It is the height of chutzpah to explode a budget deficit to the point the county’s only public hospital serving the most vulnerable in Nassau County may have to fire scores of health workers or shut down entirely while its employees face losing their health insurance for failing to pay into the system.

The Nassau Health Care Corp., a quasi-governmental public benefit corporation that runs Nassau University Medical Center, is insisting the state or federal government bail the center out to the tune of hundreds of millions of dollars while refusing to agree to any recommendations or conditions.

Add to this, NuHealth is refusing to replace the overpaid board chairman who was appointed by Nassau County Executive Bruce Blakeman despite having an SEC investigation into financial malfeasance.

And all of this is going on while the county sits on $300 million in federal pandemic aid that was intended largely to protect medical facilities from exactly the forces that led to an explosion in deficit that is now compounding its debt to the point of collapse.

As Newsday reported, Nassau Health Care Corporation had a record operating loss of $164 million in 2022, a $28 million increase, raising concern the hospital may not survive without a major infusion of funds.  This is on top of the operating loss of $135.6 million in 2021, the year the Republicans took over control of the county, despite receiving millions in federal pandemic aid aimed at helping hospitals meet the crisis. That is in addition to the $102.3 million loss in 2020, the year that COVID struck.

Yes, it is true that NUMC has had chronic financial problems – it posted losses of $64 million in 2019; $46.6 million in 2018, and $25.7 million in 2017 – which can be traced largely to woeful inadequacies of the Medicaid reimbursement formulas, since NUMC, the county’s only public hospital, mainly serves Medicaid and uninsured patients.

Also payments to NuHealth from the federal Delivery System Reform Incentive Payment program for achieving efficiencies, which was administered by New York State and generated tens of millions of dollars annually from 2011 through 2020 (thanks, Obamacare!), ended with a final $50 million payment in 2020.

NuHealth officials, who are appointed by the Nassau County executive and New York State, did not plan or adjust their finances, though the end of the program was known.

Also troubling is the $310 million NUMC owes the New York State Health Insurance Program, having failed to pay its obligation for years, violating an agreement to pay off the debt with an extra $2 million a month. That puts the workers’ health insurance at risk.

The Nassau Interim Finance Authority, the state control board that oversees county finances and since 2020 the hospital’s finances as well, brought in an outside auditor, Grant Thornton, which found that NuHealth would run out of cash by year’s end and could cease operating as a “going concern,” Newsday reported.

Blakeman, in his “State of the County” message, blamed the state for reducing aid as high as $189 million to $30 million. “This is not mismanagement, it’s not because of employees who are outstanding healthcare professionals– this is because the state has defunded our own hospital that is the safety net for the most vulnerable.”

He went on to say “you can’t take away $100 million in state aid and expect it to operate. NUMC is important to residents, firefighters. We should make sure they fulfill their obligation to Nassau County and the region.”

(Nassau County pays $5 million toward NUMC plus $21 million toward employee benefits.)

What Blakeman conveniently failed to mention is that $100 million of that state funding were for capital projects and one-shot grants, not operating expenses.

“[NUMC Chairman Matthew Bruderman] came here roughly two years ago and said he’d turn the hospital around and today we’re at the brink of collapse,” said County Legislator Siela Bynoe, a Democrat.  “It had become clear to us that [Bruderman] was going to become a detriment to our progress in so much that he was under the weight of a SEC settlement because of malfeasance and misappropriating funds from his clients.”

What could be done? Medicaid reimburses NUMC at lower rates than private providers and Medicare, putting the hospital at a disadvantage compared with major hospital networks that rely primarily on patients with insurance. The formula needs to be rationalized.

Beyond correcting the reimbursement formula, dramatic restructuring is necessary for NUMC to be viable.

Why is this 19-story hospital plus the A. Holly Patterson nursing facility on 50 acres of land?  Why can’t the facility either sell or lease land for added revenue stream?

Why does it have two floors that were never utilized, and has struggled even as major hospital systems like Northwell and NYU Langone have expanded and taken independent facilities into their networks?

Private hospitals can charge outrageous amounts of money for certain procedures that help pay for money-losing patients. Why can’t services be added that contribute to the revenue stream?

Gov. Hochul, who has said saving NUMC — the only Level 1 trauma and burn center on Long Island that treats more than 80,000 emergency patients and handles more than 178,000 patients every year — is a major priority. The state health commissioner has agreed to provide $83 million in funding in exchange for what would seem reasonable conditions: submitting a detailed five-year plan and a list of highest-paid staffers, monthly progress reports, a review of its organizational structure and leadership accountability including replacement of some leadership.

But Bruderman, a businessman and big donor who Blakeman appointed NUMC’s chairman over opposition by Democrats who are again calling for his replacement, protested.

“I’m here for 18 months. The first six months was fighting idiots trying to remove me from the board. We’re still here because I’m collecting money and cutting overhead. Your requests are b——-. What else do you have?”

Instead of revealing an actual plan to salvage NUMC, Bruderman shunted off any talk that the hospital would fail, saying it has enough cash to last through July (really??), but said he would look for a new CEO after protesting that he would not and refused to step down.

“I’m not going to comply with the state’s demand to … remove the CEO,” Bruderman said. “We’re not exchanging things that they want: to remove myself and the organization that’s fighting for it. We’re not going to give them that in exchange for basically ‘extortion,’ ” Newsday reported.

Gordon Tepper, spokesman for Gov. Kathy Hochul, said in a statement:  “NUMC is a county subsidiary and County Executive Blakeman has a responsibility to address ongoing problems with its management and operations. The State Department of Health has made recommendations on how to address these issues, and we urge the County Executive to review them.”

Blakeman’s prickly response? “It’s very clear what their objective is: It’s to close the hospital and blame my administration.”

But what exactly is Blakeman doing to fix NUMC’s crisis, except deflect blame and demand the state pony up millions? He’s busy taking photos with World Cricket executives.

Since Blakeman and Bruderman seem content to hemorrhage money, and since they keep complaining how Nassau County taxpayers are on the hook, why not spend some of the nearly $1 billion the county is hoarding in reserves, including nearly $300 million in federal pandemic aid, to repair its finances and revise the hospital’s operations so it can function sustainably?