Without Funds, N.J. Hospitals Face Crisis

Jeanne Smith and her husband, Thomas, depend on Muhlenberg.
Jeanne Smith and her husband, Thomas, depend on Muhlenberg. (Keith B. Richburg - Twp)
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By Keith B. Richburg
Washington Post Staff Writer
Monday, July 7, 2008

PLAINFIELD, N.J. -- If the country is facing a nationwide health-care crisis, then the condition in New Jersey can be described as gravely critical.

The state has an estimated 1.3 million people without health insurance who cannot pay a doctor or a hospital bill. New Jersey law requires that hospitals treat anyone who walks through their doors, and then get reimbursed later by the state. But the state's looming budget shortfall has forced it to cut back on the reimbursements, leaving hospitals to pick up the tab. And hospitals, in turn, are going broke: Six have closed in the past 18 months, and half of those remaining are operating in the red.

As the economy falters, the number of uninsured is likely to grow, and so will the burden on hospitals. And with more hospitals expected to shut their doors, New Jersey faces a nasty culmination of health-care crises.

The situation has come to a head in this city of 48,000 people -- majority black, largely poor and with many new immigrants moving in. The city's hospital of 130 years, Muhlenberg Regional Medical Center, is slated to become the latest casualty of this faltering system, closing its acute-care facility later this year. The obstetrics and pediatrics wards have already shut, and equipment is being packed up and wheeled out.

The hospital says it lost $16.8 million last year and will lose another $18 million in 2008, leaving its owners little choice but to close it down. But news of this latest closure has hit hard for those in Plainfield and surrounding towns who have come to rely on Muhlenberg. Many are elderly, some have chronic conditions, and they will now have to travel as far as 10 miles away for care.

"I don't think people know what will happen if Muhlenberg closes -- there will be a lot of deaths," said Jeanne Smith, whose husband, Thomas Smith, is paraplegic, needs dialysis and suffers from a variety of illnesses. Thomas Smith, 77, has been in and out of Muhlenberg a half-dozen times in the past year. "My husband probably would have died if Muhlenberg wasn't five minutes away," she said.

"What are people supposed to do?" asked Marion Trabelsi, a retired French and Spanish teacher who was treated at Muhlenberg for a heart attack and who relied on the hospital when she was unemployed and had no insurance. She suffers from high blood pressure and high cholesterol and says the hospital's closure "is definitely a death sentence for me," adding: "I could have a heart attack at any time."

Although everyone agrees New Jersey's health-care system is a mess, no one is quite certain where to place blame. But there is plenty of finger-pointing in all directions.

Muhlenberg, owned by Solaris Health System, blames the huge growth in uninsured patients, the underfunding of Medicaid and Medicare and the state's budget cuts for charity care. "The healthcare system in New Jersey is clearly broken," Muhlenberg says on its Web site. "And hospitals that serve a high percentage of poor and uninsured cannot survive under these pressures."

Some in the community have launched protests over the closure, blaming Solaris for wanting to close a hospital in a poor, heavily minority city while keeping open another hospital in a more affluent town, Edison, where there are fewer charity-care patients.

Others blame the state government for not fully reimbursing hospitals like Muhlenberg that provide care to the poor and the uninsured. Gov. Jon S. Corzine (D) on June 30 signed a $32.9 billion state budget for 2009 that includes $605 million for charity care, a cut of $111 million from last year. In speeches, Corzine has called the cuts to charity care "heartbreaking."

Some health-care professionals blame New Jersey's problems on the proliferation in recent years of ambulatory care centers -- outpatient facilities that have lured many insured patients away from hospitals that were once the main care providers. "They take away all of our paying patients," said Betsy Ryan, president and chief executive of the New Jersey Hospital Association.

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