The student loan forgiveness for frontline health workers act

Throughout the pandemic, Mously Diakhate has been treating people in need of urgent care in one of the Bay Area's hardest-hit communities.

A physician assistant at LifeLong Medical Care Brookside San Pablo Health Center in the small East Bay city of San Pablo, which has suffered from the highest COVID-19 rate in Contra Costa County, Diakhate has consistently shown up for her patients, even as community clinics like hers typically offer substantially lower salaries than do private practices.

“We went into medicine to help people,” Diakhate said. “A pandemic is a scary situation, but we have to step up, we have to step up.”

In addition to the constant risk of virus exposure she has faced over the last two years, Diakhate also has felt the looming weight of another major stressor: the $74,000 in student debt she owes.

While the U.S. Department of Education has paused payments and interest on federal loans since March 2020, that respite is set to end in May.

“That’s my dilemma right now,” said Diakhate, 33, an immigrant from Senegal who was the first in her family to attend college. “It’s like, do I pay this student loan or do I use that money to help my family be more financially stable?”

But Diakhate, who mostly grew up in Oakland and is now a naturalized U.S. citizen, said she’s found a glimmer of hope in a recently introduced U.S. Senate bill that would forgive or fully repay student loan debt for frontline health care workers.

Senate Bill 3828, introduced by Democratic Sens. Alex Padilla from California and Sheldon Whitehouse from Rhode Island, would benefit medical workers who have provided COVID-related health services during the pandemic. It would include physician assistants like Diakhate, as well doctors, nurses, medical interns, home health care workers, and emergency medical technicians transporting patients to hospitals.

The proposed legislation likely would have a major impact on California’s estimated 1.7 million health care workers. It comes at a time when the state is struggling to expand its health workforce to meet the needs of an increasingly diverse population, and as longtime industry staffing shortages have been further exacerbated by pandemic burnout.

“Our brave frontline health care workers have fought tirelessly throughout the pandemic to ensure that our communities stay safe, often putting their own health at risk,” Padilla said in a statement, announcing his Student Loan Forgiveness for Frontline Health Workers Act. “Unfortunately, far too many of these workers are burdened by crippling student loan debt — that is simply unacceptable.”

There have been more than 35,000 COVID cases among California’s health care workers, resulting in roughly 400 deaths, according to Padilla’s office.

Dr. Janet Coffman, who teaches health policy at UCSF’s Healthforce Center, applauded the bill’s intent of recognizing health care workers’ deep sacrifices and challenges during the pandemic. But she said its current language about who would qualify for loan forgiveness seems “vague,” as hundreds of thousands — if not millions — of people likely would be eligible for the relief.

And a huge amount of funding would be needed to provide even a portion of that relief. For instance, most physicians who graduated last year shouldered an average student debt of $203,000, according to the Association of American Medical Colleges. For recent dental graduates, it was even higher — nearly $302,000 — the American Dental Education Association reported.

“It makes sense to make it more targeted to those health professionals on the front lines in the hardest-hit communities, because the health professionals in those communities have the greatest exposure to COVID itself and the greatest stress associated with caring for people,” Coffman said.

Student loan debt is one of the main barriers preventing health professionals from working in underserved communities, where the pay is generally much lower, according to many health care experts.

Some current federal programs offer to forgive or repay a portion of student debt for health professionals who commit to working in underserved communities, like rural areas or lower-income urban neighborhoods. But those grants are extremely competitive, and Diakhate said she has been hesitant to apply, in part because many of her colleagues have been rejected.

And because she is not a physician or a dentist, Diakhate doesn’t qualify for other assistance options, such as the state-funded CalHealthCares program, which offers up to $300,000 in student loan repayments in exchange for a five-year commitment to work with Medi-Cal patients.

Diakhate said that the Padilla bill — if it passes — would make it easier for her to keep working with LifeLong’s mostly lower-income patients.

“That will be a burden taken off my shoulders and I can use whatever extra amount I can generate to further financially stabilize my family,” said Diakhate, who took a second job testing people for COVID-19 to make ends meet at home and help support her aging parents.

But whether the loan forgiveness proposal can become a reality remains a big question. A similar House bill introduced last spring hasn’t advanced, as approval of billions of dollars in pandemic-relief funding continues to stall in Congress.

Padilla and Whitehouse said they both plan to push congressional leadership for more support for their bill to overcome the 60-vote threshold.

Meanwhile, as yet another COVID variant spreads across the country, better support for health care workers is urgently needed, said Dr. Sergio Aguilar-Gaxiola, who directs the UC Davis Center for Reducing Health Disparities.

“There has been an increase in suicides [among health care workers] and certainly an increase in anxiety, mood disorders, and even substance abuse,” he said. “They have been working so much under such difficult circumstances.”