greater nashua chamber of commerce legislative symposium and reception; january 10, 2014

Welcome to theLegislative Symposium

January 10, 2014

Greater Nashua Chamber of Commerce

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Seminar 1: Overview of Medicaid Expansion in NHTime: 1:00-2:15pm

Mr. Steve Norton Mr. Tom Wilhelmsen, Jr., Mr. Charlie Arlinghaus

Executive Director of the NH Center for

Public Policy

CEO of Southern NH Health Systems

President of The Josiah Bartlett Center


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MR. STEVE NORTONExecutive Director of the NH Center for Public Policy

Overview of Medicaid Expansion in NH


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“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”

New Hampshire Medicaid Expansion

January 10, 2014Nashua Chamber of Commerce

Panel

Board of DirectorsSheila T. Francoeur, Chair

David Alukonis

William H. Dunlap

Eric Herr

Dianne Mercier

Richard Ober

James Putnam

Stephen J. Reno

Stuart V. Smith, Jr.

Donna Sytek

Brian F. Walsh

Michael Whitney

Martin L. Gross, Chair Emeritus

Todd I. Selig

Kimon S. Zachos

Directors Emeritus


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ACA and coverage? • Affordable Care Act

i. Expand publicly subsidized coverage for those up to 400% of the federal poverty level.

ii. As originally conceptualized, cover 0-138% of the federal poverty level via the Medicaid program.

iii. Supreme court decided that while the ACA was constitutional, state’s could opt in or opt out of the expansion of Medicaid coverage.

• Effective October 1st, all those above 100% of the federal poverty level are eligible for subsidized insurance coverage via the federal health insurance exchange (marketplace).

• States have the option of expanding coverage up to 138%.


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New Public Coverage138% of the Federal Poverty Level

40% of the Poverty Level

$4,596 in annual income




400% of the Federal Poverty Level

100% of the Poverty Level

Medicaid Expansion Subsidized Private Insurance


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Who are the Uninsured?

NameUninsured Adults 19-64 Male

Age 18 to 40

Age 41 to 50

Age 51 to 64

Belknap 2,063 52.2% 51.1% 24.0% 24.9%Carroll 1,951 55.5% 42.1% 27.4% 30.4%Cheshire 2,641 55.0% 57.1% 21.8% 21.2%Coos County 1,497 56.5% 46.8% 25.4% 27.8%Grafton 2,910 56.2% 52.7% 21.7% 25.6%Hillsborough 10,922 53.3% 59.5% 20.8% 19.7%Merrimack 4,192 55.8% 53.1% 24.8% 22.1%Rockingham 6,603 52.4% 48.9% 25.0% 26.1%Strafford 4,538 54.5% 63.0% 19.4% 17.7%Sullivan 1,496 53.5% 52.2% 23.2% 24.6%

Source:NHCPPS calculations using Small Area Health Insurace Estimates

NH's Uninsured Adults with Incomes Less than 138% of FPL, 2101

Percent of Uninsured Adults


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Impact on the State? Costs and Coverage • How much would a

Medicaid expansion decrease the number of uninsured? ~25,000

• This would reduce out of pocket costs for those individuals to zero.

• How much would that expansion cost the state in 2014-2015 biennium? Approximately $8 million

• What about over the 2014-2020 period?

i. $85,488,000 for the stateii. $2,510,922,000 for the

federal government.

Additional State Expenditures (Lewin Repor: Baseline Medicaid Expansion to 138%)

$3,603 $4,322

($9,138)

$9,143

$13,141

$17,371

$47,046

($15,000)

($5,000)

$5,000

$15,000

$25,000

$35,000

$45,000

$55,000

2014 2015 2016 2017 2018 2019 2020

in 1

,000

Other offsets to state expenditures are possible, but it is difficult to assess the

likelihood and timing


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Major Policy Debates• Coverage – Estimates from Lewin - An estimated 23,000

individuals who would not otherwise have coverage. i. An estimated 32,000 would shift from employer and

individual coverage to Medicaid. • Cost to the state –

i. Aside from limited administrative costsii. 100% federal participation, to be phased down to 90%

in 2017 (with an estimated cost of ~$30 million in out year

• Financial boon to hospitals, mental health centers, community health centers.

• Does it materially impact the health and well-being of New Hampshire Residents?

• If we were going to do this, can we maximize private coverage?


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Current Status - Areas of agreement• Expand health insurance coverage for low income

individuals with incomes less than 133% of the federal poverty level who are not already covered by Medicaid for other reasons (such as disability).

• Maximize the use of the private insurance through the use of the state’s Health Insurance Payment Program

• Maximize the use of the private insurance market through an individual premium assistance plan where federal dollars are used to purchase private insurance coverage on the exchange.

• The program will end in the event of a change in federal financial participation.


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Areas of Disagreement• Which populations? 0-138% or 100 to 138%?

• When will this be effective? January 1st 2015? If the state is unable to develop a waiver, the Senate plan goes away. Timing is important. i. Senate bill (less time)ii. House bill (more time for market, systems

and waivers to adjust)• Who will manage (health commission versus

DHHS and DOI)


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Want to learn more?

Online: nhpolicy.orgFacebook:

facebook.com/nhpolicyTwitter: @nhpublicpolicyOur blog: policyblognh.org(603) 226-2500

“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”


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MR. TOM WILHELMSEN, JR.

CEO of Southern NH Health Systems



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MR. CHARLIE ARLINGHAUS



MEDICAID EXPANSION CONCERNS AND COMPROMISE

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120.0

5.0

10.0

15.0

20.0

25.0

30.0

Uninsured in Maine and NH(and Arizona and New Mexico)

Maine NH NM AZ

Expansion Didn’t Affect Charity CareNH was 60% higher, now only 11%

Hospital Charity Care

50

70

90

110

130

150

170

190

210

230

250

2004 2005 2006 2007 2008 2009 2010 2011

Maine New Hampshire

Uncompensated Care is 2.3% of Total Spending

2011 National Health Spending (billions)

$2,638

$62

Other expenditures Uncompensated care


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Seminar 2: Is It Time for a Gas Tax in NH?Time: 2:30-3:45pm

Commissioner Chris Clement

Representative David Campbell

Mr. Charlie Arlinghaus

NH Department Of Transportation

(D – Nashua) President of The Josiah Bartlett Center


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COMMISSIONER CHRIS CLEMENT

NH Department Of Transportation

Is It Time for a Gas Tax in NH?

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The Roads toNew Hampshire’s Future



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Mission

Transportation excellence enhancing the

quality of life in New Hampshire


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Strategic Direction – 4 Step Approach

• Preserve Existing Infrastructure – bridges, roads

• Maintain Mobility • Improve Safety • Support the Economy


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Transportation Factoids• Roads in need of repair cost each NH motorist an

average of $330 annually in extra vehicle operating costs - $300 million statewide.

• China invested last year; $108B or 9% of GDP into Transportation Infrastructure, vs. USA will spend 1.7% GDP, with Canada 4%. GDP

• – Message is USA continues to lag behind competing countries.

• NH “Highway Fund” includes gas tax “road toll”, registrations and court fines:

• NH “Turnpike Fund is a separate fund (Enterprise Account)


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Key Facts About DOT • 1,650 permanent employees (FY14) – 20% steady decrease since 1992• Responsible for:• 2,143 State Bridges

• State Red List – 145 (8%)• State Near Red List – 261

• 1,685 Municipal Bridges• Municipal Red List – 353 (21%)• All bridges are inspected at least once every two years• State red list bridges are inspected twice every year• Municipal red list bridges are inspected once every year

• 4,559 centerline miles of roadway maintained (additional 290 town maintained)

• 8,868 lane-miles of roadway maintained• Annual paving totals 200-300 miles per year (40,000 tons asphalt)• Maintain 100,000 highway signs


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2015 - 2024 Ten Year Transportation Plan

Governors Advisory Commission on Intermodal Transportation

(GACIT)


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GACIT Process

i. DRAFT Plan, Financially Constrained• Work in progress

ii. Public Hearing Input • Regional priorities and needs

iii. GACIT Recommendation to Governor – December 2013

iv. Governor Recommendation to Legislature – January 2014

v. Legislative approval – June 2014


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I-93 Funding NH’s #1 Priority

No Current Financing Plan• $250 M Unfunded Remaining Needs Not in Ten Year Plan – Capacity

Improvements Exit 3 NB to I-293 split (excl. Exit 5)

• Financial plan delivered to FHWA – remaining I-93 project in jeopardy without statement of legislative intent to fully fund project

• Environmental Permits lapse in 2020

• Exit 4A – not funded

• Continuing Negative Impact on Ten Year Plan – 2030


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Prioritizing ResourcesNH Road System (4,559 mi)

1. National Highway System (NHS)(790 mi-18%)

• Turnpikes• Interstates• Select US Routes• Select State Numbered Routes

2. US Routes and State Numbered Routes (2,799 mi – 61%)

3. Unnumbered State Roads (970 mi-21%)


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New Hampshire Pavement Conditions: 1996-2016

ADDITIONAL $12M PER YEAR NEEDED


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Average Price of Asphalt Cement 1992 to 2012

• The cost of asphalt cement increased 460% over this period

• Diesel, gasoline, road salt increases…..


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Statewide Pavement Condition

• 19 % good condition - 828 miles• 44 % fair condition - 1,867 miles• 37 % poor condition - 1,565 miles• $615 million would be needed to bring all poor

condition pavements to good condition (not including drainage, guard rail & bridges)

• $3.7 billion is the estimated total value of the state-owned pavements

• Pavements are the State’s most valuable asset other than land and bridges

(4,559 total centerline miles 299 unrated)


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4,559 Miles• The DOT Maintained road network would stretch from

Concord, NH to Anchorage, AK

A VERY LONG DRIVE!

Anchorage, AK

Concord, NH

Anchorage, AK Concord,

NH

Fargo, ND

Lake Watson, Yukon

Would your car survive?

GOOD

FAIR

POOR

Poor Road Conditions

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NH Bridge ConditionRed List – Bridges where one or more

major structural element is rated as poor condition or worse, or require weight limit posting.

Near Red List – Bridges where one or more major structural element is rated as fair condition.

Good – Bridges where no major structural element is rated as fair or poor.

New Hampshire Red List Bridges

• Total Number of State owned bridges in 2011 = 2,143

• Additional Investment of $15m per year would repair as many as 10 bridges depending on size and conditions


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2012: 11 Municipal Bridges Closed


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Status and Estimated Costs – State Red List

• Ten Year Plan rehab/replace 98 of the 140 State Red List bridges.

• $680 M (2012 dollars) to rehabilitate or replace the current State Red List bridges.

• 100 State bridges were replaced last 10 yrs. • Current 10-Year Plan, 98 State bridges to be

replaced =10/yr.• +200 years to replace all 2,143 State bridges. • $7.82 Billion is the estimated total value of the

state-owned bridges


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Turnpike System Overview• 3 Turnpike Segments• 89 Miles Long• 170 Bridges• 10 Toll Facilities• Enterprise Fund – All Turnpike

revenue must be used on the System• Turnpike Revenue pays for:

–Operating & Maintenance Costs–Debt Service–R&R Work–Capital Improvements

• FY12 $108.7M transactions and $116.6M toll revenue


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Unfunded Projects in Current Capital Program form HB 391 – Session 2009 Authorization:• Bedford ORT - $18M (FY15 Adv)• Dover End of N-D Project - $80M (FY14 Adv)

Proposed Expanded Capital Program• Bow-Concord: I-93 Widening (I-89 to I-393) - $195M (FY18 Adv)• Nashua-Bedford: FEET Widening (Exit 8 to I-293) - $70M (FY17 Adv)• Manchester: Reconstruction of Exit 6 & FEET Widening - $88M (FY17 Adv)• Manchester: New Interchange at Exit 7 - $54M (FY 18 Adv)• Spaulding Turnpike Toll Facilities (ORT or AET) - $15M (FY16 Adv)• Spaulding Turnpike Maintenance Facilities - $8M (FY14 Adv)• Turnpike Administration Building - $7M (FY15 Adv)• Nashua-Bedford ITS Infrastructure - $4M (FY15 Adv)• Merrimack Exit 12 Toll Plaza Removal - $2M (FY15 Adv)• Sarah Mildred Long Bridge ($2M Annual Capital Contribution) - $18M (FY14 Start)• TYP 2013-2022 includes PE & ROW for Bow-Concord ($13.0M) and for Manchester Exit 6 & 7

($14.0M)

*Reference: Transportation Infrastructure Report 2011 – Building America’s Future: Falling Apart & Falling Behind

Proposed Turnpike Expanded Capital Program

Potential to create 14,000 jobs* over a ten year period


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FUNDING OUTLOOK


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Challenges Ahead• Federal Reauthorization MAP-21 expires September 2014

• Shrinking revenue from fuel efficient vehicles and less miles traveled due to recession

• One-time solutions–Not Sustainable Funding

• Rising Costs - Petroleum based business


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Increased Fuel Efficiency = Less HWY Revenue


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DOT FUNDING SOURCES• Highway Fund (road toll tax a.k.a. gas tax, motor vehicle fees, court fees, misc.) $260 m/ year)

• -$48 m deficit FY16, -$105 m FY17 Operating Budget

• Federal Aid ($143 m/year) – Capital Budget

• General Funds: Aeronautics, Rail, Transit ($900,000/year)

• Turnpike Fund: Turnpikes only (subject to covenants to bondholders): $117m/year tolls


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One-time Non-Sustainable Operating Funding

• FY 06-07 Surplus from Highway Fund

• FY 08-09 Bonding $60m

• FY 10-11 Registration Surcharge $90m

I-95 Transfer $50m

• FY 12-13 I-95 Transfer $52m

• FY 14 -15 I-95 Transfer $ 30m

• FY 16 -17 Deficit -$48m & - $105m


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Summary

• $22m / yr. : Complete I-93 widening project $250m

• $15m / yr. : Red List Bridge additional funding

• $12m /yr. : Road Paving to repair poor roads

• $35m / yr. : Maintenance & Operations of entire

transportation system

• $20 / yr. : Municipal Road & Bridge Repair


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In light of the recent Global Competitiveness Report rankings from the World Economic Forum on infrastructure quality which has listed the United States at 25th place—down from 9th place in 2009—such a major disruption to federal transportation investment will produce serious losses that threaten the gradual macroeconomic recovery seen in the last few years.


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The Roads toNew Hampshire’s Future


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Transportation Briefing

Rep. David B. Campbell (D – Nashua)


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54


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2013 Red List Bridges 145 State Owned Bridges 353 Municipal & Other Owned

Bridges


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Pavement Conditions 2000 2010

Red = Poor Condition


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LegendGT = Gas TaxDT = Diesel Tax

GT= 31.5 cents DT= 32.7 cents

GT= 26.5 cents DT= 26.5 cents

GT= 33.0 cents

DT= 33.0 cents

GT=49.3 centsDT=54.9 cents

GT= 32.3 cents

DT= 31.0 cents

GT= 19.6 cents

DT= 19.6 cents

Investments in Transportation


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MR. CHARLIE ARLINGHAUS



NEW HAMPSHIRE TRANSPORTATION FUNDING

Spending Tracks With Inflation

1998

2000

2002

2004

2006

2008

2010

2012

2014

300.00

350.00

400.00

450.00

500.00

550.00

600.00

DOT Spending and Inflation

DOT SpendingLinear (DOT Spending)Inflation

2004 2005 2006 2007 2008 2009 2010 2011 2012 201350.00

100.00

150.00

200.00

250.00

Gas Tax and Other Revenue

Other Highway Fund Revenue Gas TaxInflation

2004 2005 2006 2007 2008 2009 2010 2011 2012 201390.00

110.00

130.00

150.00

170.00

190.00

210.00

230.00

The Last Decade

Other Highway Fund Revenue Gas TaxInflation

2012-13$0.00

$100.00

$200.00

$300.00

$400.00

$500.00

$600.00

Gas Tax:$246.5

Vehicle Fees:$225.7

Tpk Robbery $52

Other $44.8

2012-13 Highway Fund Revenue

OtherTurnpike RobberyRegistrationGas Tax


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Seminar 3: Why Divestiture of PSNH Assets Matters to Southern NHTime: 4:00-5:00pm

Mr. William J. Quinlan

Mr. Daniel Allegretti

President/Chief Operating Officer of

PSNH

Vice President of State Government

Affairs with Exelon Corporation


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MR. WILLIAM J. QUINLANPresident/Chief Operating Officer of PSNH

Why Divestiture of PSNH Assets Matters to Southern NH

2014 Greater Nashua Chamber of Commerce Legislative Symposium

Bill Quinlan, President & COOPSNH

January 10, 2014

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New England’s Growing Over-Reliance on Natural Gas

Wind

Other

Hydro

Biomass

Oil

Coal

Natural Gas

Nuclear

0.0%

0.0%

5.1%

7.6%

22.3%

18.3%

14.9%

31.7%

Wind

Other

Hydro

Biomass

Oil

Coal

Natural Gas

Nuclear

1.0%

0.3%

5.8%

5.4%

0.2%

3.2%

52.8%

31.2%

2000 2012New England Generation Mix (MWH)

Source: ISO-NE, Net Energy by Source

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New England Natural Gas Delivery Prices are Increasing Significantly Compared to New York

• Historical prices => daily settlement average, 2013-14W => ICE Forward Financial Basis

Natural Gas Delivery Costs

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A Significant Amount of Generation Assets are at Risk of Retiring

• ISO-NE projects 8000 MW of generation are at risk of retiring by 2020

• More than 3000 MW of generation has already announced plans to retire

• Vermont Yankee – 604 MW• Norwalk Harbor – 342 MW• Salem Harbor – 749 MW • Brayton Point – 1535 MW• ISO-NE has cited the

region’s over-reliance on natural gas as one of the most significant challenges to grid reliability

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What’s Being Proposed for New Generation? More Natural Gas and Wind

Source: ISO-NE Energy by Fuel Type 2012 & Generator Interconnection Queue January 2014

Proposed New GenerationNatural gas and wind make up vast majority of new proposed

generation

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What’s Being Done…

• New England Governor’s Regional Energy Agreement

• PSNH’s Generation Fleet – reliable, diverse & serving NH customers

• Merrimack Station (coal) – 434 MW

• Newington Station (oil and gas) – 400 MW

• Schiller Station (coal and biomass) – 150 MW

• 9 Hydro Stations – 67 MW

• Total: 1050 MW

• The Northern Pass Project – 1200 megawatts of hydroelectric power


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MR. DANIEL ALLEGRETTI

Vice President of State Government Affairs of Constellation Energy



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Our Upcoming Events

Date: Wednesday, January 15, 2014Time: 12:00 PM – 2:00 PMLocation: Holiday Inn, Nashua

Date: Friday, February 28, 2014Time: 6:30 – 9:30 PMLocation: Crowne Plaza, Nashua

Date: Friday, March 7, 2014Time: 5:30-7:30 PMLocation: Sky Meadow Country Club, Nashua

Economic Outlook

Luncheon

Giggles & Nibbles

Comedy Night

The 11th Annual Greater Nashua

Chamber of Commerce Eminence

Awards

greater nashua chamber of commerce legislative symposium and reception; january 10, 2014

Business

expansion of medicaid

federal poverty level100

overview of medicaid

baseline medicaid expansion

new public coverage

medicaid program

federal government

subsidized coverage