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People with anxiety and depression are disproportionately prescribed painkillers. That’s what new research from the Dartmouth-Hitchcock Medical Center suggests, adding a complex layer to the opioid epidemic ravaging the United States and encouraging calls from New Hampshire’s congressional delegation to not move forward with the repeal of the Affordable Care Act.

The findings, which appear in the July issue of the Journal of the American Board of Family Medicine, show that nearly 19 percent of the 38.6 million American adults with mental health disorders use prescription opioids compared to only 5 percent of those without a disorder. Adults with depression and anxiety receive 51 percent of the 115 million opioid prescriptions distributed each year in the U.S., the study found.

“Because of the vulnerable nature of patients with mental illness, such as their susceptibility for opioid dependency and abuse, this finding warrants urgent attention to determine if the risks associated with such prescribing are balanced with therapeutic benefits,” said Brian Sites, an anesthesiologist at Dartmouth-Hitchcock and one of the co-authors of the study.

Image Credit: Dartmouth-Hitchcock

Opioid prescribing in the U.S. quadrupled between 1999 and 2015, and during that time more than 183,000 people died from overdoses related to prescription opioids, according to the Centers for Disease Control and Prevention.

Sites also notes that because pain is subjective, “the presence of mental illness may influence the complex dynamic between patient, provider, and health system that results in the decision to write an opioid prescription.”

The study does not give a specific reason why people with mental disorders are more frequently prescribed opiates. The study encourages more research on this population to understand opiate addiction.

Those patients may have some form of physical pain, but their mental condition may cause them to feel that pain more acutely or be less able to cope with it, leading to increased requests for something to dull the pain. As a result, doctors trying to be empathetic to their patients’ complaints may tend to overprescribe opioid painkillers, Stiles said.

Research also shows that patients are more likely to take opioids when there aren’t specialists nearby. A study published earlier this year found that the number of seniors in rural America who take at least three prescribed psychotropic drugs ― including opioids and antidepressants ― tripled over a nine-year period. The study found that many of these prescriptions were given without a proper diagnosis.

Being able to identify a subset of the population that could be more likely to use opioids could help providers and policymakers address opioid use. It “suggests that there may be additional patient- and provider-related factors specific to those with mental illness that increase the likelihood of receiving prescription opioids,” the authors wrote.

U.S. Rep. Annie Kuster, D-N.H., was present for a press conference about the study on Monday. She said repealing Obamacare could be disastrous for New Hampshire’s opioid epidemic.

“This is critically important in New Hampshire, as we have gone from second in the nation in deaths from the opioid crisis and heroin to first for fentanyl,” she said. “That’s not what we want to be known as first in the nation for.”

The U.S. Congress is currently in a heated healthcare battle. The Senate is working on legislation to repeal the healthcare law, but a vote on the bill has been delayed due to opposition from Republicans. New Hampshire Democratic Sens. Jeanne Shaheen and Maggie Hassan have both stated their opposition to the healthcare overhaul and have sent many press releases condemning “Trumpcare.”

“This new study is yet another reminder that, to combat the devastating opioid crisis, we must make mental health treatment affordable and accessible,” Shaheen said in a statement.

Hassan said she opposes proposed cuts to Medicaid that would affect coverage of mental health and substance abuse services.

“As we work to combat the horrific substance misuse crisis that is devastating our communities and taking a major toll on our economy in New Hampshire, this study highlights how dangerous Trumpcare, which includes massive cuts to Medicaid, would be for our state,” Hassan said in a statement. “We need a comprehensive, holistic approach to combating this epidemic that addresses the underlying causes of addiction, including mental health issues.”

To address the overprescription problem within the mental health community, Sites has suggested physicians need more access to alternative medicine besides opioids, including acupuncture, massage therapy, physical therapy, and non-opioid pharmaceuticals.

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As with the rest of the country, it appears New Hampshire is pretty divided on the Paris Climate Agreement. At the state level, Republicans are applauding President Donald Trump’s decision to pull the United States out of the global climate pact, while Democrats are hoping to use the issue as political ammo in next year’s elections. At the local level, a couple cities, colleges, and universities are figuring out how they can commit themselves to reducing carbon emissions to show the rest of the world that not everyone agrees with Trump.

That division was very apparent Thursday during one of the last full House sessions of the year. Several House Republicans staged a walkout after Rep. Lee Walker Oxenham, D-Plainfield, was granted the right to speak on the House floor about Republican Gov. Chris Sununu’s decision not to join the U.S. Climate Alliance, a group of 12 states and Puerto Rico that are committed to upholding the Paris climate deal.

NH Reps narrowly ok member to speak on Climate Change. GOP choose to walk out. Forced to return. pic.twitter.com/uhO10aNfX7

— Raymond Gagnon (@gagnon03743) June 8, 2017

The representatives that walked out were forced to return to their seats because House Speaker Shawn Jasper needed quorum in order finish the day’s business. In her speech, Oxenham mentioned Trump’s withdrawal from the Paris climate accord and Republicans let out a cheer. The New Hampshire Democratic Party was quick to criticize Republican members for their actions.

“Rather than hear their colleague on a key issue, Republicans decided to continue to plug their ears in ignorance on climate change,” said Ray Buckley, NHDP chairman, in a statement. “In doing so, they are standing with Governor Sununu and President Trump against the rest of the world. This Republican walkout is symbolic of their willful ignorance on basic science.”

Sununu stated last week that he “stands by” Trump’s decision to leave the Paris Climate Agreement and he said Monday that New Hampshire would not join the U.S. Climate Alliance.

“Not at this time, especially when we do not yet know its impact on our economy and environment,” he told the Concord Monitor.

That drew criticism from U.S. Sens. Maggie Hassan and Jeanne Shaheen, and U.S. Reps. Carol Shea-Porter and Annie Kuster — all four members of New Hampshire’s Democratic congressional delegation — who wrote a Wednesday letter to Sununu encouraging him to change his mind.

“Governor, we write in support of New Hampshire joining the U.S. Climate Alliance. It is vital that the Granite State continues to be a leader on climate change and clean energy,” they wrote. “Just as the United States’ withdrawal from the Paris Climate Accord cedes American global leadership, New Hampshire’s refusal to acknowledge the clear consensus on climate science will similarly damage our state’s reputation.”

New Hampshire already participates in a regional cap-and-trade pact with nine other states in the Northeast that works to reduce carbon emissions. Under the Regional Greenhouse Gas Initiative, fossil fuel power plants have to buy allowances for every ton of carbon dioxide they emit. Sununu has previously indicated he would be support withdrawing from RGGI, but only if other states also did it.

While lawmakers battle it out at the State House on climate change, several cities and universities in New Hampshire are reaffirming their commitment to reducing greenhouse gas emissions.

A national movement called “We Are Still In” has gained steam since Trump made his announcement last week. As of Monday, a total of 1,219 governors, mayors, businesses, investors, and colleges and universities across the country declared their intent to ensure the United States remains a global leader in the effort to combat climate change.

“In the absence of leadership from Washington, states, cities, colleges and universities, businesses and investors, representing a sizable percentage of the U.S. economy will pursue ambitious climate goals, working together to take forceful action and to ensure that the U.S. remains a global leader in reducing emissions,” the statement reads.

While no Granite State cities have signed on to that specific statement, two colleges have joined the cause — the University of New Hampshire and Southern New Hampshire University.

In a separate statement from the Mayors National Climate Action Agenda, 274 mayors committed to adopt, honor, and uphold the Paris Climate Agreement goals.

“We will continue to lead. We are increasing investments in renewable energy and energy efficiency. We will buy and create more demand for electric cars and trucks,” the statement reads. “We will increase our efforts to cut greenhouse gas emissions, create a clean energy economy, and stand for environmental justice

Nashua Mayor Jim Donchess and Portsmouth Mayor Jack Blalock have signed on to that statement, but not the one from “We Are Still In.”

In other communities in the Granite State, Durham officials held a Tuesday forum about the feasibility of scaling down the targets of the Paris agreement to a municipal level. The town of Hanover also voted in May to establish a goal of transitioning to 100 percent clean and renewable energy by 2050.

Dartmouth College President Phil Hanlon didn’t sign on to the “We Are Still In” statement, but he signed onto a similar letter with the presidents of 11 other leading research universities. That letter commits the universities to transition to low-carbon energy and enhance sustainability practices on their campuses.

In the letter released Monday, the presidents “reaffirm that commitment, which is consistent with the Paris Agreement and recognizes the concerted action that is needed at every level to slow, and ultimately prevent, the rise in the global average temperature and to facilitate the transition to a clean energy economy. Universities have a critical role to play in reducing our own greenhouse gas emissions, continuing to advance evidence-based understanding of the causes and effects of climate change on the environment, the economy and public health, and developing solutions.”

The other signatories include all the Ivy League institutions, except Princeton University, and also Duke University, Johns Hopkins University, Massachusetts Institute of Technology, and Stanford University.

Earlier this year, Dartmouth announced it would reduce greenhouse gas emissions from campus operations by 50 percent by 2025 and by 80 percent by 2050. They also pledged to transition their campus to renewable resources by 2025.

In its announcement, Dartmouth admitted that it had fallen behind some of its peer institutions on a number of sustainability fronts.

“Although Dartmouth has substantially reduced campus energy use and made other significant advances over the last decade, we lag our peer institutions with respect to commitments, actions, and reporting in the sustainability domain,” the college released in its sustainability report. “Our report recommends principles, standards, and commitments in the areas of energy, waste and materials, water, food, transportation, and landscape and ecology.”

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New Hampshire became the latest state to have three residents die of overdoses from one of the most deadly opioid drugs in the world, adding to the growing list of communities nationwide trying to handle the crisis. Gov. Chris Sununu and public health officials announced last week that for the first time in the Granite State, the synthetic opioid carfentanil was found in the bloodstream of three people who died from overdoses in March.

Two of the deaths were in Manchester, and the third was in Meredith. The substance is so potent that it’s not intended for human consumption. It’s 100 times more potent than fentanyl and is commonly used to tranquilize elephants.

“Unfortunately, today is the first day that we’ve been able to confirm this,” Sununu said at a Tuesday press conference. “And worse yet, I think we all understand that it is likely not the last day that we talk about this issue.”

New Hampshire is the first New England state to have confirmed deaths from carfentanil and its effects are being felt by many key players in the opioid crisis, including public health officials, first responders, and treatment and recovery providers.

While these are the first confirmed cases in New Hampshire, the rise in carfentanil overdoses has been happening throughout the United States over the last few months. At least 96 heroin users overdosed in one devastating week in August in just one Ohio county, with several of the overdoses linked to carfentanil. In September, the Drug Enforcement Administration issued a nationwide warning about the powerful opioid.

Tom Pifer, forensic lab director for the N.H. State Police, said the drug was developed in the mid-1970s by a pharmaceutical company, but was never made public due to its high potency.

It takes just two milligrams of carfentanil to knock out a 2,000-pound African elephant. When veterinarians or zookeepers do that, they wear gloves and face masks to prevent exposure to the drug because a dose the size of a grain of salt could kill a person. A dose may even be lethal when absorbed through the skin or potentially through inhalation. That’s why the state asked law enforcement and first responders to stop field testing drugs. The problem is that users might not know they are even taking the drug since dealers have been cutting heroin with fentanyl or carfentanil to give it a boost and stretch their supply further.

“You cannot tell the difference between heroin and fentanyl and certainly not fentanyl and carfentanil,” Pifer told New Hampshire Public Radio. “You are literally rolling the dice with any sort of dosage unit you’re purchasing on the street.”

It’s not only incredibly powerful, but it’s also incredibly resistant to naloxone — also known as Narcan, the opioid antidote that can save someone’s life from a heroin overdose. A typical overdose requires one or two shots to work, but when a dosage is laced with carfentanil, it could require six or more shots to be effective — if it works at all.

Even though there is an abundant supply of Narcan in states battling the opioid crisis, an increase in carfentanil overdoses could deplete the antidote supply fairly quickly and drain money from states who need to purchase more. With drug overdose deaths rising, state crime labs could also see a backlog of cases to investigate. In New Hampshire, there are thousands of cases dating back from 2015 that have yet to be investigated.

A criticism in New Hampshire of government officials is that funding from the state and federal government to tackle the crisis has been slow to come out.

Congress signed the 21st Century Act in December, which would provide more funding to states for the opioid crisis. In April, U.S. Sen. Jeanne Shaheen, D-N.H., said $485 million in grants would soon be administered to states. It’s not clear exactly when that would happen.

New Hampshire is ranked as the second hardest hit state in the opioid crisis based on per capita deaths. Yet, it’s only supposed to receive $3 million out of the $485 million promised to states since the formula is based on total mortality. Shaheen is urging Trump’s administration to revise the funding formula for next year.

The other Democratic senator from New Hampshire, Maggie Hassan, and Shaheen wrote in a letter last week to U.S. Health and Human Services Secretary Tom Price that the formula should be re-tooled. Officials have indicated that they will review the formula and the two senators were optimistic after their meeting with New Jersey Gov. Chris Christie, who is heading President Donald Trump’s national opioid commission.

In March, Trump created The President’s Commission on Combating Drug Addiction and the Opioid Crisis with Christie at its helm to start fulfilling his campaign promise to end the opioid crisis.

Trump promised the people of New Hampshire that he would build a wall between the U.S.-Mexico border to curb the opioid crisis and stop the flow of drugs into the area.

“New Hampshire has a tremendous drug epidemic,” he said in October. “I am going to create borders. No drugs are coming in. We’re going to build a wall. You know what I’m talking about. You have confidence in me. Believe me, I will solve the problem. They will stop coming to New Hampshire. They will stop coming to our country.”

While heroin supplies mostly come from Mexico, synthetic opioids, like fentanyl and carfentanil, are believed to originate in China. Even though it’s illegal there, secret labs in the country manufacture the drug before shipping it to the United States. People can order it online, and it’s shipped through the U.S. Postal Service before it makes its way into the local heroin supply.

It’s still not immediately clear how the drug made it into New Hampshire. It’s likely that either someone bought it online, or it was purchased in another state and then followed the traditional route of heroin and fentanyl into the Granite State, which is from major distribution centers like Philadelphia and New York and then through Massachusetts.

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If Congress doesn’t pass a long-term budget bill by the end of the month, federal funding for state infrastructure development or affordable housing might dry up, leaving cities and towns with less money in grants to fund these projects.

The Community Development Finance Authority (CDFA), the state agency that doles out those dollars, recently said it has to pause in handing out more than $2 million in community development block grants because Congress has yet to pass a continuing resolution to fund the federal government and its programs for the next year. They have an April 28 deadline.

“Towns across New Hampshire depend on these federal funds,” said Taylor Caswell, executive director of the CDFA, in a statement. “Dozens of local municipalities across the state use these resources to bring new jobs, help treat drug addiction, build workforce housing, and revitalize downtowns, among other important community and economic development projects.”

The CDFA has awarded more than $126 million in grants to projects across the state since 2003. The YMCA in Concord recently won a $500,000 federal grant for improvements on the building that hosts its child care facility and it’s assuming it will be approved by the governor and Executive Council.

However, money for four other organizations — including a child advocacy center renovation in Laconia and affordable housing in Exeter — might not receive funds, even though they would have if the CDFA had more funds. Those projects are suspended until Washington reaches a solution.

The state usually receives about $8 million each year in community development block grants and the CDFA typically finds out in January how much it will see that year. Yet, the funding for this year is in jeopardy since Congress’ stopgap spending plan expires at the end of April and the Department of Housing and Urban Development (HUD), which administers the block grants to states, has yet to release funding figures for the year.

“When a resolution in Washington D.C. is reached and HUD provides specific allocation amounts for fiscal year 2017, and it has been determined that funding level is adequate, CDFA will move swiftly to finalize awards for the remaining four projects, as well as restart suspended application reviews,” the CDFA said in a statement. “CDFA deeply regrets this situation and is in touch with New Hampshire’s federal delegation in Washington D.C. to urge swift resolution of this matter.”

New Hampshire’s Democratic Sens. Jeanne Shaheen and Maggie Hassan have been fervent supporters of the community development block grants and since the CDFA’s announcement, they’ve been sounding the alarm in Congress, encouraging lawmakers to reaffirm their commitment to funding these grants.

They joined 40 other senators earlier this month in urging federal appropriators to include $3.3 billion in federal funding for the block grant program for the 2018 fiscal year budget.

“The CDBG program is one of the federal government’s most effective means to revitalize low- and moderate-income communities across the country,” the senators wrote in a letter. “The importance of this funding to meet the unique needs of local communities is widely recognized and we find it troubling that the President’s budget proposes to eliminate the program altogether.”

President Donald Trump’s “skinny budget” called for the elimination of the block grant program, which has been used extensively in New Hampshire, especially in the North Country for low-income, elderly, and disabled residents.

Shaheen and Hassan called Trump’s proposal to eliminate the program “misguided and harmful” at a Wednesday press conference at the CDFA headquarters in Concord.

“He talked about helping those communities that are struggling with job creation to make sure people have opportunities in the future,” Shaheen said. “Well, this is totally counterproductive to what he was talking about, and this is the budget he’s proposing.”

Hassan echoed Shaheen’s sentiments saying any changes to the program would be “devastating.”

“These cuts would be devastating for New Hampshire, and I’ll do everything in my power, along with Senator Shaheen, to make sure it never happens,” she said.

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The rankings for the most popular governors are out and the top 10 are all Republicans. New Hampshire’s own Gov. Chris Sununu isn’t far behind the pack, though, coming in at 16th, highlighting a decent start to the Republican’s first term in the corner office.

Sununu has a 55 percent approval rating, with 22 percent disapproving of the first Republican governor in 12 years, according to a Morning Consult poll released Tuesday.

The New Hampshire online survey was taken between January and March with 644 voters and has a margin of error of 4 percent.

That time period is important because it’s essentially the first three months of Sununu’s term. Politically, a lot has happened during that time and the results could depend on when people were surveyed. For example, Sununu made right-to-work legislation a priority, even mentioning its importance in his inaugural address. Yet, the measure failed in House, where moderate Republicans and representatives with union ties sided with Democrats to kill the bill.

There have been bright spots for the governor too, and these could have led to his positive approval rating. He picked Gordon MacDonald to replace Joseph Foster as attorney general, and MacDonald was widely seen as a great pick across party lines. He was confirmed unanimously by the Executive Council last week, with three Republicans and two Democrats voting for him.

The recent budget battle also probably did not factor into the results either. For the first time in recent memory, the House failed to pass a budget. Conservatives banded together to defeat the House Republican leadership’s budget plan, forcing them to recess before the House could pass a budget. Democrats are trying to paint Sununu as the loser of this budget battle since he couldn’t get his own party, which has a 53-member majority in the House, to pass his, or some version of his, budget.

However, Sununu also stands the most to gain from the House’s failure. The Senate Finance Committee will now begin its part of the budget process and instead of using the House version (since there is none), they’re using Sununu’s original budget proposal as a starting point. The House previously took out his funding for full-day kindergarten, removed increased monies for the Alcohol Fund, and even cut his scholarship program for high school students to further their education. The Senate has been more open to Sununu’s priorities, already passing several bills that honored the governor’s budget wishes.

It remains to be seen what the Senate ultimately does with Sununu’s budget, but if his campaign promises remain in the final version, his approval numbers could increase.

Despite his positive approval rating, Sununu still has a high percentage of voters who don’t know about him. He actually ranked 3rd of all the governors in the country for “most unknown,” coming in at 23 percent. The most unknown governor was Republican Gov. Eric Holcomb of Indiana at 27 percent. That’s expected though for many freshman governors, as voters learn more about them throughout their terms.

Nationally though, Morning Consult’s poll found that more voters are happier with their new Republican governors than with their former Democratic ones.

Sununu, who replaced Democratic Gov. Maggie Hassan, is 3 points more popular than she was before she headed to Washington to serve in the U.S. Senate. Her approval rating was at 52 percent in the fall.

It also appears that Hassan is struggling with her approval numbers. Morning Consult also looked at the most popular senators in the country and Hassan was ranked in the middle of the pack. Her approval rating is 5 points lower than former Republican Sen. Kelly Ayotte, who Hassan replaced in the 2016 election.

According to the poll, Hassan has a 53 percent approval rating among Granite Staters, while Ayotte’s approval was at 58 percent in September. Their disapproval ratings are similar with Hassan at 31 percent compared to Ayotte’s 32 percent before the election. Yet, despite her four years as governor, 16 percent of voters don’t know who she is or have no opinion of her, while only 10 percent said the same of Ayotte in the fall.

New Hampshire Republicans have been trying to call Hassan a rubber stamp of the Democratic Party. They have also called the freshman senator an “intern” of her New Hampshire colleague U.S. Sen. Jeanne Shaheen, since they have similar voting records.

Shaheen is more popular than Hassan, according to the poll. Shaheen’s approval rating is at 57 percent, with 30 percent disapproval, and 13 percent not knowing anything about her or having no opinion.

Hassan and Shaheen aren’t up for reelection in 2018, but Sununu is already expected to face some challengers if he seeks a second term. Democrat Steve Marchard already jumped into the 2018 gubernatorial race, making his candidacy official last week. Libertarian candidate Jilletta Jarvis also threw her name into the fray in March.

In the Morning Consult survey, Republican Massachusetts Gov. Charlie Baker topped the list as the most popular governor with a 75 percent approval rating. The least popular governor was New Jersey Republican Gov. Chris Christie who had a stunning 25 percent approval rating with 71 percent disapproval.

While more Republican governors maintained positive ratings, according to the poll, it’s important to note that Republicans control 33 governorships compared to the Democrats’ 16 governors.

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New Hampshire’s infrastructure is crumbling, and it’s not just the state’s roads and bridges. A total of 12 infrastructure categories received a “mediocre” or “poor” rating, according to a Wednesday survey by the American Society of Civil Engineers (ASCE), highlighting the lack of time and investment the state has made into these projects.

Overall, the state’s infrastructure grade was a C-minus, which is a decrease from the last time the engineers conducted a survey of the state. In 2011, the state earned a C.

New Hampshire’s new grade is slightly higher than the United States’ grade, which was a D-plus.

“New Hampshire’s infrastructure is living on borrowed time thanks to past generations’ investments,” said Logan Johnson, chairman of the Report Card for New Hampshire’s Infrastructure. “We’re not investing in the maintenance and modernization our infrastructure needs to support a thriving economy.”

A team of professional engineers from across the state assessed the 12 categories and found these areas need upgrades to stay operational:

Credit: American Society of Civil Engineers Report Card for New Hampshire’s Infrastructure

The state’s energy and airport systems received the best score with a C-plus, but the ports, wastewater, and storm water systems scored the lowest grade with a D-plus.

Much of the focus at the legislative level will be on roads and bridges.

According to the state Department of Transportation (DOT), there are about 17,000 miles of roads in the state. The ASCE says there are 3,848 bridges, including 2,160 state bridges, and 1,688 municipal bridges in New Hampshire.

The state also has about 150 red-listed bridges, meaning they are in poor condition, must be inspected every two years, and be at the top of the state’s priority list of funds for repair or replacement. The ASCE found that 492 of New Hampshire’s 3,848 bridges — approximately 13 percent – were structurally deficient.

Gov. Chris Sununu has been a big proponent of improving the state’s infrastructure. In his budget, he proposed creating a $84 million Infrastructure Revitalization Fund to address some of the problems identified in the ASCE’s report, like with bridges and roads.

“This is one of the highest numbers in the country of red listed bridges,” he said during his gubernatorial campaign. “These are where our priorities need to go. Infrastructure is absolutely critical in a small state like New Hampshire, a state that’s centralized to the entire New England region. We have to get our priorities straight and we have to make tough decisions to get those projects done.”

The problem is that the estimated cost to repair or replace some of the red-list bridges is more than six times the amount Sununu proposed. That’s something Victoria Sheehan, commissioner of the N.H. DOT, said would happen if infrastructure funding is constantly kicked down the road in the legislature.

“When we defer investment, it can cost three or four times as much to get back to the same level condition,” she recently told New Hampshire Public Radio. “So, for example, if we can keep up with pavement conditioning, doing pavement preservation treatments, that’s a much lower cost in maintaining the infrastructure. Once [roads have] deteriorated, to do a full reconstruction or rehabilitation can cost a lot more money to the taxpayer. We are so underfunded at times, we make those per investment choices that end up costing more in the long run.”

U.S. Sen. Jeanne Shaheen, (D-N.H.), reintroduced legislation in the Senate that would begin to address the more than 56,000 structurally deficient bridges across the country. The Strengthen and Fortify Existing Bridges (SAFE Bridges) Act, which was also cosponsored by New Hampshire’s other Democratic senator, Maggie Hassan, would establish a program to provide funding specifically for repairing and replacing structurally deficient bridges. It would authorize an additional $2.75 billion annually through 2020 to enable state’s to fix their bridges and funding would be allocated through a needs-based formula according to their share of the nation’s deficient bridges.

“The condition of New Hampshire’s bridges is unacceptable,” Shaheen said in a statement. “Their disrepair hurts our economy, increases traffic, adds wear and tear to vehicles, and puts public safety at risk. The consequences of bridge failures are catastrophic and it is critical that Congress prioritize this infrastructure. My legislation provides a long overdue initial investment to help repair and replace New Hampshire’s structurally deficient bridges while putting Granite Staters to work.”

The ASCE survey also found that the state’s dams were increasingly at risk of being structurally deficient. About 60 percent of New Hampshire dams were built before modern dam safety engineering standards were developed.

The “years of inattention” resulted in shoddy conditions at many of the state’s ports and extensive flooding could happen unless the state makes some adjustments in how it manages storm water.

The Legislature recently made drinking water and storm water a priority during this legislative session. Both areas need improvement, according to the ASCE survey, which gave New Hampshire’s drinking water a C-minus and storm water a D-plus. The Senate is working on legislation that would give more funds to cities and towns to improve their drinking water, after recent developments which found high traces of harmful chemicals in several seacoast towns’ water supply. Sununu also is hoping the Environmental Protection Agency rolls back some storm water regulations poised to go into effect that could cost municipalities millions of dollars to comply.

The ASCE report notes that in order for the state to meet its infrastructure needs, “lawmakers need to pursue consistent policies and funding sources to ensure sustained support for infrastructure and enable long-term planning. The state needs to pursue more locally sourced funding for infrastructure, rather than relying so heavily on federal funding and financing to supplement the state’s budget for infrastructure investment.”

The report also called for consistent policy and funding sources and for the state to to pursue “more locally sourced funding,” like fully funding the Water Infrastructure Finance and Innovation Act, identifying “dependable, long-term sources of funding” for the cleanup of contaminated sites, and considering a toll increase to finance major turnpike projects.

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The New Hampshire Republican Party and other conservative groups blasted the state’s two Democratic U.S. senators after they said they will vote against Judge Neil Gorsuch, President Donald Trump’s Supreme Court nominee, when he comes up for a confirmation vote next week. The senators also said that he should not be confirmed without 60 votes in the Senate.

Both Sens. Jeanne Shaheen and Maggie Hassan announced their decisions Tuesday.

Shaheen said his record on women’s reproductive rights is “very troubling” and he has a “very alarming record” of putting corporate interests before employees’ rights.

“I cannot support a Supreme Court justice who would turn back the clock on women’s reproductive rights,” she said in a statement. “I was also disheartened by his evasive answers to questions regarding the Citizens United decision, which has dramatically increased the amount of secret money in politics.”

Hassan released her decision with a post on Medium, writing “Judge Gorsuch is not in the mainstream. He has not shown a commitment to protecting the rights of all Americans, and he does not seem to always fully consider the consequences his decisions have on real lives.”

Both senators agreed with Senate Minority Leader Chuck Schumer, D-N.Y., that Gorsuch should be required to reach a 60-vote threshold in order to be confirmed.

“When President Obama nominated Judge [Merrick] Garland, Republican leadership immediately blocked his nomination, preventing a hearing and a vote. Despite this unprecedented obstruction by the Republican majority, I remain committed to upholding the constitution’s instruction to advise and consent on Supreme Court nominations,” Shaheen said. “As Judge Gorsuch’s nomination comes to the floor, I will support a 60-vote threshold for approval, an appropriate high bar that has been met by seven of the eight current Supreme Court justices.”

The GOP Senate leadership refused to hold a hearing or vote for former President Barack Obama’s nominee, Merrick Garland, last year. After Gorsuch’s hearings last week, Schumer said he will vote no on Trump’s nominee and asked other Democrats to join him in blocking an up-or-down, or direct “yay” or “nay,” vote on Gorsuch. To overcome that obstruction, Senate Majority Leader Mitch McConnell, R-Ky., needs 60 votes, or he could invoke the “nuclear option” and change Senate rules to allow Gorsuch to be confirmed by a simple majority vote.

There’s been some confusion over the language for confirming a Supreme Court nominee. By Democrats saying Gorsuch needs to be approved by a 60-vote threshold, the Washington Post’s fact checker gave them “Two Pinocchios,” calling it “slippery” and “misleading.” It’s not required for nominees to get 60 votes, since two of the current eight justices that sit on the bench did not meet that “standard.”

Despite that, Hassan also agreed with the 60-vote threshold for Supreme Court nominees.

NHGOP Chairman Jeanie Forrester said Shaheen was participating in “political partisanship” by denying Gorsuch’s confirmation.

“Sadly, Senator Shaheen would rather play obstructionist games and vote lock-step with liberal Democrats, like Chuck Schumer, than confirm a judge who has received high praise across the board,” Forrester said in a statement.

Forrester also accused Hassan of not being an “independent voice” in the Senate, despite promising to be that during the campaign last year.

“The truth is, she is serving her party’s leadership in Washington and its extreme left wing,” Forrester said. “This is pure politics.”

America Rising Squared (AR2), an arm of the Republican opposition research group America Rising, also attempted to paint Hassan as being a rubber stamp for the Democratic Party and just repeating what Shaheen does.

“Senator Hassan’s obstruction to the highly qualified Judge Gorsuch proves that not only is she willing to take marching orders from the loony liberals in her party, it is another reminder she is going to follow Shaheen’s every move,” said Nathan Brand, spokesman for AR2 and former U.S. Sen. Kelly Ayotte campaign staffer.

Despite the political backlash for their decision not to confirm Gorsuch, Shaheen, Hassan, and even Schumer have used different rhetoric in the past about Supreme Court nominees.

Hassan penned an op-ed in the New Hampshire Union Leader last year, calling on the Senate to hold a hearing and vote to fill the Supreme Court vacancy left by the death of Justice Antonin Scalia

“As is often said, justice delayed is justice denied. A stalled Supreme Court will not move our country forward; it will only exacerbate the deep political divide and gridlock in Washington,” Hassan wrote.

There was also some confusion earlier this year on Shaheen’s comments about Gorsuch’s confirmation vote. On the Senate floor, she surprised many people when she said on February 7 that she would support an up-or-down vote.

“Unlike the Republican majority, I haven’t heard any Democrats saying we don’t think that Judge Gorsuch should get a hearing or that he should get an up-or-down vote,” she said. “Everybody I’ve talked to agrees he should get a hearing and an up-or-down vote.”

However, Ryan Nickel, Shaheen’s communications director, took to Twitter to correct the record saying she meant a cloture vote, or 60 “yeas” to be approved.

In a 2013 press conference, Schumer said Democrats prefer up-or-down votes, “no matter who’s in power.”

“We much prefer the risk of up-or-down votes in majority rule, than the risk of continued total obstruction. That is the bottom line, no matter who’s in power,” Schumer said.

Gorsuch is scheduled to receive a vote on April 7.

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The American Health Care Act (AHCA) was pulled Friday minutes before a vote was to take place on the bill in the U.S. House of Representatives, which essentially means Obamacare is here to stay.

House Republicans were shy of the votes needed to get the legislation passed, and defections from the conservative House Freedom Caucus, whose members didn’t think the “repeal and replace” bill went far enough, put it out of reach for President Donald Trump and House Speaker Paul Ryan.

After pulling the vote, Trump said that the “best thing we can do, politically speaking, is let Obamacare explode. It’s exploding right now. Almost all states have big problems.”

With no new health care plan in the foreseeable future, there are a couple of bills that New Hampshire lawmakers are expected to revisit that would make changes to Granite Staters’ health care.

Under AHCA, the Congressional Budget Office estimated that 14 million fewer people would be insured in the first year if it passed. Although it was unknown how many New Hampshire residents could have lost coverage under the plan, about 91,000 people had individual plans on the health exchanges as of February, according to state estimates. Also, 52,000 low-income people in New Hampshire who have insurance through Medicaid expansion were at risk.

It didn’t take long for the Granite State’s all-Democratic congressional delegation to praise the withdrawal of the AHCA, citing how much harm it would do to the state’s residents.

“It’s time for them to admit that while the Affordable Care Act is not perfect, it has made New Hampshire and the country healthier and is worth improving, rather than repealing,” U.S. Sen. Jeanne Shaheen said to WMUR.

U.S. Sen. Maggie Hassan also applauded the defeat of the bill.

“The failure of Trumpcare is good news for people across New Hampshire and America who would have faced higher costs for less care,” she said.

They also all said that Republicans and Democrats should work together to make improvements to former President Barack Obama’s Affordable Care Act (ACA).

“It’s time to have a serious discussion about improvements that can help our health care system work better for everyone,” U.S. Rep. Carol Shea-Porter said. “There’s so much more work to do if we can put partisanship aside and work for the good of our constituents. Let’s get to work.”

Since it appears Congress isn’t going to change health care, it’s now up to the states to make changes within the scope of the ACA, and that’s what the New Hampshire Legislature will do. Leaders of each state party also seem ready to tackle Medicaid expansion with bipartisanship, yet there appears to be some disagreement over when it should get done.

Gov. Chris Sununu said he had issues with the AHCA and he wanted flexibility under the law to allow states the power to implement the policy in ways that made sense to each state. He previously supported a block grant system for Medicaid, which would have capped the federal share, letting the states decide how to spend the dollars on care.

“The bill that’s been proposed in Congress gives us concerns on a lot of different levels,” Sununu said last week. “Expanded Medicaid is part of that discussion. There’s no doubt expanded Medicaid has provided [drug] recovery, treatment options for a lot of folks that otherwise may not have had that option available.”

New Hampshire was one of 31 states that expanded Medicaid under Obamacare. Former Democratic Gov. Maggie Hassan signed the plan into law in 2014 after working with Republican legislators to approve it in two-year increments. She signed the latest expansion bill in 2016. New Hampshire has more than 187,000 individuals enrolled in either traditional or expanded Medicaid, according to state health officials.

Now that block grants aren’t on the table anymore, New Hampshire lawmakers will figure out if they want to extend the program past 2018. The Senate tabled a bill last week, without debate, that would make Medicaid expansion permanent. Senate leadership said they wanted to see what happened with the AHCA before they debated Medicaid expansion in the state.

Senate Minority Leader Jeff Woodburn told NH1 News that “what we designed in a bipartisan fashion clearly has worked. Democrats are ready to move immediately.”

Senate Majority Leader Jeb Bradley said lawmakers shouldn’t rush into anything, especially since the New Hampshire Protection Health Program doesn’t expire until the end of next year.

“Even though the legislation in Washington was pulled and there’s no changes right now to federal guidelines for Medicaid Expansion, I think before we think about reauthorizing the current program, we need to make sure that’s exactly what’s going to happen in Washington that three or four or five months from now, they’re not coming back with a new health care bill,” Bradley told NH1 News. “If December comes and there are no changes to the ACA, that will guide us in what we’re going to do in terms of Medicaid Expansion next year. To me that’s the prudent way to do it. It’s what we did in 2016. We waited for the implementation to go forward in [2015]…So I continue to think doing it now is premature.”

Sununu has also previously indicated that he doesn’t want to continue kicking the can down the road with Medicaid expansion by renewing it every two years. He said he wants to find a long-term solution.

The right-leaning public policy group, Federalism in Action, released a 2016 study discussing the issue of long term care in New Hampshire and the challenges it will face in the future.

“New Hampshire is an apt harbinger of the country’s long-term care challenges. The state’s age 85 plus population will nearly quadruple in the next three and a half decades,” the report stated. “If its Medicaid long-term care expenditures for the elderly keep pace they’ll increase from $282 million per year to $1,047 million, more than one billion dollars every year. Sustainability at that level is highly dubious.”

It’s not immediately clear if New Hampshire lawmakers plan on taking the Medicaid expansion bill off the table in 2017 or will debate in 2018.

The N.H. Senate also tabled Senate Bill 149 last week that would allow out-of-state health insurance companies to operate in the Granite State without providing the benefits required under state law. It was tabled most likely to see what the federal government was going to do.

Significant questions still remain over what Obamacare would have in store for people with health insurance on the exchanges. Health experts are also curious about how the insurance industry will react in 2018. Will they stay or leave? What will rates be like? Minuteman Health in New Hampshire said it plans to be on the exchange in 2018, but no other health insurer has yet to say it would remain in the state.

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In the past week, there have been several questions raised about the cost of the Northern Pass project and who is poised to pick up the cost once it’s completed. It also led to some public scuffles in the media between Hydro-Québec (HQ) and its New Hampshire partner, Eversource.

On Thursday, both companies said they remain committed to the $1.6 billion project to transport 1,090 megawatts of electricity to New England from Canada to Deerfield through 192 miles of hydroelectric power lines.

“Eversource and Hydro-Québec have had a long-standing partnership to develop a transmission project that would deliver much-needed clean hydropower from Québec to New England energy consumers,” according to a statement from Eversource.

But just one day prior, in three Le Journal de Québec articles, it appeared that HQ was reassessing its financial arrangement with Eversource. One article claimed HQ would pay to bury about 60 miles of the line, mostly through the White Mountain National Forest, but refused to bury about 11 miles of the line in Canada, despite pleas from local residents.

A second article stated that HQ has assumed the risks of the project and would have to pay the entire cost. Yet, a HQ official claimed New England consumers would ultimately pay for the $500 million additional cost for burying the lines and the entire Northern Pass project — a private transmission line for the exclusive use of HQ.

The third article suggested that HQ was considering abandoning the project if it wouldn’t be profitable for Québec residents. HQ is a crown corporation, meaning it’s a business essentially owned by the Province of Québec.

On March 8, HQ spokesman Serge Abergel told 98.5 FM that his company “will not pay a penny to build the line in the United States.” He argued that Hydro-Québec wanted “the transportation costs to be borne by the American customer and that’s what the partner Eversource says too.”

But in the Northern Pass statement, the company reiterated that the cost of the project will not fall on New Hampshire customers.

“Northern Pass Transmission, an Eversource subsidiary, will finance and build Northern Pass, the U.S. portion of the transmission project,” Eversource said in a statement. “Hydro-Québec will do the same for the Canadian portion of the project. The cost of Northern Pass will be recovered through use of the transmission line for delivery of energy to New England.”

Both companies said they are also working on a proposal to supply hydropower from Québec, using the Northern Pass transmission line, to Massachusetts. Proposals are expected to be submitted to the Commonwealth in the spring.

“We firmly believe in the strength of our alliance with our American partner, Eversource,” Hydro-Québec said in a statement.

What led to this very public skirmish between the two entities? It could have to do with the fact that HQ and Eversource may not have renewed its Transmission Service Agreement (TSA) with the Federal Energy Regulatory Commission (FERC).

The TSA the companies filed in 2010 states that HQ would reimburse Eversource for all development costs. In December 2013, Eversource requested an amendment to their 2011 TSA noting delays in the project and wanting to change the term “third anniversary” with the term “approval deadline,” which they set as Feb. 14, 2017 or another date both parties mutually agree to in writing.

Spokespersons at the FERC said that to date there is no signed and renewed TSA between Eversource and HQ on file, according to a report from the Caledonian Record. Eversource also declined to say if they had a renewed TSA with HQ, what the terms were, and if it would present it to investors.

The TSA is important because it outlines how Eversouce is expected to be paid to build the Northern Pass line.

The Society for the Protection of New Hampshire Forests sent a letter to U.S. Sen. Jeanne Shaheen on Tuesday, asking her to make inquires at the FERC about the status of the TSA between Eversource and HQ:

“Northern Pass has repeatedly argued that New Hampshire ratepayers are not paying for the construction  costs of their project,” the letter states. “They repeatedly cite the TSA as the basis for their claim that Hydro-Québec is paying for the construction of the transmission line. The SEC [Site Evaluation Committee] and interveners in the upcoming adjudicatory hearing cannot fully address the economic issues of impact — or whether the project is in the public interest — without the information provided by the TSA affirming that there is in fact a legally binding agreement between the two parties to this project.”

Hearings are expected to begin on the Northern Pass project next month, which will help a subcommittee of the Site Evaluation Committee make the ultimate decision if the project will move forward or not by September 30.

While it appears the two companies have publicly reconciled their differences for now, Northern Pass project opponents are using the disagreement to reiterate their point that it’s likely Granite Staters, or even Bay Staters, will pick up the cost at some point if the project is completed.

“There’s no reason to believe them now about who will pay for Northern Pass,” said Judy Reardon, senior adviser of the group Protect the Granite State, in a statement. “You and I will pay the bill, but only if we allow Northern Pass to succeed.”

Those skeptical about the project also argue that the economic climate is changing for electric utilities, making the project less advantageous than when it was first proposed.

In 2011, when Northern Pass was first proposed, high natural gas prices drove electricity prices higher. However, those prices have dropped in recent years, and New England is currently seeing its lowest electricity costs in a decade.

According to a study released last week by the Carsey Center for Public Policy at the University of New Hampshire, the average residential electric bill in the state is the same as the national average, and the average commercial electric bill is actually lower than the national average.

People who support Northern Pass say it will create jobs, deliver cheap electricity to the New England market, and is a important long-term economic investment into keeping energy rates low for residents and businesses. Gov. Chris Sununu has been a longtime supporter of the Northern Pass project.

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