Taken from NJSpotlight
By Lilo Stanton
June 23, 2022
While New Jersey lawmakers decide how to spend billions in unanticipated revenue, they are facing a growing push to fund major improvements at Newark’s University Hospital, the state’s only public acute-care facility.
New Jersey’s largest health-care labor union stepped up a campaign on Wednesday for the state to provide at least $600 million — from a pot of nearly $3 billion in leftover federal pandemic funds — to kick-start a project to reconstruct some or all of University Hospital, estimated to cost $1.2 billion.
Advocates believe this investment would help the state live up to promises it made 50-plus years earlier to the predominantly poor and minority residents in Newark, many of whom were displaced to make way for the hospital and an associated medical school.
“If not now, when?” asked Debbie White, president of the Health Professionals and Allied Employees, or HPAE, a union of 14,000 health care workers in New Jersey, one in 10 working at University Hospital.
“If not this governor, who is so invested in social issues, then who?” she asked. “It is so egregious to me that we have one state-run hospital, and we can’t see our way to adequately funding it.”
HPAE released a report Wednesday that highlighted their argument for investment, the latest tool in the advocates’ building campaign to convince lawmakers — and Gov. Phil Murphy — that significant additional funding for University Hospital should be part of the budget they must finalize and approve by July.
University is one of three state-designated Level 1 trauma centers, meaning it handles the most critical cases in the northern region. The emergency department was caring for nearly 100,000 people a year — twice the capacity — before the pandemic, the union said.
It also plays a critical role as a teaching hospital and campus anchor at Rutgers New Jersey Medical School; serves as the nation’s top liver transplant center; and pioneered several important COVID-19 treatments, the report notes, all achievements hampered by the aging structure.
State officials provided $500,000 in the current budget for a needs assessment, which led to a formal plan for rebuilding the 43-year-old facility. Officials have so far declined to release that report.
Advocates now want the state to help fund and finance a new facility to replace the building that is twice as old as any other New Jersey hospital and faces chronic flooding and power outages, according to HPAE.
Essex County has a powerful delegation in Trenton, including Assembly Budget Chair Eliana Pintor Marin and Senate Majority Leader M. Teresa Ruiz, both Democrats. But securing legislative support for University Hospital improvements requires convincing lawmakers from South Jersey, too, the Shore and rural counties to the west, that investing in the Newark Hospital benefits constituents statewide.
Rising above shortcomings
In the HPAE report, Ruiz said that as New Jersey’s only public hospital, University essentially “functions like 125 West State Street” — the Capitol, in Trenton — and therefore deserves to be kept up and protected. University Hospital also played a critical role during COVID-19, which hit the Newark area early and hard, she said, and has a record of providing high-quality care, regardless of the facility’s faults.
“I am just making a plea here that we have a once-in-a-lifetime opportunity to build a state facility that changes itself,” Ruiz said in the report. “University Hospital is a true asset for the entire state. It’s time for us to match that excellence and expertise and have it reflected in a public building.”
“I hope the administration is listening loud and clear that it’s time for the city of Newark and the state (to support this project), because what ends up happening is that we get (labeled as a) northern institution. It is a state public health hospital that needs state support for infrastructure,” Ruiz said.
The governor’s office did not respond to a request for comment Wednesday afternoon.
Public vs. private
White, with HPAE, said New Jerseyans may not recognize how University Hospital is different from other, private, hospitals. The Newark facility is heavily dependent on reimbursements from Medicaid and Medicare, which pay less than private insurance, and treats the state’s largest share of uninsured residents. While the state reimburses hospitals for a portion of this “charity care,” officials said that for years University has been forced to spend capital funds to pay for operating costs.
University is also constrained from raising money on its own to fund reconstruction, advocates said. A 2021 audit found the hospital had enough cash on hand to last just 80 days, putting it in the bottom quarter of New Jersey’s 72 acute-care facilities, according to the report, and it struggles with a high debt load and limited remaining capital funding. Most other hospital systems in the state, including Cooper University Hospital in impoverished Camden, are in far stronger financial positions, the union found.
As a state-designated Level 1 trauma center, University is also likely to receive an additional $150 million to upgrade its emergency response capacity. HPAE has welcomed this funding but raised questions about the state’s decision to include $100 million for Hackensack Meridian Health’s use at its flagship Hackensack University Hospital — which has an accredited Level 1 trauma center that is not part of the state’s system — and elsewhere in its massive network.
“The State of New Jersey has a moral and ethical obligation to honor its commitment to University Hospital. Giving tens of millions of dollars to private hospital corporations that can fully fund their own improvements is a disservice to the citizens of New Jersey, when University Hospital should be the State’s first priority in health care,” HPAE said in the report.
Pressing health problems
White said the very nature of the state’s original agreement with the Newark community underscores the importance of its investment in University Hospital’s future. The 1968 Newark “Accords” were signed in the wake of the city’s historic riots, sparked in response to the largely Black community’s displacement by state leaders seeking to build a hospital and medical school in the city. Among other things, the agreement calls for Rutgers University to prioritize the hospital for its medical education programs in Newark and for these entities to take steps to improve residents’ health, according to HPAE.
Given the high level of health-care needs in Newark and the growing awareness of health care inequities, advocates said state support for a new hospital is important and timely. “The unique, historical role of University Hospital within the fabric of structural racism in Newark cannot be understated,” said Dr. Shereef Elnahal, the former state health commissioner and previous president and CEO of University Hospital, in a letter to the community quoted in the HPAE report.
“Beyond the physical construction, the Accords were part of a broader response to social injustice and systemic racism that was centuries in the making. Newark was and, to a significant degree, still is the epicenter of some of the most pressing public health problems in the country,” said Elnahal, who left the hospital this spring for a leadership position at the federal Veterans Administration and is now awaiting U.S. Senate confirmation.