A $1 billion gift to Johns Hopkins University from billionaire Mike Bloomberg will make medical school free for most students and increase financial aid for those enrolled in nursing, public health and other graduate programs.

In a Monday letter in the Bloomberg Philanthropies annual report, Bloomberg addressed the dual challenges of declining health and education. The gift marks an emphatic endorsement of the value of higher learning at a time when academia increasingly has been under political attack.

“As the U.S. struggles to recover from a disturbing decline in life expectancy, our country faces a serious shortage of doctors, nurses, and public health professionals — and yet, the high cost of medical, nursing, and graduate school too often bars students from enrolling,” wrote Bloomberg, a 1964 graduate of Johns Hopkins and the founder of the Bloomberg business and financial data news company. “By reducing the financial barriers to these essential fields, we can free more students to pursue careers they’re passionate about — and enable them to serve more of the families and communities who need them the most.”

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Starting this fall, Johns Hopkins will offer medical students free tuition — normally about $65,000 a year for four years — if their families earn less than $300,000 a year.

Students from families earning up to $175,000 a year will have living expenses and fees covered as well.

“It’s a full-ride scholarship,” Hopkins President Ronald J. Daniels said. “We see that as a very significant move to ensure that medical education is available to the best and brightest across the country.”

Increases in medical school tuition have outpaced inflation at both public and private institutions, said Holly J. Humphrey, president of the Josiah Macy Jr. Foundation, a nonprofit focused on improving the education of health professionals. There has been a shift in who attends, with an increasing share of students from high-income families and dwindling numbers from lower-income homes.

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The median debt from medical school for the class of 2023 was $200,000, according to the Association of American Medical Colleges.

Too many students don’t even consider medical school because of the cost, said Sanjay Desai, the chief academic officer at the American Medical Association.

Health outcomes are improved, he said, when physicians reflect the diversity of patients they treat. Studies also suggest that students from lower-income backgrounds are more likely to return to underserved communities as doctors.

There are other troubling gaps. The country needs more primary care doctors, Desai said, but student debt can drive people toward more lucrative specialty fields.

“I hope it inspires others to action,” said Desai, who is also a Johns Hopkins faculty member.

The donation brings total giving from Bloomberg Philanthropies to Johns Hopkins University to a staggering $4.55 billion, an infusion of cash that has allowed the school to vault its aspirations and impact in many areas. Affordability has been one major through line: In 2018, Bloomberg, a former mayor of New York and presidential candidate, announced a historic $1.8 billion gift for increased undergraduate financial aid and the promise that admissions decisions would be need-blind going forward. That gift helped spur changes in the student body, which now has more low-income students and greater racial diversity.

Stefano Montalvo benefited from that 2018 donation. He didn’t think he could afford college, but when he left track practice at his rural public high school in New Jersey to check whether he had been accepted into Hopkins, he saw the financial aid offer, with shock: It covered almost the entire cost of attendance.

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“I called my mom,” he said, “and we cried on the phone.”

For medical school, which he will begin at Hopkins in the fall, he expected to take on $400,000 in debt. Instead, he learned he will have tuition and cost of living covered. And on Monday, he learned that many of his classmates will, too. “It’s incredible, really,” he said.

The aid is important in giving hope to people from lower-income backgrounds, he said, “and getting those students to school is critical for progressing medicine and health care.”

Most of the patients they will treat won’t be wealthy, he said, so having students who have seen challenges growing up can help inform others about barriers to care and other issues. “In that type of learning environment, we can thrive and create physicians better prepared to deal with the diversity of society today,” he said.

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The gift announced Monday is not the first aimed at erasing medical-school tuition costs for students. Earlier this year, a billion-dollar donation to Albert Einstein College of Medicine in New York from Ruth Gottesman, the chair of its board of trustees, enabled the school to announce to cheers that fourth-year students would be reimbursed for their spring tuition and that in the future, tuition would be free. New York University’s Grossman School of Medicine announced in 2018 that it would give full-tuition scholarships to all students regardless of financial need, and a $200 million donation last summer ensured that NYU’s second medical school, NYU Grossman Long Island School of Medicine, will be tuition-free in perpetuity.

At Hopkins, existing aid has diminished the debts its students carry. In the past academic year, graduates left with an average debt of $105,000, about half the national average, school officials said.

Monday’s announcement will dramatically change that.

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Part of the value of the model is its simplicity, Daniels said: Applicants, or students aspiring to one day apply, can clearly see what their total costs would be based on their family’s income, rather than having to wait for acceptance and a financial-aid package from the school.

The donation also will increase graduate financial aid in the Johns Hopkins Bloomberg School of Public Health and School of Nursing. And it will bump up graduate financial aid at the schools of arts and sciences, advanced international studies, education, engineering, and business; the Peabody Institute; and the forthcoming school of government and policy, which was announced last fall and will be housed in the Johns Hopkins University Bloomberg Center in Washington near the Capitol.

Many students at Johns Hopkins have benefited from financial aid donations. Albert Holler, who grew up near Chicago, wanted to be a doctor ever since high school, when a classmate with leukemia died. But with a mother working variously as a hairstylist or waitress or cleaner, and a father juggling two jobs to support the family of five, he assumed he would need to take on enormous debt. After applying to medical schools, he woke up one weekend morning in his undergraduate dorm and, still groggy, opened an email from Hopkins. A dean was offering $90,000 a year in aid, a deal that included the cost of living for four years. Holler texted his dad, wondering if it could be a real offer.

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That gift from a donor, he said, “has very much altered the course of my life.”

More students having their costs of medical school covered, he said, would not only help Hopkins attract the best students regardless of their means, but also would be excellent for patient care.

An internal-medicine resident working in Baltimore and planning to become an oncologist, Holler frequently uses the Spanish he learned from his mother and honed by volunteering in health clinics. Now, with a recent influx of people from Central America to Baltimore, he relies on it to understand his patients’ needs. “It also seems to just let them take a deep breath,” he said, “and then have a little more trust.”

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