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Legislative Committee Chair: Rachakonda Prabhu, MD
Legislative Day 2013 - April 11, 2013
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Confirmed Members of House and Senate
1) Physician Shortage
a) Increase Residency Positions
In the 113th Congress, AAPI strongly supports the “Resident Physician Shortage Reduction Act of 2013,” introduced by U.S. Congressman Joe Crowley (D-NY) (H.R. 1180) and U.S. Senator Bill Nelson (D-FL) (S. 577), which would provide an additional 15,000 residency positions in Fiscal Years 2015-2019. Our nation is currently experiencing a physician shortage, which will be exacerbated by retiring baby boomers. The result of such a shortage may affect thousands of patients’ access to a physician, and ultimately the health care they need. The only way to address this future crisis is to increase the number of residency positions available for future physicians to get trained, so that our nation can effectively manage the need for increased patient care. Increasing the size of medical school classes is not enough. There must be a simultaneous increase in the size of residency positions to train these future doctors. As Congress capped the number of residency positions in 1997, it is time for Congress to act NOW to remedy this critical situation. AAPI believes that ALL Americans have the right to see a physician.
Recommendation: AAPI urges members of Congress to cosponsor H.R. 1180 and S. 577
b) Increase the Size of Entering Medical School Classes
From 1980-2005, while medical school enrollment remained flat, the U.S. population increased by more than 70 million people. Because the percentage of baby-boomer generation doctors (55 and older) rose from 27 percent to 34 percent during this time, the Association of American Medical Colleges (AAMC) predicts that America will need 90,000 physicians by 2020. The number of physicians needed by 2025 according to the AAMC will reach a staggering 130,000. One way to address this shortage is to increase medical school class sizes to meet this future health care need. This issue is vital as it pertains to health care reform, as more physicians will be needed to provide quality health care to our nation’s uninsured patients.
2) Immigration Reform
a) Include Physicians Graduating from Accredited U.S. Residency Programs for Green Cards
As part of comprehensive immigration reform, a proposal may include international students graduating with degrees in science, technology, engineering and mathematics (STEM) being fast-tracked for Green Cards. This proposal enables highly-skilled workers to remain in the United States after receiving their higher education in America. Physicians graduating from accredited U.S. residency programs should also receive similar treatment. Such a proposal would enable more physicians to be eligible for Green Cards and address the ongoing physician shortage. These physicians would still be required to meet all U.S. licensing standards before they could officially practice medicine. Hospitals and physician practices would be able to quickly hire qualified physicians who can make an immediate impact in local communities. They can forgo years of waiting in line for a Green Card, thousands of dollars in attorney fees and do what they know best – practice medicine and take care of patients.
Recommendation: AAPI urges members of Congress to include physicians graduating from U.S. residency programs for Green Cards in the comprehensive immigration reform bill.
b) Make the J-1 Visa Waiver Program Permanent
In the 112th Congress, AAPI helped secure the introduction of the “Doctors for Underserved Areas in America Act,” (H.R. 2805), by U.S. Rep. Zoe Lofgren (D-CA), which would make the J-1 Visa Waiver Program permanent. The J-1 visa gives international medical graduates the opportunity to perform their medical training and residency in the United States. Once their training is over, they must return to their home country for two years before becoming eligible to reenter the United States. Under the waiver program, a physician can waive the two-year requirement by agreeing to work in a medically underserved area for three years. The waiver program has greatly benefited local communities by giving them access to critical health care by a U.S.-trained physician. Congress has repeatedly passed legislation reauthorizing the program, and making the waiver program permanent would bring certainty to the system. Legislation has been introduced in the Senate to make the waiver permanent by U.S. Sen. Amy Klobuchar, the “Conrad State 30 and Physician Access Act” (S. 616).
Recommendation: AAPI urges members of Congress to cosponsor legislation making the J-1 Visa Waiver Program permanent when it is reintroduced in the House and to cosponsor S. 616
3) Provide a Permanent Fix to the Medicare SGR
AAPI supports Congress providing a permanent fix to the Medicare sustainable growth rate (SGR) formula. In January 2013, Congress passed a temporary patch to avert a 26.5 percent cut, which expires in 2014. For more than a decade, Congress has delayed passing a permanent fix. Without such a fix, physicians’ reimbursements will be cut by nearly 27 percent next year. This will detrimentally affect physicians’ ability to provide critical health care to patients. Congress can and should fix the Medicare SGR formula without cuts to physicians’ reimbursements to give certainty to the Medicare system. AAPI supports the bipartisan “Medicare Physician Payment Innovation Act of 2013,” (H.R. 574) which would bring certainty to the reimbursement system by eliminating the complex sustainable growth rate system, provide five years of consistent payments to physicians and test new payment models that would take into account the numerous changes that have occurred in our health care delivery system.
Recommendation: AAPI urges members of the House to cosponsor H.R. 574 to bring certainty to the Medicare reimbursement system
4) Medical Liability Reform
AAPI supports a healthy doctor-patient environment by curbing aggressive litigation targeting physicians. Such lawsuits have had a chilling effect and driven up the cost of health care, through extra testing and the practice of defensive medicine. In the 112th Congress, The “Help Efficient, Accessible, Low-cost, Timely Healthcare (HEALTH) Act of 2011,” (H.R. 5) limited the conditions for lawsuits and punitive damages for health care liability claims. It established a statute of limitations and limited noneconomic damages to $250,000. AAPI signed a coalition letter led by the American Medical Association to the Deficit Reduction Committee, which noted that the Congressional Budget Office estimated the cost savings from implementing medical liability reform, including limits on noneconomic damages, to be $62.4 billion over 10 years. Fewer physicians today practice in areas such as obstetrics and gynecology, surgery and emergency medicine, due to increased lawsuits and increasing malpractice insurance premiums.
Recommendation: AAPI supports federal and state legislation that places effective caps on non-economic damages, limits the use of joint-and-several liability, provides physicians with flexibility to negotiate settlements with medical insurers and limits the statute of limitations for filing medical malpractice claims.