Conrad State 30 and Physician Access Reauthorization Act
- Bill Number
- H.R. 1585
- Origin Chamber
- House
- Congress
- 119th Congress, Session 1
- Policy Area
- Immigration
- Status
- Introduced
- Latest Action
- 2025-02-25: Referred to the House Committee on the Judiciary.
- Last Updated
- 2026-06-30T08:06:17Z
AI-Generated Summary
Purpose of the Legislation
The Conrad State 30 and Physician Access Reauthorization Act (H.R. 1585) aims to encourage foreign-trained physicians to work in rural and medically underserved areas of the United States by extending and enhancing the Conrad State 30 Program. This program allows states to request waivers for J-1 visa holders (exchange visitors, often doctors in training) to bypass the usual two-year requirement to return to their home country after completing U.S. medical training. The goal is to address doctor shortages in these areas, improving healthcare access while providing immigration benefits to participating physicians.
Key Provisions
- Program Extension (Section 2): Extends the Conrad State 30 Program for three years beyond its previous expiration, effective as if enacted on September 30, 2018.
- Retention of Physicians (Section 3): Allows physicians who have completed required service in underserved areas (and their spouses/children) to apply for permanent residency without waiting to finish all service obligations, as long as they meet waiver conditions. This includes those who served before the Act's enactment.
- Employment Protections and Flexibilities (Section 4):
- Updates waiver processes to include bona fide job offers in shortage areas, with a three-year work commitment starting within 120 days of waiver approval or training completion.
- Permits status changes to various work-authorized visas (e.g., H-1B) without numerical limits.
- Defines "substantial" violations of agreements to trigger penalties.
- Extends nonimmigrant status for up to six months if a state denies a waiver due to quota limits, allowing physicians to seek opportunities elsewhere.
- Requires employment contracts to detail on-call hours, malpractice insurance coverage, work locations (no unauthorized additions), and bans non-compete clauses (provisions preventing doctors from working elsewhere after leaving).
- Provides a 120-day grace period for finding new jobs in shortage areas if employment ends early, maintaining lawful status.
- Recaptures unused waiver slots for states if a physician moves to another state.
- Exempts the three-year work requirement in cases of employer violations or extenuating circumstances, allowing shorter service if a new qualifying job is secured quickly; otherwise, adds one extra year per termination.
- Waiver Allotments (Section 5): Sets a baseline of 30 waivers per state annually, increasing to 35 if 90% of waivers in high-use states are utilized, with further increases to 40+ based on continued high usage (95% threshold at higher levels). Decreases occur if usage drops significantly, but not below 30. Adds up to three waivers per state for physicians at academic medical centers serving the public interest, even outside shortage areas.
- Procedural and Definitional Amendments (Section 6):
- Allows "dual intent" for J-1 physicians in training, meaning they can pursue permanent residency without risking their temporary visa.
- Clarifies national interest waivers for green cards: Physicians must commit to five years of full-time work in shortage areas or VA facilities; service counts from start date regardless of visa status or training phase; no need for long-term contracts or refiling petitions for job changes.
- Recognizes foreign medical degrees as equivalent to U.S. advanced degrees if accepted for residency.
- Provides automatic short-term extensions of H-1B status and work authorization for residency completers until October 1, with termination if petitions fail; auto-extends if visa caps are reached.
- Exempts spouses and children of J-1 physicians from the two-year home residency rule.
- Reporting Requirement (Section 7): Mandates annual reports from U.S. Citizenship and Immigration Services (USCIS) to Congress and the Department of Health and Human Services (HHS) on J-1 waiver usage by state.
Significant Changes to Existing Law
- Extension and Retroactivity: Previously set to expire in 2015, the program is now extended with retroactive effect from 2018, preventing lapses and allowing continuity.
- Increased Flexibility: Introduces grace periods, waiver recapturing, contract protections (e.g., no non-competes, mandatory malpractice details), and exceptions for employer faults—changes not in prior law, reducing risks for physicians.
- Waiver Adjustments: Shifts from a fixed 30-waiver cap per state to a dynamic system based on usage, potentially increasing total waivers nationwide; adds academic medical center exceptions.
- Immigration Streamlining: Expands dual intent to J-1 doctors, clarifies service aggregation for green cards, eases petition requirements, and removes two-year rule for families—broadening pathways compared to stricter prior rules.
- Enforcement Tweaks: Specifies "substantial" agreement violations and adds reporting for transparency.
Potential Impacts
- On Government Agencies: USCIS and HHS will handle more waiver processing and designations of shortage areas, potentially increasing workload but with automated extensions reducing backlogs. States gain tools to attract doctors, aiding rural health planning. The Department of State and DHS coordinate on waivers and status changes.
- On Citizens: Improves healthcare access in rural and underserved communities by retaining more foreign physicians, potentially lowering costs and wait times for primary/specialty care. Urban academic centers benefit from targeted waivers.
- On International Relations: Encourages international medical talent from abroad, fostering goodwill with countries supplying doctors (e.g., via J-1 exchanges), but may strain relations if seen as "brain drain" from home countries.
- Broader Effects: Could increase the physician workforce by 10-20% in shortage areas over time, based on waiver growth, supporting rural economies and reducing healthcare disparities.
Main Stakeholders Affected
- Foreign-Trained Physicians: Gain easier paths to stay and work in the U.S., with protections against exploitative contracts and job loss.
- Rural and Underserved Communities/Healthcare Facilities: Benefit from more doctors, especially in primary care and specialties, addressing shortages.
- State Agencies: Receive more waivers and flexibility to recruit, with reporting aiding program evaluation.
- Academic Medical Centers and VA Facilities: Access waivers for faculty/residency roles, enhancing training and veteran care.
- Spouses and Children of Physicians: Exempt from return-home rules, easing family immigration.
- U.S. Healthcare System: Overall gains from aggregated service counting and dual intent, reducing administrative hurdles.
Notable Legal, Constitutional, or Political Implications
- Legal: Strengthens immigration-law integration with healthcare policy by clarifying ambiguities in the Immigration and Nationality Act (e.g., service counting, dual intent), potentially reducing litigation over waivers. No overrides of core visa rules, maintaining congressional authority over immigration.
- Constitutional: Aligns with Congress's plenary power over immigration and commerce (healthcare as interstate activity); no apparent free speech, due process, or equal protection issues, as changes apply uniformly to eligible J-1 physicians.
- Political: Bipartisan sponsorship (e.g., Republicans and Democrats) signals broad support for rural health initiatives. Could influence future immigration debates by prioritizing skilled workers in public-interest fields, appealing to rural constituencies and addressing physician shortages amid aging populations. Annual reporting promotes accountability, potentially leading to further expansions if usage is high.
This summary was generated by AI and may contain inaccuracies. Refer to the official source document for the authoritative text.
Sponsor
Rep. Valadao, David G. [R-CA-22]
Cosponsors (65)
Rep. Bacon, Don [R-NE-2], Rep. Schneider, Bradley Scott [D-IL-10], Rep. Garcia, Sylvia R. [D-TX-29], Rep. Salazar, Maria Elvira [R-FL-27], Rep. Davids, Sharice [D-KS-3], Rep. Johnson, Henry C. "Hank" [D-GA-4], Rep. Scott, David [D-GA-13], Rep. Carbajal, Salud O. [D-CA-24], Rep. Costa, Jim [D-CA-21], Rep. Krishnamoorthi, Raja [D-IL-8], Rep. DelBene, Suzan K. [D-WA-1], Rep. Cherfilus-McCormick, Sheila [D-FL-20], Rep. Riley, Josh [D-NY-19], Rep. Houlahan, Chrissy [D-PA-6], Rep. Panetta, Jimmy [D-CA-19], Rep. Suozzi, Thomas R. [D-NY-3], Rep. Meuser, Daniel [R-PA-9], Rep. Gillen, Laura [D-NY-4], Rep. Gomez, Jimmy [D-CA-34], Rep. Ciscomani, Juan [R-AZ-6], Rep. McBride, Sarah [D-DE-At Large], Rep. Murphy, Gregory F. [R-NC-3], Rep. Wasserman Schultz, Debbie [D-FL-25], Rep. Lawler, Michael [R-NY-17], Rep. Baumgartner, Michael [R-WA-5], Rep. Craig, Angie [D-MN-2], Rep. Correa, J. Luis [D-CA-46], Rep. Tokuda, Jill N. [D-HI-2], Rep. Ryan, Patrick [D-NY-18], Rep. Scholten, Hillary J. [D-MI-3], Rep. Foxx, Virginia [R-NC-5], Rep. Dingell, Debbie [D-MI-6], Rep. Gottheimer, Josh [D-NJ-5], Rep. Castor, Kathy [D-FL-14], Rep. Ross, Deborah K. [D-NC-2], Rep. Casten, Sean [D-IL-6], Rep. Peters, Scott H. [D-CA-50], Rep. McClellan, Jennifer L. [D-VA-4], Rep. Gonzalez, Vicente [D-TX-34], Rep. Pettersen, Brittany [D-CO-7], Rep. Matsui, Doris O. [D-CA-7], Rep. Magaziner, Seth [D-RI-2], Rep. Dexter, Maxine [D-OR-3], Rep. Veasey, Marc A. [D-TX-33], Rep. Crow, Jason [D-CO-6], Rep. Vindman, Eugene Simon [D-VA-7], Rep. Stanton, Greg [D-AZ-4], Rep. Van Drew, Jefferson [R-NJ-2], Rep. Leger Fernandez, Teresa [D-NM-3], Rep. Subramanyam, Suhas [D-VA-10] and 15 more
Recent Actions
- 2025-02-25: Referred to the House Committee on the Judiciary.
- 2025-02-25: Introduced in House
- 2025-02-25: Introduced in House
Bill Versions
- Conrad State 30 and Physician Access Reauthorization Act — issued 2025-02-25 — PDF (20 pages)