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Rural health advisers warn Nebraska loan-repayment cuts would worsen provider shortages
Summary
Members and appointees to the Nebraska Rural Health Advisory Commission told the Health and Human Services Committee that program funding and workforce shortages threaten rural hospitals and clinics and urged investment in telehealth, hub-and-spoke models and loan repayment to recruit clinicians.
Speakers before the Health and Human Services Committee urged lawmakers to protect and expand rural recruitment tools, saying state loan-repayment programs and regional care models are central to keeping services available in small communities.
Jeffrey Harrison, chair of the UNMC department of family medicine and a long-time rural health advocate, said Nebraska must adopt new delivery models to keep care local: "Patients still want the relationship, with somebody they know," he told the committee while urging a hub-and-spoke approach that pairs centralized specialty resources with local access points staffed and supported by local teams.
Rebecca Schroeder, a clinical psychologist from Curtis and a long-serving Rural Health Advisory Commission member, described the state loan-repayment program that helped place clinicians in rural communities. She told senators: "You can get $60,000 a year to pay back your student loans by serving in a rural area," and said keeping that pipeline funded is critical to retaining new clinicians once they arrive.
Roger Wells, a physician assistant who administers rural programs and provided a December report to the committee, summarized program outcomes and county-level shortages. Wells said the commission's data show 21 percent of Nebraska hospitals are "vulnerable to closure" and that 38 percent operate in a negative margin. He also reported that 42 of 82 counties were designated primary-care shortage areas and that nearly every county (81 of 82) is a mental-health shortage area.
Wells and other witnesses warned that a proposed budget cut identified in testimony as "LB261" would sharply reduce state support for the loan-repayment and student-loan programs. Wells said testimony referenced an allocation reduction "from $2,100,000 down to $680,000," which he said would halt new loan-repayment contracts until 2026 or later.
Witnesses proposed several policy responses: maintaining or restoring loan-repayment funding, investing in regional coordination and telehealth sites where patients could get in-person assistance for tele-visits, and piloting community-health-worker and EMT-in-emergency-department models that could extend hands-on care without requiring a full hospital staffing model in every small town. Harrison suggested partnering county extension offices or other local sites as staffed telehealth hubs.
Committee members asked about training, scope of practice and the costs of emergency transport. Members and witnesses discussed the "golden hour" in trauma care and the expense of air transport; witnesses said improved local stabilization and coordinated transport remain priorities.
No committee votes were taken. Witnesses and senators asked staff to keep funding and workforce figures under review as budget discussions continue.
