Local health departments, however, say lawmakers missed a chance to provide a steady source of money that could help the state respond better to future crises.

“Public health is like a roller coaster,” said Paul David Roman, past president and legislative chair of the New Jersey Local Boards of Health Association, a trade group. “Something bad shows up and money pours (in). The thing goes away, money goes away. But we can’t maintain the readiness and capabilities without a permanent source of funding.”

New Jersey’s health care system is getting billions after Gov. Phil Murphy this week signed the state’s $46.4 billion budget in a plan that advocates say is the first step in rebuilding the industry.

More budget questions:Why ‘baby bonds’ didn’t make it into the NJ budget, and what happens now

The budget includes money for health insurance, lead paint removal, community walking trails and playgrounds. But it failed to appease officials from local public health departments, which have been starved of money for a decade and are viewed as a first line of defense against emergencies.

All of it comes against a backdrop of a state whose flaws were exposed during the pandemic. New Jersey has seen upwards of 990,000 residents diagnosed with COVID-19 and 26,000 die from the disease.

Money to spend

Murphy and lawmakers were in the rare position of approving the biggest state budget in history without raising taxes thanks to an economy that fared better than expected during the pandemic, $6 billion in extra cash federal aid and $4 billion from borrowing.

They said the budget would help the state rebound from the public health crisis and improve its readiness for future crises.

Among the winners: University Hospital in Newark, Robert Wood Johnson University Hospital in New Brunswick and Cooper Hospital/University Medical Center in Camden will share $450 million to strengthen regional health emergency preparedness infrastructure.

George Norcross, an influential Democratic political player, is chairman of the board of trustees at Cooper Hospital.

It isn’t clear what steps the health providers will take. But the budget requires them to outline their plan with the Department of Health.

“This is a responsive and responsible budget that will help guide our recovery from the most devastating public health crisis of a lifetime,” said state Sen. Paul Sarlo, D-Bergen, chairman of the budget committee. “It prioritizes the health and safety of the state’s residents and alleviates the economic consequences of the pandemic.”

New Jersey had been taking steps to restructure its health care system. It began to focus not only on doctors and hospitals, but also social determinants like good schools, child care, healthy food and transportation, leaving little distinction between what is health care and what is not.

The pandemic showed where the state fell short. Hospitals didn’t have enough protective equipment. Health care workers got sick or burned out. Black residents accounted for a disproportionate number of deaths. And even now, the vaccine isn’t universally embraced.

Filling the holes

Health care advocates and lobbying groups said the budget begins to address at least some of those holes.

The budget, for example, includes $10 million for lead paint remediation; $7 million for the Hackensack Meridian School of Medicine at Seton Hall; $500,000 for a community walking trail in North Brunswick; and $400,000 to finish construction of a Toms River park designed for people with disabilities.

And the spending plan includes behind-the-scenes shifts that advocates think will pay off. Among them, state health officials need to work with local boards of health to reach primary care doctors and nurses to help with public health campaigns.

It’s a sign government agencies and health providers were working in their own silos, each unaware of what the others were doing.

Local health care:Monmouth Medical Center Fort Monmouth campus gets $3M gift

The New Jersey Health Care Quality Institute, a research group, and BioNJ, a trade group representing the biotechnology industry, released a report in April with 24 recommendations designed to get the state back on its feet.

Among the priorities: Develop a more resilient and diverse health-care work force; and embrace innovative care and payment models.

Did the state budget accomplish its goals?

“It’s certainly a step in the right direction,” said Linda Schwimmer, president and chief executive officer of the New Jersey Health Care Quality Institute.

“The budget … begins to implement proposals to help improve our state’s health system resiliency,” said Debbie Hart, BioNJ’s president and chief executive officer.

Still, not everyone was pleased. New Jersey has 104 local public health departments responsible for everything from vaccinating the community to ensuring restaurants operate safely. In short, preventing illnesses.

Their state funding during the past decade withered away, forcing them to rely on occasional grants and funding from local municipalities whose residents already pay the nation’s highest property taxes.

New Jersey ranks 41st among the 50 states local public health expenditures. And officials say they are under-staffed.

The bare bones staff caught up with them in the spring of 2020, they said, when they didn’t have enough people to do contact tracing — talking to people who tested positive for the disease and tracking down who they were in contact with — to try to put the breaks on the pandemic.

The federal government has stepped in, providing $54.4 million to local New Jersey health departments to help with the COVID response.

But the money will dry up in a year or two, public health officials said. The risk: They will be caught unprepared for the next pandemic.

“People tend to forget about the pandemic, and it will be back to status quo,” Camden County Health Officer Paschal Nwako said. “The fire department and police department get their sustained funding, but the health department doesn’t.”

Michael L. Diamond is a business reporter who has been writing about the New Jersey economy and health care industry for more than 20 years. He can be reached at mdiamond@gannettnj.com.