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House Bill 213 — Rural nursing loan repayment program

House Bill 213 — Rural nursing loan repayment program

Parrish Miller
February 28, 2023

Bill Description: House Bill 213 would force taxpayers to subsidize the educational expenses of nurses who work in specific rural areas.

Rating: -4

NOTE: House Bill 213 is similar to House Bill 84, introduced earlier this session. This version adds that any Idaho county "without a population center of twenty thousand (20,000) or more persons" would be considered an "eligible area" for this program.

It is unclear if this standard would apply to counties that are within a core based statistical area (CBSA) or a larger combined statistical area (CSA), which includes cities with populations above 20,000.

For example, Gem County, Owyhee County, and Boise County each have a population of less than 20,000, yet they are within the CBSA that includes Boise, Meridian, and Nampa (Idaho's largest cities.) Payette County is also within the larger CSA of “Boise City-Mountain Home-Ontario, ID-OR”, yet its largest city (Payette) has a population of approximately 8,500. 

A similar situation exists for many other smaller Idaho counties. The city of Rexburg has a population of more than 20,000, which would thus disqualify Madison County. But nearby Fremont County's largest city is St. Anthony (with a population of under 4,000), and yet Fremont County is in the same CBSA as Madison County. 

If this standard applies only to counties that do not independently contain a city with a population of 20,000 or more, three-fourths of Idaho's counties would qualify for this program.

Does it create, expand, or enlarge any agency, board, program, function, or activity of government? Conversely, does it eliminate or curtail the size or scope of government?

House Bill 213 would create Chapter 25, Title 39, Idaho Code, to establish a "rural and underserved nursing incentive program." This new government program includes a "rural nursing loan repayment fund" and a "rural nursing loan repayment grant review board." This would expand the size, scope, and spending of government. 


Does it increase government redistribution of wealth? Examples include the use of tax policy or other incentives to reward specific interest groups, businesses, politicians, or government employees with special favors or perks; transfer payments; and hiring additional government employees. Conversely, does it decrease government redistribution of wealth?

House Bill 213 will offer certain nurses up to $25,000 in taxpayer-provided subsidies, in the name of helping them pay off student loans. To receive these handouts, the nurses will have to agree to work in "a rural area also designated by the United States secretary of health and human services as a health professional shortage area," "a county without a population center of twenty thousand (20,000) or more persons," or "all certified Idaho critical access hospitals." [See the note near the beginning of this analysis for discussion of the technical problems with this criterion.]

It is not the proper role of government to redistribute public money to incentivize people to take certain jobs. 


Does it increase government spending (for objectionable purposes) or debt? Conversely, does it decrease government spending or debt?

The fiscal note for House Bill 213 suggests the program would cost up to $2.5 million over six years. This is an increase in government spending for a redistributive and therefore objectionable program.


Does it violate the principles of federalism by increasing federal authority, yielding to federal blandishments, or incorporating changeable federal laws into Idaho statutes or rules? Examples include citing federal code without noting as it is written on a certain date, using state resources to enforce federal law, and refusing to support and uphold the Tenth Amendment. Conversely, does it restore or uphold the principles of federalism?

The Statement of Purpose for House Bill 213 says the purpose of the proposed program would be to create an "incentive for nurses to seek employment in rural health professional shortage areas or Idaho critical access hospitals." But, as discussed above, this would likely include most of Idaho and any area "designated by the United States secretary of health and human services as a health professional shortage area." 

By incorporating this definition into Idaho law, the state is giving the federal government the ability to alter the scope of Idaho law. 


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