How Federal Decisions Undercut Fields Where Women Lead

By the Black Women’s Health Imperative

There’s a hierarchy being built into our healthcare system, and it’s wearing the disguise of fiscal responsibility.

Earlier this year, the One Big Beautiful Bill Act 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 Reimagining and Improving 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 be capped at borrowing $20,500 per year and $100,000 total. Medical students? They can borrow up to $50,000 per year and $200,000 total. 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 happening here: this isn’t about 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

Nursing. Physical therapy. Occupational therapy. Genetic counseling. Speech-language pathology. Social work. Public health.

These aren’t side careers or hobby professions. They are the infrastructure of American healthcare. They are the people who provide primary care in rural areas where doctors won’t go. They are the professionals who manage chronic disease, 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 make up:

88% of registered nurses
67% of physical therapists
83% of occupational therapists
Over 80% of speech-language pathologists
81% of social workers
Approximately 70% of public health professionals

Black women, in particular, have long seen 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 the debt because we believe the work matters.

Now we’re being told: the work doesn’t matter enough.

The Math Doesn’t Add Up—Unless the Point Is to Push Women Out

Let’s talk dollars. A doctoral degree in nursing can easily exceed $100,000. Nurse anesthetist programs? Often $130,000 or more. Public health doctoral programs routinely cost over $100,000. Physical therapy programs average $80,000 to $150,000 depending on the institution.

Under the proposed policy, students in these fields will max out their federal loans before they finish their degrees. They’ll be forced into private loans with higher interest rates, fewer protections, and no income-driven repayment options. Or they’ll simply stop.

And starting in 2026, the Grad PLUS loan program—which has served as a critical safety net when federal loan limits run out—will be eliminated for new borrowers.

Do the math. This isn’t about controlling costs. It’s about controlling access.

What This Means for Black Women’s Health

At the Black Women’s Health Imperative, we don’t view workforce diversity as a nice-to-have. It’s 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 healthcare teams.

Our 2025-2026 National Health Policy Agenda makes this explicit: access to quality and affordable healthcare 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 don’t just hurt individuals. You dismantle the very infrastructure that communities of color depend on.

Black women face maternal mortality rates over three times higher than white women. We experience worse outcomes for heart disease, diabetes, and cancer. We live in healthcare deserts where nurses and public health workers are often the only providers available.

Shrinking the pipeline of Black women entering these fields isn’t a budget decision. It’s a public health crisis in the making.

The Pattern Is the Policy

This isn’t new. Devaluing women’s labor is an American tradition.

For decades, the work of caregiving—whether it’s nursing, teaching, or social work—has been systematically underpaid and undervalued. The excuse is always the same: these are “vocations,” driven by passion rather than 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 doesn’t cover $150,000 in student loans. 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, more prestigious, and more highly compensated. The fields that didn’t make the cut are the ones where women have built careers, advanced into leadership, and anchored entire communities.

If you wanted to design a policy to keep women out of healthcare leadership, this is what it would look like.

What Has to 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 public comment period. That window matters.

When the comment period opens, the public will have the opportunity to weigh in on whether nursing, public health, physical therapy, and other allied health fields should be excluded from the “professional degree” designation. Your voice—whether you’re a current student, a practicing professional, an educator, or someone who depends on these providers—can make a difference.

We’re calling for:

Expanding the definition of “professional degree programs” to include nursing, public health, physical therapy, occupational therapy, genetic counseling, speech-language pathology, social work, and other allied health professions that require graduate-level training.
Restoring Grad PLUS loans or creating an equivalent program that doesn’t leave students scrambling for predatory private loans halfway through their degrees.
Rejecting the gendered hierarchy embedded in this policy. The professions that keep our healthcare system running deserve the same support as the ones that get the accolades.

Black women deserve the opportunity to pursue careers in healthcare without being crushed by debt. Communities deserve access to providers who understand their lived realities. And this country deserves a healthcare system that values care as much as it values credentials.

Follow the 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 comments, and ways to amplify this issue. This fight isn’t over—and we refuse to accept a future where the women who do the hardest, most essential work are treated as expendable.

It’s time for federal policy to catch up.