By Kristen Roman
Without serious intervention, July 1 will usher in a new era for American health care, carrying dire consequences for decades to come. Under President Donald Trump’s big 2025 budget bill, known as H.R. 1, the federal government imposed unprecedented caps on federal student borrowing for graduate education while stripping nursing of its status as a professional degree under federal loan policy.
These provisions are not neutral reforms. They are targeted policies that will decimate the nursing workforce while disproportionately undermining a profession dominated by women — particularly working mothers and women of color.
Students will feel the immediate impact as they are forced to rely on more expensive private loans. Qualified nurses will be dissuaded from pursuing advanced practice altogether. And nursing programs will be in danger of closing due to decreased enrollment. Ultimately, California patients will pay the price through delayed care, higher costs and canceled services.
For decades, California has taken pride in standing up for patients, workers and access to care when federal policy falls short. From defending the Affordable Care Act, to investing in Planned Parenthood, to expanding access to providers in underserved communities, our state has repeatedly acted as a safeguard when national decisions threaten public health.
With the latest attack coming for nurses — who serve as the backbone of our health care system — California must resist and defend now more than ever.
Trump’s Under Secretary of Education Nicholas Kent claims the proposed caps will protect borrowers from debt incurred for degrees that “do not pay off.” That assertion collapses under even minimal economic scrutiny. Nursing is not an economic risk; it is an economic asset.
After years of academic excellence, bedside experience and significant personal sacrifice, advanced practice registered nurses (APRNs) add critical value across health care settings and consistently contribute to positive health outcomes. As of 2022, more than 70 percent of Registered Nurses (RNs) held a baccalaureate or higher degree. And, RNs and APRNs are among the highest-paid and most financially stable health professionals, supporting families, communities and local economies while reliably repaying income-driven loans.
In addition, advanced practice nurses, especially certified registered nurse anesthetists or nurse anesthesiologists, are among the few health care professions expected to expand by nearly 40 percent over the next six years. This rise in employment is well-timed considering the demand for anesthesia continues to grow. But if these federal caps are implemented, existing workforce shortages will be exacerbated and rural communities will be hit the hardest.
For federal policy to devalue nursing — and the education required to provide such essential care — is insulting. It also sets a dangerous precedent.
Given the demographics of the nursing workforce, the impact of these policies is not neutral. Approximately 87 percent of nurses identify as female, with 31 percent identifying as non-white. Policies that restrict access to education therefore disproportionately affect women — particularly women of color — raising serious equity concerns.
Framing these barriers as fiscal restraint overlooks their real-world consequences. It’s unfortunately not surprising that an administration that repeatedly threatens the rights of women and minorities would find a way to further block our access to education.
The greatest harm, however, will be borne by patients. In rural areas and underserved regions across the state, workforce shortages have contributed to a growing wave of hospital closures and service reductions, placing additional strain on neighboring health care systems and creating a cascading health care crisis across California. Every day, Californians are forced to travel farther for care, putting lives at risk, especially in time sensitive situations like trauma, strokes and cardiac events. With only 11 percent of physicians practicing in rural areas, more than 61 million Americans depend solely on APRNs for critical health care services.
Along with being the most trusted profession for 23 consecutive years, nurses are the backbone of care in rural and underserved communities. Yet H.R. 1 dismantles the advanced nursing pipeline while offering no alternative workforce strategy for the tens of millions of Americans living in health care deserts.
Since California’s first nursing school opened in San Francisco in 1882, the Golden State has been a fierce supporter and defender of not only education and science, but the nursing field as a whole. This moment calls for that same resolve.
Now is not the time to devalue ourselves or retreat — it is time to act. Nurses are the life blood of our health care system. If the federal government insists on undermining the workforce that keeps patients healthy, then California must, once again, take the lead by rejecting these harmful policies, protecting access to education and standing unapologetically with nurses and the patients we serve.
Kristen Roman is the president of the California Association of Nurse Anesthesiology and a doctor of nurse anesthesia practice and certified registered nurse anesthetist.