From the Black Women’s Health Imperative
There is a hierarchy built into our health care system that wears the guise of fiscal responsibility.
Earlier this year, the One Big Beautiful Bill set in motion a series of changes to federal student loan programs. Now, those changes are taking shape – and the picture isn’t pretty. In early November 2025, the Department of Education’s Review and Improvement of Student Education (RISE) committee reached a preliminary consensus on a proposed definition of “professional degree programs” that excludes public health, nursing, physical therapy and other allied health fields.
If this definition is finalized, starting in 2026, students in these fields will have a maximum borrowing limit of $20,500 per year and $100,000 in total. Medical students? They can borrow up to $50,000 per year and a total of $200,000. At the same time, Grad PLUS loans — the safety net that helped many of us finish our degrees — will be eliminated for new borrowers.
The Department of Education is expected to issue a Notice of Proposed Rulemaking in the coming weeks, opening a 30-day public comment period.
Let’s be clear about what’s going on here: these are not student loans. It’s about which professions this country values - and which ones it’s willing to let collapse under the weight of debt.
The Care Economy Gets Left Behind — Again
Breastfeeding. Physiotherapy. Occupational therapy. Genetic counseling. Speech-Language Pathology. Social work. Public health.
These are not side careers or hobby occupations. They are the infrastructure of American health care. They are the people who provide primary care in rural areas where doctors won’t go. They are the professionals who manage chronic diseases, deliver babies, provide mental health services, keep hospital patients alive and respond to pandemics.
And they are overwhelmingly women.
According to data from the Bureau of Labor Statistics, women are:
- 88% of registered nurses
- 67% of physical therapists
- 83% of occupational therapists
- Over 80% of speech pathologists
- 81% of social workers
- About 70% of public health professionals
Black women, in particular, have long viewed these fields as pathways to economic stability and community service. We show up. We complete degrees at higher rates than almost any other demographic. We take on debt because we believe work matters.
Now they tell us: work doesn’t matter enough.
The math doesn’t add up—unless the point is to drive women out
Let’s talk dollars. A PhD in nursing can easily exceed $100,000. Nurse Anesthetist Programs? Often $130,000 or more. PhD programs in public health typically cost over $100,000. Physical therapy programs cost an average of $80,000 to $150,000 depending on the institution.
Under the proposed policy, students in these fields would max out their federal loans before completing their degrees. They will be forced into private loans with higher interest rates, fewer protections and no income-based repayment options. Or they will simply stop.
And starting in 2026, the Grad PLUS loan program — which has served as a critical safety net when federal loan limits are reached — will be phased out for new borrowers.
Do the math. This is not about cost control. It’s about access control.
What does this mean for black women’s health?
At Black Women’s Health Imperative, we don’t view workforce diversity as nice. It is a necessity. Research shows that black patients have better health outcomes when they receive care from black providers. Black women are more likely to be heard, believed, and treated with dignity when they see themselves reflected in their health care teams.
Us National Health Policy Agenda 2025-2026 makes it clear: access to quality and affordable health care depends on a diverse, well-supported workforce. When you price Black women out of nursing school, out of public health programs, out of physical therapy and social work degrees, you’re not just hurting individuals. You are dismantling the very infrastructure that communities of color depend on.
Black women face maternal mortality rates more than three times higher than white women. We experience worse outcomes for heart disease, diabetes and cancer. We live in health care deserts where nurses and public health workers are often only available providers.
Shrinking the pipeline of black women entering these fields is not a budget decision. It’s a public health crisis in the making.
The pattern is politics
This is not new. Devaluing women’s work is an American tradition.
For decades, care work—whether nursing, teaching, or social work—has been systematically underpaid and undervalued. The justification is always the same: these are “callings”, driven by passion, not profit. Women choose these fields because they care, the logic goes, so we don’t need to compensate them fairly or invest in their education.
But passion doesn’t pay rent. It does not cover student loans of $150,000. And it doesn’t make up for a federal policy that explicitly tells women: your work is worth less.
The fields that made the cut — medicine, law, pharmacy, veterinary science — are more male-dominated, better-known and higher-paying. The fields that didn’t make the cut are those in which women have built careers, advanced to leadership positions, and established entire communities.
If you wanted to design a policy to keep women out of healthcare leadership, this is what it would look like.
What should happen next?
The Department of Education is expected to issue a Notice of Proposed Rulemaking in the coming weeks, which will open a 30-day period for public comment. This window matters.
When the comment period opens, the public will have an opportunity to consider whether nursing, public health, physical therapy and other allied health fields should be exempt from the “professional degree” designation. Your voice—whether you’re a current student, professional, educator, or someone who depends on these providers—can make a difference.
We are calling for:
- Extending the definition of ‘professional study programmes’ to include nursing, public health, physical therapy, occupational therapy, genetic counseling, speech pathology, social work, and other related health professions requiring graduate level education.
- Grad PLUS loan rehabilitation or creating an equivalent program that doesn’t leave students scrambling for predatory private loans halfway through their degrees.
- Rejecting gender hierarchy incorporated into this policy. The professions that keep our health care system running deserve the same support as those who receive the awards.
Black women deserve the opportunity to pursue careers in health care without being crushed by debt. Communities deserve access to providers who understand their lived realities. And this country deserves a health care system that values care as much as it values credentials.
Follow Black Women’s Health Imperative for updates on when the public comment period opens and how you can make your voice heard. We’ll share action steps, sample feedback, and ways to strengthen this issue. This fight is not over—and we refuse to accept a future where the women who do the hardest, most meaningful work are treated as expendable.
It’s time for federal policy to catch up.
