January 6, 2009 CONGRESSIONAL RECORD — SENATE S85 

they sought asylum here, Mr. Gabra, 

who has a speech impediment, had difficulty communicating his fear of persecution to the immigration judge. 

The judge denied their petition, telling the family that he did not see why 

they could not just move to another 

city in Egypt to avoid the abuse they 

were suffering. Since the time that 

they were denied asylum, Ms. Kamel’s 

brother, who lived in the same town 

and suffered similar abuse, was granted 

asylum. 

I have decided to offer legislation on 

their behalf because I believe that, 

without it, this hardworking couple 

and their four United States citizen 

children would endure immense and 

unfair hardship. 

First, in the ten years that Mr. Gabra 

and Ms. Kamel have lived here, they 

have worked to adjust their status 

through the appropriate legal channels. 

They left behind employment in Egypt 

and came to the United States on a 

lawful visa. Once here, they immediately notified authorities of their intent to seek asylum here. They have 

played by the rules and followed our 

laws. 

In addition, during those ten years, 

the couple has had four U.S. citizen 

children who do not speak Arabic and 

are unfamiliar with Egyptian culture. 

If the family is deported, the children 

would have to acclimate to a different 

culture, language and way of life. 

Jessica, age 10, is the Gabras’ oldest 

child, and in the Gifted and Talented 

Education program in Ventura County. 

Rebecca, age 9, and Rafael, age 8, are 

old enough to understand that they 

would be leaving their schools, their 

teachers, their friends and their home. 

Veronica, the Gabra’s youngest child, 

is just 3 years old. 

More troubling is the very real possibility that if sent to Egypt, these four 

American children would suffer discrimination and persecution because of 

their religion, just as the rest of their 

family reports. 

Mr. Gabra and Ms. Kamel have made 

a positive life for themselves and their 

family in the United States. Both have 

earned college degrees in Egypt and 

once in the United States, Mr. Gabra 

passed the Certified Public Accountant 

Examination on August 4, 2003. Since 

arriving here, Mr. Gabra has consistently worked to support his family. 

The positive impact they have made 

on their community is highlighted by 

the fact that I received a letter of support on their behalf signed by 160 members of their church and community. 

From everything I have learned about 

the family, we can expect that they 

will continue to contribute to their 

community in productive ways. 

Given these extraordinary and 

unique facts, I ask my colleagues to 

support this private relief bill on behalf 

of Joseph Gabra and Sharon Kamel. 

Mr. President, I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 111 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. ADJUSTMENT OF STATUS. 

(a) IN GENERAL.—Notwithstanding any 

other provision of law, for the purposes of 

the Immigration and Nationality Act (8 

U.S.C. 1101 et seq.), Joseph Gabra and Sharon 

Kamel shall each be deemed to have been 

lawfully admitted to, and remained in, the 

United States, and shall be eligible for adjustment of status to that of an alien lawfully admitted for permanent residence 

under section 245 of the Immigration and Nationality Act (8 U.S.C. 1255) upon filing an 

application for such adjustment of status. 

(b) APPLICATION AND PAYMENT OF FEES.— 

Subsection (a) shall apply only if the application for adjustment of status is filed with 

appropriate fees not later than 2 years after 

the date of the enactment of this Act. 

(c) REDUCTION OF IMMIGRANT VISA NUMBERS.—Upon the granting of permanent resident status to Joseph Gabra and Sharon 

Kamel, the Secretary of State shall instruct 

the proper officer to reduce by 2, during the 

current or subsequent fiscal year, the total 

number of immigrant visas that are made 

available to natives of the country of birth 

of Joseph Gabra and Sharon Kamel under 

section 203(a) of the Immigration and Nationality Act (8 U.S.C. 1153(a)), or, if applicable, the total number of immigrant visas 

that are made available to natives to the 

country of birth of Joseph Gabra and Sharon 

Kamel under section 202(e) of that Act (8 

U.S.C. 1152(e)). 

By Mr. INOUYE: 

S. 112. A bill to treat certain hospital 

support organizations as qualified organizations for purposes of determining 

acquisition indebtedness; to the Committee on Finance. 

Mr. INOUYE. Mr. President, the legislation I have reintroduced will extend 

to qualified teaching hospital support 

organizations the existing debt-financed safe harbor rule. Congress enacted that rule to support the public 

service activities of tax-exempt 

schools, universities, pension funds, 

and consortia of such institutions. Our 

teaching hospitals require similar support. 

As a result, for-profit hospitals are 

moving from older areas to affluent locations where residents can afford to 

pay for treatment. These private hospitals typically have no mandate for 

community service. In contrast, nonprofit hospitals must fulfill a community service requirement. They must 

stretch their resources to provide increased charitable care, update their 

facilities, and maintain skilled staffing 

resulting in closures of nonprofit hospitals due to this financial strain. 

The problem is particularly severe 

for teaching hospitals. Non-profit hospitals provide nearly all the postgraduate medical education in the 

United States. Post-graduate medical 

instruction is by nature not profitable. 

Instruction in the treatment of mental 

disorders and trauma is especially costly. 

Despite their financial problem the 

Nation’s nonprofit hospitals strive to 

deliver a very high level of service. A 

study in the December 2006 issue of Archives of International Medicine had 

surveyed hospitals’ quality of care in 

four areas of treatment. It found that 

nonprofit hospitals consistently outperformed for-profit hospitals. It also 

found that teaching hospitals had a 

higher level of performance in treatment and diagnosis. It said that investment in technology and staffing leads 

to better care. And it recommended 

that alternative payments and sources 

of payments be considered to finance 

these improvements. 

The success and financial constraints 

of nonprofit teaching hospitals is evident in work of the Queen’s Health 

Systems in my State. This 147–year-old 

organization maintains the largest, 

private, nonprofit hospital in Hawaii. 

It serves as the primary clinical teaching facility for the University of Hawaii’s medical residency programs in 

medicine, general surgery, orthopedic 

surgery, obstetrics-gynecology, pathology, and psychiatry. It conducts educational and training programs for 

nurses and allied health personnel. It 

operates the only trauma unit as well 

as the chief behavioral health program 

in the State. It maintains clinics 

throughout Hawaii, health programs 

for native Hawaiians, and a small hospital on a rural, economically depressed island. Its medical reference library is the largest in the State. Not 

the least, it annually provides millions 

of dollars in uncompensated health 

services. To help pay for these community benefits, the Queen’s Health Systems, as other nonprofit teaching hospitals, relies significantly on income 

from its endowment. 

In the past, the Congress has allowed 

tax-exempt schools, colleges, universities, and pension funds to invest their 

endowment in real estate so as to better meet their financial needs. Under 

the tax code these organizations can 

incur debt for real estate investments 

without triggering the tax on unrelated business activities. 

If the Queen’s Health Systems were 

part of a university, it could borrow 

without incurring an unrelated business income tax. Not being part of a 

university, however, a teaching hospital and its support organization run 

into the tax code’s debt financing prohibition. Nonprofit teaching hospitals 

have the same if not more pressing 

needs as universities, schools, and pension trusts. The same safe harbor rule 

should be extended to teaching hospitals. 

My bill would allow the support organizations for qualified teaching hospitals to engage in limited borrowing 

to enhance their endowment income. 

The proposal for teaching hospitals is 

actually more restricted than current 

law for schools, universities and pension trusts. Under safeguards developed 

by the Joint Committee on Taxation 

staff, a support organization for a 

teaching hospital can not buy and develop land on a commercial basis. The 

proposal is tied directly to the organization endowment. The staff’s revenue 


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S86 CONGRESSIONAL RECORD — SENATE January 6, 2009 

estimates show that the provision with 

its general application will help a number of teaching hospitals. 

The U.S. Senate several times has 

acted favorably on this proposal. The 

Senate adopted a similar provision in 

H.R. 1836, the Economic Growth and 

Tax Relief Act of 2001. The House conferees on that bill, however, objected 

that the provision was unrelated to the 

bill’s focus on individual tax relief and 

the conference deleted the provision 

from the final legislation. Subsequently, the Finance Committee included the provision in H.R. 7, the 

CARE Act of 2002, and in S. 476, the 

CARE Act of 2003 which the Senate 

passed. In a previous Congress’ S. 6, the 

Marriage, Opportunity, Relief, and Empowerment Act of 2005, which the Senate leadership introduced, also included the proposal. 

As the Senate Finance Committee’s 

recent hearings show, substantial 

health needs would go unmet if not for 

our charitable hospitals. It is time for 

the Congress to assist the Nation’s 

teaching hospitals in their charitable, 

educational service. 

Mr. President, I ask unanimous consent that the text of the bill by printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 112 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. TREATMENT OF CERTAIN HOSPITAL 

SUPPORT ORGANIZATIONS AS 

QUALIFIED ORGANIZATIONS FOR 

PURPOSES OF DETERMINING ACQUISITION INDEBTEDNESS. 

(a) IN GENERAL.—Subparagraph (C) of section 514(c)(9) of the Internal Revenue Code of 

1986 (relating to real property acquired by a 

qualified organization) is amended by striking ‘‘or’’ at the end of clause (iii), by striking 

the period at the end of clause (iv) and inserting ‘‘; or’’, and by adding at the end the 

following new clause: 

‘‘(v) a qualified hospital support organization (as defined in subparagraph (I)).’’. 

(b) QUALIFIED HOSPITAL SUPPORT ORGANIZATIONS.—Paragraph (9) of section 514(c) of 

the Internal Revenue Code of 1986 is amended 

by adding at the end the following new subparagraph: 

‘‘(I) QUALIFIED HOSPITAL SUPPORT ORGANIZATIONS.—For purposes of subparagraph 

(C)(iv), the term ‘qualified hospital support 

organization’ means, with respect to any eligible indebtedness (including any qualified 

refinancing of such eligible indebtedness), a 

support organization (as defined in section 

509(a)(3)) which supports a hospital described 

in section 119(d)(4)(B) and with respect to 

which— 

‘‘(i) more than half of its assets (by value) 

at any time since its organization— 

‘‘(I) were acquired, directly or indirectly, 

by testamentary gift or devise, and 

‘‘(II) consisted of real property, and 

‘‘(ii) the fair market value of the organization’s real estate acquired, directly or indirectly, by gift or devise, exceeded 25 percent 

of the fair market value of all investment assets held by the organization immediately 

prior to the time that the eligible indebtedness was incurred. 

For purposes of this subparagraph, the term 

‘eligible indebtedness’ means indebtedness 

secured by real property acquired by the organization, directly or indirectly, by gift or 

devise, the proceeds of which are used exclusively to acquire any leasehold interest in 

such real property or for improvements on, 

or repairs to, such real property. A determination under clauses (i) and (ii) of this 

subparagraph shall be made each time such 

an eligible indebtedness (or the qualified refinancing of such an eligible indebtedness) is 

incurred. For purposes of this subparagraph, 

a refinancing of such an eligible indebtedness shall be considered qualified if such refinancing does not exceed the amount of the 

refinanced eligible indebtedness immediately 

before the refinancing.’’. 

(c) EFFECTIVE DATE.—The amendments 

made by this section shall apply to indebtedness incurred on or after the date of the enactment of this Act. 

By Mr. INOUYE: 

S. 113. A bill to amend the Public 

Health Service Act to provide health 

care practitioners in rural areas with 

training in preventive health care, including both physical and mental care, 

and for other purposes; to the Committee on Health, Education, Labor, 

and Pensions. 

Mr. INOUYE. Mr. President, I rise 

today, again, to introduce the Rural 

Preventive Health Care Training Act, a 

bill that responds to the dire need of 

our rural communities for quality 

health care and disease prevention programs. Almost one fourth of Americans 

live in rural areas and frequently lack 

access to adequate physical and mental 

health care. As many as 21 million of 

the 3 million people living in underserved rural areas are without access 

to a primary care provider. Even in 

areas where providers do exist, there 

are numerous limits to access, such as 

geography, distance, lack of transportation, and lack of knowledge about 

available resources. Due to the diversity of rural populations, language and 

cultural obstacles are often a factor in 

the access to medical care. 

Compound these problems with limited financial resources, and the result 

is that many Americans living in rural 

communities go without vital health 

care, especially preventive care. Children fail to receive immunizations and 

routine checkups. Preventable illnesses 

and injuries occur needlessly, and lead 

to expensive hospitalizations. Early 

symptoms of emotional problems and 

substance abuse go undetected, and 

often develop into full-blown disorders. 

An Institute of Medicine, IOM, report 

entitled, ‘‘Reducing Risks for Mental 

Disorders: Frontiers for Preventive 

Intervention Research,’’ highlights the 

benefits of preventive care for all 

health problems. The training of health 

care providers in prevention is crucial 

in order to meet the demand for care in 

underserved areas. Currently, rural 

health care providers lack preventive 

care training opportunities. 

Interdisciplinary preventive training 

of rural health care providers must be 

encouraged. Through such training, 

rural health care providers can build a 

strong educational foundation from the 

behavioral, biological, and psychological sciences. Interdisciplinary team 

prevention training will also facilitate 

operations at sites with both health 

and mental health clinics by facilitating routine consultation between 

groups. Emphasizing the mental health 

disciplines and their services as part of 

the health care team will contribute to 

the overall health of rural communities. 

The Rural Preventive Health Care 

Training Act would implement the 

risk-reduction model described in the 

IOM study. This model is based on the 

identification of risk factors and targets specific interventions for those 

risk factors. The human suffering 

caused by poor health is immeasurable, 

and places a huge financial burden on 

communities, families, and individuals. 

By implementing preventive measures 

to reduce this suffering, the potential 

psychological and financial savings are 

enormous. 

Mr. President, I ask unanimous consent that the text of the bill be printed 

in the RECORD. 

There being no objection, the text of 

the bill was ordered to be printed in 

the RECORD, as follows: 

S. 113 

Be it enacted by the Senate and House of Representatives of the United States of America in 

Congress assembled, 

SECTION 1. SHORT TITLE. 

This Act may be cited as the ‘‘Rural Preventive Health Care Training Act of 2009’’. 

SEC. 2. PREVENTIVE HEALTH CARE TRAINING. 

Part D of title VII of the Public Health 

Service Act (42 U.S.C. 294 et seq.) is amended 

by inserting after section 754 the following: 

‘‘SEC. 754A. PREVENTIVE HEALTH CARE TRAINING. 

‘‘(a) IN GENERAL.—The Secretary may 

make grants to, and enter into contracts 

with, eligible applicants to enable such applicants to provide preventive health care 

training, in accordance with subsection (c), 

to health care practitioners practicing in 

rural areas. Such training shall, to the extent practicable, include training in health 

care to prevent both physical and mental 

disorders before the initial occurrence of 

such disorders. In carrying out this subsection, the Secretary shall encourage, but 

may not require, the use of interdisciplinary 

training project applications. 

‘‘(b) LIMITATION.—To be eligible to receive 

training using assistance provided under subsection (a), a health care practitioner shall 

be determined by the eligible applicant involved to be practicing, or desiring to practice, in a rural area. 

‘‘(c) USE OF ASSISTANCE.—Amounts received under a grant made or contract entered into under this section shall be used— 

‘‘(1) to provide student stipends to individuals attending rural community colleges or 

other institutions that service predominantly rural communities, for the purpose of 

enabling the individuals to receive preventive health care training; 

‘‘(2) to increase staff support at rural community colleges or other institutions that 

service predominantly rural communities to 

facilitate the provision of preventive health 

care training; 

‘‘(3) to provide training in appropriate research and program evaluation skills in 

rural communities; 

‘‘(4) to create and implement innovative 

programs and curricula with a specific prevention component; and 


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