Healthcare used to be a major concern, but somehow it got lost. Amid the crunching of credit, mortgages, and jobs, we have forgotten this even more basic, first aid. New Jersey has 1.3 million residents with no healthcare insurance. Many of its hospitals, particularly in urban areas, have only 30 percent paying customers. For the rest of the patients, facilities must negotiate for some partial payment from government sources.

For the state government, whose own fiscal health could use a booster shot, the healthcare challenge must remain ever in the forefront. For members and guests of the state Chamber of Commerce, Heather Howard, New Jersey’s commissioner of Health and Senior Services, weighs the burdens against the state’s several plans in her talk, “What Health Initiatives are Being Planned for 2009.” Part of the chamber’s monthly breakfast, the speech is set for Wednesday, December 17, at 8:30 a.m. at the Forsgate Country Club in Monroe. Cost: $95. Visit www.njchamber.com.

We caught Howard just after she had issued her department’s $44 million hospitals salvation grant, and just before she met with the state’s automation committee for improving healthcare records. Her job and her dedication are immense, and she has long proven herself a trusted aid to Governor Jon Corzine.

Howard earned her bachelor’s in history and Spanish from Duke, followed by her J.D. from NYU. She worked in the AntiTrust Division’s Healthcare Taskforce and in 2001 teamed up with then-Senator Corzine, serving as his legislative counsel and later chief of staff. Last November she was appointed the 14th commissioner of Health and Senior Services. She lives in Princeton with her family.

“It’s a fair assessment to say our state’s healthcare system is in distress,” says Howard. “Even more important, our very safety net is in distress. But we are taking quick action on many fronts.”

Healing hospitals. Those with their heads out of the sand this past year have been hearing continual threats of possible multi-hospital closings around the state — something its citizens simply cannot afford. To immediately keep the state’s hospitals and citizens surviving, the Department of Health and Senior Services is awarding six grants to 13 hospital applicants: $5 million to East Orange General Hospital; $22 million to Jersey City Medical Center; $1 million to Kimball Medical Center in Lakewood; $ 5 million to Newark Beth Israel Medical Center; $4 million to Raritan Bay Medical Center in Perth Amboy, and $7 million to St. Mary’s Hospital in Passaic. These were hospitals that, as the grant noted, “faced closure or significant reduction of services.”

Howard also points to two potential income streams of which hospitals must increasingly take advantage. The first comes by connecting with the profitable arm of nursing and post-procedural care. For-profit and non-profit nursing centers are doing very well, and hospitals need such centers to accomodate patients during recuperation. Clever hospitals have begun to partner with centers or develop their own so that they may diminish lengthy in-house expense, and also profit from the more efficient nursing center system.

Another partnering, which could transform hospitals’ cash drain to income stream, lies in today’s proliferating ambulatory care centers. “Because we deregulated them,” notes Howard, “New Jersey currently has more ambulatory care centers than Pennsylvania and New York combined.”

Owned mostly by small clusters of physicians, these centers, such as radiology services, health testing services, and the like, are springing up profitably in malls and pharmacies everywhere. “A recent survey named the income loss from these centers as a major reason for hospitals failing,” says Howard.

“Now, slowly, they are beginning to partner with the doctors, and both the physicians, hospitals, and patients are winning.”

Propping up patients. The other major piece of good healthcare news for New Jersey is an expansion of the family care system. New Jersey boasts the highest eligibility of residents for healthcare aid to be found in the nation.

The state-aid acceptance level for families was formerly set at 133 percent above Medicaid’s poverty standard. Corzine has raised ours to to 200 percent (about $40,000 for a family of four) and 300 percent for families with children in need (about $72,000 annually). Those not qualifying for the low Medicaid rates have healthcare help too. As Corzine testified before Congress, “It takes a lot more money to be poor in New Jersey.”

“We have 250,000 children in this state who need insurance, and about two thirds of them actually qualify for it, but haven’t signed up,” says Howard. Part of this is the illegal immigrant hurdle. If the child is a citizen he may be signed up for state-sponsored healthcare without any action being taken toward his illegal immigrant parents.

Federal hope. “Healthcare is flowing in reverse cycle,” Howard says. The harder the times, the more people require health basic healthcare, yet the less funding there is to finance it.” Further, elective procedures have dropped substantially, and they are typically sought by those able to pay in full.

Definitely rays of hope are coming for healthcare, from the state’s loan package, the federal promise of reform, and the new, low-income family care expansion.

But vast problems remain. Little is being done to help the small and mid-size businessman to meet the rising healthcare premiums.

Howard admits that the major problem of managing chronic disease has yet to be adequately addressed. Eighty percent of our healthcare funds are spent on the 20 percent sickest individuals — those with chronic diabetes, asthma, and geriatric diseases.

Hopefully, both the state and insurance providers can begin to give preventive measures more than a nod.

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