paragraph shall be collected by the Secretary as a condition of approval of an application for adjustment of status by the beneficiary of a petition or by the Secretary of State as a condition of issuance of a visa to such beneficiary.''.

(e) Domestic Nursing Enhancement Account.--Section 286 of the Immigration and Nationality Act (8 U.S.C. 1356) is amended by adding at the end the following:

``(w) Domestic Nursing Enhancement Account.--

``(1) ESTABLISHMENT.--There is established in the general fund of the Treasury a separate account which shall be known as the `Domestic Nursing Enhancement Account.' Notwithstanding any other provision of law, there shall be deposited as offsetting receipts into the account all fees collected under section 106(d)(5) of the American Competitiveness in the Twenty-first Century Act of 2000 (Public Law 106-313; 8 U.S.C. 1153 note). Nothing in this subsection shall prohibit the depositing of other moneys into the account established under this section.

``(2) USE OF FUNDS.--Amounts collected under section 106(d)(5) of the American Competitiveness in the Twenty-first Century Act of 2000 (Public Law 106-313; 8 U.S.C. 1153 note), and deposited into the account established under paragraph (1) shall be used by the Secretary of Health and Human Services to carry out section 832 of the Public Health Service Act. Such amounts shall be available for obligation only to the extent, and in the amount, provided in advance in appropriations Acts. Such amounts are authorized to remain available until expended.''.

(f) Capitation Grants to Increase the Number of Nursing Faculty and Students.--Part D of title VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is amended by adding at the end the following:

``SEC. 832. CAPITATION GRANTS.

``(a) In General.--For the purpose described in subsection (b), the Secretary, acting through the Health Resources and Services Administration, shall award a grant each fiscal year in an amount determined in accordance with subsection (c) to each eligible school of nursing that submits an application in accordance with this section.

``(b) Purpose.--A funding agreement for a grant under this section is that the eligible school of nursing involved will expend the grant to increase the number of nursing faculty and students at the school, including by hiring new faculty, retaining current faculty, purchasing educational equipment and audiovisual laboratories, enhancing clinical laboratories, repairing and expanding infrastructure, or recruiting students.

``(c) Grant Computation.--

``(1) AMOUNT PER STUDENT.--Subject to paragraph (2), the amount of a grant to an eligible school of nursing under this section for a fiscal year shall be the total of the following:

``(A) $1,800 for each full-time or part-time student who is enrolled at the school in a graduate program in nursing that--

``(i) leads to a masters degree, a doctoral degree, or an equivalent degree; and

``(ii) prepares individuals to serve as faculty through additional course work in education and ensuring competency in an advanced practice area.

``(B) $1,405 for each full-time or part-time student who--

``(i) is enrolled at the school in a program in nursing leading to a bachelor of science degree, a bachelor of nursing degree, a graduate degree in nursing if such program does not meet the requirements of subparagraph (A), or an equivalent degree; and

``(ii) has not more than 3 years of academic credits remaining in the program.

``(C) $966 for each full-time or part-time student who is enrolled at the school in a program in nursing leading to an associate degree in nursing or an equivalent degree.

``(2) LIMITATION.--In calculating the amount of a grant to a school under paragraph (1), the Secretary may not make a payment with respect to a particular student--

``(A) for more than 2 fiscal years in the case of a student described in paragraph (1)(A) who is enrolled in a graduate program in nursing leading to a master's degree or an equivalent degree;

``(B) for more than 4 fiscal years in the case of a student described in paragraph (1)(A) who is enrolled in a graduate program in nursing leading to a doctoral degree or an equivalent degree;

``(C) for more than 3 fiscal years in the case of a student described in paragraph (1)(B); or

``(D) for more than 2 fiscal years in the case of a student described in paragraph (1)(C).

``(d) Eligibility.--In this section, the term `eligible school of nursing' means a school of nursing that--

``(1) is accredited by a nursing accrediting agency recognized by the Secretary of Education;

``(2) has a passage rate on the National Council Licensure Examination for Registered Nurses of not less than 80 percent for each of the 3 academic years preceding submission of the grant application; and

``(3) has a graduation rate (based on the number of students in a class who graduate relative to, for a baccalaureate program, the number of students who were enrolled in the class at the beginning of junior year or, for an associate degree program, the number of students who were enrolled in the class at the end of the first year) of not less than 80 percent for each of the 3 academic years preceding submission of the grant application.

``(e) Requirements.--The Secretary may award a grant under this section to an eligible school of nursing only if the school gives assurances satisfactory to the Secretary that, for each academic year for which the grant is awarded, the school will comply with the following:

``(1) The school will maintain a passage rate on the National Council Licensure Examination for Registered Nurses of not less than 80 percent.

``(2) The school will maintain a graduation rate (as described in subsection (d)(3)) of not less than 80 percent.

``(3)(A) Subject to subparagraphs (B) and (C), the first-year enrollment of full-time nursing students in the school will exceed such enrollment for the preceding academic year by 5 percent or 5 students, whichever is greater.

``(B) Subparagraph (A) shall not apply to the first academic year for which a school receives a grant under this section.

``(C) With respect to any academic year, the Secretary may waive application of subparagraph (A) if--

``(i) the physical facilities at the school involved limit the school from enrolling additional students; or

``(ii) the school has increased enrollment in the school (as described in subparagraph (A)) for each of the 2 preceding academic years.

``(4) Not later than 1 year after receiving a grant under this section, the school will formulate and implement a plan to accomplish at least 2 of the following:

``(A) Establishing or significantly expanding an accelerated baccalaureate degree nursing program designed to graduate new nurses in 12 to 18 months.

``(B) Establishing cooperative intradisciplinary education among schools of nursing with a view toward shared use of technological resources, including information technology.

cards from prior years and nursing petitioners would pay a $1500 tax on each nurse visa as part of the deal. Here is the text of the proposed amendment:

The Senate's immigration bill, expected to come up for a vote later this week, will have an impact on health care employers if it becomes law. First and foremost, the bill overturns the entire employment-based immigration system and replaces it with a highly controversial point system that is billed as one based on merit. An analysis by the National Foundation for American Policy on the impact of the point system on health care can be found at http://www.nfap.com/pdf/0706pointsystem.pdf.

Unlike the STRIVE Act in the House and S.2611, passed last year in the Senate, there is no nurse section of the bill and no green card cap exemption. This apparently is due to the lobbying of Illinois Democratic Dick Durbin who has become the Senator most hostile to nursing immigration.

Physicians are also covered in the bill. While the bill extends the Conrad 30 program permanently and makes J-1 visas dual intent as well as B-1s for doctors coming in for exams necessary to qualify to get in to residency programs, it also would require doctors to enter the US on J-1 visas and no longer on H-1Bs. Critics of this approach worry that the limit of 30 waivers per state for J-1s would not be nearly enough to cover the demand this provision will create. Opponents of the measure are promoting an alternative approach that would offer incentives for doctors on H-1B to work in medically underserved communities such as exemptions from H-1B and green card caps.

There may be health care related amendments offered this week as well. Once the bill passes, we'll report back.

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