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New Hampshire is going to lose billions of dollars in federal funding and cripple its health care system if the legislature passes a bill to expand vaccine exemptions, health industry officials warned Wednesday.

The Senate Health and Human Service Committee heard testimony on HB 1210, which would mandate that all New Hampshire employers give nearly automatic exemptions to vaccine requirements to employees who request them. Critics of the bill concede the state has the power to regulate businesses that way if they choose. The problem, the critics say, is the federal government has its own vaccine requirements in order to receive Medicaid and Medicare funding.

Forcing hospitals, nursing homes, and other healthcare providers to hire unvaccinated healthcare providers could cost the state billions in lost federal dollars.

Paula Minnehan, with the New Hampshire Hospital Association, said if the bill passed, her members would be in danger of losing certification from the Center for Medicare and Medicaid Services, and the funding that comes with that to care for patients.

“This bill is in direct conflict with CMS requirements.,” she said. “The funding at risk for New Hampshire hospitals alone is $2.3 billion.”

That figure does not include county and private nursing homes, community health centers, medical specialists, primary care practices, and other parts of the healthcare system that rely on federal funding.

Kate Horgan, with the New Hampshire Association of Counties, said the bill could also cost county nursing homes millions, and that financial pain would also radiate out to the private facilities that contract with counties for services. Rockingham County alone would lose $30 million in federal funding.

“You will be putting the entire long-term care system at risk,” Horgan said.

The bill would impact hospitals, county nursing homes, primary care doctors who accept Medicaid and Medicare patients, and potentially private contractors who perform services for state and local governments. New Hampshire’s hospitals could lose as much as 70 percent of current revenue, leading to bankruptcies, closures, and loss of care for many New Hampshire residents. 

The bill’s prime sponsor, state Rep. Tim Lang (R-Sanbornton), said all he is trying to do is codify into law the current standard procedure for medical and religious exemptions, while also adding an exemption for non-religious “conscientious objectors” to vaccines.

“This is probably the most misunderstood bill in this session,” Lang said. “This isn’t about vaccine mandates; this is strictly about procedure.”

The federal government does not recognize the “conscientious objector” exemption for vaccine requirements and adding it to state law would push New Hampshire out of line with federal standards.

Lang’s take on the current procedure employers must follow isn’t reality, according to Andrea Chatfield, an employment attorney with the Human Resources State Council of New Hampshire. Instead, the bill would take away rights from employers, hinder their ability to have a safe workplace, and open the businesses up to potential liabilities and lawsuits, she said.

“This bill completely strips rights from employers,” Chatfield said. “The bill does not understand the reasonable accommodation process.”

David Juvet, with the Business and Industry Association, said the bill goes so far as to negatively impact other aspects of managing a safe workplace. Businesses couldn’t enforce a “no shoes, no shirt, no service” rule for customers, and it would end the handwashing requirement for employees.

“This is not the most misunderstood bill of the session. If we oppose it, it is not because we misunderstand, it means we understand it all too clearly,” Juvet said.

Some Republican HB 1210 supporters privately grumble the healthcare industry is playing Chicken Little, predicting the sky will fall. They say it is unlikely the federal government would cut off an entire hospital from Medicare funding over a few unvaccinated employees.

Steve Ahnen, president of the New Hampshire Hospital Association, says they’re wrong.

“According to the Centers for Medicare and Medicaid Services’ most recent guidance on vaccine requirements for hospitals and other health care institutions that participate in the Medicare and Medicaid program, ‘The sole enforcement remedy for non-compliance for hospitals and other acute and continuing care providers is termination,'” Ahnen said. “If passed, HB 1210 would put their Medicare and Medicaid funding at risk.”

Debby Scire, president of New Hampshire College and University Council, argues the impact of the bill would be felt far beyond healthcare. She argues that, as written, the bill would end all vaccine requirements, not just for COVID-19.  That is a potential health disaster for college campuses, she said.

“As written, it means college could not impose MMR (Measles/Mumps/Rubella) and meningitis vaccine mandates,” she said.

Anne Marie Mercuri, an immunization expert with the New Hampshire Department of Health and Human Services, said a meningitis outbreak would be devastating for the state.

“This bill places New Hampshire residents at increased risk of disease, disability, and death,” she said.

DHHS is opposing the bill as it risks public health through increased infections, as well as causes the state’s health system to become suddenly and severely underfunded.

The committee is set to vote on the bill during an executive session next week.

Baseball fans love to argue who has the strongest team, the best pitching, and fiercest lineup. And they make their case by using stats: winning record, ERA, batting average.

At the State House, many of the players say they’ll support legislation that promotes a healthy climate for job creation and a strong New Hampshire economy. Because businesses are the number one payer of state taxes, legislators often say they’ll get behind efforts that help businesses thrive. But when they finally get their turn at the plate, some just leave the bat on their shoulder and watch pitches go by.

BIA recently published its fourteenth annual Legislative Scorecard and fifth annual Victories & Defeats for New Hampshire Businesses. (Access the publication on our website, BIAofNH.com.) The companion pieces track how all Senators and House members voted on legislation of keen interest to the business community and summarizes the outcome of a wide variety of bills in a mix of policy areas.

The Scorecard section is easy to follow. Individual scores are based on roll call votes only (those in which lawmakers’ votes are recorded by the clerk), not up-or-down voice votes in which a Senator’s or Representative’s position is difficult, if not impossible, to identify. Selected legislation (ten bills for the Senate, eleven bills in the House) covers a variety of issue areas.

BIA is a nonpartisan advocate for our members – leading employers in every corner of the state. Business-friendly legislation sometimes falls on the political left and sometimes falls on the political right. Not everyone agrees with BIA on every vote; however, 141 Senators and Representatives – both democrats and republicans – scored high enough to warrant special recognition.

Those scoring between 86-100% on selected legislation received the honor, “Champion of Business.” Those who scored between 70-85% are recognized as “Friend of Business.” If you meet a state legislator running for re-election over the next few weeks, ask them what their BIA Scorecard percentage was (or look it up yourself online).

While the Scorecard is intended to hold legislators accountable for their response to business issues, the Victories & Defeats portion of the publication reports on the legislature’s efforts to enhance New Hampshire’s climate for job creation. By extension, the publication is a reflection of BIA’s efforts to influence public policy. As New Hampshire’s leading business advocate, our members expect us to communicate their concerns to elected officials. No one bats a thousand, but looking back at the 2018 session, BIA did well.

For example, in the area of employment law, we flashed some Gold Glove-caliber defense on a flurry of bills that would have allowed state government to intrude on private business decisions in everything from hiring practices to scheduling to benefits administration. We think employers know better than politicians how to run their businesses. Most lawmakers agreed with us, and all bills of this type, which are listed in the document, were defeated.

Another area where legislators heard us was on environmental policy. Most thoughtful business leaders agree the issue of emerging contaminants, such as PFOS and PFOA, should be taken seriously and thoughtfully addressed. Throughout the 2018 session however, we saw an overreaction to this issue. Although modern technology can now detect the presence of chemicals at increasingly smaller concentrations (parts-per-trillion), science around health impacts of smaller concentrations is lagging.

We saw lawmakers attempt to address this conundrum by tasking the state to do something the federal government’s Environmental Protection Agency, academia, and industry scientists have yet to do: establish new standards for a cornucopia of compounds in the air, groundwater, and surface water. Then legislators proposed taking existing standards and unilaterally change them to arbitrary levels – levels not based on science, just numbers that would show their constituents they’re “doing something.” After articulating the folly of this approach, these bills were defeated.

We had a mixture of wins and losses in the areas of tax policy, economic development, health care, and education. For example, the House and Senate missed opportunities to put downward pressure on New Hampshire electricity prices, which are already 50-60% higher than the national average year-round. They instead listened to special interests that wanted ratepayer subsidies for unprofitable power generators.

The season at the State House is over and we spectators are already thinking about the next season coming up in January. BIA’s Legislative Scorecard and Victories & Defeats publication is a stat sheet for voters to evaluate their elected officials and determine who’s an MVP and who should ride the bench.

When Sen. Dan Feltes, D-Concord, introduced a bill Wednesday, he sought a $25 million appropriation to the state’s affordable housing fund. Instead, he’s walking away with $5 million at best.

Senate Bill 94 would have put $25 million in the NH Housing Finance Authority’s Affordable Housing Fund to do what its name suggests — create more affordable housing for Granite Staters.

“This is a competitiveness issue,” Feltes testified before the Senate Capital Budget Committee. “We have to think about housing. I think, quite frankly, if there is one bill that’s a top priority, this is it. We have to do something right now and something significant.”

This funding mechanism isn’t anything new. It’s been around since its creation in 1988, under former Republican Gov. John H. Sununu, to be a revolving loan fund that provides low-interest loans and grants to build, rehabilitate, or acquire affordable housing. It’s first appropriation was $4.5 million. Since then, there have only been a few times when the Legislature has added cash to the fund. The fund didn’t see another dime until 2002, when $5 million was added to it.

In 2007, during Democratic Gov. John Lynch’s administration, approximately $750,000 was given to the fund. In 2015, $800,000 was added, and in 2016 $2 million was appropriated, but that money was earmarked for housing for people with substance use disorders.

The appropriation last year came to fruition on Tuesday where city and state officials broke ground for the Families in Transition’s Family Willows Substance Use Treatment Center and Recovery Housing in Manchester. The expanded treatment center and recovery housing focuses on women, and mothers with children dealing with the opioid crisis. It’s expected to provide treatment for about 400 women. Gov. Chris Sununu and U.S. Sen. Maggie Hassan attended the groundbreaking ceremony.

Feltes said the lack of funding for affordable housing is a “workforce, jobs, and competitiveness issue.” Testimony from leading experts on affordable housing in the state said all three areas are connected and important for New Hampshire’s future.

Without affordable housing in the state, people have trouble finding a place to live and workers end up living farther away from their jobs. Sometimes that’s too much for employees, so companies are left with an inadequate workforce, and without a strong workforce, or affordable housing, the state won’t be able to convince businesses to come and set up shop.

“You’ll hear about how we need a stronger workforce and affordable housing to keep the young working families that are demographically and economically needed as we move forward,” Feltes said.

Feltes is right. Lawmakers have heard testimony and had meetings from advocacy groups, government agencies, and political experts on how New Hampshire’s aging population will impact housing, transportation, and health care costs.

Already, workers are feeling the crunch of high housing costs, spending approximately 60 to 75 percent of their income on housing each month, according to Elissa Margolin, director of Housing Action NH, a coalition of organizations and businesses advocating for expanded workforce and affordable housing options.

Currently, the statewide median rent in New Hampshire is approximately $1,206 a month, she said, which is a 15 percent increase from five years ago. The vacancy rate, a factor in what’s driving the rising rents, is at 2 percent statewide and about 1 percent near the larger job centers.

The Granite State has already fallen behind the rest of New England and most of the country in terms of providing funding for affordable housing.

Rhode Island voters recently approved a $50 million bond for their state’s housing trust fund. They previously issued a $25 million bond in 2012 and a $50 million bond in 2006. Vermont uses a percentage of their real estate transfer tax for its housing trust fund, which is about $9 million a year.

In Maine, which has a similar population size to New Hampshire and similar workforce challenges, regularly funds its trust fund through their real estate transfer tax, with about $6 million invested annually. In 2009, a $50 million bond was approved, followed by another $15 million bond in 2015.

Connecticut and Massachusetts have also recently appropriated hundreds of millions of dollars a year to affordable housing.

Dean Christon, executive director of NH Housing Finance Authority, said the fund gives them “a lot of flexibility into how these dollars are being used.” They can be spent on housing from homeless shelters to senior housing to workforce rental housing.

David Juvet, senior vice president of public policy for the NH Business and Industry Association, said for the businesses he talks to, workforce and housing are the top issue for them.

When asked by Sen. David Watters, D-Dover, if the state should have “some skin in the game,” he responded that “there is some legitimate policy reason why the state should be involved with helping to assist economic development.”

The issue of affordable housing, workforce development, and business competitiveness of the state is usually a bipartisan issue. Everyone wants to see New Hampshire succeed. Affordable housing, especially when it comes to providing relief for the substance abuse crisis, also receives bipartisan support.

The bill only had Democratic support though, including Senate Democratic Leader Jeff Woodburn and House Democratic Leader Steve Shurtleff.

So why aren’t Republicans jumping on board? Well, it’s most likely the price tag of the legislation — $25 million can be a hard sell. During the hearing, Senate Majority Leader Jeb Bradley asked a witness if they would the measure if it were a different amount.

The committee also has to tackle a more pressing issue with the unanticipated charge costing the state millions of dollars to convert several state-owned buildings to natural gas after Concord Steam Corp. announced plans to close this year. The Senate Capital Budget Committee will her testimony on that bill in the coming weeks.

Ultimately, the committee unanimously voted on an amendment to changed the $25 million appropriation to the Affordable Housing Fund to only $5 million, and then they recommended that the bill “ought to pass” when it goes to the Senate soon.

Some activists say any little bit can help “move the needle” some more.

“We need the state’s oar int he water to help steer the ship,” said Evelyn Whelton of the Mount Washington Valley Housing Coalition. “A small push at the state level would influence housing growth and send a signal to businesses and those who want to move here, that we are engaged in economic development and are serious about it.”

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It’s an issue that’s been put on hold since last May, but soon enough, New Hampshire lawmakers are going to have to tackle net metering again. And last time, it took some serious convincing to get everyone on board.

Net metering is a policy that allows residents and businesses who use certain renewable energies, like solar, to sell excess electricity back to the grid at the same price they are spending when they buy energy from the grid. That means, when you get more electricity than you need or use in the summer months, for example, your local electric distributor keeps track of the surplus and gives you credit at their retail rate (for residents) for when you’re not getting enough during the dark, winter months. Larger consumers receive the wholesale rate, which is less than the retail rate.

But all of the state’s utilities are either approaching or have reached the statutory limits allowed for renewable energy, which is 100 megawatts — or 100 million watts. It’s apportioned to the utilities based on the number of customers each serves. That seems like a big number, but most people’s solar array for their homes run about 5 kilowatts (5000 watts).

Lawmakers created that arbitrary cap years ago when it was almost inconceivable that a limit would be reached. But over the years, solar energy increased in popularity and now many states are trying to figure out what to do.

The issue is that a lot of people don’t think this arrangement is fair. Electric utilities argue that solar customers still use the grid, but are zeroing out their bills with a “subsidy.” They say the costs are being pushed to electric customers who don’t have solar.

Solar advocates argue that there are benefits, such as reduced carbon emissions. Also, by having less demand on power lines during summer months, utilities can pass on those savings to other consumers.

Just last year, former Democratic Gov. Maggie Hassan signed a bill lifting the cap on net metering after most state utilities reached the limit. Originally, the net metering cap was 50 megawatts, but the House bill was raised to 100 megawatts. An earlier Senate version of the bill only increased the cap to 75 megawatts, but energy advocates said that wouldn’t be enough to fend off job losses in the solar industry, which ended up happening anyway. It took some Republicans a while to hop on board with raising the cap, which is why any bill on net metering could see some hurdles in the Legislature.

The bill also required the Public Utilities Commission (PUC) to review current net metering rates and set new ones. The results of their findings are expected to be released in May.

A new bill in the House Science, Technology and Energy Committee says it would eliminate the cap on net metering. However, the sponsor of House Bill 518, Rep. Richard Barry, R-Merrimack, said he plans on retaining the bill in committee until PUC releases its suggestions and then another public hearing would be held.

That didn’t stop solar advocates coming out in droves on Wednesday to list their concerns with the bill. Many attendees said they were excited about the possibility of eliminating the cap all together. But some of the language in the legislation led them to call it “a half truth and a booby trap for the growth of renewable energy.”

Specifically, they didn’t like how they eliminated the cap but were changing the net metering tariff to the average monthly wholesale energy rate, and not keeping it at the retail rate.

Holly Grossman, a resident of Barrington, said she has a solar array on her roof that takes care of all her energy needs.

“I would hate to see solar energy go down in the state,” she testified to the committee. “It’s very important for our economy. If we didn’t have it, what would we replace it with? Fossil fuels?”

It’s important to note that the legislation does not call for getting rid of net metering all together. That’s something solar advocates say would give too much control to monopoly utilities and could lead to new taxes on solar users and higher electricity rates for all customers. The bill calls for eliminating the cap, but it also includes the change in energy rate to the wholesale amount.

But that’s a change some businesses believe would be fairer.

Stefanie Lamb, vice president of public policy for the Business and Industry Association, said her group supports the bill and setting the tariff at the wholesale rate.

“People say we’re not supportive of the renewable energy industry by not opposing the bill,” she said. “We are supportive of it to help with the energy challenges in our state. But if our businesses are large energy users and make up a large part of our state’s economy. And then if they leave because the cost of business is getting outrageous, then we have a far bigger problem.”

Rep. Barry said it’s likely the bill would be changed or amended after PUC makes its recommendations. Most of the attendees applauded the move to table the bill until their study is done.

Other solar companies testified about how the bill in its current form would force them to close their doors and how they encourage young people to stay in New Hampshire, a problem the state is facing.

“Young people are leaving the state and we are providing clean tech jobs,” said Eric Shifflett of Granite State Solar. “Millennials are who we try to attract and hire. But this bill would put us out of business.”

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