Education Column
Learn more about the impact that MASA has on Alabama policy
How Eliminating Graduate PLUS Loans Would Affect Alabama Medical Students
Rachel Cotter, Health Policy and Advocacy Chair
Medical education in the United States is incredibly expensive. Today, the median cost of attendance for United States medical schools over 4 years is $286,454 for public institutions, and $390,848 for private institutions.¹ To tackle the high cost of graduate education, some lawmakers have endorsed changes to government loan options, such as modifying the cap for federal direct unsubsidized loans and eliminating graduate PLUS loans. Supporters of these changes, including Alabama’s own United States senator Tommy Tuberville, propose that this will incentivize medical schools to reduce their tuition costs, and thus reduce the amount of loans students must take out. However, recent data from the Association of American Medical Colleges suggests that the increasing cost of medical education has little to do with rising costs of tuition and more to do with rising costs of attendance due to annual inflation.²
Medical students are allowed to borrow an amount annually that equates to the cost of attendance. The cost of attendance is calculated by adding together the total cost of tuition, living expenses, personal expenses, books and supplies, transportation, and loan fees. For medical schools in the state of Alabama, the tuition ranges from $36,198 to $60,576 and the annual cost of attendance ranges from $69,123 to $100,424. Currently, the maximum amount of unsubsidized loans that a medical student can take out annually is $40,500. However, the cost of medical education greatly surpasses this value. To bridge this gap, students take out graduate PLUS loans, which are on the chopping block. The Association of American Medical Colleges estimates that about half of all medical students in the United States take out graduate PLUS loans, which equates to more than $1 billion annually.
Student loans already accrue interest at an exuberant rate. As of 2025, federal direct unsubsidized loans have a 7.94% interest rate and graduate PLUS loans have an 8.94% interest rate.³ These are still often the best option for medical students, due to the flexibility of repayments and potential for forgiveness. Without graduate PLUS loans, students will be forced to rely on predatory private student loans. The interest rates for private student loans are highly variable and are only beneficial if the interest rate is known to remain low and the debt can be repaid quickly. If you are already in a tough spot financially, private student loans can accrue interest at a rate that far exceeds that of unsubsidized and graduate PLUS loans. Therefore, eliminating graduate PLUS loans will not only increase the amount of debt for medical students, it will also exacerbate socioeconomic barriers to becoming a physician. For fellow Alabamians that oppose this legislation, reach out to our state’s US senators, Tommy Tuberville and Katie Britt, as well as your congressional district’s representative.
References
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Proposed Changes to Federal Student Loans Could Worsen the Doctor Shortage
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From Classroom to Clinic: How Grad PLUS Loans Support the Physician Workforce Patients Rely On
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Interest Rates for Direct Loans First Disbursed Between July 1st, 2025 and June 30th, 2026
Alabama
Legislative Session from the Eyes of a Medical Student
Rachel Cotter, Alabama Legislative Session Attendee and MASA-MSS Member
On April 15th, a group of medical students had the exciting opportunity to visit the Alabama State Capitol in Montgomery and witness firsthand how the state government operates. Their day began with a meeting with Evans Brown, the Manager of Government Relations and Public Affairs for the Medical Association of the State of Alabama (MASA). Brown spoke with the students about some of MASA’s current legislative priorities, including efforts to reform prior authorization processes and address scope creep. Prior authorization, which requires physicians to obtain approval from insurance companies before proceeding with certain treatments, is a major source of frustration and can lead to significant delays in patient care. Additionally, Brown discussed scope creep, a term used when non-physician providers seek to expand their scope of practice beyond their training, potentially lowering the overall standard of medical care.
Following the discussion, the students made their way to the Alabama State House to observe legislative sessions in both the House of Representatives and the Senate. A legislative session is a formal period during which elected officials meet to propose, debate, and vote on new laws and amendments. Watching these sessions gave the students valuable insight into how healthcare policy is shaped and highlighted the intricate process of turning ideas into actionable laws. It also showed how critical it is for future physicians to understand and engage with legislative processes that directly impact the practice of medicine and the wellbeing of their patients.
This experience emphasized the vital role of grassroots advocacy in protecting and improving patient care. By participating in events like these, medical students not only learn how to navigate the political landscape but also become empowered to advocate for policies that enhance healthcare delivery. Speaking out on important issues ensures that the voice of the medical community remains strong and that future changes in healthcare policy prioritize the needs of patients.
Authorizing Abortion from Rape and Incest Pregnancy
Rhea Nichani, Editor in Chief
On June 24th, 2022, Alabama began enforcing its total abortion ban, which prohibits abortion at all stages of pregnancy, following the U.S. Supreme Court’s decision to overturn Roe v. Wade in the case Dobbs v. Jackson Women’s Health Organization.
Hence under existing Alabama law, abortion exceptions are limited, based on the Human Life Protection Act. These exceptions include 1) to save the pregnant person’s life, 2) to prevent serious risk to the pregnant person’s physical health, and 3) if the fetus is not expected to survive the pregnancy. Given this, representative Juandalynn Givan is sponsoring a bill in the house that is attempting to expand abortion exceptions to include cases of rape and incest. It also mandates that the father convicted of rape or incest resulting in pregnancy must pay for the abortion and all related medical expenses. The father must also undergo court-ordered sterilization.
Given that Alabama's abortion ban is considered to be one of the strictest in the country, this bill is predicted to be a controversial topic in the current legislative session.
Alabama Lawmakers Have a Plan to Help Fix the Rural Health Crisis
Rhea Nichani, Editor in Chief
Alabama lawmakers are actively working to solve one of the state’s largest health crisis by filing legislation that enhances the existing tax credit of 5,000 to 10,000 so as to support rural hospitals by incentivizing physicians to work in underserved communities. This is increasingly important, as since 2011, according to the Center for Healthcare Quality and Payment Reform, seven rural hospitals have closed and reports predict that more than half of the state’s 52 rural hospitals are at risk of closing, with 19 at immediate risk. In fact, pediatricians, dentists, and maternity care have disappeared in over a third of the state’s counties. These healthcare facilities closing will only further impact the community by eliminating the ability to recruit industry in the area. In turn, education groups will not have children to educate in the areas.
This expansion in legislation will extend tax credit benefits to physicians residing in populations of 50,000 or fewer, as well as, municipalities with populations of 20,000 or less, in a county with 50,000 or less. The Medical Association supports this initiative, as it directly addresses longstanding healthcare disparities and bolsters access to medical care for Alabama’s rural residents.
State Funded Medical Residencies Expanded
Frances Case, Student Representative
Committee on Medical Education
To tackle the physician shortage in Alabama, the state legislature has committed to increasing support for primary care and psychiatric residency programs. An $800,000 investment has been allocated to the Cahaba Medical Care Center Family Residency program to add five new slots in Centreville, targeting rural healthcare needs. Additionally, opioid settlement funds are being used to create two new psychiatric residency programs in Montgomery and Birmingham, with a focus on substance abuse treatment. Auburn and Huntsville will also gain new psychiatric residency programs funded through other sources, addressing the critical shortage of mental health professionals in the state.
The Medical Association supports these initiatives as they directly address the urgent need for more healthcare providers in underserved areas. By expanding residency slots and focusing on substance abuse, these programs aim to improve access to essential medical and psychiatric care, particularly in regions severely affected by the opioid crisis. This proactive approach is essential for meeting the growing demand for healthcare services across Alabama, especially in counties lacking adequate mental health resources.