BELLEFONTE — Health care workers in rural Pennsylvania would be eligible for student loan forgiveness under a bipartisan proposal aimed at addressing workforce shortages in remote areas.
Doctors, nurses and midwives who work full-time in rural hospitals, clinics and birthing centers would be eligible for the Rural Health Grant Program, introduced by state Rep. Kathy Rupp (R-Warren).
After the state Assembly Health Committee unanimously sent the proposal to the full House for a vote in late June, Rupp called the program a “win-win” for local health care facilities and providers looking to pay off debts that can run into the hundreds of thousands of dollars.
“In the end, the real winners will be the rural communities that have adequately staffed teams to care for their residents,” Rupp said at the time.
Rupp told Spotlight PA that the idea for a loan forgiveness program came from discussions with state policymakers and health officials. Supporters say the program will boost recruitment efforts at rural health care facilities, with the hope that health care workers will eventually decide to stay in those areas long-term.
According to a survey by the Pennsylvania Hospital and Health Systems Association, rural hospitals have an average vacancy rate of 26% for registered nurses and 28% for nursing support staff. Statewide, vacancies for these positions are 14% and 19%, respectively, in 2023.
Rupp hopes the state Legislature will vote on the bill this fall.
Pennsylvania Rural Health Commissioner Lisa Davis told Spotlight PA that staffing has always been a major issue in rural health, but in recent years, she added, policymakers have begun to focus on staffing shortages and specialty unit closures, pointing to the recent closure of Penn Highlands Elk's obstetrics unit.
Health care providers say rising operating costs are making their finances harder, especially in rural areas where older residents rely more on Medicare and Medicaid, where government-funded health systems tend to reimburse facilities for services at lower rates than private insurance.
These challenges have led to cuts, consolidations and closures of services, making health care more difficult to access in these communities.
“When rural health care facilities can't attract or retain health care workers, they can't stay open and patients have to travel longer and longer distances to receive basic preventive and emergency care. This hurts outcomes and it's bad for our state,” said state Rep. Dan Frankel (D-Allegheny), chairman of the Health Committee, after pushing Rupp's bill. “The foundation of our health care system is our health care workers, so any efforts to support rural health care facilities must start there.”
Hospital administrators and other health officials favor loan repayment programs as a recruiting tool, and states are currently offering relief through their Primary Care Loan Repayment Program, which targets doctors, dentists, psychologists and other health care workers.
Under the state Legislature's proposal, the eligible employees who would be covered — physicians, nurse practitioners or midwives and birth attendants — would reflect the areas where stakeholders felt the program would “make the most difference and where they saw the greatest need,” Rupp said.
Davis, who also serves on the board of directors for the Pennsylvania Rural Health Association, told Spotlight PA that the proposed program is the first to focus on both rural areas and areas with limited medical services, but she would like to see policymakers clearly articulate whether eligible facilities need to be in medically underserved areas, rural counties, or both.
To qualify for debt relief under the state legislature's bill, employees must work full time at a participating facility for at least three years. Eligible workers include employees of birthing clinics, community health clinics, hospitals and federally qualified health centers that provide primary care regardless of ability to pay.
The state Health Department would administer the program and prioritize funding for facilities not affiliated with the health care system.
A spokesperson for the agency declined to comment on the bill but said in an email to Spotlight PA that the agency supports the bill's aims to recruit and retain health care workers in rural counties and underserved areas.
Under the bill, organizations applying for funds cannot receive more than $250,000 per year for employees.
Rupp's bill doesn't specify how much the relief would cost, instead directing lawmakers to decide on the amount after the bill is passed.
Loan repayment programs are often successful in recruiting and retaining workers, said Nicole Stallings, president and CEO of the Pennsylvania Association of Hospitals and Health Systems.
She also noted that debt relief benefits local communities, making businesses more likely to operate in areas where their employees have access to health care. Plus, loan repayments can free up recipients' budgets, making it easier for them to take big steps in life, like buying a home or starting a family, Davis said.
As Pennsylvania's rural population declines, opportunities for economic development are sought.
Most of the health workers who enroll in rural-focused loan repayment efforts are from those areas, and they typically stay there after their contracts end, Stallings and Davis said.
One of them is Kim Amsley Camp, a certified midwife who moved from Northern Virginia to her rural Franklin County hometown about 20 years ago as part of a federal loan repayment program.
Initially attracted to the program because of its $50,000 loan repayment benefit, Amsley Camp had always planned to move to the city, but she felt her work would make a bigger difference in a rural area.
“This is my people. This is my community,” Amsley Camp told Spotlight PA. “This is where I was born, this is a clinic in the hospital where I was born.”
She now works at Keystone Health, a federally funded facility, and Ansley Camp said the work is rewarding, despite the challenges that come with rural life.
“Rural America is a great place, but we have to market it,” she said.
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