A provision tucked in the fine print of the so-called Big Beautiful Bill passed by Congress last summer cuts borrowing limits for graduate students, raising concerns among health care providers and educators amid ongoing worker shortages.
The legislation caps most graduate student borrowing at $20,500 per year, with a lifetime limit of $100,000. The limit is higher for medicine and law, considered "professional programs" under the new guidelines. Beginning this summer, med students will be unable to borrow more than $50,000 per year, up to $200,000 total.
Melinda Cooling, OSF HealthCare chief executive for Nursing and Advanced Practice Providers, said the change could influence career paths for medical professionals “because that could push them into having to take out private loans, which some of them may or may not be able to afford.”
Notably, graduate study in nursing is left off the list of “professional” education, limiting borrowing to $100,000 maximum.
“On the nursing side, this could be a big influence on those that are pursuing advanced practice degrees, as well as those who may become future faculty,” Cooling said. “Not only do we need advanced practice registered nurses and physician assistants at the bedside, but we also need them in academia so they can continue to develop our profession and develop the workforce pipeline."
The Mennonite College of Nursing at Illinois State University offers master's and doctoral-level degrees in nursing, plus graduate certificates for family nurse practitioners, psychiatric mental health nursing and school nurses. Interim Dean Caroline Mallory doesn’t think the legislation will negatively impact most students’ ability to fund their education.
“Most of our students earn their degree in a reasonable amount of time with a pretty small amount of debt,” said Mallory. “The problem is broader than that.”
Like Cooling, Mallory said barriers to graduate nursing education could influence decision-making and produce a ripple effect through the field.
“It might, for example, mean the difference between someone pursuing a master’s degree or a doctoral degree, which would take a different length of time and would require more money,” she said. “It might mean that someone would choose not to become a certified registered nurse anesthetist because that costs more money than becoming a nurse practitioner.”
Mallory said nurses’ education is correlated to quality of care, and is inversely proportional to hospital deaths. Fewer Ph.D.s, Mallory said, also means less research, which informs evidence-based clinical practice. Plus, there are gaps in patient care filled by advanced practice nurses that free up short-in-supply doctors for care that lies only within their scope of practice.
That tracks with hiring trends at Peoria-based OSF HealthCare.
“As health care is continuing to evolve and the needs of our communities and patients that we serve are increasing, we’re having to really look at our care models overall,” said Cooling, ensuring doctors are taking care of the "sickest of the sick" patients and leading health care teams.
Why now?
Proponents of the legislation say lowering borrowing caps will incentivize students to take on less debt and force universities to right-size the cost of education.
In a statement, Under Secretary of Education Nicholas Kent said the changes "simplify our complex student loan repayment system and better align higher education with workforce needs.
"The consensus language agreed upon by the negotiators today will help drive a sea change in higher education by holding universities accountable for outcomes and putting significant downward pressure on the cost of tuition. This will benefit borrowers who will no longer be pushed into insurmountable debt to finance degrees that do not pay off.”
But Mallory said “the timing is odd” given the ongoing shortage of clinicians.
“Why would we, right now, reduce people’s capacity to engage in those professions, especially since they will be high earners when they finish their degree program?” she said. “That is a bit of a mystery.”
At a minimum, registered nurses attain an associate's degree and pass a licensure exam. Mallory said nurses with bachelor’s degrees working in Illinois, on average, earn $65,000-$110,000 per year. Advanced practice nurses with graduate-level education have starting salaries closer to $150,000-$200,000 per year.
Mallory said she supports efforts to lower costs for students, but delivering nursing education programs is expensive.
“Illinois State University has hundreds of affiliation agreements with clinical partners around Illinois,” she said. “Those partners very graciously accept our students to come to those clinical environments. And for the most part, the onus is on the student to pay for that.”
There also are onboarding fees to access health records, proficiency exams and simulation labs.
“And I haven’t even touched on faculty salaries,” she said.
More student loan changes
In addition to the borrowing caps, the Trump administration and Congress initiated sweeping changes to the federal student loan system, including the end of a Biden-era repayment plan called the Saving on a Valuable Education, or SAVE Plan.
Opponents of the SAVE Plan argued President Biden overstepped his authority by unilaterally initiating the program and passing student loan debt that borrowers agreed to pay back to taxpayers.
People enrolled in the program were placed in forbearance for years, and will soon see payments restarting. Two other income-based repayment plans based on borrowers’ incomes also were cut by the One Big Beautiful Bill Act and will end in 2028.
That means many borrowers will need to prepare to shoulder larger monthly payments. And the U.S. Department of Education began sending out notices last week to resume garnishing wages of borrowers whose loans are in default.
Public service loan forgiveness
For nearly two decades, borrowers working in public service, including health care, have been eligible for loan forgiveness after 120 payments. Changing this would require an act of Congress, but the Trump administration has signaled it will deny loan forgiveness to workers engaged in activities with “substantial illegal purpose,” as defined by the Secretary of Education.
Mallory isn’t yet sure of the downstream effect of loan forgiveness on nursing, but said recruiting nurses and other health care professionals to underserved communities has been an enduring challenge.
“Native American reservations are a good example of this,” she said. “If people go and work in the federal systems there, they could get some loan forgiveness, or if you work at a federally qualified health center.
“I think, overall, the message that we’re sending is that we’re not, as a society, willing to underwrite the education that health care providers need in order to serve our country,” she said.
Employer assistance
In addition to private loans, employer tuition assistance is another possibility making up for the reduced borrowing cap.
Champaign-based Carle Health, which has a large presence in Bloomington-Normal, has a variety of continuing education programs, including tuition assistance. Full-time employees can be reimbursed up to $4,000 per year, with $5,250 available for nurses seeking higher education.
"The national health care worker shortage will likely not end anytime soon, which is a challenge all health care providers face," a spokesperson said. "Carle Health is committed to supporting the growth of team members and we will continue to monitor how the proposed changes may impact future staffing."
In some cases, OSF HealthCare will pay the full cost of continuing education — something Cooling said she is especially proud of.
“The most important thing we can do as health care professionals is talk about the privilege that it really is to be able to walk alongside a patient and their family during sometimes the most joyful or difficult times in their life,” she said. “That, to me, is what sells it.”
She views the spirit of the legislation as “operational,” not personal, aimed at helping future professionals avoid shouldering a mountain of debt while working difficult jobs.
Still, ISU's Caroline Mallory, who has worked in health care for nearly 50 years, said putting up barriers to nursing education feels like “a slap in the face.”
“Let’s just take from COVID forward,” she said. “The sacrifices nurses made — not only on the job, but in the loss of life caring for COVID patients. The dedication from birth to death that nurses give to every single patient, their families, their communities. Their dedication to public health. This feels like a devaluing of our work, and I can’t help but feel angry about that.”
