The ugly truth about the student loan caps in Trump’s ‘big beautiful’ law  

New federal student loan caps pose an urgent and overlooked threat to the health of all Americans. These changes will severely undermine the graduate education pipeline for the clinician workforce — including both nurses and physicians— jeopardizing access to care, straining the workforce and, ultimately, harming patients. 

The bill, now signed into law, will cap graduate unsubsidized student loans at $20,500, with a $100,000 total cap on top of undergrad loans, and phase out Grad PLUS loans. These changes are especially detrimental for those pursuing clinician roles, such as nurse practitioners. Nurse practitioners play a crucial role, filling gaps in primary care — especially in rural and underserved communities. Their presence expands access, relieves pressure on healthcare systems and allows physicians to focus on the most complex cases. 

Graduate education is not optional for becoming a nurse practitioner. Nor is it optional for becoming faculty to teach the next generation of physicians and nurses. Weakening the pipeline of advanced practice nurses doesn’t just hurt nursing, it threatens the entire care delivery system. 

For nursing, this is a moment where education is already strained. Nurses have left the profession en masse since the COVID-19 pandemic and older nurses are retiring. We urgently need more nurses and nurse educators in the pipeline. Yet in 2023, enrollment in bachelor’s-level nursing programs grew by just 0.3 percent. Meanwhile, enrollment in master’s and Ph.D. nursing programs declined by 0.9 percent and 3.1 percent, respectively. That same year, U.S. nursing schools turned away more than 65,000 qualified applications due to a lack of faculty, clinical placements and funding — not because of a lack of interest. 

Faculty shortages are especially dire. Nearly 2,000 full-time faculty vacancies remain unfilled nationwide, according to the American Association of Colleges of Nursing. These positions require a master’s or doctoral degree — precisely the kind of education now placed at risk by this legislation. Without nurse educators, we cannot train the next generation of nurses at any level. 

This law also directly contradicts the Make America Healthy Again initiative, which calls on healthcare systems to take on chronic disease through prevention. Nurses make up the largest segment of the healthcare workforce. Their education emphasizes prevention and whole-person care for people and communities. Nurses are central to the shift from reactive “sick care” to proactive prevention, so restricting their ability to enter the profession is not just shortsighted, it’s self-defeating. 

A diminished nursing workforce will trigger a familiar cycle: reduced access, longer wait times, more chronic disease and an even more overwhelmed workforce. And these consequences won’t be limited to nurses — they will affect physicians, hospitals, insurers and, most of all, everyday Americans. 

This is a national health issue. While the bill has passed, it is not too late to mitigate its harm. Policymakers must find alternative solutions, from scholarship expansion to loan forgiveness, to ensure access to graduate nursing education remains within reach. We cannot solve a workforce shortage and a chronic disease crisis by cutting off the professionals trained to fix it.  

Sarah Szanton is dean of the Johns Hopkins School of Nursing.