The Fight to Save SUNY Downstate

SUNY Downstate, one of the State University of New York’s three teaching hospitals, has been at the center of a yearslong battle to protect access to healthcare in central Brooklyn. Despite decades of underfunding, SUNY Downstate is a crucial academic medical center and safety-net hospital that delivers quality care to a primarily Black and Latinx community with disproportionately high rates of chronic illness. When SUNY Chancellor John King announced plans to shut the hospital down in January 2024, Downstate’s unions and a broad community coalition fought back. Unified and vocal, they won a resounding victory in June 2025, when they secured $1.1 billion to upgrade and expand SUNY Downstate’s facilities and services. But with the Trump administration’s cuts of nearly $1 trillion to Medicaid over the coming decade, the fight is far from over.

To learn more about this incredible victory and the ongoing community campaign to protect healthcare in central Brooklyn, we spoke with affiliate leaders from the Public Employees Federation (PEF) and United University Professions (UUP). Redetha Abrahams-Nichols, DNP, MPA, RN, has worked as a nurse at SUNY Downstate for 25 years, including more than a decade as the assistant director of nursing in the emergency department; she is also the president of UUP’s Downstate chapter and serves on the UUP Executive Board and the AFT Nurses and Health Professionals Program and Policy Council. Deb Egel, RN, JD, is a longtime nurse and attorney and serves PEF as an interim director of regional field services. Fred Kowal, PhD, is the president of UUP and an AFT vice president; he is a member of the New York State United Teachers Board of Directors and Executive Committee and serves on the New York State AFL-CIO Executive Council. Wayne Spence is a parole officer and the president of PEF; a vice president of the AFT, he also serves on the AFT Nurses and Health Professionals Program and Policy Council and on the executive councils of the New York State AFL-CIO and the Service Employees International Union.

–EDITORS

EDITORS: What can you tell us about the history of SUNY Downstate and the long fight to save it?

REDETHA ABRAHAMS-NICHOLS: I am a member of the SUNY Downstate community. My mom, my grandmother, and my family—we’re all from here. When I graduated from nursing school in 2001, I came to Downstate because of its mission and because I wanted to serve the Black and Latinx communities. The hospital was struggling, and Percy Allen, who was in charge at that time, had a vision for a new emergency department (ED) that would incorporate the community and save the hospital. So I came with a passion to support Downstate and started in the ED, and I saw it grow in numbers. Within two years we became 911-receiving, and we eventually saw 75,000 visits a year. The hospital received accolades, with cardiothoracic surgery, radiology, oncology, and psychiatry as our pillars. I have been here through big wins but also through services closing and downsizing. I know what Downstate can do, and it’s important to me that it stays open for the next generation.

SUNY Downstate isn’t just a hospital—it’s an academic medical center that combines higher education and clinical practice. It’s the only medical school in Brooklyn, and a lot of people of color get their training here.¹ We know that cultural competency and concordance are essential in healthcare, and SUNY Downstate does a good job of hiring clinicians with the same backgrounds as the patient population they serve, which is predominantly Black and Latinx with 53 percent first-generation immigrants, primarily from Caribbean nations.² With our five schools (the colleges of medicine and nursing and the schools of public health, health professions, and graduate studies), we create the whole healthcare team at the bedside in one place and train the next generation of clinicians. One in four doctors working in New York state has practiced in some way at Downstate. Kings County Hospital is across the street, but it’s overloaded—when its ED is full, it uses our facility. Perhaps more importantly, it doesn’t have the teaching component or the same specialized departments, and it doesn’t serve the same purpose in the community.

Downstate provides so much care to the people of central Brooklyn. The median income in our area is lower than the city average, and 42.6 percent of people in the neighborhood are insured by Medicaid and/or Medicare³—but more than 80 percent of our revenue comes from Medicaid, Medicare, and state supplements to help us care for people who are less fortunate. On top of that, Downstate has done a lot of humanitarian work, with clinicians traveling to other countries to provide care and the hospital also bringing people from other countries to train here. The value of Downstate is that it’s so big and multilayered, supporting our community and creating the kind of melting pot that New York City is known for.

WAYNE SPENCE: SUNY Downstate has a really special history. In addition to training clinicians, it has been a center of medical innovation. The first MRI machine was built there in 1977,⁴ and it has been home to many medical discoveries, including research that resulted in a Nobel Prize.⁵ The hospital also provides advanced care in its Level 4 NICU, its kidney transplant center, and other areas.

My part in the fight to save Downstate began in 2012, when I was a vice president of PEF. A panel appointed by the then-governor of New York, Andrew Cuomo, recommended that the hospital campus be closed and its operations consolidated with University Hospital of Brooklyn at Long Island College Hospital (LICH), which was in a wealthier, predominantly white neighborhood.⁶ We brought in a medical and economics expert, Dr. Fred Hyde, to help us and got the New York state comptroller involved. The comptroller’s audit found that Downstate had been in good financial health until the SUNY system acquired Victory Memorial Hospital in 2008 and LICH in 2011⁷ (moves that the Downstate unions had opposed).

By the time I got involved, the folks on the ground already had a campaign that was building momentum through a community coalition that included local religious leaders. We learned very quickly that we wouldn’t be successful if our message was just about saving union members’ jobs. The focus had to be on patients saving their hospital, and the roots had to be in the community.

FRED KOWAL: When I became president of UUP in 2013, Downstate was in the middle of this campaign. Attending a rally at Downstate, I felt the energy of our members and PEF’s members. They were doing such incredible work in a hospital that had been underfunded for so long, and it was clear that then-Governor Cuomo was trying to starve the institution or close it down. In the early aughts, the state made a deal to provide a subsidy covering the significant costs of the fringe benefits we negotiated for UUP’s 2,200 members, in recognition of Downstate’s heavy Medicaid patient load. But Cuomo zeroed out that subsidy, and we had to fight to get some of that money put back in the budget.

We decided that we would go on the offensive. We all felt, including the community, that we needed to do more than stop Cuomo from closing the hospital. We needed to make the hospital stronger in providing healthcare for the community as well as education and training for the medical school. This became one of the hallmarks of the campaign then and now: Don’t just save Downstate, improve it. It’s a vital institution in an underserved, under-resourced community that needs this hospital to be the best it can be. That’s where I started, and even though we prevailed in 2014, it’s still been nonstop since then, including the last two years.

EDITORS: Will you tell us more about what led to the threat of closure in 2024?

DEB EGEL: Part of the problem was that Downstate was designated as a COVID-19–only hospital during the most intense period of 2020.⁸ Downstate couldn’t take non-COVID patients, which meant no other money coming in, and relief funding was slow to materialize.⁹ It’s estimated that Downstate lost more than $100 million in revenue during that time.¹⁰ But a bigger underlying problem is that the Medicaid reimbursement for Downstate is less than that of other hospitals in the area, although Downstate provides the same care in higher numbers. That creates financial problems, which of course leads to less reinvestment.

As a side note, one of the things I find most amazing about Downstate is that the doctors who work there and teach in the medical school don’t get paid extra. Many of them graduated from SUNY and are still working and teaching there 50 years later. It’s an incredible testimony to the dedication the school inspires and the commitment to educating the people who will care for the community. That kind of loyalty is hard to find, and it’s here at SUNY Downstate.

FRED: From 2014 on, every year the fight to hold onto the state subsidies got tougher and the subsidies got smaller, but the care model didn’t change. If Brooklyn were a city on its own, it would be the third largest in the United States. We’re talking incredible population density. But Downstate is the only state hospital and the only teaching hospital in the area, and it has to take every patient that comes through the door. The hospital has taken a lot of financial hits, so it’s no wonder that SUNY eventually claimed it couldn’t afford to keep Downstate open—but that’s because the state had broken its part of the deal.

WAYNE: Cuomo kept dismantling Downstate by cutting departments. By 2024, the hospital was limping along after so many years of neglect. In 2012, PEF had close to 1,000 members at Downstate, and now we’re down to about 400 because Downstate hasn’t gotten the crucial support it needs.

REDETHA: One consequence of chronic underfunding is that our facilities and equipment are aging. Very little has been done to upgrade the hospital since it was built in the 1960s. We were getting money to maintain the hospital but not to actually fix it. Many clinicians have left because they can’t get the right supplies and because services are being closed as funding is cut, so they fear they won’t be able to give good care to our community. Our hearts are in this work, but we don’t have the resources.

Many hospitals rely on patients with private insurance to provide revenue that balances the costs of care for uninsured patients. That’s not the case with Downstate because people who have private insurance believe they can get better care across the bridge in Manhattan. Meanwhile, their community suffers and the hospital is financially overburdened.

EDITORS: Tell us about the last two years. What happened, and how did you organize and strategize for the campaign to save Downstate?

WAYNE: On Martin Luther King Jr. Day in 2024, we were informed that SUNY Chancellor John King planned to make Downstate basically an oversized urgent care, shifting most staff and operations to other hospitals. He and his team tried to pit PEF against UUP, promising that while UUP might have some cuts, PEF members would be safe, but we didn’t fall for that. We knew what the hospital means to our members and to the community they live and work in. Fred and I immediately started coordinating our strategy.

FRED: John King had come in as the new chancellor about a year earlier. In my monthly meetings with him, we talked about Downstate, and I repeatedly asked him to bring in all the stakeholders for a conversation, but that never happened. Then this plan was announced to relocate services, build a new campus center, and provide some outpatient care. I think the chancellor expected that we wouldn’t fight it, but he was wrong. I talked to Wayne and to Redetha, and we got a campaign going. Right from the start, we focused on a very simple message: “If you close this hospital, people will die.” Community members, people who had been treated at Downstate for a long time with serious illnesses, were saying it, too. No matter what the chancellor tried to throw at us, claiming it was just the unions trying to save their jobs, we stuck with our simple message.

REDETHA: The first thing we did was drop a letter telling the membership what was going to happen, before the president of the hospital did. We had everyone on our side because we were the ones giving the information. Our first meeting was January 26, which was the birthday of Rowena Blackman-Stroud, a longtime chapter president. That was meaningful because this struggle started for me 12 years ago, when I used to walk with her around the hospital. It’s been a relay race, with the baton being passed from one set of union leaders to another, and that’s what this campaign felt like. Two weeks later, we had another meeting where members of other UUP chapters toured the hospital to see the conditions, and that helped fuel the fire.

We started with building the groundwork: finding our trusted and respected people in the community, having these natural leaders do outreach and build awareness, developing existing relationships, and forging new ones. We made our priorities clear. We wanted everyone in the community to know what was happening to their hospital and what we were asking them to do. I felt like I was on a press junket. I went with a couple of members to different community organizations every night to talk about Downstate and what we were fighting for. Every community board member, every NAACP member, every small grassroots organization—we knew that we would need all those people to make this fight real.

DEB: We built alliances by showing up at these meetings, talking to people, and listening to them. And we had to be patient. Finding common ground takes time, but once you land on it, whole communities can bring their energy to fight for your shared goal. We also had to learn the real meaning of union solidarity, going beyond the “Solidarity Forever” song we sing. Redetha and I would get on calls in the middle of the night and early in the morning, sharing information and talking through ideas. We didn’t always see everything eye to eye, but we always yielded to the right mission, which was to keep SUNY Downstate open. We worked in solidarity across union lines and learned how to truly live that value.

FRED: We followed our usual strategy of gradual escalation, always considering how to continue to build momentum and keep the other side on the defensive. Even we were surprised by the response to that first membership meeting. AFT President Randi Weingarten attended, as did Melinda Person, the president of New York State United Teachers, and more than 300 people crammed into that meeting room eager to learn what was next and to take action. So many said, “We’ve got friends in the community who can do this task or help out with that.” It was a resounding response.

Then Wayne and I got together again to figure out the next steps. We decided the pressure point had to be state legislators in Albany, so we planned a big press conference and rally at the state capitol to kick off our advocacy and our media campaign. All the labor leaders—Randi, Melinda, Wayne, and me—as well as people from Downstate, including medical students, and legislators joined in. That was the first escalation. Then we planned a big rally at SUNY Downstate for February 29. It was freezing cold, but it was a big success. Everything just kept escalating from there.

At every event, PEF and UUP asked people, “Would you be willing to tell your story at a public hearing?” We accumulated all these contacts, so when we lobbied in Albany and held public meetings and hearings, we didn’t have to speak. Wayne and I just stood at the back of the room and listened to the community speak to elected officials and SUNY leadership. But always, we were asking ourselves, “What’s the next step? How can we escalate this and increase pressure?”

WAYNE: We found some natural allies in the legislators because many of them live in the Downstate area. As hard as COVID-19 was, it was a gift in the sense that three elected officials—a state senator and two state Assembly members—received treatment there. They said, “Downstate saved my life. If not for this hospital, I wouldn’t be alive” or “My family wouldn’t be alive.” But we knew we needed to keep building support. So we kept holding community meetings, lobbying, keeping up pressure in the media, and working to build momentum.

Going into the end of the 2023–24 budget year (at the end of March 2024), we brought in Fred Hyde again to do financial analysis and figure out how much money we needed to save Downstate. His calculations came close to $1 billion. Governor Kathy Hochul gave us a gift in that she had recently committed $850 million in public funds to build a new stadium for the Buffalo Bills.¹¹ We kept asking how they could come up with that money for a football team but not for healthcare.

An important part of our strategy was to let community members lead the way. Fred and I recognized that legislators could easily write us off as union leaders, but they couldn’t do that with, say, members of the clergy. Redetha had been holding meetings in schools and churches, and the community saw for themselves which politicians were lukewarm and started giving them heat. We brought a group of local leaders, including Bishop Orlando Findlayter, to Albany, and we sat behind them in support, but we didn’t have to say anything in those meetings. We knew we were all on the same page, and we were all speaking with one voice.

FRED: In the state’s 2024–25 budget, we won a commitment to keep the hospital open with an additional $750 million to $850 million for capital expenses. The governor also agreed to form the Downstate Community Advisory Board with members appointed from the legislature, SUNY, the community, and the unions. Since UUP is the largest union at Downstate, I was asked to serve on the board.

The board was supposed to come up with a plan, but SUNY consultants (who seemed to be part of the initial plan to close Downstate) were providing the majority of the information. Thanks to the coalition we had formed, we were well organized for public hearings, and the community was loud and persistent about what needed to be done. We also did our own research to provide information to the board, lobby board members, and extend the process so we could keep fighting for a better outcome.

We had crucial support in this stage from Downstate’s clinicians and medical students. The clinicians analyzed SUNY’s plan from their dual perspectives as faculty and clinical care providers. SUNY claimed the medical school would be fine and the only real change would be getting rid of the building, but our physicians and nurses gave detailed explanations why a medical school of Downstate’s size needs an attached hospital to succeed. As far as the medical students, their schedules and Downstate’s location have made advocacy in Albany difficult in the past, but they stepped up. It was so powerful for many of my colleagues on the board to hear the students say, “We don’t want a campus center. We want a hospital and we want this hospital so we can get the best education.”

REDETHA: That was one of our biggest strengths in the grassroots campaign: Everyone owned this fight as theirs. We had so many ambassadors wearing our Brooklyn Needs Downstate T-shirts. I saw them everywhere I went, and I still see them, because the community still has that fire, and they carried that energy throughout the campaign.

WAYNE: The community wasn’t just a prop for us. It was a true partnership. Instead of taking over, say, design and printing of materials (which we could have handled in our Albany headquarters), we asked our community partners, “Who can take on this responsibility?” When we held meetings at churches, we covered the costs of electricity and other expenses because it was important to be clear that we didn’t expect the clergy to foot the bill. We were all sharing the burden.

FRED: I think the chancellor and others behind closing Downstate believed it was a done deal and were shocked at the organized resistance. I heard the chancellor say in Downstate advisory board meetings that our campaign was based on lies and politics, but it was based on the truth: Without that hospital, people wouldn’t get healthcare and people would die. Making it about the community wasn’t merely a political strategy. We knew we were on the right side, and that’s why we had so much support. And eventually we convinced the governor, which is how we got to the planning stage last year and to where we are today.

The advisory board’s official recommendation in June 2025 was that New York state invest $1 billion to keep the hospital open and fully renovate and expand the facilities,¹² and on June 17, the governor announced a $1.1 billion funding commitment.¹³ The funds will go toward supporting existing services, expanding the ED, building a new annex with an ambulatory care center, upgrading building infrastructure, and educating the next generation of clinicians. It’s a great win for the community.

EDITORS: What were some of the keys to success for this campaign? What would you tell other affiliates that are facing similar fights?

WAYNE: We coordinated with UUP from the beginning and strategized about how we could play off each other. There were certain actions that Fred would take or projects that UUP would fund, and there were others that PEF would fund. We considered our existing relationships with legislators and community leaders and focused on playing to those strengths. It reminded me of the biopic about Bayard Rustin, which showed how politicians and communities came together during the civil rights movement to plan the March on Washington, building on commonalities instead of harping on differences. Here, unions were powering a movement that was about more than just jobs. It really was about healthcare and the community. And that got us crucial support from Hochul and the Democratic majorities in the Senate and Assembly to secure the funding we needed.

The huge challenges we faced at Downstate were a blessing because of the volumes they spoke about our health professionals. We could point to COVID-19 as evidence of how essential Downstate is to the community and how the hospital rose to the occasion in spite of so many obstacles. For people who pretended they didn’t understand Downstate’s worth, we only needed to go back to the news footage to remind them that in a time of fear, the community relied on Downstate.

DEB: Consistency was one of the biggest keys. We continued to push even when the odds were against us. And we had to not only find our allies and build coalitions but also maintain and grow them. We had to ask, “Who are all the stakeholders? Who else can we involve in this fight? And how do we find common ground?” We didn’t always get along with every organization, but we looked at everything strategically and tried not to take differences of opinion personally. We reminded ourselves to focus on the shared goals.

Earlier, Redetha mentioned finding our trusted people, and I would add that it was important for us to find champions who would stay and fight no matter what. We had several—Redetha, Wayne, and Fred, as well as Bishop Findlayter, to name a few. Their perseverance and leadership made it possible for us to keep pushing. But it’s a balancing act because you also need to give space for passionate people who aren’t necessarily leaders to speak from the heart.

REDETHA: In creating this campaign, we considered what happened at Kingsbrook Jewish Medical Center, which stopped inpatient admissions in 2021 and closed for good in November 2023.¹⁴ The Kingsbrook staff was unionized but the physicians weren’t, and that made it easier for the administration to divide the employees. The administration promised that if the physicians backed down about the closure, they’d reopen the ED and open an outpatient center. But none of that happened, and now Kingsbrook is going to be apartments. When former Kingsbrook staff heard what was happening at Downstate, they joined our fight. Our physicians are unionized and live in the community, so they had just as much at stake as the rest of us. That made a big difference.

FRED: I don’t want to understate how much work this has been. I’ve never worked so hard in my life, and I saw the hours UUP and PEF folks put in handling administrative work and logistics, in addition to constantly building our coalition and supporting community engagement. So many people worked so hard for many, many months. But we were also effective because we had a simple message. When the chancellor got on television, he would talk in circles trying to explain how they weren’t really closing a hospital. He missed the central lesson of politics, which is if you have to keep explaining your plan, you’re not going to win. Our plan was clear as day: The hospital cured people and saved people’s lives; without it, people would die. We had the facts on our side, and we had a broad coalition—that’s why we were successful in the end.

EDITORS: This victory isn’t the end of the battle for Downstate, especially with Trump’s Big Ugly Bill cutting nearly a trillion dollars from Medicaid. How are you continuing the fight to protect healthcare in central Brooklyn?

FRED: I’m afraid the cuts will be devastating. Estimates on the budget hits that the state will take starting in the 2027 fiscal year are as high as $15 billion a year,¹⁵ and more than 70 hospitals in the state will be in danger of closing.¹⁶ That includes all three SUNY hospitals. Our challenge is twofold: One, we need to make sure the promised capital funding comes through and construction gets going. Two, New York has the opportunity to counteract what Trump is doing by raising state taxes on the billionaires and ultra-wealthy who are getting a federal break and using that money to make New York state the envy of the country in terms of healthcare. Fund these hospitals, keep them going strong, and show that there’s a better, more compassionate way to run a society than what Trump and his authoritarian buddies are doing. That’s the challenge I hope we can rise to.

WAYNE: When Hochul announced the $1.1 billion investment in Downstate, we already had the state comptroller’s report on how the Big Ugly Bill would affect New York state’s agencies, so we knew we’d have to stay vigilant. We have the promises, and now we need to see the action. We know we have the support of Hochul, but the chancellor is controlling the process, and he didn’t want this project to begin with. It would be far too easy to delay and then say, “Downstate had all this money and didn’t spend it, so they must not have really needed it. Let’s give it to someone else.” So this coalition will be needed for quite some time to come. Hochul announced the beginning of the design stage in December,¹⁷ and that’s a good start, but we need to keep fighting to see the chancellor sign contracts and break ground for the hospital this community deserves.

DEB: In that vein, we recently were approved for an AFT MOVE (Mobilize, Organize, Vote, Empower) grant to continue our collaboration and build a stronger coalition in Brooklyn. Longer term, if Downstate is going to survive whatever cuts are coming down the line, it needs to actively work to bring in more private insurance dollars, which the renovations should help with, and to negotiate a fair reimbursement rate for Medicaid. And Downstate can learn from SUNY Stony Brook, which has foundations that support facilities, medical equipment, and scholarships. Those are three places to start.

REDETHA: The members on the ground own the facility because we’re also part of the community, and we haven’t stopped the campaign. We continue to march for the construction to start now, and we’re not going to stop. The passion is here, and the members are here and want to be part of sustaining healthcare in our community for Black and Latinx people. We want to be a case study for others to see that when people come together around an issue, anything is possible.

Endnotes

1. Downstate Health Sciences University, “Fast Facts,” downstate.edu/about/fast-facts.html.

2. Community Advisory Board, Data Analysis & Recommendations for the Future of SUNY Downstate, December 3, 2024, brooklynfordownstate.com/wp-content/uploads/2024/12/Data-Analysis-Recommendations-for-the-Future-of-SUNY-Downstate-12.3.24.pdf.

3. Data USA, “NYC-Brooklyn Community District 17--East Flatbush PUMA, NY,” datausa.io/profile/geo/nyc-brooklyn-community-district-17-east-flatbush-puma-ny?social-social_needs=internet.

4. Research Foundation for the State University of New York, “The Invention of MRI: A Tale of Two Researchers,” www.rfsuny.org/rf-news/suny-invention-of-mri/suny-
invention-of-mri.html.

5. H. Greene, “How Charleston Native Robert Furchgott’s Groundbreaking Research Earned Him the Nobel Prize,” Charleston, June 2024, charlestonmag.com/features/how_charleston_native_robert_
furchgott_s_groundbreaking_research_earned_him_the_nobel_prize.

6. New York City Department for the Aging, “Demographics by Neighborhood Tabulation Area (NTA),” November 2020, nyc.gov/assets/dfta/downloads/pdf/reports/Demographics_by_NTA.pdf.

7. A. Hartocollis, “Audit, Citing Mismanagement, Finds SUNY Downstate in Dire Fiscal Straits,” New York Times, January 17, 2013, nytimes.com/2013/01/18/nyregion/audit-finds-suny-downstate-in-dire-fiscal-straits.html.

8. M. Schwirtz, “One Rich N.Y. Hospital Got Warren Buffett’s Help. This One Got Duct Tape,” New York Times, April 26, 2020, nytimes.com/2020/04/26/nyregion/
coronavirus-new-york-university-hospital.html; and Downstate Community Advisory Board, Report of the Downstate Community Advisory Board, June 4, 2025, downstateadvisoryboard.org/wp-content/uploads/2025/06/
Final-DCAB-Report.pdf.

9. Downstate Community Advisory Board, Report.

10. P. Tomao, “SUNY Downstate Is Still in Debt After Serving as a ‘COVID-Only’ Hospital During the Pandemic,” City & State New York, August 25, 2022, cityandstateny.com/personality/2022/08/suny-downstate-still-debt-
after-serving-covid-only-hospital-during-pandemic/376288.

11. CBS New York, “Gov. Hochul Backs $850 Million in Taxpayer Funds for New Buffalo Bills Stadium,” March 28, 2022, cbsnews.com/newyork/news/buffalo-bills-new-
stadium-construction-kathy-hochul-new-york-taxpayer-funds.

12. K. Brendlen, “To Save Cash-Strapped SUNY Downstate, Advisory Board Recommends Expanding Services with Massive State Investment,” Brooklyn Paper, June 9, 2025, brooklynpaper.com/save-suny-downstate-advisory-board-proposal.

13. C. Solnik, “New York State Investing $1B Plus in Downstate Hospital,” amNY, June 18, 2025, amny.com/lifestyle/health/new-york-state-investing-downstate-hospital.

14. C. Lewis, “Following Pandemic Battle, Brooklyn Hospital Moves Forward with Plan to Cut 200 Beds,” Gothamist, June 29, 2021, gothamist.com/news/following-pandemic-
battle-brooklyn-hospital-moves-forward-plan-cut-200-beds; and M. Kaufman, “Brooklyn Safety-Net Hospital Slated for More Cuts,” Politico, August 7, 2023, politico.com/news/2023/08/07/brooklyn-hospital-cuts-00109936.

15. M. Kinnucan, “One Big Beautiful Fiscal Crisis,” Fiscal Policy Institute, July 2, 2025, fiscalpolicy.org/wp-content/uploads/2025/07/2025.07.02-The-
Scale-of-the-Federal-Impact-OBBBA.pdf.

16. E. Eisner and M. Kinnucan, “New York Hospitals Will Close Under the ‘One Big Beautiful Bill Act,’” Fiscal Policy Institute, June 27, 2025, fiscalpolicy.org/new-york-hospitals-will-
close-under-the-one-big-beautiful-bill-act.

17. New York State, “Governor Hochul Announces Design Phase Set to Begin for $1.1 Billion Investment at SUNY Downstate’s Hospital,” December 10, 2025, governor.ny.gov/news/governor-hochul-announces-design-phase-set-
begin-11-billion-investment-suny-downstates.

[Photo credits: AFT; New York Daily News / Contributor / Getty Images; UNITED UNIVERSITY PROFESSIONS; New York State United Teachers; Deb Egel; Public Employees Federation]