This non-partisan open forum presents an opportunity for our state’s representatives to connect just prior to the session’s beginning, which will run until June. We aim to speak theoretically, beyond specific bills and votes, as well as to educate them on topics that will directly affect our business community. We approach the issues through the lens of the business community’s needs over the next 10 years, and break down the trends to see where we are compared to where we need to be. Topics and Speakers: Overview of Medicaid Expansion in NH Mr. Steve Norton, Executive Director of the NH Center for Public Policy Mr. Tom Wilhelmsen, Jr., CEO of Southern NH Health Systems* Mr. Charlie Arlinghaus, President of The Josiah Bartlett Center Is It Time for a Gas Tax in NH? Commissioner Chris Clement, NH Dept. Of Transportation Representative David Campbell (D-Nashua) Mr. Charlie Arlinghaus, President of The Josiah Bartlett Center Why Divestiture of PSNH Assets Matters to Southern NH Mr. William J. Quinlan, President/Chief Operating Officer of PSNH Mr. Daniel Allegretti, Vice President of State Government Affairs with Constellation Energy* *Note: Mr. Tom Wilhelmsen, Jr. and Mr. Daniel Allegretti did not use PowerPoint slides during their presentations.

1. Welcome to the
Legislative Symposium
January 10, 2014

2. Seminar 1: Overview of Medicaid
Expansion in NH
Time: 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
Greater Nashua Chamber of Commerce
2

3. Overview of Medicaid Expansion in NH
Executive Director of the NH Center for Public Policy
MR. STEVE NORTON
Greater Nashua Chamber of Commerce
3

4. New Hampshire
Medicaid Expansion
Board of Directors
Sheila T. Francoeur, Chair
David Alukonis
William H. Dunlap
Eric Herr
Dianne Mercier
Richard Ober
James Putnam
January 10, 2014
Nashua Chamber of Commerce Panel
Stephen J. Reno
Stuart V. Smith, Jr.
Donna Sytek
Brian F. Walsh
Michael Whitney
Martin L. Gross, Chair Emeritus
“…to raise new ideas and improve policy debates through
quality information and analysis on issues shaping New
Hampshire’s future.”
Todd I. Selig
Kimon S. Zachos
Directors Emeritus
Greater Nashua Chamber of Commerce
4

5. ACA and coverage?
• Affordable Care Act
i.
ii.
iii.
Expand publicly subsidized coverage for those up to 400% of
the federal poverty level.
As originally conceptualized, cover 0-138% of the federal
poverty level via the Medicaid program.
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%.
Greater Nashua Chamber of Commerce
5

6. New Public Coverage
138% of the
Federal Poverty
Level
$15,856 in
annual income
40% of the
Poverty Level
$4,596 in
annual income
Medicaid Expansion
Greater Nashua Chamber of Commerce
$45,960 in
annual income
$11,490 in
annual income
400% of the
Federal Poverty
Level
100% of the
Poverty Level
Subsidized Private Insurance
6

7. Who are the Uninsured?
NH's Uninsured Adults with Incomes Less than 138% of FPL, 2101
Percent of Uninsured Adults
Name
Belknap
Carroll
Cheshire
Coos County
Grafton
Hillsborough
Merrimack
Rockingham
Strafford
Sullivan
Uninsured Adults
19-64
2,063
1,951
2,641
1,497
2,910
10,922
4,192
6,603
4,538
1,496
Male
52.2%
55.5%
55.0%
56.5%
56.2%
53.3%
55.8%
52.4%
54.5%
53.5%
Age 18
to 40
51.1%
42.1%
57.1%
46.8%
52.7%
59.5%
53.1%
48.9%
63.0%
52.2%
Age 41
to 50
24.0%
27.4%
21.8%
25.4%
21.7%
20.8%
24.8%
25.0%
19.4%
23.2%
Age 51
to 64
24.9%
30.4%
21.2%
27.8%
25.6%
19.7%
22.1%
26.1%
17.7%
24.6%
Source:NHCPPS calculations using Small Area Health Insurace Estimates
Greater Nashua Chamber of Commerce
7

8. Impact on the State? Costs and Coverage
i.
ii.
$85,488,000 for the state
$2,510,922,000 for the
federal government.
$55,000
$47,046
$45,000
$35,000
in 1,000
• 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 20142020 period?
Additional State Expenditures
(Lewin Repor: Baseline Medicaid Expansion to 138%)
$25,000
$17,371
$13,141
$15,000
$9,143
$5,000
$3,603
$4,322
($5,000)
2014
2015
2016
2017
2018
2019
2020
($9,138)
($15,000)
Other offsets to state expenditures are
possible, but it is difficult to assess the
likelihood and timing
8
Greater Nashua Chamber of Commerce
8

9. 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 costs
ii.
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?
Greater Nashua Chamber of Commerce
9

10. 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.
Greater Nashua Chamber of Commerce
10

11. 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)
Greater Nashua Chamber of Commerce
11

12. Want to learn more?
Online: nhpolicy.org
Facebook: facebook.com/nhpolicy
Twitter: @nhpublicpolicy
Our 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.”
Greater Nashua Chamber of Commerce
12

13. Overview of Medicaid Expansion in NH
CEO of Southern NH Health Systems
MR. TOM WILHELMSEN, JR.
Greater Nashua Chamber of Commerce
13

14. Overview of Medicaid Expansion in NH
President of The Josiah Bartlett Center
MR. CHARLIE ARLINGHAUS
MEDICAID EXPANSION CONCERNS AND COMPROMISE
Greater Nashua Chamber of Commerce
14

15. Uninsured in Maine and NH
(and Arizona and New Mexico)
30.0
25.0
20.0
15.0
10.0
5.0
0.0
2001
2002
2003
2004
2005
2006
Maine
2007
NH
2008
2009
NM
AZ
2010
2011
2012

16. Expansion Didn’t Affect Charity Care
NH was 60% higher, now only 11%
Hospital Charity Care
250
230
210
190
170
150
130
110
90
70
50
2004
2005
2006
2007
Maine
2008
2009
New Hampshire
2010
2011

17. Uncompensated Care is 2.3% of Total
Spending
2011 National Health Spending (billions)
$62
$2,638
Other expenditures
Uncompensated care

18. 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
Greater Nashua Chamber of Commerce
18

19. Is It Time for a Gas Tax in NH?
NH Department Of Transportation
COMMISSIONER CHRIS CLEMENT
Greater Nashua Chamber of Commerce
19

20. The Roads to
New Hampshire’s Future
Greater Nashua Chamber of Commerce
20

21. Mission
Transportation excellence
enhancing the
quality of life in New Hampshire
Greater Nashua Chamber of Commerce
21

22. Strategic Direction – 4 Step
Approach
• Preserve Existing Infrastructure –
bridges, roads
• Maintain Mobility
• Improve Safety
• Support the Economy
Greater Nashua Chamber of Commerce
22

23. 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)
Greater Nashua Chamber of Commerce
23

24. 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
Greater Nashua Chamber of Commerce
24

25. 2015 - 2024
Ten Year Transportation Plan
Governors Advisory Commission on
Intermodal Transportation
(GACIT)
Greater Nashua Chamber of Commerce
25

26. Greater Nashua Chamber of Commerce
26

27. Greater Nashua Chamber of Commerce
27

28. 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
Greater Nashua Chamber of Commerce
28

29. 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
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
Greater Nashua Chamber of Commerce
jeopardy
29

30. Prioritizing Resources
NH Road System (4,559 mi)
1.
2.
3.
National Highway System
(NHS)(790 mi-18%)
•
Turnpikes
•
Interstates
•
Select US Routes
•
Select State Numbered Routes
US Routes and State Numbered
Routes (2,799 mi – 61%)
Unnumbered State Roads
(970 mi-21%)
Greater Nashua Chamber of Commerce
30

31. New Hampshire Pavement Conditions: 1996-2016
ADDITIONAL $12M PER YEAR NEEDED
Greater Nashua Chamber of Commerce
31

32. Greater Nashua Chamber of Commerce
32

33. Average Price of Asphalt Cement 1992 to 2012
• The cost of asphalt cement increased 460% over this period
• Diesel, gasoline, road salt increases…..
Greater Nashua Chamber of Commerce
33

34. Statewide Pavement Condition
(4,559 total centerline miles 299 unrated)
•
•
•
•
•
•
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
Greater Nashua Chamber of Commerce
34

35. •
4,559 Miles
The DOT Maintained road network would stretch
from Concord, NH to Anchorage, AK
Anchorage, AK
Concord, NH
A VERY LONG DRIVE!
Greater Nashua Chamber of Commerce
35

36. Poor Road Conditions
Lake Watson, Yukon
Anchorage, AK
Concord, NH
Fargo, ND
Would your car survive?
4

37. NH Bridge Condition
Red 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.

38. 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

39. 2012: 11 Municipal Bridges
Closed
Greater Nashua Chamber of Commerce
39

40. 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 stateowned bridges
Greater Nashua Chamber of Commerce
40

41. 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
Greater Nashua Chamber of Commerce
41

42. Proposed
Turnpike Expanded Capital Program
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)
Potential to create 14,000
jobs* over a ten year
period
• 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
Greater Nashua Chamber of Commerce
42

43. FUNDING OUTLOOK
Greater Nashua Chamber of Commerce
43

44. 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
Greater Nashua Chamber of Commerce
44

45. Increased Fuel Efficiency = Less HWY Revenue
Greater Nashua Chamber of Commerce
45

46. 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
to bondholders): $117m/year tolls
Greater Nashua Chamber of Commerce
covenants
46

47. 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
Greater Nashua Chamber of Commerce
47

48. 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
Greater Nashua Chamber of Commerce
48

49. 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.
Greater Nashua Chamber of Commerce
49

50. The Roads to
New Hampshire’s Future
Greater Nashua Chamber of Commerce
50

51. Transportation Briefing
Rep. David B. Campbell (D – Nashua)
Greater Nashua Chamber of Commerce
51

52. Greater Nashua Chamber of Commerce
52

53. Greater Nashua Chamber of Commerce
53

54. Greater Nashua Chamber of Commerce
54

55. Greater Nashua Chamber of Commerce
55

56. 2013 Red List Bridges
145 State Owned Bridges
Greater Nashua Chamber of Commerce
353 Municipal & Other Owned Bridges
56

57. Pavement Conditions
2000
2010
Red = Poor Condition
Greater Nashua Chamber of Commerce
57

58. Investments in Transportation
Legend
GT = Gas Tax
DT = Diesel Tax
GT= 19.6 cents
DT= 19.6 cents
GT= 31.5 cents
DT= 32.7 cents
GT= 32.3 cents
DT= 31.0 cents
GT= 26.5 cents
DT= 26.5 cents
GT=49.3 cents
DT=54.9 cents
Greater Nashua Chamber of Commerce
GT= 33.0 cents
DT= 33.0 cents
58

59. Is It Time for a Gas Tax in NH?
President of The Josiah Bartlett Center
MR. CHARLIE ARLINGHAUS
NEW HAMPSHIRE TRANSPORTATION FUNDING
Greater Nashua Chamber of Commerce
59

60. Spending Tracks With Inflation
DOT Spending and Inflation
600.00
550.00
500.00
450.00
DOT Spending
Inflation
400.00
350.00
300.00
Linear (DOT Spending)

61. 250.00
Gas Tax and Other Revenue
200.00
150.00
100.00
50.00
2004
2005
2006
2007
2008
Other Highway Fund Revenue
2009
2010
Gas Tax
2011
2012
Inflation
2013

62. 230.00
The Last Decade
210.00
190.00
170.00
150.00
130.00
110.00
90.00
2004
2005
2006
2007
2008
Other Highway Fund Revenue
2009
2010
Gas Tax
2011
Inflation
2012
2013

63. 2012-13 Highway Fund Revenue
$600.00
Other $44.8
$500.00
$400.00
Tpk Robbery $52
Vehicle Fees:
$225.7
$300.00
Other
Turnpike Robbery
Registration
Gas Tax
$200.00
$100.00
Gas Tax:
$246.5
$0.00
2012-13

64. Seminar 3: Why Divestiture of PSNH Assets
Matters to Southern NH
Time: 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
Greater Nashua Chamber of Commerce
64

65. Why Divestiture of PSNH Assets Matters to
Southern NH
President/Chief Operating Officer of PSNH
MR. WILLIAM J. QUINLAN
Greater Nashua Chamber of Commerce
65

66. 2014 Greater Nashua Chamber of Commerce
Legislative Symposium
Bill Quinlan, President & COO
PSNH
January 10, 2014

67. New England’s Growing Over-Reliance on
Natural Gas
2000
New England Generation Mix
(MWH)
Nuclear
31.7%
Natural Gas
18.3%
Oil
22.3%
Biomass
7.6%
Hydro
Nuclear
31.2%
52.8%
Natural Gas
14.9%
Coal
2012
5.1%
Coal
Oil
3.2%
0.2%
Biomass
5.4%
Hydro
5.8%
Other
0.0%
Other
0.3%
Wind
0.0%
Wind
1.0%
Source: ISO-NE, Net Energy by Source
67

68. New England Natural Gas Delivery Prices are Increasing
Significantly Compared to New York
Natural Gas Delivery Costs
•
Historical prices => daily settlement average, 2013-14W => ICE Forward Financial Basis
68

69. 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
69

70. What’s Being Proposed for New Generation?
More Natural Gas and Wind
Proposed New Generation
Natural gas and wind make up vast majority of new proposed generation
Source: ISO-NE Energy by Fuel Type 2012 & Generator Interconnection Queue January 2014
70

71. 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
•
71

72. Is It Time for a Gas Tax in NH?
Vice President of State Government Affairs of Constellation Energy
MR. DANIEL ALLEGRETTI
Greater Nashua Chamber of Commerce
72

73. Our Upcoming Events
Economic
Outlook
Luncheon
Giggles &
Nibbles Comedy
Night
Date: Wednesday, January
15, 2014
Time: 12:00 PM – 2:00 PM
Location: Holiday
Inn, Nashua
Greater Nashua Chamber of Commerce
Date: Friday,
February 28, 2014
Time: 6:30 – 9:30 PM
Location: Crowne
Plaza, Nashua
The 11th Annual Greater
Nashua Chamber of
Commerce Eminence
Awards
Date: Friday,
March 7, 2014
Time: 5:30-7:30 PM
Location: Sky Meadow
Country Club, Nashua
73