Thoughts About the Future Given the "One Big Beautiful Bill" & What This Means For Me

Including wondering what you, my readers, would like to see, in this Substack?

Happy Friday, good people!

As I said in my Substack post of this last Monday (Happy Post-Independence Day Weekend 2025!) and this last Wednesday (Dual-School Academic Planning) - I’ve been mulling over some thoughts regarding the future of this Substack, which I’d like to discuss with you fine people.

Part 1 - Discussion of the One Big Beautiful Bill

So, to begin, I’m sure many if not most of you caught the news about the passage in Congress (and President Donald Trump signing into law on I Day 2025) of the “One Big Beautiful Bill” (aka OBBB), especially with respect to the ability of someone to attend medical school (and let’s not forget, one of the founding chief principles behind my starting this Substack is to serve as a resource for people like me looking to attend medical school, by documenting my journey).

For those of you who have not, as it has been discussed in:

I) Politico (Republican plans to cap student borrowing could shatter an everyday profession, Rebecca Carballo, 21 June 2025),

II) Student Doctor Network (The "One Big Beautiful Bill" and Medical Education, SDN Staff, 4 July 2025),

III) NBC News (Medical students fret over student loan cap in 'big, beautiful bill', Shannon Pettypiece and Rebecca Shabad, 8 July 2025),

IV) Vox (The One Big Beautiful Bill is about to make student loans worse, Abdallah Fayyad, 9 July 2025)

V) Town & Country (Loan Caps and Repayment Changes - How the New Spending Bill Changes College Loans, Norman Vanamee, 8 July 2025)

VI) Business Insider (A big change to student loans in Trump's spending bill could make it harder to become a doctor or lawyer, Ayelet Sheffey, 8 July 2025)

VII) New York Times (Opinion | The Ugliness of the ‘Big, Beautiful’ Bill, in Charts, Steven Rattner, 3 July 2025)

VIII) Forbes (Senate Passes Massive Changes To Student Loan Borrowing And Repayment, Robert Farrington, 1 July 2025)

what this means for future of graduate student education in America is (and I’m trying to remain as objective as possible when discussing it - for anyone who wants my personal opinions on the OBBB - if you already know me IRL, just text me to set up a time to discuss):

1. Drastic Caps on Federal Student Loans

• Graduate borrowing capped at $20,500/year (≤ $100k lifetime); Professional degrees (such as MD/DO degrees) capped at $50,000/year and $200,000 total.

• Medical education at present usually costs $280k+ at public schools and $390k+ at private ones.

• Eliminates Grad PLUS & unlimited parental borrowing - postgraduate and parent loans are now tightly capped.

Impact:

1. Funding gap: You'll likely fall short of actual costs unless you take out private loans—which are typically more expensive, require cosigners, and offer fewer protections.

2. Financial deterrent: Students from low‑income or underrepresented backgrounds may be discouraged from even applying.

2. Worsening Workforce Shortages & Lower Diversity

• Without sufficient federal (and state) support, fewer students can afford to attend medical school - particularly in public institutions or community-based specialties.

• Associations including AAMC warn that limiting borrowing capacity will intensify the existing physician shortage (projected up to 124k by 2034).

• Students from diverse and low-income backgrounds are particularly at risk, threatening socio-economic and racial representation in the medical field.

3. Shift Toward Riskier Private Loans

• With federal limits insufficient, many students will turn to private lenders. Those often come with:

  • Higher interest rates

  • Cosigner requirements

  • No federal protections (e.g., forgiveness, deferment)

4. Repayment Plan Changes That Hurt Low-Income Borrowers

• The bill eliminates the Biden‑era SAVE program and legacy income-driven plans, replacing them with just two options:

  • Standard fixed repayment (10–25 years)

  • A new “Repayment Assistance Plan” (RAP): payments 1–10pc of income, with forgiveness after 30 years.

• Under RAP, monthly payments could exceed those under SAVE, and the plan doesn’t adjust for inflation - so low-income borrowers may pay more in real terms.

5. Collateral Fallout in Healthcare & Training

• The bill includes Medicaid cuts, reduced federal support for hospitals and community care centers - especially safety-net and rural facilities.

• This can lead to fewer residency spots in underserved areas, fewer training sites, and less clinical exposure for students committed to primary care or rural medicine.

6. Mixed-Up Promises vs. Reality

• Proponents argue the loan caps will curb tuition inflation and simplify repayment.

• However, the practical impact likely defeats that aim. Many students won’t be able to borrow enough to attend, and simplification reduces flexibility, but without addressing program costs or affordability.

Challenge What it Means for Someone Who Wants to Attend Med School

1. Loan Caps Borrow far less than needed for med school

2. Private Loans Enter riskier, higher-cost debt

3. Repayment Plans Less favourable terms for low-income borrowers

4. Workforce Effect Fewer physicians in underserved areas, lower diversity

5. Health System Cuts Fewer training spots & resources in key settings

The TL; DR

If you’re planning to attend medical school, prepare for significant financial barriers:

1. Estimate total cost and compare with the new federal cap of $200k.

2. Explore scholarships, institutional aid, and state or foundation grants to bridge the gap.

3. Carefully assess any private loans - interest rates, terms, protections.

4. Consider long-term implications like repayment burdens and career choices (e.g., primary vs. specialty care).

Part 2 - What the OBBB Does Through the Lens of My History

Given my own personal history - this likely would have meant:

1. My first masters (the research MSc I did at UVA), plus the additional student loans I took out as a PhD student at UPenn after, likely would have been the only student loans I could have taken out (this of course depends on whether or not my Cornell MEng would be seen as a “professional” (which I interpret to mean terminal) degree or not - but even still, that 50k cap per year wouldn’t have even covered my whole cost of Cornell tuition, never mind the living expenses part. And before anyone asks, even as a funded graduate student at UVA and Penn, the cost of living, especially given the particulars of my life (such as my chronic disabilities) required expenditures beyond what my grad student stipends covered (and that includes having grad student health insurance at both institutions covered as part of my compensation)

2. Even assuming that my Cornell MEng (which I took to try to get away from cleared, federal-sector work…except the COVID-19 Pandemic got in the way of that plan) would have been covered under the “professional” student loans bucket, and that that bucket is separate from the “graduate” student loans bucket, it still means that, I’d have only $150k of student loans available to take out for med school.

Now, for anyone who knows me IRL (or has been reading this Substack long enough to wonder: “Hey Everett, you’re a veteran, didn’t the GI Bill and/or other VA benefits cover you for grad school?” to which, I’d have to tell you the following:

1. As I discuss in my post of this last Wednesday (the aforementioned Dual-School Academic Planning) - my undergrad at UW was funded by VA Chapter 31 (aka Voc Rehab) not either GI Bill (neither the Montgomery GI Bill nor the post-9/11 GI Bill), and, for every month of Voc Rehab for me, I had to give up a month’s worth of GI Bill,

2. By the time this interpretation of the policy of Voc Rehab vis-a-vis the GI Bill was corrected/changed, it was after I had already racked up the federal student loans for Cornell,

3. Not like I could retroactively apply the GI Bill towards federal student loans I had taken out to fund my graduate education in any case,

4. Even with VA medical benefits, given both the locations of the universities I’ve attended relative to the nearest VA medical centres (none of UVA, Cornell, and UVM are near VA medical centres) as well as the difference in time cost of pursuing care through the VA vis-a-vis paying for care via student insurance and the associated co-pays (and when given the choice of paying for my own care or using the VA - the former won out every single time given trying to get care through the VA is so time-consuming relative to going to the student health service or a physician in a regular community centre), and,

5. Given when I left the US military (aka my ETS/EAS - depending on your service background), my delimiting date of when I could use my GI Bill benefits by was before I started at Cornell [and this one really chaps my butt because if I had been discharged in 2013 or later, instead of roughly a decade before, there would have been no delimiting date restricting when I could claim those benefits].

All of this is a really long-winded way of saying - it looks like my ability to attend medical school is now severely compromised if not entirely blocked, without the ability to raise more money for myself, unless or until this portion of the OBBB is reversed in the near future.

This gets to…

Part 3 - The issue of what to do with this Substack from here forward

I created this Substack to serve as a free resource for people like me, who are trying to change careers into medicine after doing something else, but also as a place to share my views/analysis on various current events, policy issues, etc. - which causes me to wonder the following:

1. What sort of content would the readers of my Substack be willing to pay for?

2. How much of my content creation should be restricted to those willing to pay for said content?

3. What would be the frequency of that content for my paid subscribers only would have to occur for there to be a positive value proposition for my paid subscribers (or to induce my non-paid subscribers to becoming paid subscribers)?

In practice, this means, the options are:

1. Stay 100% Free - Keep all content public; seek donations or sponsorship later (but this will limit my ability to provide content in the short-term).

2. Mixed Model - Some posts free, others behind paywall - likely policy & personal content

3. Full Supporter Tier - All posts public, but offer bonus Q&As or subscriber chats to paid tier

I leave this for people to contemplate, and for those who would like to provide me feedback to:

1. Comment on this post or send me an email at: ae434 (at) cornell (dot) edu, or,

2. For those of you who know me IRL & already have my mobile number, to text/ring me on it to discuss what you’d like to see here.

=//=

Now off to my Orgo lecture, and to go run some errands after before a weekend of studying for my exams in both Bio 3 and Orgo 1 next week.

And on that note, that’s a full lid for today, 11 July 2025.