Congress: Reauthorize loan repayment programs for the public health workforce
September 2025
Big Cities Health Coalition (BCHC) and 86 other organizations are asking Congress to reauthorize the bipartisan-supported Public Health and Bio-Preparedness Workforce Loan Repayment Programs (H.R. 4445) as soon as possible this year.
These targeted programs are needed to incentivize individuals to pursue careers in public health and infectious diseases (ID) by providing up to three years of loan repayment in exchange for service in rural communities and other areas with health professional shortages, as well as federal facilities like VA hospitals, Ryan White clinics, and community health centers.
The local and state public health workforce is the backbone of the nation’s governmental public health system but is also facing an emergency. Without sufficient funding to recruit and retain staff, health departments cannot provide essential services like screening and treatment for both chronic and communicable diseases; maternal and child health services; epidemiology and surveillance; routine immunizations; primary prevention services; and inspection or licensing activities.
An underinvestment in the public health workforce leaves our communities under-prepared to respond to emergencies, including infectious disease outbreaks, environmental hazards, and weather-related events.
Unfortunately, the ID workforce is also in crisis. In 2024, 80 percent of U.S. counties lacked an ID physician, and just over half of ID physician training programs filled, compared to most other physician specialties which filled nearly all their programs. Average medical student debt is $250,000, making a lower-paying specialty like ID frequently out of reach.
Communities without ID health care professionals will be less equipped to respond to threats like antimicrobial resistance, health care associated infections, sepsis, and infectious diseases associated with the opioid epidemic, and less able to advance the End the HIV Epidemic initiative and eliminate viral hepatitis.
As the Subcommittee considers legislation this year, we urge Congress to reauthorize the Public Health Workforce Loan Repayment Program and the Bio-Preparedness Workforce Pilot Program this year. These bipartisan, commonsense recruitment tools will help ensure our public health and ID workforces can keep our communities safe and healthy in the years to come.
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