Looking Forward BEL Newsletter

Understanding the Substance Use Disorder Workforce Loan Repayment Program

By Bureau of Emerging Leaders


This article is from the April 2022 issue of the Looking Forward BEL newsletter.

The AOA Bureau of Emerging Leaders recently spoke with John-Michael Villarama, MA, AOA Senior Director of Congressional Affairs and Affiliate Engagement about AOA advocacy regarding the Substance Use Disorder Workforce Loan Repayment Program.

This interview has been edited for clarity.

For those unfamiliar, what exactly is the Substance Use Disorder Workforce Loan Repayment Program?

JMV:  It is a loan repayment program that can extend for up to six years and would allow up to $250,000 to be forgiven for physicians that practice in a substance use disorder treatment job in a mental health professional shortage area or in a county where the drug overdose death rate is higher than the national average. Ultimately, the goal is to provide access to care in parts of the country that is hard hit by the opioid epidemic.

How did the program start?

Back in 2017, there was an intense push by Congress to address the opioid epidemic spreading throughout the country and we wanted to make sure that rural America had access to care. A way to this was through the creation of this program. We worked with several offices, [including Representatives Katherine Clark (D-MA), Hal Rogers (R-KY), and Senator Joe Donnelly (D-IN)] in creating the program, which builds upon the National Health Services Corps.

And are these congressional offices that the AOA has historically had a good working relationship with?

We have a long history working with members like Senator Lisa Murkowski (R-AK), and Congressman Hal Rogers (R-KY), and the AOA has a great relationship with Members of Congress, in both parties, in general.

Apart from those, who else was involved in the early inception?

In the early stages, our primary goals were to secure funding for the program and to keep the legislation bipartisan. We reached out to members in committee of jurisdiction that have expressed interest in this policy area and kept them informed of our intensions. Senators from states hard hit by the opioid epidemic like Senators Maggie Hassan (D-NH) and Shelley Moore Capito (R-WV) were very involved in the early stages.

And what was that process like, from conception to policy?

Our goal was to get the legislation introduced in late 2017, but with all that was happening at the time and the time it took to secure $25 million to fund the program for five years, it was not until February of 2018 that in was introduced in the House of Representatives.

Our efforts then turned to getting the legislation introduced in the Senate. It was important that the legislation remain bipartisan. Senator Donnelley was our Democratic champion and we needed a Republican. This was when we partnered with the Alaska Osteopathic Medical Society (AKOMA) in requesting Senator Lisa Murkowski (R-AK) to be the lead Republican.

From there, we tried to garner as many cosponsors as we could specially Members in committee of jurisdiction. Shortly after introduction, AOA launched a letter campaign that was co-signed by 32 national associations asking members of congress to support the legislation by co-sponsoring the legislation. The AOA also sent 3 separate action alerts to students and physicians to ask their representatives and senators to co-sponsor the bill.

The legislation passed the House in June as part of a larger legislative package, the SUPPORT for Patients and Communities Act.  Unfortunately, there was pushback from the Senate. In response, the AOA sent an action alert to our members to encourage Senate leadership to include the House-passed version of the legislation rather than the Senate HELP Committee’s amended version. The Senate’s amended version limited the program to two years with a maximum repayment of $50,000. This was a drastic change that would have dwarfed the program’s impact.

When the Senate passed their amended version of the bill, we focused our advocacy efforts to the Conference Committee to address our concerns. For background, when a House and Senate passed legislation differ from each other, a Conference Committee is created. Members of which are appointed to by the Senate and House leadership with the goal of negotiating differences between the two versions that can pass both chambers.

When the conference committee members were named, the AOA had another big advocacy push and led a sign-on letter advocating for the legislation, which garnered support from 42 state and national associations.

We were ultimately successful in our advocacy. The conference committee’s negotiated language preserved the original text of the legislation, and the House and Senate passed the SUPPORT for Patients and Communities Act. The President then signed it into law on October 24, 2018. It is a six-year program so we will be up for reauthorization next year.

A lot of Action Alerts were going out through that process, what’s your assessment of the importance of those Action Alerts in advancing support for the cause?

They serve such an enormous importance for moving legislations and priorities. It reinforces our message to Congress and shows that their constituents back home care about the issue.

It seems there are multiple times when those Action Alerts are particularly time-sensitive, with legislation moving quickly.

Yes, that is the nature of how things can sometimes move here, and why it is so important that we continuously educate members on what is important to the osteopathic profession.

How did the AOA find itself in a key role in this legislation?

I think it’s a combination of offices knowing our interest in this area, our reputation for bipartisanship, and our approach to problem solving.

A big challenge was addressing the differences in the House and Senate versions, what were other challenges along the way?

Outside of securing funding for the program, the differing versions really became the main concern.

This legislation wouldn’t have moved as quickly without the advocacy of osteopathic state affiliates and membership support through Action Alerts. The legislation is due for reauthorization next year and membership advocacy will be very important in the future to keep the program going.