Legislative Affairs

Legislative Committee Chair: Krishan Aggarwal, MD

Director: Dino Teppara, Esquire
Contact: LegislativeAffairs@aapiusa.net




AAPI Initiatives
By Dino Teppara, Esq.
AAPI Director of Legislative Affairs

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% to 34% during this time, the Association of American Medical Colleges (AAMC) predicts that 250,000 active physicians will retire by the year 2020.  Medical school class sizes should be increased to meet future health care needs.  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.

Increase Residency Slots Nationwide
Increased residency slots across the U.S. are needed to address the current physician shortage.  Currently, there are 25,000 available residency slots with more than 35,000 applicants on an annual basis, resulting in more than 10,000 physicians who are unable to begin their residencies, delaying their training and ability to become licensed physicians.  The “Resident Physician Shortage Reduction Act of 2009,” (H.R. 2251, S. 973) fills a critical need for residency positions by distributing residency slots to hospitals of need and increasing overall residency positions by 15%.  With an aging U.S. population, more residency slots are needed today to fill much-needed physician positions in the future.  The Indian American community is uniquely situated to fill these positions as our nation experienced a surplus of physicians and a shortage of available residency slots by more than 10,000 this past year.  As a result, hundreds of well-qualified Indian Americans and International Medical Graduates (IMGs) were unable to begin their residency programs.

This legislation was recently incorporated into “America’s Affordable Health Choices Act of 2009,” (H.R. 3200) in the portion marked up by the House Committee on Ways and Means and in the portion marked up by the Senate Finance Committee. It is awaiting further action in the House and Senate, although the part of the bill providing for extra residency slots was removed in committee.

An amendment was introduced on December 4, 2009 to the Senate health care reform bill that would add 15,000 residency slots to our current system. To learn more, please click here.

Defer Federal Student Loan Payments During Residencies
The “Medical Economic Deferment for Students (MEDS) Act,” (H.R. 1615, S. 646), allows medical students to defer payments on their federal student loans during their medical residencies.  This legislation reverses legislation passed by Congress in 2007, and once again would allow students to defer their federal loan payments for three years.  For many residents, their average salary during residency is only $44,000 while the average medical school debt is $140,000.  This common-sense bill recognizes the financial limitations most residents experience during their residency, especially since many must work at hospitals in urban areas with very high costs of living.  This bill does not seek to forgive federal student loans, but simply defers payments during the time when medical residents are saddled with their highest debt, lowest salary, and under immense pressure during their residencies.

The Conrad 30 Program/J-1 Visa
International Medical Graduates (IMGs) can participate in medical education or training in the U.S. while on a J-1 visa for up to seven years under the Exchange Visitor Program.  This visa requires physicians to return to their home country for two years before attempting to reenter the U.S. on another visa.

The Conrad 30 program was established in 1994, allowing state health agencies to provide up to 30 waivers per fiscal year to qualified J-1 visa holders willing to work in underserved or rural areas where there is a shortage of medical professionals.  This important program expired on September 30, 2009.  AAPI signed a letter to U.S. House and Senate conferees on the Homeland Security Appropriations Conference Committee asking for a three-year renewal of the Conrad 30/J-1 visa waiver program.

International Medical Graduates comprise more than 20% of incoming residents in the U.S. and outnumber U.S. medical graduates by a 3:1 ratio in rural, underserved areas.   Additionally, IMGs offer unique experiences from their international backgrounds making their skill-sets an invaluable and integral part of their medical practice.  Many highly skilled Indian physicians successfully practice medicine in underserved areas across the U.S. while on J-1 visas. The Conrad 30 Program/J-1 Visa Waiver was renewed for three additional years through September 30, 2012. AAPI signed a coalition letter on this subject and also sent individual letters to Members of Congress on this issue.

With many qualified Indian physicians ready to practice medicine in the U.S. and with a strong need for health care in underserved communities, AAPI is pleased that this vital visa waiver program was renewed for three additional years. H.R. 1127 was signed into law on March 20, 2009 (Public Law No: 111-009), and extended the J-1 visa waiver program until September 30, 2009.  With many qualified Indian physicians ready to practice medicine in the U.S. and with a strong need for health care in underserved communities, it is vital to renew this visa waiver program for three additional years.

Protect Medicare and Medicaid Physician Reimbursements
Medicare and Medicaid physician reimbursements should be protected while eliminating unnecessary medical costs.  These reimbursements are in constant jeopardy of being reduced, adversely affecting doctors and hindering physician-accessibility for patients.  Reimbursement cuts lead to decreased patient-physician time and fewer physicians accepting Medicare and Medicaid patients.  Projections by the American Medical Association (AMA) suggest that 45% of physicians would decrease or stop accepting new Medicare patients if the annual reimbursement cuts were to take place.  Medicare reimbursements have remained constant from 2001 to 2008 and are expected to decrease by 5% to 10% annually in the near future, despite a growing patient-class of Medicare-eligible citizens.  Legislation is pending that protects physician reimbursements under the Medicare and Medicaid programs.

Establishing Meaningful Liability Reforms Nationwide
On any given day, there are 125,000 lawsuits pending against physicians.  In 2005, the Physician Insurers Association of America (PIAA) found that 75% of medical liability claims were closed without any payment to the plaintiff.  Only 7% of cases went to trial, and in those, physicians prevailed 83% of the time but incurred nearly $100,000 in legal costs.  According to the Centers for Medicare and Medicaid Services, medical malpractice insurance premiums paid by physicians rose 15% over just two years.  Such steep insurance premium rises fosters an unhealthy environment of “defensive medicine,” where health care costs are inflated by unnecessary tests and defensive spending.  Furthermore, states such as Texas that have instituted caps on malpractice claims have noted a 30% rise in licensing applications by physicians because they prefer to practice in these “physician friendly” environments.

Fewer physicians today practice in areas such as obstetrics and gynecology, surgery, and emergency medicine, due to increased lawsuits and skyrocketing malpractice insurance premiums.  AAPI is concerned over these costs, which results in fewer doctors practicing in vital specialty areas and fewer medical residents willing to enter such fields.  Federal and state legislation is pending that places effective caps on non-economic damages, limits the use of joint-and-several liability, and limits the statutes of limitations for filing medical malpractice claims.