LC 14. IE6/Z1 ,”""3 800[o°i U CONGRESSIONAL IWilfimlflwilfiflflflWW LIBRARY OF CONGRESS HEALTH PROFESSIONS AND NURSE TRAINING PROGRAM ISSUES ISSUE BRIEF NUMBER IB80069 AUTHOR: Bailey , Susan Education and Public Welfare Division THE LIBRARY OF CONGRESS CONGRESSIONAL RESEARCH SERVICE unaon Issuns szsrnu DATE ORIGINATED gggggggg DATE UPDATED Qggggggg FOR ADDITIONAL INFORMATION CALL 287-5700 0806 CRS- 1 IB80069 UPDATE-O8/06/H0 l§§!§_2§El!l$lQ! Congress last considered legislation between 1970 and 1976 to revise and extend the Federal programs for health professions education (medicine, osteopathy, dentistry, optometry, pharmacy, podiatry, veterinary medicine, and public health) authorized by Title VII of the Public Health Service Act. P.L- 94-H84, the Health Professions Educational Assistance Act of 1976, resulted in a revision and 3-year extension of authorities for these programs through FY80. The most recent nurse training legislation, P.L. 96-76, the Nurse Training Amendments, enacted in 1979, extended Title VIII programs for 1 year through FY80. During FY80 the Congress is again considering legislation to extend Title VII and Title VIII programs. Congressional debate is focused on the issues of health manpower geographic and specialty maldistribution, and the level and types of’ Federal support necessary for health professios and nursing education. E EAQKGRQQ!D-A§2-2QLlQX.A!ALY5l§ l!2EQ2EQ-_Q! Title VII programs have provided Federal assistance for health professions aining since 1963. Since that time, Federal health manpower policy has shifted from its original emphasis on increasing the national supply of health manpower towards improving the geographic and specialty distribution of practicing health professionals. _P.L. 94-H80 included provisions intended to ease the geographic and specialty maldistribution of health professionals. The legislation greatly increased the funding authorizations for two programs, the National Health Service Corps and its scholarship program, designed to encourage health professions personnel to serve in health manpower shortage areas. P.L. 90-480 also encouraged physicians to enter primary care training by requiring medical schools receiving capitation assistance (fommula grants to health professions schools for general educational purposes based on the number of students enrolled) to maintain 1a specified percentage of first-year residency positions in primary care. I HI§TORY with the enactment in 1963 of P.L. 88-129, the Health Professions Educational Assistance Act, the Federal Government began to provide direct financial assistance to schools and students of the health professions. Prior to that. time, the Government's role in health manpower’ training programs had been limited to indirect support provided through biomedical research grants from the National Institute of Health. The 1963 legislation was intended to address a perceived- problem of < Ltical health manpower shortages in the Nation by encouraging increased enrollments at health professions schools. According to the House Interstate and Foreign Commerce Committee report on th measure, increases in the number of new physicians and dental students were needed just to maintain then-current ratios of physicians and dentists to population. The committee noted the need to increase the number of people entering medicine and dentistry from 12,500 in 1963 to 19,000 annually. This was intended to cns— 2 IB80069 UPDATE-08/06/80 increase total medical and dental school enrollnent from 46,000 in 1963 to 75,000 by 1970. P.L. 88-129, authorized (1) matching grants to construct new or expand existing health professions schools, and (2) loans for students in three of tthe health professions (medicine, osteopathy, and dentistry). Congress revised the legislation in 1965 and 1968. Health manpower shortages were still perceived by Congress as a critical problem in 1971, even though the number of practicing physicians had increased from 280,500 (142 per 100,000 population) to 325,000 (155 per 1100,000 population) between (1960 and 1970. Huch of this increase was attributable to an increase in the number of foreign medical graduates (FHGS) practicing in the United States. In 1963, 11.2% of ~all physicians in the United States were Fuss. By 1970, that percentage had increased to 17.1%. In 1971, the Senate Labor and Public Welfare Committee estimated the shortage of physicians in the United States to be 50,000. To alleviate these shortages, P.L. 92-157, the Comprehensive Health Manpower Training Act, authorized an expanded program of institutional support to health professions schools known as capitation grants. The amount of each school's capitation grant was determined by a formula based on the number of students enrolled in each class. Congress designed capitation grants to provide a stable base of revenue to health professions schools. In its 1971 Report, the Labor and Public welfare Committee contended that health professions institutions would respond to national needs for increased manpower if the schools were assured a predictable amount of Federal funds sufficient to stabilize their financer The committee noted that the current financial crisis among health professions educational institutions precluded effective action on their part in response to national needs. The committee further observed that prior to 1971, some 60 medical and osteopathic schools and 22 dental schools received X substantial Federal assistance because of their severe financial straits. P-L. 92-157 also reflected congressional awareness that it was important to consider not only the supply of physicians, but also their specialties and the geographic areas in which they chose to practice. For example, funds were targeted by the Act for training in the new primary care specialty, family medicine; Loan-forgiveness provisions were included as well to promote service in health manpower shortage areas. ‘ By 1974, it was clear that Federal support to health professions schools had resulted in.substantial increases in enrollments. TABLE 1. First-year enrollment in medical schools 1222 Enrellaenr 1930 6,055 1950 3,293 1970 11,303 CRS- 3 IB80069 UPDATE-08/06/30 ' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ when congress began in 1974 to consider health manpower training programs once again, the need to increase aggregate supplies of health personnel no longer caused the concern of prior years. Rather, problems associated with the “distribution of health professions across the Nation --geographically and by specialty —— were perceived to be the issues requiring legislative response; The 1975 House Interstate and Foreign Commerce Committee Report on health manpower legislation indicated that increases in the number of health professionals had not resulted in a more equitable geopraphic distribution of health manpower. Despite those increases, the geographic maldistribution of health manpower had actually increased since 1965. Health manpower was maldistributed by region and by demographic units within regions. For example, in 1974, the northeast and Paci£ic:regions of the Nation had on a per capita basis, over 50% more physicians than did Midwestern and Southeastern regions. Further, on a national basis, the physician: population ratio in urban areas was 170 physicians per 100,000 population, more than twice the non-urban ratio of 80 per 100,000. é Another issue before Congress during their consideration of the 1910 legislation was the naldistribution of physicians by specialty. The proportion of primary care physicians had declined significantly by 1974. En 1909, 50% of all physicians were general. practitioners. By 1970, that percentage decreased to 16.4%. The decline in prinary care physicians exacerbated geographic maldistribution problems because these physicians tend ’ be more evenly distributed throughout the population whereas. specialists are more likely to locate disproportionately in more highly populated areas. P.L. 9Q-484, the Health Professions Educational Assistance Act of 1976, revised and extended Title VII authorities through FY80. Under P.L. 94-484, Federal funds are authorized for health professions schools for capitation assistance, construction grants, and special project grants. Financial assistance is authorized for health professions students in the for: of Health Professions Student Loans (HPSL), Health Education Assistance Loans (HEAL), National Health Service Corps Scholarships, and Scholarships for First—Iear Students with Exceptional Financial Heed. ‘ ‘ The 1976 Act included provisions designed to improve access to physician services for persons in underserved areas. For example, the law encouraged participation in the National Health Service Corps (NHSC) and its Scholarship program. Established in 1972 by P.L. 92-585, the Emergency Health Personnel Act Amendments of 1972, the NHSC was designed to provide a continuing source of medical personnel in health manpower shortage areas by requiring its members to serve in those areas. Health professions students became eligible for HHSC scholarship support in return for an obligation to serve in designated health manpower shortage areas after completion of their studies. Among other things, PAL. 9n-uau greatly increased the funding authorizations for the Corps and its scholarship program. 9 other provisions of P.L. 94-48H were designed to encourage physicians to e ;er primary care training. one such provision was tied to capitation assistance which was reauthorized under the Act. To receive capitation assistance, medical schools were required to maintain a specified percentage of first—year residency positions in primary care. The Act also authorized several special project grants to promote the study of family medicine. ° The 1976 legislation also amended health. professions student assistance cns- u IB8 0069 UPDATE-O8/06/30 programs by requiring health professions students to assume a greater share in the costs of their education. Health professions scholarships were phase‘ out - only scholarships for first-year students of exceptional financip need remained. To supplement this scholarship program, Congress expanded the NHSC scholarship program, as previously mentioned. In addition, the Act continued the Health Professions Student Loan (HPSL) program but on a limited basis. As a final student assistance provision, P.L. 94-ueu authorized a new federally insured student loan program, known as Health Educational Assistance Loans (HEAL), which allowed health professions students to borrow greater amounts but at a higher interest rate than the HPSL program. i 9232332 l55Q£§ Health manpower authorities under Title VII and nurse training authoities under Title VIII of the Public Health. Service Act expire in FY80. Legislation has been introduced in the 96th Congress to reauthorize these programs. This legislation includes H.R. 7203 - Health Professions, Educational Assistance and Nurse Training Amendments of 1980 (fiaxman et al.M; and S. 2375 - Health Professions Education and Distribution Act of 1980 (Byrd for Kennedy). In congressional debate on the reauthorization of health manpower and nurse training programs, a number of complex issues have been raised. l 1 Ee29re2hi2-a2Q.§222ia;$1-2i§§ribusien- Congress sought to improve the geographic and specialty distribution of health professionals with the enactment of P.L. 9n-nan. pAt present, data are generally inadequate to evaluate the impact of that legislation, because so little time has elapsed since its enactment (first-year medical school classes of 1976 would only graduate this year with most graduates entering residency training before beginning actual practice). Q Certain evidence does indicate, however, that some progress has been made in alleviating specialty maldistribution problems. The trend toward declining numbers of physicians entering primary care specialties may be ending. Federal legislation identifies family medicine, and general internal medicine, and general pediatrics as primary" care specialties, whereas the American Hedical Association also includes obstetrics and gynecology. A 1918 Department of Health, Education, and Welfare (HER) report to the President and Congress. 9n.§he-§:222§_2§-§e2lth-£r2£§§§i2n§.2e£§2gnel. indicated that the decline in the number of primary care physicians showed signs of abating beginning in 1976. The report further speculated that the decline wouLd reverse itself in the 1980s, largely due to the recent increases in family practice and internal medicine residencies. A Despite increasescin aggregate supply, only limited progress has been made toward improving the geographic distribution of health professionals especially in rural and inner city areas, according to the above mentioned HEW report. Bills introduced in the 96th Congress contain provisions to alleviate geographic and specialty maldistribution of health professionals. For example, H.R. 7203 and S- 2375 would reauthorize, in some form, the National Health Service corps (NHSC) and its scholarship program. These two programs seek to encourage health professions personnel to serve in health manpower CRS- 5 IB80069 UPDATE-08/06/80 shortage areas. 5. 2375 would also authorize a new grant progran to States 1 assist them in neeting the needs of health manpower shortage areas. Under the State program, scholarship assistance would be provided to students in the health professions, allied health, graduate programs in health administration, and programs for the training of physician assistants, expanded function dental auxiliaries, clinical psychologists, and nurse. practitioners, in return for their service in a health manpower shortage area. Both bills also contain provisions to improve the current specialty distribution of physicians. Each would, in some form, reauthorize special? project grants to encourage training in general internal medicine, general pediatrics, and fanily medicine. “ : .4s92.I;2..en1.<1..I12e..9;t...1:'e«1sra1 Aid :0 Heé1..l.:c.h.:':1:.<.>£.:e..$.§'».i2I.1§._§@.11..cs:=1.ri2.r;- In their 1978 report. Qp...’2he.§£.a;.1;2§_2f-;I!e;2;tL1._I3r2.1:.9._s§i9n§- ;P<.er§.9I.1L1._e._1_. HEW stated that by 1990 the tremendous increases in health manpower supply should result in the closest balance in the Nation's history between requirements and actual supply for most health professions. HEW projected that no severe shortages would exist in any health manpower category in 1990. 3 Because of a growing sense that there is an adequate supply of health manpower in this country, questions have been raised as to whether new legislation need concentrate on producing more health professionals. HEW projects an increase in physician supply of 37% between 1975 and 1990, from ’ 3 to 241 physicians per 100,000 people. Some observers are concerned that the country may be producing too many physicians. Consequently, some policyuakers favor a reduction in Federal assistance to health professions education. As a result, the major issue Congress may have to contend with during the health manpower debate is what type and how much Federal support should be authorized for health professions education. Sone, including the Administration, have already advocated phasing out capitation assistance. 0 Bxaaination of the funding of capitation assistance reveals a peaking of" such assistance in 1974, with decreasing obligations and decreasing grants per student being awarded to each of the professional schools since then. For example, in 1970 capitation awards to medical schools totaled $105,604,000. capitation grants per medical student totaled $2,090. Those figures have since decreased to $66,500,000, and $1,072, respectively, in 1979. Further, in 1975-76, Federal capitation amounted to only 3% of medical schools‘ total revenues. At such levels of funding, one may question to what extent such assistance is then required for enrollment objectives or for the financial stability of institutions. If the number of various health professionals will be adequate in the future, should capitation assistance remain linked to enrollment requirements? can schools continue to sustain and support enrollments (at levels they might not otherwise have reached without Federal incentives) without continued capitation assistance? In the past, capitation assistance has been tied to certain requirements designed to help neet national health manpower objectives. Has the capitation grant progra: been an effective tool by which to achieve these manpower objectives 1 .'exa:ple, alleviating distributional problems? other questions before the Congress include: What impact would the termination of capitation assistance have on health professions schools? Further, in recent years medical school tuition costs have greatly increased. What impact has decreasing Federal support had on tuition levels at health professions schools? If Federal support is decreasing, are other sources of cns- 6 1330059 UPDAIE-08/06/80 financial assistance available for schools to draw on for the support of peducational objectives? Health manpower and nurse training legislation would not reauthorize capitation assistance in its current form. H.R. 7203 would phase it out for ischools of medicine, osteopathy, dentistry, veterinary medicine, optometry, pharmacy and podiatry over a 3-year period. 5. 2375 would establish a national priority incentive grant program to make annual grants to health professions and nursing schools to support health manpower programs, projects and activities in the national interest. 1'.u;.1;;9.r.1_<.=<.>.s’.c§.2:_t.I<_e2Ll:h.L’r91.’:<.e§§ i9n§..§<1t.1<.=e’2i9:.1 - As indicated by Table 2, tuition costs for students at health professiods schools have increased dramatically in recent years. To what extent do such increases entail a burden for students? TXBLB 2. Average tuition for the entering class?‘ ...--- 1 public and private medical schools ‘ 1975*76 and 1973~79 £t.1.2;;s-!.1<.e<.i.ica1 _S2.t;9.2.1.§ 399299229 5192299 Eer292Le92.;22;92§2 1919-79 s1,63u u3% 1975-75 1,139 -- Eeerseiéeese 1978-79 3,575 usx 1975-76 2,u7o -- 1978-79 $6,114 9 62% 1973~76 3,767 -- Direct financial assistance to health.professions students has also--declined in recent years. P.L. 9n-nan required these students to share to a geater extent in the costs of their education. The legislation contained provisions linking national health manpower goals such as improved geographic and specialty distribution student assistance programs. Under P.L. 9n-48¢, student assistance programs emphasized scholarships requiring repayment service in health manpower shortage areas. Should the Federal Gvoernmeut continue to provide special student assistance programs for health professions students? Or, should new legislation reguire health professions students to share, to an even greater extent, the responsibility for the costs of their education? As indicated above, student financial assistance programs have increasingly emphasized service commitment. Should that CBS- 7 IB80069 UPDATE—08/06/80 emphasis be further strengthened by providing that all student financial p aosistance programs require service in a health manpower shortage area? As might be expected in view of the rising costs of health professions education, the proportion of medical students with debts has increased in the I last 10 years from 44% in 1968 to 67% in 1975 to 73% in 1978. The average amount of debt for students has risen from $11,600 in the 197a-75 academic year to $17,300 in the 1977-78 year, a u9% increase. What role does increasing indebtedness play in the specialty choices of students? As the costs of health professions education. continue to rise, and as students are required to assume a larger share of the costs of their education, their ability to finance their education may determine who will consider a career in the health professions in the future. Although the wrelative representation of financially disadvantaged students in medical schools has increased over the years, the great majority of students continue to come from families with higher incomes. The median parental income of students in medical schools for 1977-78 was $25,000 compared to $20,249 in 1974-75 and $1u,627 in 1970-71. There are also indications that increases fin minority students enrollment appear to be leveling off. What impact do the costs of health professions education have in deterring students, particularly disadvantaged and minority.individuals, from seeking a career in the health professions? will heavy financial burdens incurred by those already accepted to health professions schools deter them from completing their professional studies? S. 2375 would authorize a new student loan program emphasizing service ,c-mmitment. If enacted, the measure would authorize a new service-contingent loan program to provide loans to students in training programs for health professions, graduate health administration, and physician assistants or expanded function dental auxiliaries. In return for interest subsidizatidn of the loan, the borrower would, at the discretion of the Secretary of HHS, be requested to serve in areas of national priority needs. § The nurse training program authorized uder Title VIII of the Public Health Service Act provides Federal support.for nursing students and schools. The Federal Government has been involved in assisting nursing programs since the 1930s. The first comprehensive Federal legislation to provide funds for nursing education, P.L. 88-581, the Nurse Training Act of 196a, consolidated those programs which had been in effect for 30 years, as well as expanded the authorizations. Enactment of PuL. 88-581 in 1963 :represented congressional response to the increasing concern for existing and potential shortages in the nursing profession. ? 9.1.. 88-581 added Title VIII, Nurse Training, to the Public Health Service Act, and authorized (1) grants to assist rin the construction of teaching facilities; (2) grants to defray the costs of special projects to strengthen n ‘se education programs; (3) formula payments to diploma schools of nursing; anJ (4) the extension of the Professional Nurse Traineeship Programs. Subsequent enactments in 1966 (P.L. 89-751), 1968 (P.L. 90-490), 1971 (P.L. 92-158), and 1975 (P.L. 9u—63) reauthorized the nurse training programs. The most recent nurse training legislation is P.L. 96-76, enacted by Congress in 1979. These enactments reflected continuing congressional efforts to insure an adequate supply of nursing personnel for the Nation. I (:ns— 8 IB80069 UPDA'.l'E—O8/06/810 At present, Federal funds are authorized for nursing schools for thc %“construction of teaching facilities, ‘capitation assistance, and speci; projects to improve nurse training. Federal funds are also authorized far grants to nursing schools for advanced nurse training programs. Federal assistance is available to nursing students in the form of loans, scholarships, and advanced nurse and nurse anesthetist traineeships. 9 Recent administrations sought to reduce Federal support for nurse training, maintaining that increases in the nursing supply had resulted in pa current and projected supply adequate to meet nationwide health care needs. In the past 25 years, the number of actively employed nurses in this country has increased dramatically. Since 1957, the number of active nurses has more than doubled to almost a million. Twelve years ago, in 1968, there were 300 active nurses per 100,000 population in the United States. By the beginning of 1977, this ratio had risen to 395 per 100,000 population. 4 President Carter, in his veto message of nurse training legislation in the 95th Congress, called the outlook good for adequate, sustained growth in the Asupply of nurses. The Department of Health, Education and He1fare‘s Second Report to the Congress on the Nurse Training Act also indicated that by 1985 the aggregate supply of nurses would be roughly equal to the aggregate requirements, estimated to be between 1,205,600 and 1,316,300 registerd nurses. However, the report noted that maldistribution might remain in certain areas of the country, in certain nursing settings, and among certain types of registered nurses. E Although the number of nurses has increased greatly, there are those wL-a believe the country continues to face a nursing shortage. The American Nursing Association (ABA) estimates that by 1982 there will be a shortage of over 100,000 full-time employed registered nurses in hospitals and other segments of the health care field. In 1978, the unemployment rate for nurses seeking work was 1.8%, the lowest since 1969. According to the ANA, hospitals, in various American communities seeking to employ registered nurses, are currently offering bounties ranging from $100 to $1,000 for each nurse hired. Z The National League of Nursing (NLN) noted, in 1978, the first decline in admissions to registered nurse training pnmgrams since the 1960s. The NLN added that for the next several years no further aggregate enrollment growth could be expected with the probability high.that further declines will occur. LEGISLATION H.R. 7203 (iaxman et al.) Health Professions and Educational Assistance and Nurse Training 1 Amendments of 1980. Revises and extends. the Public Health Service Act programs for health professions (Title VII) and nurse training (Title VIII) education for 3 years through FY83. Among other things, phases out capitation assistance, renamed ‘institutional support grants" under the bi] for medical, osteopathicq dental, veterinary medicine, optometry, pharmacy, and podiarty schools over a 3-year period. I Extends the construction loan guarantee program for health professions schools. Also authorizes conversion grants to 2-year medical schools to assist them in becoming Q-year institutions. Extends financial distress. grants for health professions schools. Also extends startup grants but only for new schools of veterinary CRS- 9 IB80069 UPDATE-08/06/80 medicine, optometry, podiatry, pharmacy, and public health. Extends and ? ends certain special project grant programs. Extends and amends the NHSC, I aid its scholarship program, as well as the Health Education Assistance Loan Program, and the Scholarship Program for First-Year Students of Exceptional Financial Heed. Also extends the Health Professions Student Loan Program. ‘ Extends the program of traineeships for public health students, as well as project grants for public health schools and graduate programs in health administration. Also extends project grants for allied health schools, as well as traineeships and disadvantaged assistance for allied health students. Establishes a Graduate Medical National Advisory Committee (GMENAC). A Amends Title VIII to authorize institutional support grants for nursing schools similar to capitation grants but at different levels of financial support. Extends construction grants for (1) nursing schools but only for those schools in health manpower shortage areas, (2) nursing special projects, (3) the advanced nurse training program, (Q) traineeships for nurse anesthetists, and (5) nursing student loans and scholarships. Also extends and amends the nurse practitioner program, and advanced nurse traineeships.‘ ! I Originally introduced as H.B. 6802 Mar. 12, 1980; referred to Interstate and Foreign Commerce Committee. Hearings held Mar. 20, 21, 20, 26, and 27. H.R. 6802 was then considered by the Interstate and Commerce Subcommittee on Health and the Environment, and ordered reported as a clean bill, H.R. 7203, Apr. 29, 1980. H.H. 7203 was considered by the full committee and reported May 15, 1980 (H-Bept. 96-978). 9 S. 2375 (Byrd for Kennedy et al.) Health Professions Training and Distribution Act of 1980. Revises and extends Public Health service Act programs for health professions (Title VII) and nurse training (Title VIII) education for 3 years, FY82-8H. Among other things, amends Title VII to repeal capitation assistance for health professions schools. Establishes a national priority incentive grant program to provide institutional support grants to health professions schools if they fulfill or are fulfilling certain national objectives. Establishes a program to provide grants, loan guarantees and interest subsidies for: (1) renovation and modernization of existing facilities for teaching and’ research; and (2) construction, and conversion of existing facilities for ambulatory primary care teaching. Establishes a one-time grant for conversion of any 2-year medical school to a degree granting institution. Continues funding for a number of special projects and authorizes various new initiatives. Continues startup grants but only for new schools of veterinary medicine, optometry, podiatry, and public health. Continues financial distress grants with support limited to 3 years, and creates a. grant program to help health professions schools achieve financial solvency within an additional 5-year period. Extends and amends the Health Education Assistance Loan (HEAL) program. Continues the health professions student loan program through FY81, but phases out the program beginning in FY82 when loans would he made only to senior students who were previous loan recipients to allow them to complete their education. Authorizes a new service-contingent loan program to students in the following programs: health.professions, graduate programs in 1 Llth administration, and programs for the training of physician assistants or expanded function dental auxiliaries. Creates a new program of loan forgiveness for persons who practice in underserved areas. Extends and amends the National Health Service Corps but only through FY81. Also extends and amends the NHSC scholarship program, and the Scholarship Program for First-Year Students of Exceptional Financial Need. Establishes a Federal program of grants to states to fund the cost of health manpower shortage area CRS—10 IB80069 UPDATE-OQ/06/GO service scholarships offered by the State to health professions students. Extends and amends programs for training in public health administration, at‘ allied health. Among other things, amends Title VIII to repeal capitation assistance ford nursing schools. Establishes a national priority incentive grant program do provide institutional support grants to nursing schools if they fulfill or are fulfilling certain national objectives. Extends construction grant authority for new schools. Revises special project grant authority; and extends existing program authority for nurse practitioner and advancedv nurse ytraining, and traineeships for advanced nurse training and nurse anesthetists. Creates a new program of financial distress grants for nursing schools as well as an advanced grant program with up to 5 years of support. Authorizes startup assistance for new schools of nursing, and creates a new program of educational assistance to individuals from disadvantaged backgrounds. Extends the nursing scholarship programs but with an authorization ceiling. Amends the HEAL program to include students in collegiate nursing schools. Also authorizes a new service-contingent loan program for nursing and nurse anesthetist students. Continues the nursing student loan program through FY81, but phases out the program beginning fln FY82 when loans would be made only to senior students who were previous 1o‘n recipients to allow them to complete their education. 1 Amends the Immigration and Nationality Act to extend the maximum period Ea "J" foreign medical graduate (EH6) may remain here for 3 years to the lesser of 7 years or the time required to complete the program. Also extends the expiration date of the substantial disruption waiver for certain "J" Fuss fr 5 years to Dec. 31, 1985 if the individuals.meet certain conditions. E I Three Senate bills (5. 21uu —-Schweiker, S. 2375 — Kennedy, and S. 2378 §— Javits) amending Titles VII and VIII were originally introduced in the 96th Congress, and referred to the Labor and Human Resources Committee. Hearings held uar. 10-11, 1980. Certain provisions of the bills were then combined into a single legislative proposal, S. 2375, which was approved by the Labor and Human Resources Subcommittee on Health and Scientific Research May 22, 1980. S. 2375 was considered by the full committee and ordered favorably reported with amendments June 27, 1980. ? §I.EéBI..1!§§ 0-5. congress. House. Committee on Interstate and Foreign Commerce. Subcommittee on Health and Environment. Health Professions Educational Assistance and Nurse Training Act of 1980. Hearings, 96th Congress, 2d session. Mar. 20, 21, 24, 26, and 27, 1980. [not yet printed] 0.5. Congress. Senate. Committee on Labor and Human Resources. Subcommittee on Health and Scientific Research. Health professions education assistance. Hearings, 96th Congress, 2d session. Bar. 10 and 12, 1980. [not yet printed] §§BQ§Z§-AE2-EQ!§B§§§lQ§AL.2QQ!!EN2§ U.S. Congress. House. Committee on Interstate and Foreign Commerce. Current health manpower issues. Washington, U.S. Govt. Print. 0ff., October 1979 (96th Congress, 1st session. CR5-11 IB80069 UPDATE-08/06/80 House. Rept. no. 96-IFC-30). ---- Health Professions Educational Assistance and Nurse Training Amendments of 1980; report to accompany H.R. 7203. Bay 15, 1980. Washington, 0.5. Govt. Print. Off., 1980. (96th Congress, 2d session. House. Report no. 96-978). ---- Health Hanpower Act of 1975; a report to accompany (94th Congress, 1st session. House» Report no. 9H-266). Health Professions Educational Assistance Act; a report to accompany H.R- 12. Washington, 0.5. Govt. Print. Off., 1963. (88th Congress, 1st session. HOUSE» Report no. 109). 0-5. Congress. Senate. Committee on Labor and Public Welfare. Health Professions Educational Assistance Act of 1976; a report to accompany S. 3239. Washington, Govt. Print. Off., 1976. (94th Congrss, 2d session. Senate. Report no. 94-887). ---- Health Professions Educational Assistance Amendments of 1971; a report to accompany S. 934. Washington, 0.5. Govt. Print. Off., 1971. (92d congress, 1st session. Senate. Report no. 92-251). f EQEQLQE-.X..Q.E-.15!15i§2§ 06/27/80 - Senate Labor and Human Resources Committee ordered S. 2375 favorably reported with amendments. 05/22/80 - Senate Labor and Human Resouces Subcommittee on Health and Scientific Research approved a new version of S. 2375 which combined provisions from S. 2144, the original 5. 2375, and S. 2378. 05/15/80 - House Interstate and Foreign Commerce Committee reported H.R. 7203 (H.Rept. 96-978). 03/12/80 - H.R. 6802, the Health Professions and Educational Assistance and Nurse Training Amendments of 1980, was introduced by Representative Waxman, and referred to the Interstate and Foreign Commerce Committee. —— H.R. 6800, the Health Professions Education Amendments Rof 1980, was introduced by Representative staggers by request, and referred to the Interstate and Foreign Commerce Committee. 03/04/80 - S. 2378, the Health Care Management and Health Personnel Distribution Improvement Act of 1980, was introduced by Senator Javits, and referred to the Labor and Human Resources Committee. 03/00/80 —— S. 2375, the Health Professions Training and Distributio Act of 1980, was introduced by Senator Byrd for Senator Kennedy, and referred to the Labor and Human Resources Committee. 12/17/79 A10/12/758 11/13/71 03/15/53 10/22/65 09/2“/63 CRS—12 IB80069 UPDATE~0Q;O6/80 5. 214a, the Health Professions Educational Assistance and Nurse Training Act of 1980, was introduced by Senator Schweiker, and referred to the Labor and Human Resources Committee . ‘P.L. 9n-nan, the Health Professions Educational Assistance Act of 1976, signed into law. P.L. 92-157, the Comprehensive Health Hanpover Training Act, signed into law. P.L. 90-H90, the Health Manpower Act of 1968, signed P.L. 89-290, the Health Professions Educational Assistance Amendments of 1965, signed into law. P.L. 88-129, the Health Professions Educational Assistance Act of 1963, signed into law. A22IT1Q!AL-B§E§§§!§§-§QQB§E5 ELI testimony cites "intensifying" nursing shortage. League Nursing shortage acute. National of Nursing News, v. 28, January—February 1980. American Nurses‘ Association Press Release, Oct. 17, 1979. nurse training Act of 1975 -- Second Report to the Congress, 1 Mar. 15, 1979. 0.5. Departnent of Health, Education, and Welfare. Dndergraduate medical education. Association, V. 200, December 22/29, Unpublished Health Journal of the American Hedical 1978. data, 0.5. Department of Health and Human Services, Resources Administration, Bureau of Health Hanpower Analysis, January 1980. 0.3. Department of Health, Education, and Welfare. A report to the President and Congress on the status of health professions personnel in the United States (Washington, 1978). "3 -‘I-'mK«, , .4. ’?‘‘‘‘A -‘T'=—‘~ 2. Q1‘) 5-. at .—. 7 H V " -~K'-:‘-..,,._n,_ S't'._'3’lT"%: ‘ — _. .,._,_ _,-“ -.. ya V,’ :. ‘~rt;/{‘} L]_;t*.:‘-‘H5’ 1'; .;- ;‘ (_§;«n7:: E«*%€flxs*s-grhgw 5 5:JT‘\5I‘JE-‘«‘::~l=. y 3 A LA fimTv tmre;;§£§-MQ, , .1.J__‘1' ‘ -191: an‘ _:‘fi_,