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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.

With the American Health Care Act moving to the U.S. Senate, some New Hampshire Republicans are cheering as the bill makes its way through the legislative process. Yet, for some Trump supporters in the Granite State, especially in the North Country, they might not be too happy with its current version.

Despite still having some concerns about the AHCA, Gov. Chris Sununu said on Thursday that he was glad the bill passed the Republican-led U.S. House of Representatives.

“Failure to reform our health care system is not an option,” he said. “It is critical that we keep this conversation moving forward. My concerns with the AHCA remain firm and I expect that the United States Senate will take those concerns into consideration as they work to improve our nation’s health care system.”

Before the House passed the bill on Thursday afternoon, Sununu and 15 other governors sent a letter to House Speaker Paul Ryan reiterating their support for the Obamacare replacement and asked for states to have more flexibility when it comes to Medicaid.

It’s a similar letter Sununu signed on to earlier this year when the U.S. House tried to repeal and replace the Affordable Care Act the first time. In a Friday interview with the Concord Monitor, he applauded the passage of AHCA, but said he still had issues with the current version.

“I love the idea that Congress is taking action, the president is taking action,” he said. “They’re listening to the American people and they’re moving the ball forward. In it’s current form, I still have a lot of concerns, there’s no doubt. But we are moving it forward, and more important than anything is the need to reform the health care system right now that has failed the American people.”

It’s a different tone than he had in March, when he said the first version of the bill didn’t give states flexibility and would hurt New Hampshire’s expanded Medicaid program, which had bipartisan support.

“The bill that’s been proposed in Congress gives us concerns on a lot of different levels, to be very blunt about it,” Sununu said at a March press conference. “What I’m seeing in Washington gives me a lot of pause for concern to be sure, not just on the Medicaid expansion front, because that would drastically affect New Hampshire, but just on the mandates that are coming out of it.”

As expected, all of New Hampshire’s Democratic congressional delegation is opposed to the GOP-led plan. U.S. Reps. Carol Shea-Porter and Annie Kuster voted against the bill. Critics slammed the bill for potentially making millions lose health care and making it harder for people with some pre-existing conditions to find affordable insurance.

Some Granite State health care providers say more than 100,000 low-income New Hampshire residents could be at risk of losing health coverage under the AHCA plan. New Hampshire Hospital Association President Steve Ahnen said his organization was “deeply disappointed” that the U.S. House passed the health care bill.

“This bill is a significant step backwards on the commitment to ensure coverage and we cannot support it,” he said. “We will continue to work with Congress as this bill moves over to the Senate to ensure that any final legislation to repeal and replace the Affordable Care Act improves our health care system in a thoughtful and responsible way, rather than dismantling coverage for our most vulnerable residents.”

President Donald Trump campaigned aggressively on repealing Obamacare and lowering premiums. However, according to recent analysis, it appears premiums would significantly increase for older Granite Staters.

The Henry J. Kaiser Family Foundation, a nonprofit focused on health care, compared premium costs under the ACA and AHCA. For New Hampshire residents aged 60 or older who make $30,000, they could see their premium costs increase by 173 percent under AHCA. However, the same analysis also says younger residents in New Hampshire would pay less under the AHCA plan.

Many critics point out that the Trump-approved health care bill would negatively impact the people who voted for him. This holds up when using Coos County as an example.

Coos County overwhelmingly voted for Trump over Democrat Hillary Clinton by 52 to 43 percent, respectively. There is a large number of residents who are aged 65 and older in the North Country and the average household income is about $42,000, according to U.S. Census Bureau data. Those residents could fare worse under the AHCA plan than under the ACA.

In a Granite State Poll released Monday by the University of New Hampshire Survey Center, Trump’s approval rating in the state has remained steady at 43 percent. It’s the same rating he had in February. Republicans also still overwhelming approve of the president at 83 percent. Survey results from the North Country showed a statistically insignificant change.

It will be interesting to see over the next few months if residents in the North Country, especially those who voted for Trump, change their support. Nationally, it seems his base is sticking with him so far. Now, the U.S. Senate will now take over the AHCA bill and reports suggest the chamber will overhaul the legislation, making it different from the House version. The health care debate in Washington is far from over, leaving how it will ultimately impact New Hampshire a mystery for now.

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