By Steven K. Ragsdale
A new federal policy set to take effect in 2026 will sharply limit how much students can borrow to pursue biomedical, nursing, dental and other health-professional degrees.
On paper, it reads like a cynical budgetary adjustment that cuts into the lean meat of the country’s healthcare business economies. But in Baltimore, it threatens to become something far more devastating. In a city where most residents are Black, where household wealth gaps remain deep and where healthcare is the region’s dominant economic engine, restricting access to professional education risks shutting most Baltimoreans out of medicine altogether. The question is not whether this policy will change who gets trained. The question is whether our local health systems care enough to confront what that change will mean for the communities that have sustained them for generations.
To understand why THIS policy matters, it is impossible to talk about Baltimore’s current situation without examining the role of its schools and their relationship to the fabric of medicine and education. Two historically Black schools, Frederick Douglass High School in West Baltimore and Paul Laurence Dunbar High School in East Baltimore, have stood as twin pillars of survival, excellence and aspiration for more than a century. Yet the pathways they created were never equal. That difference quietly shaped the city’s social and economic landscape and continues to decide who gets to care for the residents who stay disproportionately concentrated at the bottom of Baltimore’s billion-dollar healthcare economy.
The second high school built specifically for African Americans in the U.S., West Baltimore’s Douglass High School opened its doors in 1883 and produced famous generations of lawyers, educators and national civil rights leaders. Its alumni include members of the Mitchell family, Verda Welcome, George Russell Jr., and the first Black Supreme Court Justice, the Honorable Thurgood Marshall. Douglass became a well-known launchpad for Black professional leadership in Maryland and beyond.
East Baltimore’s Dunbar High School, where many members of my family and I came of age, did not become a full high school until 1937, more than fifty years later. Ironically, it shared its name with the first high school built for Black students in the country in Washington, D.C. Expectations for the often-overcrowded school were clearly different. Baltimore pipelined Dunbar’s young people routinely into the industries surrounding us: hospitals, hotels, service trades and other forms of basic, back breaking labor.
In an industrial city, those jobs sometimes came with a steady paycheck, but more often with a bonus of immediate health risks, with other health issues deferred until starting a very short-lived retirement. Compared to other communities, many in East Baltimore have historically more chronic conditions and often do not survive long enough to reach retirement age. For decades, rumors persisted in the African American community that academic researchers might snatch your body off the streets for medical experimentation, with stories passed along from the cradle to the grave. Having your care prioritized over moving research forward was always a gamble where I grew up. Although researchers have received untold millions to study the effects of living in tough conditions historically, the only time East Baltimore saw any significant improvement in social determining factors is when the vast majority of its residents packed up and moved to other parts of the city.
Yes…It is TRUE! Dunbar produced America’s first Black billionaire, T. Reginald Lewis, Robert Bell, the first African American Chief Judge of Maryland’s highest court, and Bob Wade, the legendary coach who put local sports in the national conversation. Even Ester McCready, the first Black student admitted to the University of Maryland’s nursing program in 1939, as one test case that led to the Brown decision, received much deserved attention toward the end of her life.
But who– in local media– can tell you the tale of Brandon Lockett, the founder and CEO of Neutron Engineering?
Lockett is a prominent community leader in Baltimore, notably as the former Board Chair of the Historic East Baltimore Community Action Coalition (HEBCAC). While getting his two degrees from Johns Hopkins, he worked nine years as a Network and Technical Engineer for Johns Hopkins Medicine. He is a Dunbar graduate, native of East Baltimore and is constantly involved in local philanthropic efforts in sports and education.
Who is reporting on the important community efforts of a Delora Sanchez-Ifekauche, a prominent government affairs attorney and lobbyist in Maryland. Her origin story has ties to her days at Dunbar and she has constantly tied her work and her heart to Baltimore, first working with Johns Hopkins. But her name and energetic voice are found commonly in non-profit board service. Before becoming the principal for an Annapolis lobbying firm. Ifekauche worked for a decade at Johns Hopkins as the Director of Policy and Advocacy for State Affairs and was the key to setting up the Maryland MCO Association. Less well known is that she never forgot her own path and serves on the board of a local non-profit that creates support networks for struggling youth to help them graduate high school.
We can all agree that even before the legendary tales of Alan “Skip” Wise, sports and famous athletes grew Dunbar’s name and reputation locally and nationally. But quieter successes in medicine, science and leadership rarely received the same recognition. We learn early that many locals measure our value by criminal statistics and not labor statistics, resilience to disease tolerance and not necessarily by our empathy, intellect or capacity to lead and care for ourselves.
For a brief moment, Dunbar’s students defied those assumptions. My homeroom included a Cornell-bound valedictorian, two PhDs, a Hopkins-trained radiologist, a JD/PhD and a research scientist whose work continues to affect patients nationwide. The issue was never talent. It has always been about gaining access to the city’s narrow and carefully guarded pipelines that shape who achieves long-term economic and professional security.
Our systems embedded that truth into the geography of East Baltimore itself. Johns Hopkins, the centerpiece of American research medicine, was built atop what early public health leaders once described as a “living laboratory.” The promise was uplift. The reality was exclusion. For decades, Hopkins produced world-class physicians while denying most local African Americans admission. Early Black doctors and nurses were, by law and custom, steered toward Provident Hospital or forced to seek training out of state as Hopkins resisted integration well into the twentieth century.
The University of Maryland, Baltimore followed a similar path in medicine, dentistry and law, famously defending exclusion through the courts rather than dismantling it. These decisions shaped not only who entered professional schools, but who would go on to define healthcare leadership in Maryland for generations.
After the turbulence of the 1960s, Dunbar parents and surrounding communities attempted to fill the educational and employment gaps that local institutions would not fully address. For roughly a decade, from the late 1970s through the early 1980s, Dunbar’s Health Careers Program trained much of the workforce that helped fuel Johns Hopkins’ growth. But the pipeline was tilted from the start. Large numbers of graduates became aides, technicians and other lower-level employees, with only a few advancing to work in registered nursing roles. Meanwhile, graduates of Hopkins and the University of Maryland became surgeons, researchers and hospital executives, filling essential roles in the regional and national healthcare infrastructure.
Baltimore’s healthcare success, once again, rested on Black labor rather than Black leadership.
I experienced this imbalance from multiple vantage points: as a student-athlete, a scholar, a patient, a research subject, a data point in public health and later as a local healthcare administrator. Athletics taught me discipline and perseverance. But it was my years working in healthcare systems and public health scholarship that ultimately led me into the classroom. For more than 25 years, I have been invited to teach graduate students at Johns Hopkins and the University of Maryland about the history of the neighborhoods surrounding their expansive campuses.
Each time I teach, it reminds me that proximity does not equal access. This divide was not accidental. Our history has clearly shown that our local gateway was designed with particular purpose and intent over decades, reinforced by gaps in public and private education that have never disappeared. Now, even the most optimistic observers expect those gaps to grow.
A new barrier with an old shape
For students without access to family wealth, these loan caps will make advanced healthcare education significantly harder to obtain, if not entirely out of reach. Critics warn that the policy will shrink the future healthcare workforce. What stays unspoken, is what Baltimore already knows.
Lower income in America remains disproportionately Black and Latin-X. When you cap financial access, you cap local potential.
Once again, Baltimore faces a familiar risk. Johns Hopkins and the University of Maryland will continue producing doctors and other health professionals, just in smaller numbers. At the same time, Dunbar and other local high schools will continue supplying a workforce historically classified by the U.S. Department of Labor as the City’s low-wage earners, a distinction that they have held for more than a century. East and West Baltimore’s children will remain shut out of economic self-determination long before they reach the classroom or more importantly, the exam room.
This is not an abstract debate about who performs surgeries and who cleans hospital floors. It is about who sets healthcare policy and whose lives receive priority when resources are scarce. At a moment when every major system claims to be searching for culturally connected clinicians, Baltimore cannot afford to lose talented students simply because tuition barriers have become the latest glass ceilings.
Baltimore must reject this future
If federal officials will not invest in the next generation of healthcare leaders from our communities, then Baltimore’s medical institutions must confront what lies ahead. The new loan caps will limit entry into medicine, nursing, dentistry and the biomedical sciences. In a city where income and race remain tightly linked, those limits will fall hardest on neighborhoods that have long supplied the labor while carrying the greatest burden of health inequity.
Treating this moment as just another policy change would be a mistake. It is a structural threat to Baltimore’s healthcare future and reinforces the unequal pipelines that have shaped this city for more than a century. One must wonder what members of the American College of Healthcare Executives are considering as this policy approaches. Has the Maryland Hospital Association taken a public position on this emerging crisis? Local systems like Johns Hopkins, the University of Maryland, MedStar, LifeBridge and others have repeatedly shown how they respond when federal rules threaten operations. They work together. They share data. They act with a sense of urgency and precision when readmission penalties rise, reimbursement shifts or patient safety and quality metrics risk their financial stability. But I have no recent memory of reporting that local hospitals consulted with field experts, such as the National Medical Association, which has been advising on these issues for more than a century.
Baltimore’s healthcare leaders must bring that same collective resolve to the question of who enters the exam room not as a patient or technician, but as a clinician, researcher or future decision maker.
No single institution can solve this alone. But together, they need to decide whether Baltimore continues to reproduce a low wage workforce or finally open several pathways into healthcare clinical care and leadership for its own children. The answers will not come through charity or short-term programs. They will come through a shared commitment to protecting access to professional education for the communities that have powered Baltimore’s healthcare engine from the beginning.
What is still uncertain is whether local leadership will act with the imagination, innovation and shared responsibility this moment requires. Baltimore has never lacked talent. What it has lacked is a system willing to recognize that talent as worthy of sustained investment and leadership opportunity.
Our children deserve more than a narrow place in the healthcare economy. They deserve the chance not only to work in it, but to build it and lead it. How Baltimore’s medical community responds to this moment will tell us exactly how much it values its own future and the healthcare future of its 270 recognized neighborhoods.
The opinions expressed in this commentary are those of the writer and not necessarily those of the AFRO.