New Jersey will seek to further expand access to affordable healthcare and wellness services — including treatment for drug addiction, mental illness and maternal care — while reducing racial disparities and improving patient outcomes overall.
These goals are among the priorities of Gov. Phil Murphy’s choices to lead the state’s top health-related agencies: Department of Health Commissioner Dr. Shereef Elnahal and Department of Human Services Commissioner Carole Johnson, who were approved unanimously by the Senate Judiciary Committee yesterday. Both are New Jersey natives.
Lawmakers raised sometimes partisan-leaning questions about a handful of popular subjects — including marijuana policy, surprise medical bills, and hospital regulation — but Elnahal and Johnson, both of whom have worked for the federal government, focused primarily on how they will use their experience to build a stronger, more efficient system to better protect and sustain public health.
“This is one benefit of the change in the (presidential) administration,” Sen. Loretta Weinberg (D-Bergen) said, noting that the election of President Donald Trump had resulted in the availability of a lot of “good talent for New Jersey.”
With degrees from Johns Hopkins and Harvard universities, Elnahal was a White House Fellow under former President Barack Obama and served at the Department of Veterans Affairs, where he focused on reducing wait times and improving quality care. Johnson was a senior policy director in the White House who worked on the Affordable Care Act, mental health, substance abuse, and aging initiatives.
Fending off federal reforms
Murphy, a Democrat who took office seven weeks ago, made a point of nominating a number of former Obama officials to state cabinet posts, in part to help fend off the potentially damaging impacts of federal reforms to the ACA and other national policies. Cabinet officials require approval from the Senate, a process that some have suggested is taking longer than in past administrations.
Elnahal, who was one of a half dozen members of Murphy’s core healthcare transition team, will oversee the DOH, which has a $2.8 billion budget and 5,700 employees. The agency licenses hospitals, ambulatory care facilities and nursing homes, oversees a wide range of public health programs and, as of last fall, operates mental health and addiction services, including four state psychiatric hospitals and a network of nonprofit providers.
Behavioral health services — which involve $1.1 billion of the health department’s budget and 4,470 of its staff members — were previously operated under the DHS, until former Gov. Chris Christie called for the portfolio to be shifted to the DOH in an effort to better coordinate care. The healthcare transition team has urged Murphy to return some of these responsibilities to Human Services, but Elnahal said yesterday that he would continue to oversee these responsibilities — with input from Johnson — until there is another policy change.
At the DHS, Johnson will manage a whopping $11 billion budget and 14,000 employees. Human Services operates Medicaid, or FamilyCare, which insures some 1.8 million New Jersey residents, and a diverse set of programs for seniors, individuals with disabilities, and families with economic, health and other social-service needs. It also runs WorkFirst, the state’s welfare program.
“This mission is vitally important not just to the New Jerseyans who depend on the Department’s services, but to the economic success of the state. When individuals and families get the chance to thrive, New Jersey thrives,” Johnson said. While DHS is the state’s largest department, her hearing before the Judiciary committee lasted all of 20 minutes.
Healthcare ‘a basic human right’
Both officials said they would be guided by their past work as policymakers, and Elnahal said he would also draw on his experience both as a physician and as a patient who was diagnosed with diabetes at age 12. But while he had supportive parents who were physicians themselves, access to quality care, and solid insurance coverage, too many residents suffer from similar or worse conditions without the benefit of these resources, he said.
“So, I know what it means when Governor Murphy and many of you in the Legislature have said that healthcare is a basic human right; for me, that belief is personal,” he said.
The commissioners also stressed the impact of their families, especially youngsters, on their work. Johnson, who grew up in Cape May County, thanked her husband and parents and said she hoped to serve as an example to her nieces and nephews and other Garden State kids. Elnahal, whose family immigrated from Egypt to settle in Atlantic County, introduced to the committee his wife Marwa, who is nine months pregnant with their second child, and other members of his family.
“My chief of staff, principal deputy, and deputy commissioner all have young children and are committed to achieving better health outcomes for New Jersey residents,” Elnahal added, echoing a sentiment he shared in his first Health Matters newsletter, published last month.
New projects underway
A number of new initiatives are already underway, the commissioners noted. Johnson praised Murphy’s decision to commit an additional $7.4 million annually to women’s healthcare services, expand access to Medicaid for family planning services and improve options for Medicaid patients who are seeking long-acting birth control, initiatives the new governor outlined during his first bill signing last month.
Elnahal shared concerns about the state’s medical marijuana program and said he was eager to see the conclusions of a panel now studying the issue; he is also waiting on a review of the state’s psychiatric hospitals, which some have criticized for being overcrowded and unsafe, and has committed to continue state efforts to protect children against lead poisoning. Next up include a review of the regulations surrounding outpatient surgery centers, which have come under scrutiny in recent news reports, and an assessment of palliative care, he added.
Weinberg urged him to revisit how the DOH inspects acute-care hospitals, and Sen. Michael Doherty (R-Warren) pressed him on licensing practices as they relate to elective angioplasty, a potentially life-saving procedure to reduce cardiovascular risk. Some community hospitals have questioned the state’s policy on permitting this potentially life-saving practice, which they said favors larger healthcare systems.
Sen. Nick Scutari (D-Union), the committee chairman, asked Elnahal about legislative proposals to reduce the impact of surprise, or out-of-network, health insurance bills. The commissioner agreed this was a priority but said the administration has not yet “come to a consensus” on which proposal is preferable.
Questions about pot
Many of the questions for Elnahal, who testified for close to an hour, involved marijuana policy. Weinberg stressed the need to improve the state’s medical marijuana policy, something the commissioner agreed was critical. “We’re going to be recommending a lot of changes that will improve patient access,” he said.
Scutari, who has led the charge on legalizing pot, asked about the potential benefits of commercial access to the drug and wondered about its impact on treating pain, as an alternative to opioids, which contribute to nearly 2,000 deaths a year in New Jersey. Sen. Gerald Cardinale (R-Union), on the other hand, questioned the potential downside of legalizing pot, including whether it serves as a “gateway drug” to harder substances.
Elnahal said while some studies have shown an association between marijuana use and other drugs, new research from Colorado, where pot is commercially available, points to a decline in opiate use.
“Of course, there are risks with the use of marijuana, as there are with many of the drugs we prescribe, opioids included,” he told Cardinale. But the new studies are “certainly encouraging. Hopefully it can be one of the tools we use to reduce opioid prescriptions,” he added.
The Judiciary Committee also approved the nomination of Robert Asaro-Angelo for commissioner of the state Department of Labor and Workforce Development. Asaro-Angelo, a New Jersey native, also served in the Obama administration, in the federal Department of Labor.