II 

108TH CONGRESS 

2D SESSION S. 2613 

To amend the Public Health Service Act to establish a scholarship and 

loan repayment program for public health preparedness workforce development to eliminate critical public health preparedness workforce shortages in Federal, State, and local public health agencies. 

IN THE SENATE OF THE UNITED STATES 

JULY 7, 2004 

Mr. HAGEL (for himself and Mr. DURBIN) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to establish a scholarship and loan repayment program for public health 

preparedness workforce development to eliminate critical 

public health preparedness workforce shortages in Federal, State, and local public health agencies. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Public Health Pre5 paredness Workforce Development Act of 2004’’. 

6 SEC. 2. FINDINGS. 

7 Congress makes the following findings: 
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1 (1) The ability of the public health system to 

2 prevent, respond to, and recover from bioterrorism 

3 or acute outbreaks of infectious diseases and other 

4 health threats and emergencies depends upon the ex5 istence of adequate numbers of well-trained public 

6 health professionals in Federal, State, and local pub7 lic health departments. The public health system has 

8 an aging staff nearing retirement with no clear pipe9 line of highly-skilled and capable employees to fill 

10 the void. The average age of the State public health 

11 workforce is 47, 7 years older than the average age 

12 of the nation’s workforce. More than 50 percent of 

13 the States cite the lack of qualified individuals or in14 dividuals willing to relocate as being a major barrier 

15 to preparedness. 

16 (2) The National Association of State Personnel 

17 Executives reports that State governments could lose 

18 more than 30 percent of their workforce to retire19 ment, private-sector employers, and alternative ca20 reers by 2006. The rates for State public health de21 partments are as high as 45 percent. 

22 (3) The ratio of public health workers to the 

23 population has dropped from 219 per 100,000 in 

24 1980 to 158 per 100,000 in 2000. 
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1 (4) Approximately 42 percent of the current ep2 idemiology workforce in State and territorial health 

3 departments lacks formal academic training in epi4 demiology. 

5 (5) Thirteen State public health laboratories 

6 are without doctoral-level molecular scientists on 

7 staff, 23 have only one, and only 15 States have any 

8 staff redundancy at this level. 

9 (6) Public health nurses comprise the largest 

10 segment of the public health workforce. The leaders 

11 of State public health nursing average more than 30 

12 years service and are very close to retirement. In one 

13 State nearly 40 percent of the public health nursing 

14 workforce is eligible for retirement today. 

15 SEC. 3. PUBLIC HEALTH WORKFORCE SCHOLARSHIP AND 

16 LOAN REPAYMENT PROGRAM. 

17 Part E of Title VII of the Public Health Service Act 

18 (42 U.S.C. 294n et seq.) is amended by adding at the end 

19 the following: 

20 ‘‘Subpart 3—Public Health Workforce Scholarship 

21 and Loan Repayment Program 

22 ‘‘SEC. 780. PUBLIC HEALTH WORKFORCE SCHOLARSHIP 

23 PROGRAM. 

24 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab25 lish the Public Health Workforce Scholarship Program 
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1 (referred to in this section as the ‘Program’) to assure 

2 an adequate supply of public health professionals to elimi3 nate critical public health preparedness workforce short4 ages in Federal, State, and local public health agencies. 

5 ‘‘(b) ELIGIBILITY.—To be eligible to participate in 

6 the Program, an individual shall— 

7 ‘‘(1) be accepted for enrollment, or be enrolled, 

8 as a full-time student— 

9 ‘‘(A) in an accredited (as determined by 

10 the Secretary) educational institution in a State 

11 or territory; and 

12 ‘‘(B) in a course of study or program, of13 fered by such institution and approved by the 

14 Secretary, leading to a health professions de15 gree (graduate, undergraduate, or associate) or 

16 certificate, which may include laboratory 

17 sciences, epidemiology, environmental health, 

18 health communications, information sciences, or 

19 public administration; 

20 ‘‘(2) be a United States citizen; 

21 ‘‘(3) submit an application to the Secretary to 

22 participate in the Program; and 

23 ‘‘(4) sign and submit to the Secretary, at the 

24 time of the submittal of such application, a written 

25 contract (described in subsection (d)) to serve, upon 
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1 the completion of the course of study or program in2 volved, for the applicable period of obligated service 

3 in the full-time employment of a Federal, State, or 

4 local public health agency. 

5 ‘‘(c) DISSEMINATION OF INFORMATION.— 

6 ‘‘(1) APPLICATION AND CONTRACT FORMS.— 

7 The Secretary shall disseminate application forms 

8 and contract forms to individuals desiring to partici9 pate in the Program. The Secretary shall include 

10 with such forms— 

11 ‘‘(A) a fair summary of the rights and li12 abilities of an individual whose application is 

13 approved (and whose contract is accepted) by 

14 the Secretary, including in the summary a clear 

15 explanation of the damages to which the United 

16 States is entitled to recover in the case of the 

17 individual’s breach of the contract; and 

18 ‘‘(B) information relating to the service ob19 ligation and such other information as may be 

20 necessary for the individual to understand the 

21 individual’s prospective participation in the Pro22 gram. 

23 ‘‘(2) INFORMATION FOR SCHOOLS.—The Sec24 retary shall distribute to health professions schools 

25 and other appropriate accredited academic institu-
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1 tions and relevant Federal, State, and local public 

2 health agencies, materials providing information on 

3 the Program and shall encourage such schools, insti4 tutions, and agencies to disseminate such materials 

5 to potentially eligible students. 

6 ‘‘(3) UNDERSTANDABILITY AND TIMING.—The 

7 application form, contract form, and all other infor8 mation furnished by the Secretary under this section 

9 shall— 

10 ‘‘(A) be written in a manner calculated to 

11 be understood by the average individual apply12 ing to participate in the Program; and 

13 ‘‘(B) be made available by the Secretary on 

14 a date sufficiently early to ensure that such in15 dividuals have adequate time to carefully review 

16 and evaluate such forms and information. 

17 ‘‘(d) CONTRACT.—The written contract (referred to 

18 in this section) between the Secretary and an individual 

19 shall contain— 

20 ‘‘(1) an agreement on the part of the Secretary 

21 that the Secretary will provide the individual with a 

22 scholarship for a period of years (not to exceed 4 

23 academic years) during which the individual shall 

24 pursue an approved course of study or program to 
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1 prepare the individual to serve in the public health 

2 workforce; 

3 ‘‘(2) an agreement on the part of the individual 

4 that the individual will— 

5 ‘‘(A) maintain enrollment in the approved 

6 course of study or program described in sub7 section (b)(1) until the individual completes 

8 that course of study or program; 

9 ‘‘(B) while enrolled in the course of study 

10 or program, maintain an acceptable level of aca11 demic standing (as determined under regula12 tions of the Secretary by the educational insti13 tution offering such course of study or pro14 gram); and 

15 ‘‘(C) immediately upon graduation, serve 

16 in the full-time employment of a Federal, State, 

17 or local public health agency in a position re18 lated to the course of study or program for 

19 which the contract was awarded for a period of 

20 time (referred to in this section as the ‘period 

21 of obligated service’) equal to the greater of— 

22 ‘‘(i) 1 year for each academic year for 

23 which the individual was provided a schol24 arship under the Program; or 

25 ‘‘(ii) 2 years; 
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1 ‘‘(3) an agreement by both parties as to the na2 ture and extent of the scholarship assistance, which 

3 may include— 

4 ‘‘(A) payment of the tuition expenses of 

5 the individual; 

6 ‘‘(B) payment of all other reasonable edu7 cational expenses of the individual including 

8 fees, books, equipment and laboratory expenses; 

9 and 

10 ‘‘(C) payment of a stipend of not more 

11 than $1,200 per month for each month of the 

12 academic year involved (indexed to account for 

13 increases in the Consumer Price Index); and 

14 ‘‘(4) a provision that any financial obligation of 

15 the United States arising out of a contract entered 

16 into under this section and any obligation of the in17 dividual which is conditioned thereon, is contingent 

18 upon funds being appropriated for scholarships 

19 under this section; 

20 ‘‘(5) a statement of the damages to which the 

21 United States is entitled for the individual’s breach 

22 of the contract; and 

23 ‘‘(6) such other statements of the rights and li24 abilities of the Secretary and of the individual, not 

25 inconsistent with the provisions of this section. 
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1 ‘‘(e) POSTPONING OBLIGATED SERVICE.—With re2 spect to an individual receiving a degree or certificate from 

3 a school of medicine, public health, nursing, osteopathic 

4 medicine, dentistry, veterinary medicine, optometry, po5 diatry, pharmacy, psychology, or social work under a 

6 scholarship under the Program, the date of the initiation 

7 of the period of obligated service may be postponed, upon 

8 the submission by the individual of a petition for such 

9 postponement and approval by the Secretary, to the date 

10 on which the individual completes an approved internship, 

11 residency, or other relevant public health preparedness ad12 vanced training program. 

13 ‘‘(f) ADMINISTRATIVE PROVISIONS.— 

14 ‘‘(1) CONTRACTS WITH INSTITUTIONS.—The 

15 Secretary may contract with an educational institu16 tion in which a participant in the Program is en17 rolled, for the payment to the educational institution 

18 of the amounts of tuition and other reasonable edu19 cational expenses described in subsection (d)(3). 

20 ‘‘(2) EMPLOYMENT CEILINGS.—Notwith21 standing any other provision of law, individuals who 

22 have entered into written contracts with the Sec23 retary under this section, while undergoing academic 

24 training, shall not be counted against any employ-
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1 ment ceiling affecting the Department or any other 

2 Federal agency. 

3 ‘‘(g) BREACH OF CONTRACT.—An individual who 

4 fails to comply with the contract entered into under sub5 section (d) shall be subject to the same financial penalties 

6 as provided for under section 338E for breaches of schol7 arship contracts under sections 338A. 

8 ‘‘SEC. 781. PUBLIC HEALTH WORKFORCE LOAN REPAYMENT 

9 PROGRAM. 

10 ‘‘(a) ESTABLISHMENT.—The Secretary shall estab11 lish the Public Health Workforce Loan Repayment Pro12 gram (referred to in this section as the ‘Program’) to as13 sure an adequate supply of public health professionals to 

14 eliminate critical public health preparedness workforce 

15 shortages in Federal, State, and local public health agen16 cies. 

17 ‘‘(b) ELIGIBILITY.—To be eligible to participate in 

18 the Program, an individual shall— 

19 ‘‘(1)(A) be accepted for enrollment, or be en20 rolled, as a full-time or part-time student in an ac21 credited academic educational institution in a State 

22 or territory in the final year of a course of study or 

23 program offered by that institution leading to a 

24 health professions degree or certificate, which may 

25 include a degree (graduate, undergraduate, or asso-
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1 ciate) or certificate relating to laboratory sciences, 

2 epidemiology, environmental health, health commu3 nications, information sciences, or public administra4 tion; or 

5 ‘‘(B) have graduated, within 10 years, from an 

6 accredited educational institution in a State or terri7 tory and received a health professions degree (grad8 uate, undergraduate, or associate) or certificate, 

9 which may include a degree (graduate, under10 graduate, or associate) or certificate relating to lab11 oratory sciences, epidemiology, environmental health, 

12 health communications, information sciences, or 

13 public administration; 

14 ‘‘(2)(A) in the case of an individual described in 

15 paragraph (1)(A), have accepted employment with a 

16 Federal, State, or local public health agency, as rec17 ognized by the Secretary, to commence upon gradua18 tion; or 

19 ‘‘(B) in the case of an individual described in 

20 paragraph (1)(B), be employed by, or have accepted 

21 employment with, a Federal, State, or local govern22 mental public health agency, as recognized by the 

23 Secretary; 

24 ‘‘(3) be a United States citizen; 
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1 ‘‘(4) submit an application to the Secretary to 

2 participate in the Program; and 

3 ‘‘(5) sign and submit to the Secretary, at the 

4 time of the submittal of such application, a written 

5 contract (described in subsection (d)) to serve for 

6 the applicable period of obligated service in the full7 time employment of a Federal, State, or local public 

8 health agency. 

9 ‘‘(c) DISSEMINATION OF INFORMATION.— 

10 ‘‘(1) APPLICATION AND CONTRACT FORMS.— 

11 The Secretary shall disseminate application forms 

12 and contract forms to individuals desiring to partici13 pate in the Program. The Secretary shall include 

14 with such forms— 

15 ‘‘(A) a fair summary of the rights and li16 abilities of an individual whose application is 

17 approved (and whose contract is accepted) by 

18 the Secretary, including in the summary a clear 

19 explanation of the damages to which the United 

20 States is entitled to recover in the case of the 

21 individual’s breach of the contract; and 

22 ‘‘(B) information relating to the service ob23 ligation and such other information as may be 

24 necessary for the individual to understand the 
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1 individual’s prospective participation in the Pro2 gram. 

3 ‘‘(2) INFORMATION FOR SCHOOLS.—The Sec4 retary shall distribute to health professions schools 

5 and other appropriate accredited academic institu6 tions and relevant Federal, State, and local public 

7 health agencies, materials providing information on 

8 the Program and shall encourage such schools, insti9 tutions, and agencies to disseminate such materials 

10 to potentially eligible students. 

11 ‘‘(3) UNDERSTANDABILITY AND TIMING.—The 

12 application form, contract form, and all other infor13 mation furnished by the Secretary under this section 

14 shall— 

15 ‘‘(A) be written in a manner calculated to 

16 be understood by the average individual apply17 ing to participate in the Program; and 

18 ‘‘(B) be made available by the Secretary on 

19 a date sufficiently early to ensure that such in20 dividuals have adequate time to carefully review 

21 and evaluate such forms and information. 

22 ‘‘(d) CONTRACT.—The written contract (referred to 

23 in this section) between the Secretary and an individual 

24 shall contain— 
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1 ‘‘(1) an agreement on the part of the Secretary 

2 that the Secretary will repay on behalf of the indi3 vidual loans incurred by the individual in the pursuit 

4 of the relevant public health preparedness workforce 

5 educational degree or certificate in accordance with 

6 the terms of the contract; 

7 ‘‘(2) an agreement on the part of the individual 

8 that the individual will serve, immediately upon 

9 graduation in the case of an individual described in 

10 subsection (b)(1)(A) service, or in the case of an in11 dividual described in subsection (b)(1)(B) continue 

12 to serve, in the full-time employment of a Federal, 

13 State, or local public health agency in a position re14 lated to the course of study or program for which 

15 the contract was awarded for a period of time (re16 ferred to in this section as the ‘period of obligated 

17 service’) equal to the greater of— 

18 ‘‘(i) 3 years; or 

19 ‘‘(ii) such longer period of time as de20 termined appropriate by the Secretary and 

21 the individual; 

22 ‘‘(3) an agreement, as appropriate, on the part 

23 of the individual to relocate for the entire period of 

24 obligated service to a political jurisdiction designated 

25 by the Secretary to be a priority service area in ex-
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1 change for an additional loan repayment incentive 

2 amount that does not exceed 20 percent of the indi3 vidual’s eligible loan repayment award per academic 

4 year such that the total of the loan repayment and 

the incentive amount shall not exceed 1 5 ⁄3 of the eligi6 ble loan balance per year; 

7 ‘‘(4) in the case of an individual described in 

8 subsection (b)(1)(A) who is in the final year of study 

9 and who has accepted employment with a Federal, 

10 State, or local public health agency upon graduation, 

11 an agreement on the part of the individual to com12 plete the education or training, maintain an accept13 able level of academic standing (as determined by 

14 the education institution offering the course of study 

15 or training), and agree to the period of obligated 

16 service; 

17 ‘‘(5) a provision that any financial obligation of 

18 the United States arising out of a contract entered 

19 into under this section and any obligation of the in20 dividual that is conditioned thereon, is contingent on 

21 funds being appropriated for loan repayments under 

22 this section; 

23 ‘‘(6) a statement of the damages to which the 

24 United States is entitled, under this section for the 

25 individual’s breach of the contract; and 
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1 ‘‘(7) such other statements of the rights and li2 abilities of the Secretary and of the individual, not 

3 inconsistent with this section. 

4 ‘‘(e) PAYMENTS.— 

5 ‘‘(1) IN GENERAL.—A loan repayment provided 

6 for an individual under a written contract under the 

7 Program shall consist of payment, in accordance 

8 with paragraph (2), on behalf of the individual of 

9 the principal, interest, and related expenses on gov10 ernment and commercial loans received by the indi11 vidual regarding the undergraduate or graduate edu12 cation of the individual (or both), which loans were 

13 made for— 

14 ‘‘(A) tuition expenses; or 

15 ‘‘(B) all other reasonable educational ex16 penses, including fees, books, and laboratory ex17 penses, incurred by the individual. 

18 ‘‘(2) PAYMENTS FOR YEARS SERVED.— 

19 ‘‘(A) IN GENERAL.—For each year of obli20 gated service that an individual contracts to 

21 serve under subsection (d) the Secretary may 

22 pay up to $35,000 on behalf of the individual 

23 for loans described in paragraph (1). With re24 spect to participants under the Program whose 

25 total eligible loans are less than $105,000, the 
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1 Secretary shall pay an amount that does not ex2 ceed 1/3 of the eligible loan balance for each 

3 year of obligated service of the individual. 

4 ‘‘(B) REPAYMENT SCHEDULE.—Any ar5 rangement made by the Secretary for the mak6 ing of loan repayments in accordance with this 

7 subsection shall provide that any repayments 

8 for a year of obligated service shall be made no 

9 later than the end of the fiscal year in which 

10 the individual completes such year of service. 

11 ‘‘(3) TAX LIABILITY.—For the purpose of pro12 viding reimbursements for tax liability resulting 

13 from payments under paragraph (2) on behalf of an 

14 individual— 

15 ‘‘(A) the Secretary shall, in addition to 

16 such payments, make payments to the indi17 vidual in an amount not to exceed 39 percent 

18 of the total amount of loan repayments made 

19 for the taxable year involved; and 

20 ‘‘(B) may make such additional payments 

21 as the Secretary determines to be appropriate 

22 with respect to such purpose. 

23 ‘‘(4) PAYMENT SCHEDULE.—The Secretary 

24 may enter into an agreement with the holder of any 

25 loan for which payments are made under the Pro-
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1 gram to establish a schedule for the making of such 

2 payments. 

3 ‘‘(f) POSTPONING OBLIGATED SERVICE.—With re4 spect to an individual receiving a degree or certificate from 

5 a school of medicine, public health, nursing, osteopathic 

6 medicine, dentistry, veterinary medicine, optometry, po7 diatry, pharmacy, psychology, or social work, the date of 

8 the initiation of the period of obligated service may be 

9 postponed, upon the submission by the individual of a peti10 tion for such postponement and approval by the Secretary, 

11 to the date on which the individual completes an approved 

12 internship, residency, or other relevant public health pre13 paredness advanced training program. 

14 ‘‘(g) ADMINISTRATIVE PROVISIONS.— 

15 ‘‘(1) HIRING PRIORITY.—Notwithstanding any 

16 other provision of law, Federal, State, and local pub17 lic health agencies may give hiring priority to any 

18 individual who has qualified for and is willing to exe19 cute a contract to participate in the Program. 

20 ‘‘(2) EMPLOYMENT CEILINGS.—Notwith21 standing any other provision of law, individuals who 

22 have entered into written contracts with the Sec23 retary under this section, who are serving as full24 time employees of a State or local public health 

25 agency, or who are in the last year of public health 
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1 workforce academic preparation, shall not be counted 

2 against any employment ceiling affecting the Depart3 ment or any other Federal agency. 

4 ‘‘(h) BREACH OF CONTRACT.—An individual who 

5 fails to comply with the contract entered into under sub6 section (d) shall be subject to the same financial penalties 

7 as provided for under section 338E for breaches of loan 

8 repayment contracts under section 338B. 

9 ‘‘SEC. 782. GRANTS FOR STATE AND LOCAL PROGRAMS. 

10 ‘‘(a) IN GENERAL.—For the purpose of operating 

11 State and local public health workforce loan repayment 

12 programs, the Secretary shall award a grant to any public 

13 health agency that receives public health preparedness co14 operative agreements, or other successor cooperative 

15 agreements, from the Department of Health and Human 

16 Services. 

17 ‘‘(b) REQUIREMENTS.—A State or local loan repay18 ment program operated with a grant under subsection (a) 

19 shall incorporate all provisions of the Public Health Work20 force Loan Repayment Program under section 781, in21 cluding the ability to designate priority service areas with22 in the relevant political jurisdiction. 

23 ‘‘(c) ADMINISTRATION.—The head of the State or 

24 local office that receives a grant under subsection (a) shall 
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1 be responsible for contracting and operating the loan re2 payment program under the grant. 

3 ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec4 tion shall be construed to obligate or limit any State or 

5 local government entity from implementing independent or 

6 supplemental public health workforce development pro7 grams within their borders. 

8 ‘‘SEC. 783. AUTHORIZATION OF APPROPRIATIONS. 

9 ‘‘(a) SCHOLARSHIP PROGRAM.—For the purpose of 

10 carrying out section 780, there is authorized to be appro11 priated $35,000,000 for fiscal year 2004, and such sums 

12 as may be necessary for each of fiscal years 2005 through 

13 2009. 

14 ‘‘(b) LOAN REPAYMENT PROGRAMS.— 

15 ‘‘(1) IN GENERAL.—For the purpose of car16 rying out sections 781 and 782, there is authorized 

17 to be appropriated $195,000,000 for fiscal year 

18 2004, and such sums as may be necessary for each 

19 of fiscal years 2005 through 2009. 

20 ‘‘(2) ALLOCATION.—Not less than 80 percent 

21 of the amount appropriated under paragraph (1) in 

22 each fiscal year shall be made available to carry out 

23 section 782. 
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1 ‘‘SEC. 784. SEVERABILITY. 

2 ‘‘If any provision of this subpart, or the application 

3 of such provision to any person or circumstance, is held 

4 to be unconstitutional, the remainder of this subpart and 

5 the application of the provisions of this subpart to any 

6 person or circumstance shall not be affected thereby.’’. 

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