AAPPR Engaging Offices to Strengthen the Conrad 30 Program

With the Conrad State 30 and Physician Access Reauthorization Act now introduced in both chambers of Congress, we are actively working to build support for these measures, primarily by increasing the number of cosponsors. As part of this effort, we are reaching out to offices that have previously cosponsored the legislation to encourage them to do so again. These conversations also provide an opportunity to introduce AAPPR and highlight the important work our members do across the country.

Recently, in discussions with one such office, concerns were raised about how the Conrad program currently operates in their state. Because the state is highly rural and has a low population, the vast majority of its participation in the Conrad program is through “flex” spots. This reliance on flex waivers limits the use of non-flex slots, despite ongoing interest in recruiting more physicians than the flex waiver cap allows. Under the current program, each state may sponsor up to 30 J-1 waiver applicants per federal fiscal year, with up to 10 of those being “flex” waivers for physicians who do not work in a designated shortage area but serve patients from such areas.

We are exploring ways to allow states that rely exclusively on flex waivers to request a limited increase in their flex waiver allotment, which could help drive physician recruitment to these states. The lawmaker indicated that their support for the Conrad program depends on making it more effective for their state, especially given the significant variation in how the program is used across the country. This presents a valuable opportunity to collaborate with the state and to highlight the unique challenges of recruiting physicians in rural areas.

Other Legislative Updates

We recently met with the sponsors of the Healthcare Workforce Resilience Act who indicated the re-introduction should be coming soon. We are prepared to endorse the bill and help build support in a similar way as the Conrad 30 reauthorization legislation. Additionally, in meeting with other stakeholder groups, we anticipate the Resident Physician Shortage Reduction Act will be introduced this month, which directs the increase in the total number of graduate medical education slots.

Reconciliation Update

Reconciliation is taking up all the oxygen right now. House Republicans are expected to make key decisions this week during committee consideration of the health and tax portions of the reconciliation package. A key question for House Republicans is how to find consensus around shifting costs in Medicaid to generate savings. One such proposal would cap spending in states that expanded Medicaid under the Affordable Care Act.

However, the Congressional Budget Office (CBO) recently assessed various Medicaid proposals that have been reported on in recent weeks, considering how it would impact changes in enrollment and how states may respond to such changes. This analysis will make certain proposals less palatable for House GOP moderates and the Republican Senate, especially as stakeholders assess the local impacts.

Closing Word

In terms of identifying a hard deadline for the reconciliation package, the Treasury Secretary said the US is likely to hit the debt limit in August, which is the date the government expects to default on its obligations. This means that Congress’ realistic deadline for a reconciliation package that raises the debt limit is the end of July, since Congress typically leaves town for the month of August.

We will follow up with more details on reconciliation as the bill develops and stay tuned for more updates on new approaches to strengthen the Conrad 30 program, and other legislation to strengthen the physician workforce.