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Without a federal loan, graduating with a Master of Science in Public Health in 2024 would not have been possible for Veena Thamilselvan. But recent changes in federal aid threaten to pull up the ladder for her and thousands of future students.
Among the many cuts made under the devastating federal budget bill adopted by Congress and President Trump in July was an end to the Grad PLUS loan, which allowed students to cover the full cost of their studies at favorable interest rates. That change could put a crimp in Thamilselvan's financial planning for medical school, as she is now unable to access the loan that helped her finish her MSPH degree.
“My vision of getting my MSPH with my med degree was that I could serve patients and then turn around and advocate for policies that protect all patients and community members across the city, the health care system, the nation,” Thamilselvan, a Johns Hopkins Bloomberg School of Public Health graduate and former chair of APHA's Student Assembly, told The Nation's Health.
For students and recent graduates such as Thamilselvan, the new rules are yet another blow to early-career professionals during a year that saw public health funding dry up, such as through the clawback of monies at the National Institutes of Health and Centers for Disease Control and Prevention. The actions are ringing alarm bells across the public health professional pipeline.
“It just seems like anyone who would pass a bill and say ‘this makes sense' has never worked in a low-resource clinic like I have, or worked at a long-term care facility and have seen how nurse shortages, poor patient-to-health-care worker ratios lead to bad health outcomes,” Thamilselvan said. “If you've seen what any public health student has seen and learned about, you couldn't in your right mind approve something like this.”
With the elimination of the Grad PLUS loan also comes new caps on borrowing. Starting July 1, instead of taking out loans to cover the full cost of school, full-time students pursuing master or doctoral degrees will only be able to borrow $20,500 per year and $100,000 total. For professional degrees in areas such as medicine, students can borrow $50,000 per year and no more than $200,000 overall. Students may receive even less money overall depending on the length of their program and if they are attending school part-time.
While the caps do not take effect until summer, many students are already borrowing above the new limits, especially in professional fields such as dentistry, where 56% of full-time students exceed the annual $50,000 cap, along with 41% of medical and osteopathic medicine students, according to an Urban Institute analysis.
Federal student loans have helped millions of students. But new federal rules may make it harder for them to earn some degrees.
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In November, the U.S. Department of Education decided master and doctoral public health degrees, among many others, are no longer considered professional degrees. Other affected fields across allied health include advanced nursing, physical therapy, social work, occupational therapy and physician assistants.
The reclassification restricts not only how much money students in those fields can borrow, but also threatens the public health workforce at a time when there is already a critical worker shortage in local and state health departments, according to Beeta Rasouli, MPH, director of advocacy and federal affairs for the Association of Schools and Programs of Public Health.
At least 80,000 full-time positions are needed across U.S. state and local health departments, according to a 2021 research brief from the de Beaumont Foundation and the Public Health National Center for Innovations.
“If you look at public health, it's such a multifaceted profession, where you have epidemiologists, biostatisticians, policy professionals — these are all important components of the public health workforce,” Rasouli told The Nation's Health. “We're all linked together. If you're attacking one part of the workforce, you're attacking the entire public health workforce.”
It remains to be seen if colleges and universities will lower tuition for certain programs or if there is a scenario in which students who need to borrow beyond the new caps can replace that federal loan funding with private loans with favorable terms, said Jason Cohn, an Urban Institute research associate.
“There's also a scenario where a lot of students, especially those from more marginalized backgrounds, might not be able to get favorable loan terms or a loan at all on the private market,” Cohn told The Nation's Health. “And I know there are also concerns about whether the private market will be ready to handle a big influx of borrowers for these programs and how they're going to go about underwriting those loans.”
As health care systems shift their focus to underlying social determinants of health and wellness at the population level, the new rules make it more difficult for nurses, physicians, social workers and other allied health workers to pursue companion degrees in public health, said Adam Arechiga, PsyD, DrPH, MA, dean of Loma Linda University's School of Public Health. The university offers a joint MD and MPH program.
“There is this significant sense of concern that fewer and fewer health care providers of many different kinds are going to be understanding this concept of population health like they need to,” Arechiga told The Nation's Health. “Unlike other health professions that focus primarily on individual patient care, public health experts are at the forefront of population health, disease prevention, health promotion and crisis response. This work is integral to safeguarding communities, managing health emergencies and addressing health inequities.”
Graduate public health degree programs do not typically receive the same endowments other programs do, meaning there is less financial aid to go around, according to Gregg Gonsalves, PhD, an assistant professor in epidemiology at the Yale School of Public Health and a member of Defend Public Health. The volunteer coalition of thousands of public health workers, physicians, nurses, lawyers and more is aimed at promoting science and health in the face of Trump administration actions.
New loan caps from the U.S. Department of Education could hurt public health students.
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“We will have fewer physicians, fewer nurses, fewer public health professionals,” he told The Nation's Health. “We're going to see individual health care get more precarious, but also see population-level effects across the board.”
As public health programs are squeezed financially and experience a deepening personnel shortage, patients will have longer wait times for care. Some people are already waiting months at a time for primary care visits in the Northeast and in rural areas, he said.
“This is going to make people sick and people are going to die,” Gonsalves said. “Let's be clear. The longer you wait in an emergency room to see a person, the longer you have to delay a primary care visit, the more chance you'll receive a late diagnosis for breast cancer, or colon cancer or diabetes. All of these things are just going to snowball.”
ASPPH is urging all schools and programs to reach out to Congress and the Department of Education to share concerns about the professional designation loss for public health degrees, said Tim Leshan, MPA, ASPPH's chief external relations and advocacy officer.
The organization is also following DOE's negotiated rulemaking process and will be asking members and broader networks to submit their feedback.
Arechiga said it is time for academia to join medical and policy organizations in a unified voice that fights for the professional status of health professions, whether it is through meetings with lawmakers or submitting public comments.
“After COVID, I think the population got a little bit of a confused understanding and doesn't realize the comprehensive nature of public health professionals,” Arechiga said. “We also have to provide evidence-based testimony to policymakers.”
Thamilselvan said it is up to her and fellow health professionals to reach out to people in their communities and make sure they understand the value of public health.
“Something you can do today is calling that aunt, uncle, cousin, neighbor who disagrees with you or doesn't get what's the big deal and having an honest dialogue with them about what you do,” Thamilselvan said. “Those are the small things we can do to make a big change.”
For more information, visit www.aspph.org.
- Copyright The Nation’s Health, American Public Health Association
