After already saying no to keno, N.H. municipalities have to do it again

New ‘opt out’ law overrides prior local votes to prohibit it

 By Daniel Sarch, Granite State News Collaborative 

 A new law is compelling some New Hampshire communities to consider once again asking voters to decide whether to prohibit bars, restaurants and grocery stores from offering Keno 603, a lottery-like gambling game, to patrons.  

While the communities have voted multiple times to bar Keno 603 since its inception in New Hampshire, a new state “opt-out” law automatically authorizes it in all cities and towns — unless a community’s voters decide not to allow it. If there’s no vote by 2027, Keno 603 will automatically be authorized in a community. 

Under the previous law, municipalities had to “opt in” to allow keno at local establishments.

Keno, first legalized in New Hampshire in 2017, allows players to choose numbers between one and 80. After a bet is made, a set of numbers from a ball machine or random number generator determines if the selected numbers are a match, and gives earnings based on the wager.

In Keene, for example, voters have already been asked to allow keno — in 2017 and 2019. Both times they rejected it. City Councilor Jacob Favolise is spearheading the latest effort to let voters weigh in on the keno question in this year’s municipal election. Favolise emphasized that he has no stance on the game itself, but believes it’s important to let his constituents make their voice heard.

David Yeo, sits at the bar drinking his Moxie cocktail playing pull tabs with the KENO game behind him at the Elks Lodge 1280, in Franklin, N.H., on Oct. 24, 2025. While Yeo has been mostly unsuccessful with KENO, he claims to have once previously won a $55,000 prize. (Photo by Daniel Sarch)

“It's less about keno than it is about local control and communities having a say over what happens within their city limits,” he said.

Now, nine cities and 84 towns allow keno. Along with Keene, Concord and Portsmouth — both of which have also voted twice to prohibit the game — have the question on their ballot in November.

Most Granite State towns do not hold their town meetings until March, and at this point it is unclear which of them will be considering the keno question. The only city that does not have keno and is not voting on it in November is Lebanon, which holds municipal elections in March.

Lebanon Deputy City Manager David Brooks explained that the city council has voted three times from 2018 through 2020 to decline putting the question on the ballot. But Brooks said that, while he had heard about the latest legislation, he was unfamiliar with the new law’s language.

“Speaking for myself, as opposed to the city, it feels a little underhanded for the communities that decided they didn't want to put it on the ballot, didn't want to support it, and now it's forced on us, and we're obligated to put it on the ballot in order to opt out,” Brooks said.

Growth of gambling in N.H.

Margaret Byrnes, executive director of the N.H. Municipal Association, says she is grateful for the two-year decision window, but has concerns over the law’s opt-out nature.

“When it comes to making decisions locally, we want the voters or the legislative body to have to take an affirmative vote or make an affirmative decision on something, rather than allowing something by default because they did not act,” she said.

The continued growth of gambling in New Hampshire concerns Ed Talbot, president of the board of directors of the N.H. Council on Problem Gambling and a gambling addict in recovery for 47 years. He estimates 8,000 people in the state are compulsive or pathological gamblers, and 65,000 have a lesser gambling problem. According to a press release in July on a survey conducted by the National Council on Problem Gambling, nearly 20 million U.S. adults report problem gambling behavior. 

But Talbot is not as concerned with keno as he is with other forms of gambling, such as sports betting, particularly among young adults. He said that prior to the COVID-19 pandemic, the most popular gambling outlets were the lottery, casinos and sports gambling. Since then, with increased access and popularity of wagering through apps like Draft Kings and FanDuel, sports betting has leaped to the top of his list of concerns.

“The state has been very slow to address it. They provide little funding, and New Hampshire was really way, way low in the services available” to address problem gambling, Talbot said. “That's going to change this year. They're really making an effort to address things.”

He pointed to a bill that would allow people recovering from gambling addiction to choose to be voluntarily barred from entering gambling locations. It didn’t pass in the last legislative session, but is expected to be revived for the upcoming session.

Claremont City Councilor Nicholas Koloski is a co-owner of Time-Out Americana Grill, which makes keno available for its customers.

“We have some people in the community that still like to come down, and when they grab dinner, or even to-go, they'll grab a few keno tickets,” he said. “It's more of a convenience item for people.”

Allan Beetle, co-owner of Patrick’s Pub and Eatery in Gilford, said he prefers not to have keno in his establishment. Gilford rejected the game in 2019.

“I never really liked the atmosphere as much when people are playing that game while sitting around at a bar,” Beetle said. “I prefer the bar being a more social area, where people are chatting with themselves and others and the staff.”

Money for education 

Under state law, the net profits of all NH Lottery products, including keno, are earmarked for education funding. As of May, the NH Lottery has contributed $3 billion toward education. 

A keno machine at the Elks Lodge 1280 in Franklin, the first municipality in the state to approve KENO. (Photo by Daniel Sarch)

In the 2024 fiscal year, the lottery generated an all-time high of $207 million in revenue for public schools. In the 2025 fiscal year, $11,790,000 was earmarked for education through Keno 603 alone, according to Maura McCann, the lottery’s director of marketing.

The N.H. Fiscal Policy Institute recently noted that, in 2019, NH Lottery funds comprised between 6% and 10% of Education Trust Fund expenditures. In the last two years, NH Lottery contributions made up almost 17% of the fund.

While the new keno opt-out law is expected to increase funding for public education, Policy Director Alexandra Tilsley of Reaching Higher NH said lottery money is also used for private education programs such as Education Freedom Accounts, which provides vouchers to help families pay for private school tuition and needs. It was estimated that the EFA program will cost about $50 million, leaving less money for public schools.

And despite a N.H. Supreme Court ruling this year to increase base adequacy aid for education, this year’s state budget showed little increase in public school funding. And with lottery games being a voluntary expense, stable funding is not always certain.

“It's unlikely that expanding Keno is going to meaningfully move the needle in the way we need,” Tilsley said. “I think we hope that lawmakers continue to explore other, more stable sources of funding that can really help promote success in the schools.”

These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

New Hampshire startups: How Launch 603 has connected small businesses

 By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

According to the U.S. Small Business Administration, about 97% of New Hampshire's businesses are small businesses that together employ nearly half of the state's private-sector workforce. A relatively new annual event, Launch 603, brings key startup resources into one space for a half-day of learning and connecting, while also recognizing some of the leading startups in the state. To talk about Launch 603 is Matt Mowry, co-publisher and executive editor of Business NH Magazine.

Melanie Plenda:

The 2025 Launch 603, which took place on Oct. 28, was the second time that you have brought together startups and key service providers. What inspired you to go from writing about startups to creating this event? 

Matt Mowry:

We saw an explosion of startups during the pandemic. It was “The Great Reassessment.” People were stuck at home, and they were wondering, “Is this really what I want from my life?” For some, that meant changing jobs, some for changing careers, and for others, it was taking control of their own destiny and finally starting that new business. 

One of the things that I was commonly hearing from these startups as they moved along is that they didn't realize the resources that we had here in New Hampshire that were either free or low-cost, that could provide them with everything from funding to coaching. So we started producing a guide for startups in our July issue, which is our Business Resource Directory. It's chock full of great information and statistics about the state for businesses. We thought that was a perfect place to put our startup guide, and it received such a phenomenal response, we thought, “Let's take this rich learning we're providing out of the magazine and put it into the real world, where people can interact with these experts and ask questions and have just a full day learning experience that they can emerge from to move their startups to the next level.”

Melanie Plenda:

You had as one of your featured speakers, Brian Gottlob, director of the Economic and Labor Market Information Bureau. When startups are often at the mom-and-pop stage, how important is it to understand the labor market? 

Matt Mowry:

Well, it's one aspect of the economy, and even if you don't have employees, it's good to understand what your customers are going through and what those indicators mean for the economy. Brian's a well -known economist in our state, and he offers an overall look at the economy of New Hampshire to really give some context to our startups about what they're going to be facing in the coming year.

We're entering a stage of economic uncertainty that's going to be a challenge for any business, but particularly for startups who are vulnerable, who don't have the history, the capital and the customer base built quite yet. So we want to give them all the arsenal that they can have at their disposal and Brian's helped set the table for our discussion for the day.

Melanie Plenda:

What about New Hampshire’s business climate makes it a good place to launch a startup?

Matt Mowry:

One is access to people. You have access to things like the Small Business Administration and the Small Business Development Center, SCORE. There's a lot of organizations, and some of them are national, but here in New Hampshire it's very easy to get in touch with them, to get access to experts. We're a state where you can have access to our leaders. If you're having a problem, it's easy to reach out and find someone that can help you solve it. So I think that's one of the really key advantages that we have here in New Hampshire. 

That isn't to say we aren't without challenges but we do have a rich startup culture. We;re ranked 13th overall, according to U.S. News and World Report, for business creation. So we have a lot of entrepreneurial spirit here in the state. But Wallet Hub ranked New Hampshire 45th for conditions that support startups, due to our business environment, business costs and our access to resources, such as funding. So there are challenges of being in a small state and doing a startup, but because of the access that we have to folks to help a startup succeed, I think that makes us a really great place to be.

Melanie Plenda:

We hear often about the “New Hampshire Advantage,” mainly touting lower business taxes, being a draw. Does this really make a difference for small shops?

Matt Mowry:

When you are starting up, you are resource-poor and expense-rich. You're spending a lot of money and at the same time you're not bringing in probably as much as you would like. So any savings is a help, especially when it comes to tax situations. But it's not the only advantage here in New Hampshire. It's the access to people being able to make those connections that can get you to whatever it is that you need.

Melanie Plenda:

It seems as though new banks are entering the New Hampshire market every week. Are they all after the big fish or does this translate to capital startup? 

Matt Mowry:

New Hampshire has been a rich market for banks. We have attracted a lot of out-of-state banks. We've seen a lot of mergers and acquisitions. There's a reason they're attracted to what would appear to be a small marketplace, but we have a lot of businesses here. There's a lot of opportunity. We have a lot of wealth here in our state. So banks are attracted to that.

But different banks are attracted for different reasons. Some of them are going after those big fish, but big fish are a small part of the New Hampshire economy. Small- and medium-sized businesses are an important part of the marketplace in who they want to attract. Startups, depending on the bank, may not be on their radar yet. Startups come with a lot of risk, and especially with the economic uncertainty that we are entering, banks are not going to be willing to take as many risks without some backups. So that's where it's important, where startups can make those connections to things like the Small Business Administration that can provide loan guarantees that make it more attractive for banks to want to do that.

But startups are having to bootstrap more. They're having to go to friends and family. There's crowdsourcing. There's a lot of different options that startups have to look at before maybe they get to the stage where banks are going to take a closer look at them,

Melanie Plenda:

From cybersecurity to the potential for violence in the workplace, how are these challenges different for a small business?

Matt Mowry:

For small businesses, cybersecurity is actually a huge issue. Most people think that it's the big guns out there that really have to worry about it, and while they are targets, they also are more savvy. They have better protection against cyber threats. That's why we're seeing an increase in cyber attacks on small- and medium-sized businesses that don't have as many resources to protect themselves against such attacks. So as a startup, it's something that they really have to consider and look at what they can do to protect themselves. 

Violence in the workplace is an issue for any business. That may not be as much of an issue for a small business because they just don't have employees as a startup, or have a small number of them. But, those attacks are coming from all over. Any concern that a larger or medium-sized business may have, startups are going to have those same concerns. It's just more compounded because they are just getting off the ground, and they just don't have the resources, perhaps, to address all those issues yet.

Melanie Plenda:

What do businesses need to know about AI?

Matt Mowry:

For startups, it's a real opportunity here, and for small businesses, AI can become that extra employee that fills in some of the talent gaps you may not have or expedite some of the things that you're doing as a startup, as an entrepreneur. It can be a real advantage, but there's a lot of pitfalls to AI that people need to know about. There's legalities involved with it too. So there's a lot of catching up to do in a market that's changing very quickly due to AI.

Melanie Plenda:

Can you talk about some of the startups honored at your event? 

Matt Mowry:

So in our July issue, we did in addition to providing information, we wanted to be aspirational, and so we selected some startup stars from those who applied to us for it, as well as working with our partners, the SBA, the SBDC and the New Hampshire Tech Alliance, to identify great startups that are here in the state.

There is a real range of them. Everything from Big Dog Sauce Company, which makes a variety of barbecue sauces and hot sauces and we have New England Sports Hub, which is a large sports dome in Somersworth. That came out from an idea of someone seeing a hole in the marketplace where such a facility might be needed. 

We also have The Printing Press in Dover, started by a woman who used to work for more corporate ‘big box’ printing and copying providers. She wanted to do better for her customers, and decided that she could do so and started her own little, small, independent business.

We had a lot of great companies that we honored as examples of the type of startup and entrepreneurial spirit we have in New Hampshire.

Melanie Plenda:

Matt Mowry, co-publisher and executive editor of Business NH Magazine, thank you for joining us today.

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.

Who’s under the mask? Tricks, treats, and the real monsters among us

By Shamecca Brown, Granite State News Collaborative

Let’s talk, people. I don’t have any tricks, but I do have a treat, and that treat is finding out who’s really under these masks. I’m not talking about the plastic vampire fangs or the dollar-store Spider-Man costumes. I’m talking about the real masks people wear when lining up with racial profiling, discrimination and being flat-out racist. 

I say this because I’ve seen it with my own eyes: a line of people in ski masks on Main Street, holding signs telling others to “go back to where you came from,” “no gays allowed,” “we hate Jews” – and the list goes on. Is that their “trick”? To show up, hide their faces, and try to scare people with their hate? Because, honestly, it looks less like a trick and more like cowardice dressed up as protest.

Now if we’re keeping with the Halloween theme, I’ll admit I’ve got a trick too. My trick would be to make them disappear and reappear in a land just for them. Picture it: They’re all stuck together, forever trapped inside a crystal ball like some spooky snow globe of hate. They can yell their nonsense all they want, but no one has to hear it. Out of sight, out of mind. A little abracadabra, and poof –  they’re gone. But let’s keep it real. That’s not how life works and, unfortunately, hate doesn’t vanish with a magic spell.

Here’s the shame of it: When people act like this, they aren’t just hiding their identities; they’re sending a dangerous message. Hate groups love to mask up because they want to intimidate without accountability. They want the attention without the consequence. But you know who suffers the most from this kind of public display? Kids.

October is supposed to be about children having fun, dressing up, collecting candy, and maybe getting a little spooked by fake skeletons on a neighbor’s lawn. Not by adults in ski masks spewing hate on Main Street. I hope kids are safe this season, and that no one messes with them – or anyone, for that matter. Because when children see that kind of behavior, it plants seeds of fear, confusion and division. And if we aren’t careful, those seeds grow.

The irony is Halloween teaches us more about humanity than these masked protestors ever could. On Halloween night, we knock on strangers’ doors, we greet one another with kindness, and we share. You don’t need to know who’s under the mask to hand out candy; you just give it because that’s what the holiday is about – treats, generosity, fun. Imagine if life worked that way year-round.

Instead, we’ve got grown folks using masks – not for fun, but to cover up their hate. They’ll say it’s about “freedom of speech,” but when your words are so ugly that you have to hide your face to say them, is it really freedom, or is it fear?

Here’s the truth: Racism, antisemitism, homophobia – these aren’t costumes people put on for a night. They’re masks some people wear every day to avoid confronting their own ignorance. And while I can joke about trapping them in a crystal ball, the real power lies in unmasking them. Naming the hate. Calling it what it is.

So this October, I’m asking: What kind of mask are you wearing? Is it one that hides prejudice, anger or fear? Or is it one of courage, compassion and accountability? Because at the end of the day, masks come off. And when they do, the real you shows.

I’ll keep my treat simple: I want a world where kids can trick-or-treat without worry, where families don’t have to explain why people are chanting hate in the streets, and where we can all laugh at spooky decorations instead of cringing at the real monsters hiding in plain sight.

And to the ones still hiding behind ski masks with hateful signs, here’s a little Halloween tip: the scariest costume isn’t the one you put on. It’s the one you live in when your heart is filled with hate. Boo.

Shamecca Brown is a New Hampshire-based columnist who is family-oriented and passionate about serving underserved communities. These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

$1,800 for a one-bedroom apartment? No wonder people are losing their homes

By Shamecca Brown, Granite State News Collaborative

Wow. A one-bedroom apartment starting at $1,800-a-month rent with nothing included. Who’s really surviving this? I can tell you right now – for many of us, it’s not easy. And I’m personally living it.

I’m working, taking care of my family, paying every bill on time, and still feeling like I’m drowning. I’m doing everything I’m supposed to do – showing up to work, being a good neighbor, helping my community, yet I’m sitting here wondering how I’m supposed to afford another rent hike without something else falling apart.

When I first saw my new rent prices, my stomach dropped. $1,800 for a one-bedroom apartment – and that’s before utilities, food, car insurance, gas, or even the basic things families need to get by. It’s like no matter how hard you work, it’s never enough. When did surviving become this expensive?

I know firsthand that homelessness doesn’t always start on the streets; it starts with one rent increase too many, when someone’s paycheck can’t stretch any further, when a single parent has to choose between paying rent or buying groceries for their kids. I work with individuals who receive help through Section 8 or other programs, and even they’re facing rent prices that make no sense. Some of them are still paying hundreds out of pocket just to keep their homes, even with assistance. And what’s worse, I’ve seen landlords take advantage of them just because they hold a voucher. A voucher is supposed to give people a fair chance at decent housing, not turn them into targets for discrimination or price manipulation.

The prices keep going up, but wages aren’t following. It’s like there’s this huge disconnect between what people earn and what landlords expect. And when management companies or landlords keep hiking rent, no matter what’s going on in your life, it feels like greed is winning over compassion.

People talk about homelessness like it’s a personal failure. The truth is, for many families it’s the system that’s failing them. When you’re paying $1,800 just for a roof over your head, how are you supposed to save for emergencies, for your kids, or even for a future? One unexpected bill, a car repair, a medical expense, a lost shift  and you’re in trouble. The worst part about all this is the emotional toll. When your rent goes up, your peace of mind goes down. You start questioning everything – should I move, should I get a second job, will I even qualify for another place if I leave? You feel trapped.

Every time I look at my rent statement, I feel like I’m being punished for trying to live decently. I’m not alone. I’ve seen friends pack up their homes because they can’t afford another increase. I’ve seen families split up because one person had to move in with relatives while the other stayed behind just to keep the lease alive. This isn’t just numbers on paper, it’s people’s lives being rearranged because of unaffordable housing.

Landlords and management companies have a right to make money, but not at the expense of human dignity. We shouldn’t have to work ourselves into exhaustion just to keep a roof overhead. We’re not asking for handouts, just fairness – a system that remembers people are behind those rent checks. Teachers, nurses, shelter advocates, cashiers, drivers are the backbone of the community, yet  many of us can’t even afford to live in the same communities we serve.

Rent shouldn’t be a luxury. Housing is a human need, and when it’s priced out of reach, that’s when homelessness begins. Not because people gave up, but because the system gave out. Staying silent helps no one. It’s uncomfortable to admit that I’m struggling, but it’s the truth. Too many of us are quietly holding on by a thread, afraid to say it out loud. But maybe if more of us do, someone will finally start listening.

We need accountability. We need laws that protect tenants from unreasonable increases. We need rent caps that reflect real life, not corporate greed. And we need more people in power to understand that stability shouldn’t be a privilege; it should be a right. Because at the end of the day, homelessness isn’t just about losing a home, it’s about losing peace, safety, and a sense of belonging. It’s time we start connecting those dots.

Shamecca Brown is a New Hampshire-based columnist who is family-oriented and passionate about serving underserved communities. These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

Education takes center stage in first year of New Hampshire’s data privacy law

While complaints have been filed, the focus is on making affected businesses aware of the statute

By Daniel Sarch

Investigative Paralegal Isaiah Hutchinson, left, and Assistant Attorney General Warren Cormack of the state’s new Data Privacy Unit stand in front of the data server in the Office of the Attorney General in Concord. The three- member unit is tasked with enforcing New Hampshire’s new comprehensive data privacy law. The third member of the unit, Investigator Frederick Lulka, was unavailable for a photo due to preparing and participating in several grand jury proceedings. (Photo by Daniel Sarch)

Nearly a year after New Hampshire’s comprehensive data privacy law took effect, the state’s new enforcement unit has received 27 consumer complaints — a sign of early awareness of the new law.

However, officials say much more work is needed to educate consumers and businesses about the new protections and obligations.

The law, which took effect on Jan. 1, gives consumers more control over how their personal data is used and puts certain responsibilities on businesses. For instance, consumers have the right to learn whether a business is storing their data, and if so, to request access to it, to obtain a copy of it, to correct inaccuracies, and to request that the data be deleted. 

They can also opt out of targeted advertising, and the sale of their personal data or any profiling based on that data.

The law applies only to businesses that process the data of at least 35,000 consumers each year.

With the new law in effect, the Attorney General’s Office has formed a Data Privacy Unit that’s responsible for enforcing the law and responding to complaints. 

Assistant Attorney General Warren Cormack, who heads the state’s new Data Privacy Unit. (Photo by Daniel Sarch)

“Not only are we receiving consumer complaints, but also as part of our work, we're going out and we're doing proactive data privacy enforcement by reviewing business policies and making sure that everything that they're publishing in terms of privacy notices and their business processes generally are operating properly,” said Assistant Attorney General Warren Cormack, who heads up the unit.

Other members of the three-person unit are investigative paralegal Isaiah Hutchinson and investigator Frederick Lulka. Cormack had previously worked in the AG’s Consumer Protection and Antitrust Bureau, focusing on general consumer protection matters. Hutchinson previously worked as a paralegal in the Medicaid Fraud Control Unit, and Lulka spent much of his career as a detective with the State Police major crime unit.

Investigative Paralegal Isaiah Hutchinson, left, and Assistant Attorney General Warren Cormack of the state’s new Data Privacy Unit shown in Office of the Attorney General in Concord, Sep. 23, 2025. Investigator Frederick Lulka was unavailable for a photo due to preparing and participating in several grand jury proceedings. (Photo by Daniel Sarch)

The trio are “sort of the tip of the spear” of the state’s data privacy enforcement efforts, said Michael Garrity, director of communications and external affairs at the N.H. Department of Justice. “If you have cases that need resources, you certainly would be able to pull other investigators in, or other agencies — partner agencies.” Those agencies include not just New Hampshire’s, but data privacy enforcement units in other states, too. 

Working to ‘reach out’ to businesses

So far, Cormack said, the typical complaint involves concern that a business has a consumer’s information and is not deleting it as the new law requires, even after the consumer has filed a deletion request with that business. 

For example, he pointed to a complaint involving a property management company. The consumer alleged the company was keeping their personal information beyond the date they left the apartment. The data privacy unit reached out to the business, which resulted in revisions in its privacy notice to include consumer rights, and the consumer’s data was deleted.

Investigative Paralegal Isaiah Hutchinson, left, and Assistant Attorney General Warren Cormack of the state’s new Data Privacy Unit stand in front of the data server in the Office of the Attorney General in Concord. The three-member unit is tasked with enforcing New Hampshire’s new comprehensive data privacy law. The third member of the unit, Investigator Frederick Lulka, was unavailable for a photo due to preparing and participating in several grand jury proceedings. (Photo by Daniel Sarch)

“When we reach out, it tends to be that they work with us really well,” Cormack said. “We're able to get a good result for the consumer and also put businesses in a better position to be able to honor those rights requests that are required under law now.”

So far, the Data Privacy Unit has not sued anyone as part of its enforcement efforts. During the unit’s first year, the law only requires the state to give notice of possible violation to any company and asks it to find a “cure” before bringing legal action. Companies are given 60 days to do so. But, starting in 2026, the state will not be required to allow companies that “cure” period.

Like any new law, there are growing pains. Since its formation, the Data Privacy Unit has been working to educate the public about the new law, including through Data Privacy FAQs for consumers and businesses.

But the main problem with the law’s rollout is that it remains relatively unknown, said attorney Cameron Shilling, director of the litigation department and chair of the cybersecurity and privacy group at the Manchester-based law firm of McLane Middleton.

“The majority of businesses are unaware of this law, and an even greater majority are unaware of what this law does, or how to comply with it,” Shilling said.

Investigative Paralegal Isaiah Hutchinson, left, and Assistant Attorney General Warren Cormack of the state’s new Data Privacy Unit shown in the Office of the Attorney General in Concord on Sept. 23, 2025. A third member of the unit, investigator Frederick Lulka was unavailable for a photo due to preparing and participating in several grand jury proceedings. (Photo by Daniel Sarch)

With something as abstract as data privacy, Shilling said, some businesses are slow to realize that they must comply with the law. Some businesses have budgetary concerns, he said, and while they allocate money for marketing, client outreach, sales and capital expenditures such as new computers and servers, the benefit of investing in data privacy compliance is not always so clear.

“Businesses prefer to buy things that are tangible,” Shilling said. “Businesses believe that cybersecurity and privacy, at least superficially, is not making them any money. That's just going to cost them money.”

Some businesses have not built data privacy into their management structure. It doesn’t belong in the job description of a chief executive or chief financial officer or a vice president of sales or operations or quality control. Nor does it fall neatly within the IT department. 

But Cormack said the law need not require most businesses to go through a major restructuring. Sometimes t’s as simple as handling rights requests through email.

“As long as you're doing it within the statutory timeframe, and you're doing it in response to consumer concerns, and you're doing it in compliance with the statute … that's a totally reasonable way of operating,” he said.

Easier to comply

Investigative paralegal Isaiah Hutchinson, a member of New Hampshire’s new Data Privacy Unit staff. (Photo by Daniel Sarch)

Shilling compared what is happening with data privacy with the dawn of cybersecurity awareness in the early 2000s, when businesses began switching from paper to digital records. It didn’t become a serious consideration until the 2005 data breach of ChoicePoint, one of the nation’s largest data brokers, that compromised the personal information of more than 163,000 consumers, and resulted in 800 cases of identity theft. 

A settlement in 2006 required the company to pay $10 million in civil penalties and $5 million in consumer redress. That incident also led the nonprofit Privacy Rights Clearinghouse to begin tracking data breaches in 2005. It has since documented over 75,000 data breaches.

Data privacy awareness has been on a similarly slow track. The first widespread data privacy law was enacted by the European Union in May 2015, but didn’t become effective until three years later. The United States had few regulations on data privacy until California passed the California Consumer Privacy Act in June 2018, which took effect in 2020. Since then, 20 states have now enacted their own data privacy laws.

Shilling believes it was the data breaches that led businesses to pursue proper cybersecurity measures, and worries that it might take a similar crisis to bring about adequate data privacy responsibilities. 

“At some point in time, we might see plaintiffs, lawyers and class action lawsuits enforcing privacy laws,” he said. “But we're not there yet, and I'm not sure whether or not we're going to be there anytime soon.”

 But with more and more states passing these acts, businesses will become more aware, Shilling said, and because New Hampshire’s law is like many other states’ laws, it will be easier for businesses to comply.

 “New Hampshire did a good thing by choosing to adopt a law that comes from other states,” he said. “Instead of having a patchwork of state laws, you have a synergy of state laws. It also is good in that it's fairly detailed.”

These articles are being shared by partners in the Granite State News Collaborative.Don’t just read this. Share it with one person who doesn’t usually follow local news — that’s how we make an impact. For more information, visitcollaborativenh.org.

Radically Rural: What the summit’s 2025 edition looks like

The Radically Rural summit is back. The annual event brings together those who love rural life, but also want to solve small-town challenges. Radically Rural is a grassroots movement founded in 2018 in Keene that connects people who are passionate about small-town life with those who are pioneering innovative solutions to common problems. It’s back for 2025 with new ideas and new solutions. To preview the summit are Executive Director Julianna Dodson and Lillian Chase, program and development coordinator, both from the Hannah Grimes Center for Entrepreneurship and part of the planning team for the summit.

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Melanie Plenda:

Julianna, can you tell us a bit about the background of Radically Rural and its connection to the Hannah Grimes Center? 

 Julianna Dodson:

The Hannah Grimes Center started as the marketplace on Main Street about 28 years ago, and has continually evolved to kind of meet the moment that we're in as a region and to meet needs that we have through innovation, collaboration and gathering together.

 About 18 years ago, they started an annual event called Connect and met annually, and it worked really well for our region to kind of come together and shape and share ideas and increase connections, share solutions and making sure folks weren't duplicating efforts, things like that. 

 When The Keene Sentinel got involved in that effort in 2016, the event just continued to grow. At one of the events, someone stood up during an idea jam, and said, “Rural places shouldn't be kept out of being able to host large gatherings just because we don't have large convention centers. We should be able to use our whole downtown as a convention center.” And everyone was like, “We should do that.” So a group got together and really did some brainstorming around what that could look like. 

 Melanie Plenda:

How has it evolved over the years?

 Julianna Dodson:

We had two years before the pandemic of hosting in downtown Keene, and it was hugely successful. Then when the pandemic hit, we moved everything online. Then they received a Northern Border Regional Commission grant to hire a Radically Rural director, and that's where I came on the scene. 

 When I started, we had our first hybrid year, and from that point forward, having someone who is dedicated to this work, we were able to actually expand to year-round programming through virtual roundtables. Over time, we have also evolved to include small town trips every year where we visit one small town and learn all about them and what they're doing and make what makes them unique, what models they have to offer, what challenges they're grappling with. We've also started last year with an annual correspondence to Congress to help communicate some of the needs that we're hearing about from the grassroots community that we steward. 

 I would say also, I think what has evolved the most, in my view, is the relationships in the community, which gets stronger and stronger every year, and that has really allowed us to individually and in groups, kind of customize our support relationally and with connections to resources.

Melanie Plenda:

Lillian, tell us about the theme this year, which is “resonance,” and how that will play out. 

 Lillian Chase:

After last year's summit, based on some feedback from our advisory group, we knew we wanted to do some radical imagination exercises and just look at the stories we're telling about rural communities — and if we could have a perfect rural community, what it would look like and how we could get there. So we started by finding a partner for that work, and we started working with the Resonance Network. They're going to be speaking at several of our sessions

 They explained to us kind of what their name means, and this idea that it's a single force that makes a single vibration something greater. We loved that because it resonated with us. We thought that's what we do at Radically Rural. We take a single idea or thought or model, and we bounce it off everyone else in the room to create a solution, to create ideas that can spark rural innovation across the country. 

 This year, we're diving into that with more cross-sector collaboration than ever. We really want people in public health to be able to bounce ideas off of people in the arts and see what creative solutions can come from.

 Melanie Plenda:

Lillian, what’s new this year at the summit?

 Lillian Chase:

More cross-sector collaboration than ever. Our Wednesday and Thursday sessions are all going to touch on more than one track. So it might be the arts, it might be clean energy, it might be land, but it's going to be multiple of those every single time.

 The other new thing that we're doing is adding a day, so Tuesday, the first day of the summit, is going to be focused on staying in your track, collaborating, making connections with people who are doing similar work to you, so that you can have those bonds and a place to start before you dive into more cross sector collaboration. 

 We're having field trips. We're having track specific sessions. One of the really cool things we're going to do is our Land and Community track is going to Yellowbud Farm in Massachusetts. They're going to talk with the folks that are farming there and just have a chance to really kind of be immersed in the agriculture and the ideas behind the things that are going to be on panels that we're going to talk about in the next few days. 

Melanie Plenda:

Julianna, what kind of an impact do you think the summit has had over the years? 

 Lillian Chase:

This is a fun one, because I am 100% certain that I have not even remotely been able to keep track of all of the impacts and all the mycelium under the soil that has just spread like wildfire. But there are a couple of really tangible things that I can point to. We've had other people start conferences, replicating Radically Rural, and that's been really fun, because we just like to share. So we’re like, “Take everything.” For our programs, we share them freely with anyone who wants to use them and replicate them and change them. 


My favorite part, honestly, is that people have become really good friends through this, and they connect during the year. They support each other during the year. I personally have at least three of my best voice memo friends through Radically Rural, and it's just been delightful to see how it's grown and strengthened over the years.

 Melanie Plenda:

Lillian, who comes to Radically Rural? How do they find out about it?

 Lillian Chase:

We like to say that anybody who hears a problem and wants to solve it comes to Radical Rural — people with that spark of “I could contribute.” Those are the kind of people that come, and then obviously people who love their rural communities. That's why we get together — to celebrate rural, to solve problems for rural areas. So if you live, work or recreate in rural areas, Radically Rural is really the place for you to come meet your people, and people find out about it at this point from previous attendance. 

 Melanie Plenda:

Julianna, what do you hope people take away from attending the summit?

 Julianna Dodson: 

I would say two things. The first one is something else that we haven't done and that we're doing this year is an Education track, and so I'm really hoping that folks can kind of come together from different perspectives as educators and really kind of like work on issues together.

 Then the second thing I would say is we've always been known as very solutions-based, upbeat, positive. As one of our founders, Mary Ann  Kristiansen, would say, “No wringing of the hands, let's actually move forward.” That hasn't changed. However, I would say as we've matured as programming and as we've grown over time, we are more interested, not in what could be considered like low-hanging fruit, we're more interested in really grasping at the roots. 

 Every year we've gotten more and more kind of intentional in addressing how entangled everything really is, ecologically, economically, socially. And that's one of the reasons that we have more sessions that are cross-pollinating this year, and why we're kind of bringing up topics that we really haven't before.

 Melanie Plenda:

And Lillian, where do people go if they want more information about this? 

Lillian Chase:

Go to Radicallyrural.org and you can check out our agenda there. You can sort by track. You can get your tickets there. Definitely go to our website.

Melanie Plenda:

So interesting. Julianna and Lillian, thank you for joining us today.

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.

From survivor to advocate: a response to Trump’s comments on domestic violence

Why dismissing abuse as a ‘little fight’ isn’t just wrong – it’s deadly

By Shamecca Brown-Granite State News Collaborative 

I know this took place at the beginning of September, but I had to take a couple of deep breaths and really reflect before writing this piece. I am a survivor. I was a victim. And now I am an advocate. And I’m here for all people who have been through domestic violence, no matter their gender, the color of their skin, or their age.

On Sept. 8, Donald Trump, speaking at the Museum of the Bible in Washington, said, while defending his claim that because he sent troops to the capital, that crime was “down 87%” there and that it would be even lower if not for “things that take place in the home they call crime.”

He added: “They’ll do anything they can to find something. If a man has a little fight with the wife, they say ‘this was a crime.’”

When I heard these words, I felt anger, sadness and disbelief all at once. I had to pause, breathe and reflect before writing, because these comments don’t just miss the point – they erase the lived experiences of millions of people. Domestic violence is not “a little fight with the wife.” It is not a minor squabble. It is abuse, it is trauma, and for too many, it is deadly.

Why I’m speaking out

I never even realized I was a victim at first. Like many survivors, I normalized the behavior, told myself it was just a bad argument, or that I had provoked it. I said to myself, “Oh, it’s not that bad.” I even said, “I fought back.” But then I would look in the mirror at my fat lip, my blue and black eye, and my bruised arms. For me, I convinced myself it was somehow protection, twisted into love.

But domestic violence is never love. And it’s never protection. You see, it still hurts, to hear, to see and to go through these things with people I’m helping. Yes, I said people. Because domestic violence doesn’t discriminate. I work with men, women, teens, LGBTQ survivors, immigrants – all walks of life. And every time I sit with someone, I see my story reflected back at me.

I’m glad I had training to help, but more than anything, I’ve lived it. And that’s why I speak out. Because I know it isn’t easy to leave. Not the first time, not the second, not even the fifth. Sometimes you’re just trying to make it out alive. I’ve seen too much. I’ve answered hospital calls. I’ve hidden victims. I’ve watched the trauma crack open inside people who just want peace. And the truth? The trauma cracks open inside me too, because it brings back memories of what I survived.

Yet, while survivors fight for their lives, some abusers walk free. Some stalk. Some kill. Some make bail and never spend a day behind bars. And still, Trump stood there and said this isn’t really a crime. That’s not just careless – it’s cruel.

For every survivor who still questions their worth, for every child who thinks violence is normal, for every life lost to abuse, we must stand up, speak the truth and demand better. Domestic violence is not a “little fight.” It is not lesser. It is not optional to count. It is real, it is devastating, and it deserves every ounce of our attention.

Shamecca Brown is a New Hampshire–based columnist who is family-oriented and passionate about serving underserved communities. Her advocacy extends to a range of social issues, with a strong commitment to supporting survivors of domestic and sexual violence. These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

State House update: Upcoming issues, possible legislation, and how that could affect you

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

A new session of the Legislature won’t begin until next January, but lawmakers are already filing new legislation. What issues and bills might come up? How will they affect you? To discuss this is Anna Brown, executive director of Citizens Count, a nonprofit and nonpartisan organization dedicated to educating voters about the political process. Brown is also executive director of the Warren B. Rudman Center for Justice, Leadership, and Public Service at the University of New Hampshire’s Franklin Pierce School of Law.

 Melanie Plenda:

Anna, ‘tis the season for lawmakers to file new bills that may eventually become laws here in New Hampshire. 

 Anna Brown:

We're entering the second year of the legislative session, which usually means we dig into some thornier policy debates that were put off during the first-year budget process, and that's still true. But we also saw House and Senate leaders explicitly say, please put in fewer bills this year, because there's a lot of logistical challenges — parking challenges and some renovations at the Legislative Office Building. So far, it does look like there are significantly fewer bills, but still lots to talk about.

 We're definitely going to see continued debate over housing-related legislation and zoning issues as well as social issues, particularly related to gender and free speech. I've got my eyes on bills related to school funding, because there were those recent New Hampshire Supreme Court rulings which told the Legislature it needs to act.

 Melanie Plenda:

Let’s dig a little deeper. What’s going on in the perpetual struggle between local and state control over zoning? What’s going on in that realm? 

 Anna Brown:

Just this past year, the Legislature passed several laws related to state limits on zoning. For example, expanding accessory dwelling units by right, limiting parking requirements, and so on. There's definitely a group of Republican legislators who are not happy with these changes. I've been watching the fights play out on social media over the summer, so I'm not surprised to see some bill proposals that basically want to repeal what was done last year.

 Melanie Plenda:

When it comes to spending priorities, local towns have been trying to get the state more involved in education — by sending more money — for years. In fact, there have been three, I believe, successful lawsuits that point out the state isn’t meeting its obligations for education funding, yet little seems to change. Will this come up again? What do you expect? 

 Anna Brown:

The debate is already happening. We've seen legislators meeting in committees and talking about what solutions might be brought forward, and they haven't really made much progress. The most recent New Hampshire Supreme Court ruling said the state has to spend more on that base per-pupil amount. It didn't say how. It didn't say when. There's also a group of Republicans who argue the Supreme Court overstepped its bounds. It's a major separation of powers power struggle. 

 I'm curious to see how it's going to play out in the Legislature, and realistically, there will be a lot of debate. But this is another one of those issues where I wouldn't be surprised if any changes are pushed off until the next legislative session, after the following election, because if they do increase base funding, they're going to have to come up with new revenue. Right now, the budget is looking very tight. 

 Melanie Plenda:

What about funding for child care? Is that another issue we might see tackled this session? If so, how?

 Anna Brown:

It's interesting to me, because whenever I go to chambers of commerce or other business groups, they bring up child care as a workforce issue. It's no secret there's a major shortage of child care in New Hampshire, and the speaker of the House even made a special committee on child care not too long ago, but we haven't seen the policy momentum around this issue that we saw around housing. 

 Now, more funding for child care — that's tough because, as I alluded to, we're on a very tight budget right now. There's not that free -flowing money from huge business tax revenue or Covid money from the federal government. That being said, Rep. Katelyn Kuttab from Windham has put in a bill that would create a child care tax credit program. We don't know what that looks like yet — we’ll have to wait for the bill text. I've seen similar ideas get floated before, so maybe momentum is building.

 Melanie Plenda:

As you mentioned, state revenues are already down this year, for a variety of reasons. Is this something the Legislature will have to address this term? Why? 

 Anna Brown:

Realistically, we're operating on a two-year budget. It would have to be a really huge crisis for the Legislature to reopen the budget and make changes like that until 2027, the next usual budget cycle.

 That being said, the first two months of the fiscal year, July and August, business tax revenue came in below projections. If that continues, we might enter the election year with a budget deficit, and it would be up to the governor and legislators to sort of speak to that during their election campaigns. So we already have a really lean state budget and there were some major cuts in this previous budget. For example, positions in the office of the child advocate were getting cut. Republicans also did vote to raise various fees, such as car registration, to help cover the budget. So it's too early to speculate what legislators might do two years from now, but certainly, like the economy, our budget is in a bit of an uncertain pocket.

 Melanie Plenda:

What happens if there is a major deficit? What does that mean?

 Anna Brown:

When we last saw something like that happen, it was during the Great Recession, and that ultimately resulted in some really huge cuts to the university system, for example. Now what's interesting here is we actually saw a big cut to the university system this most recent budget cycle. How deep can you cut? 

 At that point, do you have a conversation about maybe bringing back the interest in dividends tax, which was phased out. I'm sure Republicans don't want to do that? Then again, if we do enter a budget crisis going into that election year, maybe that would give the Democrats something to argue for.

 Melanie Plenda:

Will we see anything related to the assassination of Charlie Kirk?

 Anna Brown:

We're already seeing one big piece of legislation from House Majority Leader Jason Osborne, and he's sponsoring a bill named the CHARLIE Act, which is an acronym for countering hate and revolutionary leftist indoctrination in education. We haven't seen the text of this bill, but you can tell from its name, it's looking to add penalties for teachers who are teaching certain subjects, certain ways of thinking.

 We don't really know how that would be defined. It could result in fines. It could potentially revoke teacher licenses. I will say if it did pass, it would almost certainly face a court challenge, because we've seen court challenges on bills that looked to restrict teaching related to diversity, equity and inclusion, critical race theory, and so on. And if it's not really clearly defined, and how that would be determined, that's when you start to run into trouble with the courts. Also Governor Ayotte has not come out in support of this. Her line so far in the wake of the Charlie Kirk assassination is that “We need to lower the temperature. We need more civil dialogue. Free speech is important.”

 Melanie Plenda:

What about gender issues? Will we see anything like that come out of the Legislature this term?

 Anna Brown:

This is another one that I think is teeing up tension between Republicans in the Legislature and Governor Ayotte, who is also a Republican. This past summer, she vetoed a bill that would allow some discrimination based on biological sex — locker rooms, bathrooms, and so on. Republicans, it appears, are putting forward pretty similar limit legislation again. Once again, we don't have the bill texts, so we don't know how much movement there is. 

Then there's a couple of bills that are looking at other ways gender is in state law. For example, a bill to eliminate or restrict the ability to change the gender on your driver's license, and then also maybe removing references to gender identity in state law. Will those have enough momentum? Will they move forward? I mean, prior to the Charlie Kirk assassination, this looked like it was going to be the most passionate social issue debate that was going to be happening in the Legislature, so I still expect that to be a very intense topic that legislators are grappling with.

Melanie Plenda:

Fascinating as always. Anna, thank you for joining us today. 

These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org. “The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communications. It is shared with partners in the Granite State News Collaborative, of which both organizations are members.

Districts explore whether and how to charge tuition to EFA students

Students who have Educational Freedom Accounts, commonly known as vouchers, are not entitled to free participation in programming from their local districts

By Kelly Burch, Granite State News Collaborative

School districts around the state are scrambling to draft policies about whether and how to charge tuition to students enrolled in the Education Freedom Account program — students who, unlike traditional homeschoolers, are not legally entitled to free participation in district programming. 

“It’s emerging from almost the premise of double-dipping," said Nicole Heimarck, executive director of Reaching Higher NH, a nonprofit focused on education.

The EFA program, commonly known as vouchers, allows families to directly access the state portion of educational funding, known as adequacy funding. This year, the base amount is $4,182, with additional funds for some students, including those with disabilities or who qualify for free and reduced lunches. Last year, families received an average EFA grant of $5,204, according to the state Department of Education. 

It’s relatively common for students educated outside of public schools to participate in select activities in their local school, like science lab, sports or band, educators say. Yet EFA students are not entitled to participate free of charge in programming from their local districts, as districts are no longer receiving state funds to educate those pupils. According to the N.H. Department of Education, districts may allow EFA students to participate in classes and extracurriculars free of charge, decline to allow participation, or charge tuition. 

"That’s totally up to the community itself,” said William Phillips, staff attorney and director of policy services with the N.H. School Boards Association. 

The need to draft policies has become more acute this year, Phillips said, due to the expansion of the EFA program. In August, the program met its 10,000-student cap, nearly double the 5,321 students enrolled last year, before the state removed income caps for the programs. State law allows for the continued expansion of the program if it meets its cap annually. 

Responsibility to taxpayers, students

The Kearsarge Regional School District — which made headlines last year after a resident introduced the idea of a per-pupil spending cap — is one of the school administrative units looking into charging students who are receiving EFAs and also participating in district programming. 

Michael Bessette, assistant superintendent in the district, said charging tuition is a matter of being responsible to the local taxpayers who fund the schools. 

“We work hard to try to get the best out of taxpayer dollars,” Bessette said. “They’re expensive dollars.”

If a family is taking EFA funds, but also free district services, “they’re double-dipping,” Bassette said. 

(By comparison, if a traditional homeschool student takes classes or extracurriculars at the district, the state pays a portion of that student’s adequacy funding to the district, so the district is compensated, educators note.) 

In New London — one of the seven towns in the Kearsarge district — there were 35 EFA students as of early September. If those children were enrolled in public schools, the district would receive an extra $158,452.92 in adequacy funding from the state, Bassette said. 

Proponents of EFAs point out that families receiving the vouchers are still supporting public schools through their property taxes. Local funding accounts for about 70% of public school funding in New Hampshire, according to the N.H. Fiscal Policy Institute.

“If you’re living in a town and paying property tax, that money is funding the school,” said Kate Baker Demers, executive director of the Children’s Scholarship Fund NH, which administers the EFA program. 

Because of that, “a district, especially a smaller district with a relatively close-knit community, might be more accepting of students from within the district at no charge,” said Phillips. 

Districts may be more apt to charge tuition to EFA students who aren’t local residents, he added. 

“When you bring in a student from another district it’s reasonable for all of the taxpayers, the folks who are funding the local school, to have some offset,” he said.

The N.H. School Boards Association sometimes provides sample policies for districts to adapt. The association hasn’t done that for EFAs and tuition due to the “enormous variance in how a district might do this,” Phillips said. 

‘As transparent as mud’

When EFAs were established in 2021, Anne Fowler knew she was “going to have a difficult time.”

Fowler is principal of the Concord Regional Technical Center, one of the state’s Career and Technical Education centers. When a student enrolls in a technical school, the center bills the student’s home district for tuition, which varies by program but is typically $7,000 to $8,000 annually, according to Fowler. 

If a student receives an EFA, the residential school district isn’t responsible for tuition; the family is. The tuition bill came as a surprise to at least one family enrolled at the Concord technical center last year, Fowler said.

To try to avoid surprise billing, she amended the school's application to ask prospective students if they have an EFA. Yet she remains concerned that when this year’s tuition bills are mailed in February, she may notice students who misclassified themselves as homeschoolers when they are, in fact, receiving an EFA. 

Fowler’s experience highlights a common frustration for districts: It’s very difficult to identify which students receive EFA funding. 

“It’s entirely self-reported,” Phillips said. “The districts have no way of monitoring it.”

This fall, the department of education made it easier for districts to identify a “cross-district conflict” — a student who receives an EFA and is also enrolled more than 50% of the time in a local district, educators say. That’s not allowed under state law. 

At Kearsarge Regional High School, five students are in violation of that law, according to Bassette. The district is working with those families and will likely give them a deadline by which they must be under the 50% enrollment threshold or withdraw from the EFA program, he said. 

Yet there’s still no simple way for districts to identify students who are receiving an EFA — and thus could be charged tuition, but who are not enrolled in the district more than 50% of the time. Kearsarge is trying to identify these students using multiple data sheets and student identification numbers, but the process is arduous, Bassette said. 

“It’s been really challenging to obtain information on education freedom accounts,” said Heimarck. “We have heard stories of districts having a hard time verifying whether a student is public school enrolled or a voucher student, and that is creating funding problems for our local districts.”

That’s a point of great frustration for educators. 

"This transparency that the state talks about is about as transparent as mud,” Bassette said. 

In addition, there’s nothing stopping families from quickly spending down their EFA funding on eligible expenses, then reclassifying themselves as homeschool students to access district programming without charge, Phillips said. It’s “very problematic,” he added. 

A strain across the system

Baker Demers said that she’s glad to see more people talking about using EFAs to pay for programming at public schools. Some districts, she said, have been accepting EFA funds for years.

“It’s exciting that that’s on everyone’s radar now, because the public schools can be an incredible resource,” she said. “That is the entire goal of participating in the EFA, to find each educational or learning opportunity that matches the child’s needs exactly.”

However, some educators feel that the state is reinforcing existing inequities by funding EFAs while underfunding other educational options.  

Bassette said Kearsarge can only update its policies because they have the money and staff to research exactly how many students are receiving EFAs and participating in district programming. That likely wouldn’t happen in under-funded districts like Newport or Claremont, he added. 

"Because we have somebody who monitors this type of data, we were able to discover it,” he said.

Fowler pointed out that there’s often a gap in payments for technical education due to the state underpaying its portion of the bill. The gap falls to local districts to pay, she said. It occurs because the state has capped funding for career and technical centers at $9 million, while allocating $27.7 million, last year, for EFAs. 

“It doesn’t seem equitable …” Fowler said. “Schools are being pinched. Taxpayers are upset. And the students themselves are losing out at the end of the day.”

These articles are being shared by partners in the Granite State News Collaborative.Don’t just read this. Share it with one person who doesn’t usually follow local news — that’s how we make an impact. For more information, visitcollaborativenh.org.

How beech leaf disease affects New Hampshire’s forest ecology

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Beech leaf disease is the latest threat to the state’s beech trees. It’s quickly spread across the state and could have several environmental and human impacts. Here to discuss what’s happening is Lindsay Watkins, a field specialist in forest resources for Strafford County at the University of New Hampshire Cooperative Extension.

Melanie Plenda:

Lindsay, what is beech leaf disease? Where does it come from? What does it look like? 

Lindsay Watkins:

Beech leaf disease is the newest of our forest's health threats that we're seeing here in New Hampshire. It's caused by a foliar nematode. Nematodes are microscopic, worm-like creatures, so we can't see them unless we're looking at them with a microscope. But they're tiny, little worm-like deals that get into the buds of beech trees and do quite a bit of damage.

Beech leaf disease, as far as we know, came from Asia, and likely came on nursery plants or in soil that came in plants from overseas. It was first detected in Ohio in 2012, made its way east pretty quickly and spread up the Atlantic coast. It was first found in New Hampshire in 2022 in Deerfield, Nottingham, Durham and Madbury. Since then, it has spread pretty quickly throughout New Hampshire. 

Melanie Plenda:

How prevalent is this? Are many trees in the areas you mentioned affected?

Lindsay Watkins:

It's extremely prevalent. Last year it was kind of one of those things most of the towns that I would visit in Stratford County, if I looked for it, I could find it in some places. It was very readily apparent. This year, it's everywhere. You can't miss it. The trees look almost what I would describe as kind of crispy this year. The leaves are just leathery, thick, crinkled, and just look really unhealthy.

Melanie Plenda:

Why is this a concern here in New Hampshire?

Lindsay Watkins:

One of the big concerns is that we're seeing beech leaf disease cause pretty rapid mortality in beech trees. In some of the smaller trees, we're seeing those trees die off in about three to six years. It might take a little bit longer for some of our larger, more mature beech trees, but one of the things that we have in New Hampshire as a result of our past forest management, as well as beech bark disease — which is another disease that affects beech trees- is that we have a lot of .smaller, understory, midstory beech tree, and so when you look out into a forest, most of what you're seeing in that lower layer of the forest canopy, in many cases is beech. That's going to change a lot about how our forest ecosystems look and how they function.

So you're changing the amount of light that reaches the forest floor, you're changing the humidity and moisture levels in that understory layer, you are potentially opening up space for other species to come in. Those may be native species, those may be invasive species in some cases. So there's just a lot of things about the dynamics of how our forest ecosystems work that are going to change as a result of beech leaf disease.

Melanie Plenda:

Tell us more about beech bark disease. What is it and when did that become a concern?  

Lindsay Watkins:

Beech bark disease started to appear in New Hampshire around the 1950s, 1960s, and it became really prevalent. It's a more complex disease. It's caused by a combination of a scale insect that is feeding on beach bark and in the process spreading fungal pathogens.

There are actually a couple of fungal pathogens that are believed to be involved. They're native to New England and North America. The scale insect came from Europe. I believe it arrived in Nova Scotia in the early 1900s and then kind of spread south and west.

Beech bark disease is more complex in the way it works. It doesn't outright kill beech trees the way that beech leaf disease might, but it did take out a lot of our older, more mature beech trees and our forests and part of beeches’ ecology is that when a tree is stressed, or when it's killed, it puts out root sprouts. So if you kill a very large beech tree, or you stress out a very large beech tree, part of the way it's going to react is it's going to send out all of these root sprouts, and that's part of why we have so many of these smaller, sapling-size beech trees in our forest.

Melanie Plenda:

What happens if we lose the state’s beech trees? What does that look like? What impact will that have? 

Lindsay Watkins:

The first thing that comes to mind when I think about losing beech trees is just how valuable they are as a tree for wildlife. Beeches produce beech nuts, which are an extremely valuable food source. They're high in fat and protein. They're particularly valuable for bears, but there's a lot of other species that rely on beech nuts as a food source as well. That's a pretty big impact when you think about removing a species that is so important to so many different species. 

On the flip side of that, because of some of the challenges that I mentioned before with beech bark disease, a lot of foresters have spent many years trying to figure out how to manage beech so that there's less of it, so that we can encourage other species that might be more desirable from an economic standpoint, or even just to have greater biodiversity to grow, because in a lot of cases, you'll have so much beech in your forest that it's shading out other species, like sugar maple or red oak or other species that we want to grow. So there's a certain degree to which some folks maybe aren't heartbroken that we're losing some of our beach, but I don't think this is the way we would want this to go.We don't want to lose all of it. It's a really important species for a lot of reasons. 

Melanie Plenda:

How will wildlife be affected? How will people be affected?

Lindsay Watkins:

Sometimes it can be harder to see the direct impacts to us on losing a species or many trees of a species, but beeches are really important characters, like the characteristic tree of our forest.

Think about the northern hardwood forest: You think maple, beech and birch. Those are the species that really make up that forest assemblage. So there's going to be a visual impact. People are going to notice it. It has not been detected in the White Mountains, but I'm pretty sure that by next year, we're going to start to see it throughout the White Mountains. So people out hiking are going to notice it. It's going to change, really, the look of our forests, and I think it's going to change the function of our forest ecosystems, maybe in ways that we don't even quite recognize yet.

Melanie Plenda:

Overall, how healthy are New Hampshire forests? What concerns do you have? 

Lindsay Watkins:

That's a really tricky question — forest health is complex. When I think about what a healthy forest is, I think about a forest that is functioning in a way that it's providing ecosystem services for all of the species that live there — a variety of different tree species, a variety of different tree age classes and sizes, you have different wildlife that are making use of our forests for food and for habitat and getting their needs met. 

I think one of the challenges that we're seeing is that we have these different pests and diseases that, in many cases, are detrimental to an entire species. So we've lost chestnut, largely lost elm, seeing our ash trees die off on a wide scale, and now it's beech. So every time we lose a species like that, it takes away some of the complexity. It takes away some of the ecosystem's ability to respond to further stress and additional disturbances. If you eliminate all the beech, you start to get to a point where your forests are made of one or two or three species, and then what's next? It becomes a little bit of a domino effect. 

Melanie Plenda:

What can the average person do, if anything, about this? 

Lindsay Watkins:

I wish I had some better answers. I think just being aware of what's going on and paying attention. Extension and the New Hampshire Division of Forests and Lands maintain nhbugs.org — it’s a website that has a lot of information about forest pests and diseases. You can go on there and get more information about what to look for.

If you are in the southern half of the state, we probably don't need you to report beech leaf disease. We're pretty sure we know where it is and we've got it. But if you are in the more northern half of the state and you're seeing beech leaf disease in a place that it hasn't been reported yet, please do submit a report to nhbugs or reach out to your county forester and just let them know that it's there. It's just helpful to keep track of where it is, how it's spreading, how quickly it's spreading, as we continue to learn more about it and figure out what we might be able to do from a practical, hands-on perspective. 

If you're a landowner who's managing forest land, I don't think there's anything that you necessarily need to change as a result of beech leaf disease. If you're working with a forester, if you have a forest management plan, it's definitely something to consider going forward how you're going to continue to manage that forest land. If you were going to cut the beech anyway, it's great firewood. By all means, cut beech trees for firewood. If you weren't going to cut beech trees down, there's not really a reason to go out and do that just because this disease is here. It's not a situation where if we cut our beech trees down, we're going to help prevent it from spreading further.

Melanie Plenda:

So interesting! Lindsay, thank you for joining us today. 

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.

‘The power of collaboration and partnership’ invigorates health care in North Country

While other rural health care systems falter, Coos County Family Health-Androscoggin Valley Hospital alliance shores up access to health care

By Kelly Burch-Granite State News Collaborative

Sue Bergquist is 80 and dealing with multiple health issues that have her seeing an oncologist, neurologist and neurosurgeon, along with other providers. That is stressful enough, but Bergquist was also deeply worried about how she’d get from her home in Berlin to all those appointments, which can be up to three hours away. 

Earlier this year, one of her providers put her in touch with the Great Northwoods Community Foundation, which was able to help arrange Bergquist’s transport, providing much-needed relief. 

“Just knowing I don’t have to deal with the rides — that takes a burden off of me,” Bergquist said. 

The Great Northwoods Community Foundation emerged in 2019 through a partnership between Androscoggin Valley Hospital in Berlin and Coos County Family Health, a federally qualified health center with locations in Berlin, Gorham and Colebrook. For more than 20 years, the hospital and the health center have had a collaboration in which they share space and staff. 

Recently, in the face of changes to Medicaid, the partnership has provided a sense of financial security to the health center. Leaders at both institutions say the partnership has benefited their organizations and the surrounding communities, shoring up access to health care at a time when rural health care systems are too often faltering.

“The collaboration has been really critical,” said Ken Gordon, CEO of Coos County Family Health. “We’ve been able to achieve some things we wouldn’t be able to on our own.”

Leveraging federal funding structures

To understand the partnership, it’s helpful to have some context about health care funding. 

An American flag flies in the wind in front of the Coos County Family Health Service clinic, in Berlin, New Hampshire, on Thursday morning, Sept. 18, 2025. (Photo by Daniel Sarch)

Rural hospitals, like Androscoggin Valley, are often on tenuous financial footing. According to KFF, a nonprofit focused on health care policy, 44% of rural hospitals were operating at a loss in 2023, the most recent year for which data are available. This is one factor that’s contributed to the consolidation of hospitals in New Hampshire and other rural states. 

This is true for many reasons, yet perhaps the biggest factor is Medicaid. Medicaid covered 53% of hospital discharges in rural areas in 2023, according to KFF, compared to 45% in urban areas. 

Medicaid, a government health insurance program, is notorious for its low reimbursement rates. Most rural hospitals lose money providing care to Medicaid patients, according to the American Medical Association. 

Federally qualified health centers (FQHCs) like Coos County Family Health are funded primarily by a federal grant known as a Section 330 grant. The grant allows FQHCs to be paid more than other health providers for treating Medicaid or Medicare patients.

Given the different payment structures, leaders at the hospital and the health center realized back in 2003 that it was more advantageous to have the health center deliver the North County’s primary care, rather than the hospital. 

Primary care "was a loss center for the hospital, but a win for [Coos County Family Health’s] structure,” said Kris McCracken, president and CEO of Amoskeag Health, an FQHC in Manchester. 

A ‘symbiotic’ relationship

Together, the institutions had “an opportunity to leverage the FQHC funding mechanism,” said Michael Peterson, president and CEO of Androscoggin Valley Hospital.

The hospital stopped delivering primary care, instead shifting staff and patients to the health center. Today, the health center provides primary care to about 13,000 patients in the North Country, Gordon said.

The shift in primary care allowed both institutions to improve their finances, Peterson said, and also cut down on competition between the two organizations in a region that didn't have the population to support two primary care systems. 

Cecile Belanger, 58, left, and medical social worker Bridget Laflamme laugh while sitting together in a social determinate office at the Coos County Family Health Service clinic in Berlin, on Thursday morning, Sept. 18, 2025. Belanger says she visits the clinic for primary care other health services due to her narcolepsy, which prevents her from working. Laflamme works with Belanger to get assistance through the Great Northwoods Community Foundation. (Photo by Daniel Sarch)

“The power of collaboration and partnership … is more valuable to the mission of either organization than trying to go head-to-head and compete,” Peterson said. “We had to take the egos out of the situation and realize we need each other."

At the time, the hospital committed to providing the health center a community benefit grant annually for 20 years, in part to cover the cost of starting the primary care program. The grant was initially $1.5 million annually, but decreased over time, Peterson said.

Today, with that agreement expired, the relationship between the health center and the hospital is “symbiotic,” Peterson said. 

“Each of us depend on the other for the good of delivering on our mission,” he said. 

The organizations rent space from each other: The health center rents office space in the hospital to deliver primary care and express care, and the hospital rents lab space in a clinic that the health center owns. The hospital provides space at no charge for the health center to run a dental clinic in Colebrook. 

“We wouldn’t have a dental clinic there if it weren’t for that,” Gordon said. 

The organizations also share staff, which is especially beneficial to the health center, Gordon said. Community health centers often can’t compete with the pay that hospitals can offer. Without the partnership, the health center “probably wouldn’t have gotten these candidates,” Gordon said, including a recent hire who is working as a hospitalist and primary care provider. 

This year, the partnership has provided another benefit to the health center. Since the center serves the entire community, it has a higher proportion of patients with private insurance than many other FQHCs. That could provide some insulation against federal changes in Medicaid funding. 

“We’re less reliant on Medicaid than other FQHCs who predominantly serve people with Medicaid,” Gordon said. “It’s advantageous.”

Hiccup in the relationship becomes an opportunity

Physician assistant Maryanne Christiansen with patient Kimberly Mulroney, 61,at  the Coos County Family Health Service clinic in Berlin, New Hampshire, on Thursday morning, Sept. 18, 2025. Mulroney has been a longtime patient with the health clinic, and comes in regularly for primary care appointments. (Photo by Daniel Sarch)

The partnership hasn’t always been without challenges, however. Over time, the grant provided by the hospital became a sticking point. Neither Peterson nor Gordon was leading their organizations during the initial negotiations, but they were tasked with renegotiating the terms of the grant in about 2016.

At that point, “the FQHC was financially solvent, and the hospital margins were getting thinner and thinner,” Peterson said. That change made it difficult for the two sides to agree on a grant amount. Negotiations stalled with a $90,000 difference in what the hospital was willing to provide and what the health center would accept. 

That’s when Gordon and Peterson met up at a local diner. They realized that each organization was impacted by uncompensated care — care delivered to people who couldn’t pay. One way to ease that burden would be through addressing social determinants of health — factors such as transportation and access to nutritious food that contribute to poor health outcomes before someone even sets foot in the hospital or clinic. 

The two formed an idea, which they later brought to their respective boards: They would agree to a smaller grant between the hospital and FQHC, and each organization would contribute seed money to form an organization to address social determinants of health. That was the start of the Great Northwoods Community Foundation — the same organization that’s helping Sue Bergquist secure rides to her appointments. 

The foundation began operation in 2019, and has helped with everything from getting air conditioners to people with breathing challenges to building wheelchair ramps, Peterson said. 

“That’s one of the most proud accomplishments I can point to over the 10 years we’ve been working together,” he said. “That was significant, to turn a challenge into an opportunity.”

Benefiting the community

Peterson says the relationship between Coos County Family Health and Androscoggin Hospital is unique in New Hampshire.

“Typically FQHCs and hospitals have traditionally butted heads,” he said. “They’ve been at odds.”

Team coordinator Shannon Young speaks with a patient over the phone at the Coos County Family Health Service clinic in Berlin  on Thursday morning, Sept. 18, 2025. (Photo by Daniel Sarch)

And yet, the relationship also shows the way that collaboration can lead to two health care organizations having a bigger community impact than either could have on their own. 

Community members see that when they’re getting dental cleanings in Colebrook, being cared for by staff who were attracted to the dual roles available with the hospital and clinic, or taking advantage of the Great Northwoods Community Foundation.

“I don’t know what I’d do without this program,” Bergquist said. “I really don’t.”

She’s just one example of the significance of the partnership, Gordon said: “There are lots of examples of how the collaboration has benefited the community.”

This story is part of Critical Condition: What hospital consolidation means for care, access, and your community, a special series co-produced by partners in the Granite State News Collaborative. These stories are being shared by media outlets across New Hampshire. We want to hear from you! Take our short survey at https://tinyurl.com/3au39uct about your healthcare experiences. For more information, visit collaborativenh.org.

Trump proves again that he can’t handle Black excellence

His attempt to fire Fed member Lisa Cook isn’t about fraud – it’s about race

By Shamecca Brown, Columnist, Granite State News Collaborative 

Donald Trump has never hidden his disdain for diversity or equity. He proved it again in August, abruptly saying he would fire Lisa Cook, the first Black woman to ever serve on the Federal Reserve Board. He called her “incompetent” and accused her of “fraud,” but let’s be clear: This isn’t about fraud. This is about race, power and Trump’s long history of targeting Black leaders who break barriers.

Lisa Cook isn’t just another official. She’s a brilliant economist who rose to the highest levels of government despite the barriers Black women face in academia, finance and public policy. Her appointment to the Federal Reserve was historic – a breakthrough moment that inspired many who rarely see themselves represented in these powerful spaces. To Trump, that very representation is the problem.

This is the same Trump who questioned the intelligence of Barack Obama, and who mocked Black journalists for asking tough questions. It’s the same Trump who attacks DEI (diversity, equity and inclusion) programs, claiming they’re “reverse racism,” while ignoring centuries of systemic exclusion. Each move follows a pattern: When Black excellence shines too brightly, Trump does everything he can to dim it.

Firing Lisa Cook isn’t about policy disagreements or fiscal concerns. It’s about control. Trump wants to send a message that Black voices in positions of authority are disposable, that no matter how hard you work or how much you achieve, he can erase it with a smear and a press release.

And the timing matters. His recent remarks about the Smithsonian Institution’s exhibits on slavery were already called out as racist by figures like tennis great Martina Navratilova, who noted his pattern of belittling Black history. Now, with Cook’s dismissal, he’s doubling down on the same agenda: erasing progress, rewriting history and reasserting power over spaces where Black excellence has finally been recognized.

Let’s not forget: Representation at the highest levels isn’t symbolic. It’s systemic change. Cook’s role meant a voice at the table when decisions about interest rates, employment and the economy are made, decisions that directly affect working-class families, including millions of Black households already struggling with inequality. Silencing her isn’t just personal; it’s political.

Donald Trump has always thrived on division. He fuels his base by stoking resentment against women, immigrants, and especially people of color who refuse to “stay in their place.” But the truth is, no firing, no smear and no headline can erase the impact Lisa Cook has already made.

Let me clear the air as well: I’m very sure people know racism when they see it or hear it and, in my opinion and experience, I know firsthand on seeing it and feeling it. I mean, I can walk down my street and see a Trump sign and Confederate flag in someone’s yard and just know that this world is divided. Instead of covering up and saying little sarcastic words or marking up businesses and neighborhoods with Nazi symbols, just be blunt and let us know you’re racist and stay outta my way.

What makes this moment so dangerous is that many folks shrug it off as just “Trump being Trump.” But that’s how erosion happens. First, you fire one Black leader. Then another. Then you rewrite history books and museum exhibits to erase slavery and racism. Then you dismantle DEI programs and make sure the next generation has no tools to even recognize discrimination when they see it. By the time people wake up, the damage is baked in.

We can’t afford to shrug anymore.

This isn’t about partisan politics. You don’t have to be a Democrat or a liberal to see that erasing Black leadership and silencing history is wrong. You just have to believe in fairness, representation and the idea that America is stronger when everyone has a seat at the table.

Trump wants us to believe this is about rooting out corruption or fighting “wokeness.” But when the only people being removed are Black, when the only history being erased is Black history, and when the only policies being scrapped are the ones designed to level the playing field, that’s not coincidence. That’s racism. And you know it.

Lisa Cook’s fight is about more than her seat on the Fed. It’s about whether we let Trump keep rewriting the rules to suit his vision of America: one where Black leaders are expendable, diversity is dangerous, and history is sanitized to protect fragile feelings.

In my opinion we should be standing with Cook. Because if her voice doesn’t matter, none of ours do.

Shamecca Brown is a New Hampshire-based columnist who is family-oriented and passionate about serving underserved communities. These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

Know Your News: A New England-wide effort to promote media literacy and the role local news outlets play in civic life

This article is edited for length and clarity.

By Rosemary Ford and Caitliin Agnew

Your right to know — it’s an almost sacred concept here in the United States, enshrined in the Constitution’s Bill of Rights. What do you know about that right, and the news organizations that keep you informed? Today, we’re talking about something we hope you’re about to hear a lot more of, the Know Your News campaign. 

This New England–wide effort, coordinated by the Granite State News Collaborative and the New England Newspaper & Press Association’s First Amendment Committee, is designed to raise awareness about the First Amendment and the essential role of local news in civic life.

News organizations across New Hampshire and New England will be participating in this endeavor, and to discuss it we have Jeff Feingold, Granite State News Collaborative editor on the project, and Linda Conway, executive director of the New England Newspaper & Press Association. 

Melanie Plenda:

Let’s start with Linda. Can you tell us more about the campaign and the idea behind it? 

Linda Conway:

The annual New England Newspaper and Press Association convention is an annual convention where we have dozens of training sessions for journalists. So this year we had a town hall-style meeting with journalists, editors, publishers, First Amendment advocates and attorneys to discuss the importance of a free press and some of the challenges that the news organizations are facing on the local and regional level.

This was our most popular session this year. The room was packed, and the engagement level was off the charts. It was really energizing. So based on this session, we developed a First Amendment committee to look at ways that our organization can help newsrooms. We came out with a whole list of things to do. One was to develop ways to share stories, editorials and information on First Amendment issues, and the second was to develop a public information campaign to tell the story of how our efforts to dig out public information helps our community.

Melanie, the director of the Granite State News Collaborative and a member of our board of directors, and was elected chair of the committee. The collaborative had already developed a platform that they use in New Hampshire, and being generous enough to allow us to use in our efforts to help connect the entire New England news community.

Melanie Plenda:

Linda, how many organizations do you expect are participating across New England? What was the reaction to it? 

Linda Conway:

I've gotten emails from several people that are really excited about it. We're anticipating a couple of dozen news organizations to begin with. We're still registering news organizations this week, and I anticipate that a few more will probably join the effort after the kickoff, Sept. 17, on Constitution Day. I think that a couple of newsrooms, after they see other newspapers running the stories, will join as well. Ideally, we'd love every newsroom to join.

Melanie Plenda:

Here in New Hampshire, the Granite State News Collaborative produced a lot of stories for the series. Jeff, can you tell us more about that and what it entailed? 

Jeff Feingold:

What we've done is come up with over 30 articles on all kinds of topics, ranging from what local news is, about the role of the press — particularly the role of the local press. That's something that we're really focusing on, local news — because all of the newspapers taking part of this are community papers — and how important the local press is to a strong community. We have articles explaining the First Amendment, media literacy, right-to-know laws and things like that.

What we did was we gathered a group of really good journalists, really strong journalists, who were immediately interested in writing these articles for us. And it was really heartening, because people who have been journalists know how important journalism is, how important understanding what's going on in your community is. This campaign is kind of a way to push back at the unfortunate situation we have now where people aren't quite clear about what the role of the press is. They don’t necessarily turn to newspapers or other media outlets for information, so we're trying to educate people again.

Melanie Plenda:

Jeff can you give us some highlights from these articles?

Jeff Feingold:

We are trying to focus on explaining what local news is and why community reporting is so important. Local news is telling you what's going on in your community and helps you understand more about what it is to be a member of your community. It's telling you about what local businesses are talking about — sports teams and stuff — and it's also telling you about what's going on at the zoning board or the planning board, the selectboard of the city council. Knowing that is important for you as a citizen to understand what's going on because part of the problem we have now is that the lack of understanding about how important news is and turning to professional news organizations for your information means that people are becoming less engaged with their community — which is the whole point of our society. Our job is to be an informed electorate to really make this thing work. This is part of what this campaign is about. It’s kind of reminding people that this is how it works. You have to uphold your end of the bargain by being an informed, educated voter.

Melanie Plenda:

Local news organizations do a lot to inform and educate their communities. But trust in news is at an all-time low. In fact, stories in the series address this. Jeff, can you speak a little about how the media can address the "fake news" narrative?

Jeff Feingold:

I think part of it is getting people to understand what the role of the press is.

What a professional news organization does is collect information, gather information and then disseminate it. We know how to gather information professionally. We try our best to report it. We try our best to avoid bias, to avoid disinformation. 

Disinformation is so widespread now because of social media, because of AI, because of deepfakes and all that other stuff. It's a matter of us as professionals to share this information and to try to get people to understand there's a difference just reading something somewhere that might confirm your own biases, but that doesn’t mean it's true.

Our job is to try our best to not be biased, to be impartial and report it. Other sources are not doing that. They are biased. They are willfully spreading false information, disinformation, and it's important for people as readers or consumers of the news, to understand that there is a difference, and to turn to professional organizations, organizations whose job it is to understand what reality is, to speak.

Melanie Plenda:

Linda and Jeff, this is for both of you. Why is something like this needed now? Let’s go to Linda and then Jeff.

Linda Conway:

Well, as Jeff mentioned, so many people are skeptical of the media right now, especially in today's charged environment, and with the volume of information and misinformation that they find online and through social media it's tough to figure out what's real and what isn’t.

If the public understands how journalists verify their facts, vet their sources, uphold ethical standards, they'll be more likely to trust legitimate reporting and to distinguish it from misinformation, bias, and propaganda. We're hoping that by educating them on legitimate news, promoting transparency, we can empower more people to participate in that democracy. 

Jeff Feingold:

Because so many people are spending their time in the digital world, on social media and the like, the result is we don't have that social connectedness anymore in our communities. We're losing it. It's something that's been happening over quite a period of time, but it seems today even more people are disengaged from their neighbors, from the rest of their community. 

Having a source of information that everyone could turn to to understand what's going on in the community, can help bring back that kind of connectedness. I think it's something that's really important to think about — that's really what local news outlets are doing, is trying to bring the community together.

Melanie Plenda:

Here’s another one for the two of you: When you hear a phrase like Know Your News, what does that mean to you? Let’s start with Jeff and then to Linda.

Jeff Feingold:

I've been thinking a lot about what it means. It's been an unfortunate reality that fewer and fewer people are working to become well informed, or even trying to keep well informed. And I think Americans in general just are failing to grasp the idea of how our society works. The whole thing falls apart without an informed electorate. It's not just being informed about what's going on in Washington or in the state capitol, but at the local level, the county, the school board, all the things that make this system that we have work. Know Your News is basically a campaign by news outlets to say, “We’re here. We've always been here. We know you like your social media. But that's not the only way to stay informed and be engaged.”

Linda Conway:

The average person doesn't know the processes of a local newsroom. We know that local news is essential to a healthy, functioning democracy, and it still keeps communities connected. As Jeff mentioned, it keeps people updated on issues that directly affect them — school board decisions, city council policies, public safety, if your taxes are increased and how they're spent, local elections, crime and a whole host of things. Without local news, citizens may be uninformed about developments that impact their daily lives, so our goal is to make people aware of what's happening locally and the role that newspapers play in their communities, so that they're more likely to vote, attend community meetings, hold leaders accountable — essentially, to be engaged in their communities.

Melanie Plenda:

Linda and Jeff, what do you hope the outcome of all of this will be? Linda, let’s go to you first. Jeff?

Linda Conway:

There are so many news deserts that have come around the country, with corporate companies owning local news. I feel like many people don't understand what the consequences are of losing a local newsroom. The voter turnout drops and there's less transparency, there's more misinformation.

We're hoping that by educating people they will become more engaged in their local newspaper. Perhaps they'll start working at their local newspaper. Perhaps they become community reporters. They will get more involved in civic things, and they'll be empowered to participate in things. They'll go to community meetings. People don't understand that they can just go to meetings — the average person doesn’t. And then they realize that when they can't go, because everybody has busy lives, they're busy with their children and their jobs,and that local journalists are there to cover that information and give it to them.

Jeff Feingold:

I'm hoping that it makes people aware of how important it is to be media-literate, to understand what the media is, what your sources of information are, how legitimate they are, and how important it is to do your own homework on things. It sounds like a big job, but it's not really. Just learn to take a minute to say, “Is this true? Maybe I could find some other place to find out, to see if this information is true.” 

There's also just the idea to be aware of what your source of information is, how valid it is, and how important it is on your part as a consumer of news and as a citizen to understand you have a responsibility. I think a lot of us forget how important that responsibility is.

Melanie Plenda:

That was a great discussion. Linda and Jeff, thank you for joining us.

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. This story is part of the Know Your News campaign — a Granite State News Collaborative and NENPA Press Freedom Committee initiative on why the First Amendment, press freedom and local news matter. Don’t just read this. Share it with one person who doesn’t usually follow local news — that’s how we make an impact. Find out more at collaborativenh.org.

Back-to-school crisis: Are New Hampshire students getting the support they deserve?

Mental health and special education services protect the learning environment for every child, not just those getting help 

By Shamecca Brown, Independent Columnist

As families across New Hampshire settle into the new school year, one crisis continues to loom — and it doesn’t wait for the first bell. Cuts to mental health programs and special education supports are leaving students without the help they need – and that affects every child, every classroom and every family.

As a parent of two teens, I see it firsthand. When mental health counselors and special education staff are reduced, it’s not just kids with IEPs (individualized education plans) or 504 plans who are impacted – it’s the entire classroom. Teachers are stretched thin, students who need extra help may fall behind, and parents are left wondering whether schools can truly support all students while keeping learning on track.

Special education and mental health programs are critical for helping students manage stress, anxiety, learning challenges and trauma. Students with disabilities or those on the spectrum rely on these programs – and on IEPs and 504 plans – to get the accommodations and support they need to succeed.

When these programs are cut or underfunded, everyone feels it:

• Teachers are forced to manage larger classrooms with more students needing individual attention.

• Students without proper support may struggle academically and socially, disrupting the learning environment for everyone.

• Families are left worrying if their children are truly getting the help they need while trying to keep them on track.

Cuts to mental health and special education services don’t just affect individual students, they affect every child in the classroom. Numbers on a spreadsheet don’t show the stress and frustration families are feeling. Teens who once had weekly counseling or learning support may now wait weeks or months. Teachers are doing their best, but they are stretched beyond capacity. Students who need extra help may slip through the cracks, while classmates feel the ripple effect in their own learning experience.

Schools are often the first place students receive help for mental health or learning challenges. Parents trust that professionals will advocate for their children’s growth, safety and success. But when funding is cut, that trust is tested. Families can no longer assume that IEPs, 504 plans or mental health supports will be fully implemented – especially for students navigating social pressures, academic stress or behavioral challenges.

We can’t wait for someone else to fix this. Parents, educators and community members must speak up. Advocate for restored funding, make sure IEPs and 504 plans are being followed, and demand that policymakers understand the real-life consequences of these cuts.

Every voice matters. Every action counts. Supporting mental health and special education in schools doesn’t just help the students who need it most – it strengthens classrooms, supports teachers, and protects the learning environment for every child.

As the school year begins, it’s clear: cuts to mental health and special education programs affect every family in New Hampshire. Parents and students cannot assume the system will uphold IEPs, 504 plans, or other critical supports without active advocacy. To protect learning, mental health and academic success, we must raise our voices and demand the resources our schools and families deserve – before more students fall behind.

Shamecca Brown

Shamecca Brown is a New Hampshire-based columnist who is family-oriented and passionate about serving underserved communities. These articles are being shared by partners in the Granite State News Collaborative. The views expressed are not necessarily the views of GSNC or its partner organizations. For more information, visit collaborativenh.org. 

These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

The effects of lower spending on higher education in New Hampshire

According to a new study from the nonpartisan, independent research nonprofit, the N.H. Fiscal Policy Institute, New Hampshire spends the least on higher education — and this could have far-reaching consequences for students, colleges and the state’s future workforce. On this episode of “The State We’re In,” Dr. Nicole Heller, a senior policy analyst with the N.H. Fiscal Policy Institute, who is studying the issue.

This article has been edited for length and clarity.

By Rosemary Ford and Caitlin Agnew

Melanie Plenda:

Tell us about your research on higher education. What did you look at? 

Nicole Heller:

We summarized data from the State Higher Education Executive Officers Association, which allowed us to compare New Hampshire's spending for public higher education to other states in a standardized fashion.

We report on New Hampshire state funding for public higher education from state fiscal year 2006 to 2027 — what we have budgeted for that fiscal year. We also examined tuition rates at the three university system institutions, which include Keene State, Plymouth State and the University of New Hampshire, as well as the community college system of seven colleges.

Melanie Plenda:

What were some of your findings?

Nicole Heller:

Our finding that New Hampshire is the lowest funder of public higher education in the country is consistent with our 2019 and 2023 reports on this topic. In this report, we found that the state of New Hampshire spends approximately $4,600 of funding per full-time student enrolled in public higher education institutions, while the national average is about $11,700. These figures are derived from the amount of funding allocated to USNH (the University System of New Hampshire) and CCSNH (the Community College System of New Hampshire) in the state budget, not the amount these systems spend on each full-time equivalent student attending their institutions.

What's different about this most recent report is that it's written in the context of a small 1% increase for the community college system’s budget and a considerable 17.6% decrease in the University System of New Hampshire's budget for state fiscal year 2026 and 2027 compared to the prior state budget.

Melanie Plenda: 

Were any of these findings a surprise to you, and if so why?

Nicole Heller:

In 2024, the public institutions relied heavily on student tuition payments for revenue. So 68% of all revenue was from student tuition. And this is compared to a national average of contributions of 39%. New Hampshire’s public institutions are tuition-dependent, meaning that they’re highly reliant on student tuition to cover their operating budgets. When any revenue of a tuition-dependent institution’s budget is reduced, additional revenue is needed. So this often means tuition increases for students and families so the institution can balance its operating budget.

New Hampshire has seen this in both the community college system and the university system this academic year, with 7% increases in the community college tuition and a range of between 2.5% and 4.9% at the university system institutions.

Melanie Plenda:

Let's talk about some of your key findings. Why is New Hampshire’s spending on higher education a cause for concern? 

Nicole Heller:

This is cause for concern because when we think about New Hampshire, our workforce and population are aging. We need young people to remain in or come to New Hampshire in order to fill positions that are opening as a result of individuals’ retirements.

Additionally, about half of the occupations projected to have the most growth through 2032 require a college degree, and this includes software developers, registered nurses and nurse practitioners. So high tuition rates may make it difficult for individuals to afford degrees required for these occupations and contribute to workforce shortages.

Melanie Plenda:

How is this spending, or lack thereof, expected to affect New Hampshire’s workforce?

Nicole Heller:

High tuition rates for public institutions might result in more students leaving a state to pursue their higher education, and these students may not return to the state after they've completed their degree.

Right now, we have a really tight housing market, even among rental units, it's expensive to live in the state, and additionally, high non-resident tuition rates or out-of-state tuition rates may also deter young people from coming to New Hampshire to pursue their education. They may be able to afford another college within the Northeast that costs less, and that might attract them there. Since we do have a reduced number of students, high school graduates, in the Northeast, and this is a trend that's been predicted over time, and so the institutions, particularly in the Northeast, are competing for fewer and fewer students to attend their institutions.

Melanie Plenda:

You also compared funding at four-year and two-year institutions. What did you find there? And what implications does that have?

Nicole Heller:

New Hampshire invests more funding in students attending two-year institutions than four-year institutions on a per-enrollee basis. The education appropriation for full-time equivalent students was about $9,800 at our two-year institutions and approximately $4,000 at our four-year institutions in state fiscal year 2024. I want to point out that these figures include both in-state and out-of-state enrollees. 

So while there's more investment in the community college system — and that may make accessing education more affordable for individuals pursuing occupations that require two-year degrees — individuals who are pursuing careers that require four-year degrees may find the pathway to their chosen careers inaccessible due to high tuition costs.

Melanie Plenda:

Is there a connection between students who study in New Hampshire and young people who stay in New Hampshire? 

Nicole Heller:

According to a 2023 report from the University System of New Hampshire, students are twice as likely to stay and join the New Hampshire workforce if they attend a four-year public college or university and complete an internship program within the state university system. The university system also reports that about 2,000 USNH graduates join the Granite State workforce every year.

Melanie Plenda:

What other causes of concern did your research find? 

Nicole Heller:

New Hampshire college graduates are experiencing more and higher rates of student loan debt than graduates from other states. The most recent number from 2022 suggests graduates from New Hampshire's colleges and universities who have debt carry the highest average debt at nearly $40,000 compared to all other graduates in the country. New Hampshire also has the second highest percentage of graduates with student loan debt, at 70%.

Melanie Plenda:

Let’s say you are a Granite Stater with no connection to higher ed — not a student, not a university worker, not a parent of a current or future student. Would you still be concerned? Why?

Nicole Heller:

High college tuition rates can have long-term effects that impact the overall Granite State economy. As I mentioned earlier, those high tuition rates can deter individuals from pursuing degrees and careers and high demand occupations, which will adversely affect our workforce, particularly in certain industries.

Additionally, students and families may take on more of that student loan debt that we discussed, which can impact their financial stability and wealth-building over time — for example, saving for retirement, buying a house or having funds for emergencies.

Another option for individuals may be to forgo a postsecondary education or training entirely if they're not able to afford and access that education, which can hinder their long-term earning potential — again lowering the amount of money that they have to save for their retirement, for buying a home, for emergency savings.

In both scenarios, the Granite State economy is impacted when residents don't have enough resources available to spend on goods and services that help build our local and state economies.

Melanie Plenda:

What’s the solution here? What can the average person concerned about this do? 

Nicole Heller:

Additional funding for public higher education may help slow those tuition rate increases and help ensure students can access and afford degrees necessary for in-demand occupations. When our legislators were crafting the current state budget, revenues were considerably smaller than in the last budget cycle, for a variety of reasons. Federal pandemic aid has mostly ended. New Hampshire repealed its interest and dividends tax, so that funding — though it's still trickling in as various portfolios are wrapped up — has drastically decreased and will eventually go away entirely. Then we have reduced combined business taxes related to reductions in those tax rates. 

So while those tax rates were initially reduced and we did see differences, because spending went up — particularly in the pandemic era, as we weren't able to travel, consumer spending went up, particularly with stimulus income that came in from the federal government — that spending has slowed over time, and so now those business tax reductions are starting to be seen in the amount of revenues that are coming in. So as a result of relatively reduced revenues, the Legislature had a lot of difficult decisions to make, and one of them included drastically reducing public support for the USNH budget.

Melanie Plenda:

So interesting. Dr. Nicole Heller, thank you for joining us. 

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.

‘It’s Your Money’: Learning about the forces that affect your own economy

From the cost of everyday items at the grocery store to the ins and outs of financial scams, Maureen Milliken has written about all that — and much more. What can she tell us about where our hard-earned dollars go, and how to hang on to them a bit longer? Milliken, a freelance journalist, writes the award-winning “It’s Your Money” column for the Ink Link Group and has years of experience writing about consumer issues.

This article has been edited for length and clarity.

By Rosemary Ford and Caitlin Agnew

Melanie Plenda:

First, let’s talk about your column. What was the inspiration for it, and what sorts of things have you been writing about? 

Maureen Milliken:

I left the full-time journalism world that I'd been in for 35 years several years ago and was doing some freelance work. One of them, which I still do, is for a nonprofit credit counseling agency, writing web content. So I have become this expert on consumer economics from the consumer end, not the economist. I had all this knowledge and had nowhere to put it.

And a friend of mine, maybe four years ago, said, “I was having all these savings and great things,” and her credit score is 740 but she couldn't get it any higher. I told her your credit score doesn't have anything to do with your savings — it's about your credit and how you use it. And I think, “She’s a smart person with money, but doesn't know these things. And I bet a lot of other people don't know either, but I do.” So I asked Carol Robidoux, the publisher of InkLink — who I'd started doing some work for — if I can write this monthly column where I just explain this stuff to people that they should know about, hear about all the time, but really don’t understand?

Melanie Plenda:

One column you wrote that seemed to resonate with readers was about a financial scam. Can you tell us more about that?

Maureen Milliken:

One of the things I've realized is that most people — and I think it's human nature — think that they’re not going to get scammed. 

A close relative of mine — she lives in Manchester, she has a Ph.D., she runs a three-generation household, she’s smart and did get scammed. It actually began with her Facebook page being hacked and her calling a help desk that looked like a real one that turned out to be a part of the scam. So in this column, I go through how it happened, what her reactions were, what happened, what the fallout was, and of course how to try to avoid this happening to you. 

I tried to put it in a personal way that people would identify with because one of the biggest issues is the ways you can get scammed are just so devious and multiple. I felt that it resonated with people. I still get emails about it – it was a personal story about someone people could identify with. 

Melanie Plenda:

Over the last few months, you’ve also been tracking the cost of items at the grocery store and writing about those changes. Can you tell us more about that?  

Maureen Milliken:

I'm not really a good person with math, but I love making charts and tracking things. One of the big things I preach in my column is budgeting, and I think people are adverse to it for a lot of reasons, but it doesn't have to be some big, complicated, involved thing, and mine certainly wasn't. I have a certain amount I budget for groceries every month. I'm lucky, I live by myself, I don't have to worry about feeding aging parents or kids.

In the beginning last year, people would talk about the economy, and how grocery prices are going up. The more I thought about it — because I didn't really pay attention to the price of things because I would just as I went on through the month, and if I was running out of money, that's one less pizza that I'm going to order. Or go to my reserve coffee in the freezer instead of buying another pound of coffee. 

So I thought it'd be kind of neat to just track my grocery items, or some of them — a variety of them — over the months, especially with the tariffs coming, and see what happens. It's not a big scientific study, and I say that in the study. It’s just a snapshot to look at one person’s grocery bill and see how it’s affected or how it changes.

It's just a snapshot to look at one person's grocery bill and see how it's affected or how it changes. I don't necessarily think my grocery bill is typical, but I don't think any person is typical. It depends on your household — what you like to eat. I thought, “I’m going to track a variety of grocery items over at least the next year every month and see how they change.” And maybe this will make you look at your grocery items with a little more awareness too — or maybe you just like looking at charts, and we'll like to see how things change.

Melanie Plenda:

What items are you tracking? And why did you choose these items?  

Maureen Milliken:

I chose several produce items that I thought might be affected by the tariffs, or ones that people were talking about. So there's bananas, tomatoes, avocado, grapefruit and oranges. Then other things - eggs, milk, rotisserie chicken, coffee. cat food — because I have cats, and I figured a lot of people have pets, and they're buying pet food. Then things like dishwasher detergent, maple syrup, because of the Canada tariffs. So I tried to make it a variety that would give a picture where I'm not just looking at one item that might be affected by one type of tariff.

Melanie Plenda:

What do you hope people take away from all this? 

Maureen Milliken:

I guess my hope is the same thing that I've hoped through my entire journalism career with anything I wrote — is that people coming away from reading something I've done will be better informed and have things to think about that will have an impact on their lives. 

My dream would be that we stop hearing people on TV say, “My grocery bill has gone up, and I blame so and so for it”  and start figuring out what they can do. And in all my consumer columns, I try to stress, “You're the one in control of your money. You're the one in control of your finances.”

When you talk about the economy, you're talking about your economy for the most part, and no matter how little or how much money you have, you're in control of your own economy. You may have to do things you don't like or hard things, and things may not work out, but there's not these amorphous forces that you have no control over. There are some, but you can control what you do and what you buy and how you spend your money. And budget — that's my thing. Everybody needs to budget.

Melanie Plenda:

What do you have planned for future columns? 

Maureen Milliken:

I've started delving into the effects of the so-called Big Beautiful Bill, because I think people really don't understand. My last column on it was what they really mean by no tax on tips, no tax on overtime, no tax on Social Security, because it's not those things at all, what was going on with SNAP and what was going on with the Affordable Care Act. My next one is going to be about Medicaid — how it's affecting you personally as a consumer. I think people are kind of overwhelmed with what they're hearing and seeing and have no clue about the impact it has on them. Also I will continue to write about general things, like financial literacy because I don’t think people are really sure what that is or how it affects them. 

Melanie Plenda:

Maureen Milliken, freelance journalist and author of the “It’s Your Money” column with the Ink Link Group — thank you for joining us. 

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.

This side of the glass: the power of being real when we need help the most

When people seek help from the system, the system doesn’t always see them as people

By Shamecca Brown, columnist

Being off work lately gave me time to really think, to feel. And what I realized in that space is this: I was made to help people. 

It’s in my blood. But I didn’t fully understand how deep that ran until I had to help a family member apply for Social Security Disability insurance. This time, I was on the other side, watching someone I love get treated like they were less than human just for needing help. And that broke me.

I sat in that office and watched how cold it was. Not the temperature, the energy. The looks. The tone. The way the woman behind the glass asked questions like she had somewhere better to be. “Just fill this out and bring it back,” she said, like we were wasting her time. No eye contact. No warmth. Just another number in her day.

I kept thinking: Why are some people in these roles if they don’t care? I get that not every day is easy, but when your job is to serve the public, especially the vulnerable, why show up with apathy? Why weaponize your position to remind others that they’re already down?

They’re dealing with a real person, not a number. A real person going through something hard, probably embarrassing, probably painful. And instead of being met with care or even just basic decency, we got treated like an inconvenience.

They ask for papers, proof, pay stubs, statements, and a million other things that feel like a test. And if you “fail”? You don’t eat. You don’t get help with rent. You don’t get medicine.

It’s wild how you can work your whole life, pay into the system, only to be told you make too much to qualify for help, but somehow, you still don’t have enough to survive.

I’m not gonna lie, I sat there getting hot. Angry. Not just for us, but for everyone who has to sit in that chair. Because it’s not just about forms or documents, but because of how the system makes people feel in that moment. I received the unspoken message: You don’t matter. That was how I was feeling.

And that’s when it hit me –  some jobs require more than just showing up. If working with people, especially those who are vulnerable, is part of the role, then empathy, patience and basic decency should come with it. This kind of work isn’t for everyone, and that’s okay. But choosing it means choosing to show up with heart.

To the workers on the other side of the glass: I know you have a job to do. I respect that. But sometimes the job is all you see – the checklist, the quota, the script. You don’t always see the people. You don’t feel the quiet panic in someone’s chest when they’re told they don’t qualify.

I wonder if they ever had to sit in a chair like mine? Or ever felt like they had to prove their worth just to get the basics needs to survive?

Because for some of us, it’s not just humbling, it’s deeply uncomfortable. Sometimes it feels like you have to be invisible, completely broken down, just to be seen as “deserving.” And that’s a hard truth.

Sitting and waiting for help

What’s even harder is watching how unstable things have become. Rent keeps rising, food prices are through the roof, jobs are disappearing. Yet when people reach out for help, they’re met with judgment instead of compassion. I’m not saying all, but from where I was sitting I witnessed that and it didn’t feel good. 

One of my own family members got $12 in food stamps. Twelve dollars. That’s what they said she was “entitled to.” What are you supposed to do with that? It’s almost more insulting than getting nothing. It’s like the system is saying, “We see you, but not really.”

As I sat in that chair, I even felt like giving up – and I’m strong as hell. So I know how people feel sitting and waiting for that help. 

Sometimes, the people on the other side of the glass don’t even realize they’re holding privilege. It’s not always about money. It’s about comfort. Security. The luxury of never having to ask for help. They don’t seem to understand what it’s like to pray your lights stay on or to stretch a meal or feel the weight of shame while waiting in a line that screams “poverty” to everyone who passes by. When you’ve never had to live like that, it’s easy to see someone like me and think I’m not trying hard enough.

Easy to judge. Easy to say, “Well, if you just…” or “That’s not our policy.”

People say, “I’ve been there,” but not everyone’s been where I’m from. Where asking for help feels like shame, not strength. Where showing emotion gets you judged, and needing support gets you labeled. And I know not everyone on the other side is like that. But I do hope more folks start showing up with compassion. A little more help can go a long way.

This isn’t just about my family member. This is about the system. About morals. About the human part of helping that gets lost when you stop seeing people. I don’t know what the solution is yet, but I do know this: I’ll keep advocating from the other side of the glass. People don’t want handouts. They just want a fair shot. But the way things are set up, sometimes you have to swallow your pride to apply for assistance. And that takes a toll on your spirit.

All I’m asking is this: look up and see the person, not just the paperwork. Because sometimes your kindness is the only dignity we’ll receive that day. And that kind of dignity? It can change everything.

Shamecca Brown,  is a New Hampshire-based columnist who is family-oriented and passionate about serving underserved communities. These articles are being shared by partners in the Granite State News Collaborative. For more information, visit collaborativenh.org.

Defending democracy: How can it be done in a time of polarization?

In recent months, Granite Staters have gotten louder about preserving democracy. With a former president back in office, activist groups across the state have taken action in the streets, and at the State House, demanding democratic preservation. But what does that mean? To discuss this we have Dr. Christina Cliff, associate professor of political science at Franklin Pierce University. Welcome, Dr. Cliff. 

This article has been edited for length and clarity.

By Rosemary Ford and Caitin Agnew

Melanie Plenda:

To start us off, several activist groups in the state say “we need to preserve democracy.” What do they mean by that?

Christina Cliff:

Different people have different meanings at different times. Democracy, by definition, is government for the people, by the people. What they're protesting is what they see as an erosion of things like checks and balances, particularly with executive orders essentially bypassing Congress. That seems to be the democracy that they're concerned about, because those executive orders and those executive decision-making processes seem to cut out the people requirements of U.S. democracy.

Melanie Plenda:

Why do people think our democracy is at stake? What rights are being jeopardized, and who is concerned?

Christina Cliff:

I think there's a variety of different groups and individuals concerned for different reasons. You know, particularly LGBTQ+ organizations are going to be worried about transgender bans that we've seen in the military and in athletics. There's going to be immigrants, both lawful and undocumented, that are concerned, particularly with the recent ICE raids and potentially changes to birthright citizenship. There's a variety of different people concerned. 

There's other decisions that more broadly affect people, like changes to environmental protection policy and changes to tariffs. All of those have the potential to impact various groups of people, and that's really where their concern is coming from — that, individually or collectively, they feel that things are changing, and they don't have what they consider their usual say in those changes.

Melanie Plenda:

Some people say democracy in the U.S. has always been flawed. Are protestors trying to preserve something broken, or trying to reinvent it?

Christina Cliff:

I think there's a variety of groups in the United States that would tell you exactly how flawed U.S. democracy has been, particularly people of color and women, for instance. 

Democracy is fundamentally flawed. It is going to be, because you have people who are fundamentally flawed. Winston Churchill said that democracy was the worst form of government in the world, except for all the others that have been tried. It's going to be messy. It's going to be problematic. Are the protesters trying to preserve a broken system? A little bit, because we don't like change, but are they also potentially trying to fix the broken system? 

I think some people felt like they had made some strides in fixing some of the things that they thought were flawed in our democracy,and now those changes are being rolled back. And I think, really that's where a lot of the concern and the anger comes from that.

Melanie Plenda:

There's been several protests this year, including a nationwide “No Kings” protest on June 14th. What was the purpose, and who is involved?

Christina Cliff:

It was individuals. It was groups. The whole purpose was to sort of collectively let the Trump administration know that they didn't believe he should have or should be taking as much power into himself as he has been, again, primarily with executive orders. It was intended to be semi-reminiscent of the Declaration of Independence and the American Revolution, demanding rights. 

Melanie Plenda:

A number of people believe we are in a time of crisis. What might they be referring to? And how do we navigate what truly is a crisis?

Christina Cliff:

Crisis gets defined differently by different people. Like the Trump administration has argued repeatedly that the reason they're making executive decisions are because there are current, immediate crises. They said this with the immigration enforcement, and just in the last several days, sending the National Guard into Washington, D.C., saying that crime was a crisis there. The Trump administration is arguing that those are immediate, current crises for other folks. 

I think some of the perception of crises outside of the presidential administration is a broader issue of our politics and our society.

One of my bigger concerns is that what we're creating in terms of damaging democracy and damaging the political environment is polarization — not of our elected officials, but of our average citizens. We've been making people pick sides. And if they pick a side that isn't ours, we reject the person — not the idea, not the beliefs. We reject the whole person, and what essentially the average person is starting to see is an extremist approach to politics, where it's not just you have to be on my side, but if you're not on my side you're a bad person and you're a threat.

That's becoming normalized, and that's what has the potential, as much as anything else, to damage our democracy. If you cannot have the people work together towards a common solution, you can't have democracy. You won't have democracy.

Melanie Plenda:

While we are on the topic of protests, when have we seen protests similar to the ones we are seeing today in the U.S.? Was democracy at stake then? And what were they fighting for? 

Christina Cliff:

The United States has a long history of protest and protest movements. Obviously, there have been some incredibly successful protest movements.

The Civil Rights movement, for instance, the protests against the Vietnam War had an effect, and more recently, the Black Lives Matter movements and protests started conversations. These protests have to start conversations, because conversations then lead to discussions. Discussions then lead to decisions, and then you fundamentally get change. But you have to keep in mind, too, the Civil Rights movement was decades long, right? The Vietnam protest took years. 

That's one of the things with the current protest. You had the big nationwide No Kings protest, but if you go to any town in New Hampshire, on the weekend, you might see eight to 10 people in town square with their signs and stuff. You have to appreciate their dedication, but that's not necessarily the kind of protest movement that is going to demand or make change.

Melanie Plenda:

Is there any significant difference between those protests and today's?

Christina Cliff:

I think part of it is that not everybody sees the current environment as a crisis. The number of people that see this as a crisis is significantly different. When you had the Civil Rights era movement, it wasn't just people of color that were protesting — they had allies. When you had the anti-Vietnam War protest, it wasn't just the hippies, it was everyday people coming together and making a statement.

I wonder about whether or not this particular movement can get allies outside of the dedicated protesters. Can they pull people in? I think that's a fairly significant question for the protesters that want change.

Melanie Plenda:

You held an event at Franklin Pierce University called “You Might be an Extremist if …”. You briefly mentioned the polarization of picking a side. Tell me more about that. And how could that contribute to a failing democracy? 

Christina Cliff:

Extremist ideology is basically the idea that there is an “out” group that is a threat to your “in” group, and extremists define those “out” groups however it fits their narrative. But one of the reasons I gave that talk on campus was that one of the questions I wanted people to ask is, “Do you tend towards thinking about politics in particular, in an extremist fashion? Do you base someone on what you find out about somebody's voting habits, judge them and judge their entire character based on that?”

Now, everybody has potentially had these thoughts at one point. That doesn't make you an extremist, but it's something that we need to be paying attention to — are you separating yourself out? Part of the problem is, once you start doing that, you reject any possibility that the other people have valid points. You have convinced yourself that your group, that your ideas are right and necessary and that everybody else's ideas are wrong and dangerous. That’s not a functional place to be if you want to have a democracy.

That's very much what I worry about. It has become normalized to think that way. We have politicians, we have pundits, we have average people on the street thinking that way and talking that way. We need to be aware that we're doing it. 

Melanie Plenda:

Recently, there was a violent scuffle involving a neo-Nazi group and peaceful protestors at the State House. How does freedom of speech fit into a democratic society?

Christina Cliff:

You have to have freedom of speech. Do you have to have the American version? Not necessarily. Freedom of speech is one thing. Fistfighting is another. That's not freedom of speech anymore. That's a physical altercation.

We give hate groups space because we can't come together and condemn the hate speech. Does anybody think that their giant flag and their masks and what should be embarrassing rental truck getaway — did anyone think that was cool? No, they don’t.

But there's a lot of people across this political spectrum that aren't willing to say, “You’ve got freedom of speech all day, but we're not going to tolerate and support and acknowledge that.”

We have a number of organizations in this state that do this kind of thing on a semi-regular basis. We've seen protests at drag story hours. We've seen protests on the street. We've seen banners hung from highway overpasses. It's to get attention.

There was a moment a few years ago dealing particularly with school shootings, called the “No Notoriety Movement” — don’t name them, don’t give them the air time, don’t give them attention. I feel like we’re missing that boat.


It's a polarization. Again, it's people literally feeling like they are right and everybody else is wrong. And not only are they right, but they need to defend and demand change that fits their narrative.

Melanie Plenda:

Dr. Cliff, Can a democracy survive without a shared sense of truth?

Christina Cliff:

Maybe. It’s not going to be a democracy that the vast majority of people want. It's more of an oligarchy, where whoever shouts the loudest and demands that their truth be right would be in charge, and then everybody that follows them would be — but you'd also see that rotate over time. You'd see that fluctuate. I

I do think this goes a little bit along with the polarization. We do have to come back to the realization that there are objective facts in the world. You may not like them, but they exist. I think misinformation and disinformation, accidentally or deliberately, spreading inaccuracies has become so prevalent that we don't take the time to pay attention to whether it exists. It’s helping fuel that there is no truth. 

There are objective truths. We're so bombarded with content that is either misconstrued or just false that we're having a hard time deciphering where that truth exists. That's really about people working on their information literacy, taking the time to take a look and research stuff. Again, we’re all very busy. We don't necessarily have all the time in the world, but if something's really important to you, take the time to make sure you know what it's about.

Melanie Plenda:

Lastly, what can Granite Staters do to help our democracy move forward?

Christina Cliff:

If you want to protest, protest. It's a public effort to draw attention to an issue that is important to you. Get out and try to rally support for your cause. But I do think, on a secondary level, think about how angry you want to be about politics. Do you want to be mad? Do you want to be furious? Do you want to push your kids, their friends away from politics so that we have a whole generation of people who are like, “Oh no, I saw how bad that gets,” and opt out? We already have a low young voter turnout rate.

Think about how you want to engage in politics and do you want to be angry. And the second part of that is — don’t take the easy way out and opt out. Pay attention, because otherwise you may end up in a system that you really, really don't like and isn't healthy for you. So you have to work at it. You have to be engaged, and you have to figure out if you really need to be angry.

Melanie Plenda:

Thank Dr. Christina Cliff for joining us today.

“The State We’re In” is a weekly digital public affairs show produced by NH PBS and The Marlin Fitzwater Center for Communication at Franklin Pierce University. It is shared with partners in the Granite State News Collaborative, of which both organizations are members. For more information, visit collaborativenh.org.

Doctors and patients see a care alternative in concierge medicine

New to N.H, direct primary care offers unhurried, personalized service for a monthly fee 

By Meera Mahadevan, Granite State News Collaborative

Primary care doctors,  feeling the weight of industry-wide changes,  say the pressure from outside forces – such as insurance companies and corporate ownership of hospitals and doctor practices – has forced them to see more patients in a shorter amount of time; spend a good chunk of their day talking to  patients’ insurers to get prior authorization; catch up with electronic medical records; and spend too much time on their electronic portals communicating with patients at the end of the day on their own personal time,  all in the name of their employer’s bottom line. 

Gone are the days when a family physician could spend extended time with their patient and get to know them on a deeper level. The steady shift away from that traditional model has drastically impacted and reduced a doctor’s own quality of life or even resulted in burnout.

“I felt like I couldn’t practice medicine the way I wanted to,” said Dr. Kelly Parker-Mello, a pediatrician in Portsmouth. “I couldn’t make the same impact I wanted to make. It was that hamster wheel all day long. Barely eating, I used my lunch to catch up. I take a lot of time with my patients. I’m really thorough. I wasn’t finishing my notes. I was running late with patients. I felt terrible for my next patient. It was this constant churning and then running out at 6:30 to see my kids. I only worked part time, but I had this constant feeling I was behind on my notes. I worked on my days off. As a mom, it felt horrible.”

Dr. Kelly Parker-Mello during a home visit. She started Tailored Pediatric Medicine, a concierge medicine provider in Portsmouth, because ‘I felt I couldn’t practice medicine the way I wanted to. I couldn’t make the same impact I wanted to make. It was that hamster wheel all day long.’ (Courtesy photo)

As a result, some doctors, including Parker-Mello, are turning to innovative ways to cut out insurers, and improve their own quality-of-life issues  and going directly to patients through a membership model of payment  known as concierge service or direct primary care. 

Proponents say that under this model, which is relatively new to New Hampshire, patients can have direct access to doctors at every visit, can see their doctor for a longer period of time than they would under a traditional model, and can get seen much sooner for appointments. Concierge medicine also provides the opportunity to develop strong patient-doctor relationships and offers what they say is transparent pricing. Some practices even offer home visits from the doctor for an added fee.

The rates of membership and the services they offer vary at various practices. For instance, at Dr. Parker-Mello’s practice, Tailored Pediatrics, the fee is $315 a month for patients who are newborn to 12 months. For ages three to 22, the fee is $179 a month. The fee is higher for the first year because infants require more frequent visits and more checkups. 

At Winding Brook Direct Primary Care in Wolfeboro, the monthly membership fee is $125 for those 55 and over and $75 for those 18 to 35. Add-on services, such as lab testing or joint injections, cost extra. The doctors say they always let the patient know ahead of time what the services will cost before they are charged.

To be sure, direct primary care doctors still encourage patients to have health insurance in case of hospitalizations or catastrophic illnesses, but opting for the new model can give patients the opportunity to return to the days when a doctor could really get to know a patient and give them the time it takes to treat them. Concierge doctors also say that the membership fee ends up being not much more than what patients might pay in co-pays and deductibles under a traditional insurance model. 

There are currently eight direct primary care practices in New Hampshire, according to the New England Primary Care Alliance, a regional association of concierge providers. In comparison, Maine has 46 such practices; there are none listed in Vermont.

“It has been the best decision I have ever made,” said Winding Brook’s Dr. Rebecca Owen, a primary care doctor who switched over to the concierge model after being employed by two hospital systems for several years. 

Her patients agree. 

Lewis Gurnari, 72, of Gilford, says he is glad he and his wife have chosen Dr. Owen as their primary care doctor after what he described as seeing a revolving door of practitioners after their primary care doctor retired five years ago.

“It’s all about the physician,” said Gurnari. “I don’t care what you call the service. ..  You need to have a physician who becomes your advocate and helps manage scenarios, all of it – - the specialists, the follow-ups, developments and interpreting it. She can define it for me and give me options.”

“It gives you an advocate,” Gurnari added. “It gives you accessibility at all levels, which you do not have in the current system. I can call her tomorrow and get it done. If I call my general practitioner, I’m three to four weeks out unless it’s a critical event. If she calls (for a CAT scan for example), I get moved to the top of the list. What you’re purchasing is accessibility.”

However, some analysts say concierge medicine runs the risk of excluding patients who may not be able to afford the membership costs and does not alleviate concerns over the workforce shortage in primary care.

Dr. Karl Dietrich, director of Dartmouth Health’s family residency program at Cheshire Medical Center in Keene, says the “challenge’ with concierge medicine “is that it is wonderful for a small set of folks, but it doesn’t solve the global issue and it doesn’t create more primary care for everybody. I want to both applaud the emphasis on provider wellness and people setting boundaries around what is reasonable expectation, but at the same time how can we make sure that we’re solving the global problem, because if every doctor moves to direct primary care panels, we are going to need a whole lot more (physicians) than we even need right now. So how can we continue to think about ensuring physician wellness and offer an equitable access to care that would put a family doctor in every community that needs one?”

This story is part of Critical Condition: What hospital consolidation means for care, access, and your community, a special series co-produced by partners in the Granite State News Collaborative. These stories are being shared by media outlets across New Hampshire. We want to hear from you! Take our short survey athttps://tinyurl.com/3au39uctabout your healthcare experiences. For more information, visitcollaborativenh.org.

Are primary care doctors becoming a vanishing breed in New Hampshire?

It’s getting harder for patients to find a doctor as wait times and access barriers grow amid a shortage, other challenges 

By Meera Madadevan, Granite State News Collaborative

About three years ago, Loren Selig, a Durham resident and mother of two college-aged daughters, went from having one family physician for her, her husband and their kids since the time their children were born to receiving medical care from nurse practitioners. The change happened after their doctor’s practice got purchased.

Kylee Rock, 23, moved to Dover from Tilton a few years ago. She is so afraid of not being able to find a local primary care doctor – given negative stories she has heard -- that she still drives an hour to see her doctor in Concord, even though she works full-time and finds it hard to do so.

Rachel Legard, a 63-year-old Lee resident, routinely jots down names of highly recommended primary care doctors whenever she hears about one from friends because, as her own doctor nears retirement age, she too is afraid she’ll be stuck without a doctor soon.

All three are trying to adjust to an acute shortage of primary care doctors that lingers on in New Hampshire and nationally. Some say it is reaching a crisis point.

“We used a family practitioner from when our kids were babies rather than a separate pediatrician,” said Selig. “We had one doctor for all of us, and it was a model we really liked, but our doctor’s practice got swallowed up by [Beth Israeli Lahey-owned] Core Physicians, and the level of personal care we noticed changed at that point, from having one where they would take their time with us to ‘You’ve got 15 minutes’ kind of thing. … It’s been challenging on all sorts of levels.”

Interviews with about a dozen patients reveal nervousness and frustration over not being able to find a doctor who not only is accepting new patients but also over experiencing long wait times to get an appointment. Some patients likened the primary care doctor to the role of the wizard from the Wizard of Oz. “You know he’s there, but you never see him,” said Holly Breton of Rochester.

Access to a doctor is just part of the problem. Primary care doctors themselves are under enormous pressure to see more patients in a shorter time, face mounting administrative burdens, and are paid far less in reimbursements than their specialist counterparts. As a result, some are choosing to leave the field altogether or are turning to innovative ways of bypassing insurers and offering annual memberships to patients much like a gym membership. 

“Things were a lot simpler back then,” said Dr. Sangita Agarwal, a family physician who works in Seabrook and has been a family doctor for 30 years. “It was easy to submit to insurance companies because there were only a handful of insurers back then. We felt we could concentrate more on our practice and our patients. … Now, we are practicing medicine with prior authorizations which have taken on a life of their own.”

She says she now has to contact the insurance company on behalf of her patients to get such tests as a CAT scan or medications approved. While she says she is usually successful in getting them approved, it is time-consuming. “It just makes day-to-day life more onerous. It’s not helping, and it’s an injustice for the patients.”

Industry experts also say an increased number of hospital consolidations in New Hampshire have placed pressure on hospitals to boost their investments on higher-margin specialties, such as oncology and cardiology, rather than invest in primary care. Analysts also worry that drastic federal budget cuts targeting Medicaid and the Affordable Care Act will further impede focus on primary care and prevention. 

A crucial lifeline for patients

A shortage of primary care doctors – amid an overall physician shortage – has been brewing for several years, and the trend does not seem to be easing up. What is new is that the shortage is being exacerbated as health care consolidation intensifies in New Hampshire and corporate ownership of physician practices rises.

In fact, to adequately meet health care needs, New Hampshire will need an additional 333 so-called primary care physicians by 2030 – a 29 percent increase from 2010, when there were 110 so-called PCPs, according to data from the Robert Graham Center for Policy Studies, a primary care research arm of the American Academy of Family Physicians. New Hampshire’s PCP ratio is one doctor per 1,247 people, which is lower than the national average of one doctor per 1,463 people, according to the same report. 

 But compared to the rest of New England, New Hampshire appears to have the greatest need for primary care doctors. The Graham Center report projects that Vermont needs an additional 119 primary care physicians by 2030, a 19 percent increase from 2010. Maine needs an additional 120 PCPs, a 9 percent increase. Massachusetts needs 725 PCPs, a 12 percent increase. Rhode Island needs 99 PCPs, an 11 percent increase. And Connecticut needs 404 PCPs, a 15 percent increase.

While the N.H. Department of Health and Human Services acknowledges the shortage of primary care doctors, it says that the state ranks fifth in the nation when it comes to the number of primary care providers per 100,000 people (a number that includes doctors and other primary care providers, such as nurse practitioners and physician assistants), according to a a study by United Health Foundation, an arm of United Health Group, the nation’s largest health insurer. The state also points to an increasing number of nurse practitioners and physician assistants in the state who are authorized to prescribe medicine and see patients in lieu of a primary care doctor. 

Citing 2022 numbers, the 2024 Annual Report on the NH Health Care Workforce and Data Collection  said the number of physicians in the state grew by a modest 5.5 percent while the number of nurse practitioners grew by 42 percent and physician assistants grew by 16.6 percent. 

Primary care physicians – defined broadly as family physicians, pediatricians, geriatricians and general practitioners – are often the first point of contact and a crucial lifeline for patients. They play an integral role in not only diagnosing and helping to manage illnesses like heart disease, hypertension, diabetes and asthma, but also provide preventive care with routine checkups, risk assessments, screening tests and helping patients maintain an overall healthy lifestyle. They are also often a patient’s link to getting referrals and coordinating care with specialist doctors, who also often have long wait periods for appointments.

“The fact of the matter is that when there’s a primary care doctor in a ZIP code, the life expectancy of the people in that ZIP code increases,” said Dr. Maria Ramas, a family physician and a medical consultant. She is also a member of the state’s Healthcare Consumer Protection Advisory Commission that was recently created to assess the impact of hospital consolidations in New Hampshire. “The presence of a primary care doctor is very important.”

Despite their vital role, primary care physicians are among the lowest paid doctors in the industry. Experts say that needs to change.

“I think there’s a movement to try and figure out how to better compensate for primary care, because we really undervalue and under-invest in primary care,” said Lucy Hodder, director of the Health and Life Sciences Law and Policy programs at the University of New Hampshire’s law school.  “We just pay them peanuts compared to what we pay specialists because of the way we reimburse physician services with RVUs.”

RVU, or relative value unit, is a system used to measure and value the time, effort, complexity of a procedure and expertise required to provide a specific medical service. Government programs such as Medicare and private insurers use RVUs to determine physician reimbursement. They can also be used to track physician productivity and efficiency.

Adding to the complexity of the physician shortage and woeful reimbursement is New Hampshire’s health care landscape, which is changing dramatically, due to mergers and acquisitions sweeping the industry as larger hospital systems, insurers and private equity firms buy up physician practices. 

“If there is a change in ownership, there may be a change in mission and a change in support to reimburse and compensate and invest in primary care, mental health, substance abuse, eldercare, etc,” Hodder said. “We have a real shortage on all of those, and you may see practices that are hospital-owned focusing on higher-end surgeries, cardiac services, inpatient ICU care, oncology, orthopedics. None of that is primary care, so I think that’s why when there’s a hospital merger, there’s a real question about to what extent is there a commitment to invest in primary care.”

In 2024, the percentage of doctors nationwide who were in private practice dropped to 42.1 percent from 60.1 percent in 2012, according to the American Medical Association’s most recent Physician Practice Benchmark Physician Practice Benchmark Survey This means that around 80,000 fewer doctors were in private practice in 2024 than in 2012, growth of the physician population notwithstanding, the association said.

The share of doctors employed at hospital-owned practices increased to 34.5 percent in 2024 from 23.4 percent in 2012. Doctors in the survey cited a need to better negotiate higher payment rates with insurance companies and to lessen costly resources as the top two reasons for no longer owning their own practices.

Even Amazon is seizing on the opportunity with its One Medical platform, which allows anyone with a Prime membership to opt to pay $99 a year or $9 a month, and receive “24/7 On Demand Care” by being able to chat by video or message with a provider for more than 40 common conditions, such as a cold, stomach bug and yeast infections. It also offers the option to schedule next-day appointments with a nurse practitioner, physician assistant, or even a medical doctor in major cities such as Boston, Atlanta, and about 20 other metropolitan areas.

Reasons abound

Experts cite several reasons for the increased demand for and shortage of primary care doctors. Topping the list is New Hampshire’s aging population, which often requires more health care. It is aging faster than nearly every other state, and that shift is already influencing not only health care but also housing issues, according to the NH Fiscal Policy Institute.

As the general population ages, so are primary care doctors themselves. Many are nearing retirement age, and there is concern that there are not enough medical students and residents in the pipeline to replace them. 

There has also been an increase in the number of people with health insurance, due to the Affordable Care Act, which has increased demand. But that could change with current federal budget cuts. 

Shown are annual average salaries by medical specialty for physicians in the U.S. (White Coat Investor)

In addition, doctors say reimbursement rates for primary care from insurance companies are dismal, especially compared to rates for higher-end specialties. Many of them, already burned out from the Covid-19 epidemic, are under pressure from insurers to see more patients in a shorter amount of time and choose to leave medicine altogether. And, because it’s not financially lucrative, fewer medical students and residents are opting for primary care, reducing the pool of doctors in the pipeline. 

Possible solutions 

What are state policymakers doing to help alleviate the primary care workforce shortage? Experts say some steps have been taken, but not enough.

In 2010, lawmakers established an ongoing commission called the Interdisciplinary Primary Care Workforce to help assess and recommend policies and programs to strengthen the number of providers serving the state’s rural areas. The 20-member commission – made up of a broad coalition of lawmakers, state officials, a doctor, nurses, a pharmacist and a dental society representative, among others – continues to meet monthly.

According to a 2021 Primary Care Needs Assessment report published by the state Department of Health and Human Services, the state legislative commission said it is prioritizing efforts to create a clinical placement program, a rural residency track and getting additional funding for the State Loan Repayment Program. It is not clear whether the state has made any progress with these initiatives.

The State Loan Repayment Program, which secured $300,000 in 2024, provides funds to health care professionals working in areas of the state designated as medically under-served and who are willing to commit to working a minimum of three years there. However, funding for the program is at the mercy of lawmakers and annual state budget approvals. 

The state also created a Health Professions Data Center to collect data on how many primary care providers actually work in the state. As of 2019, all health care providers – doctors, physician assistants, nurse practitioners and clinical social workers, among others – who apply to renew their medical license with the state’s professional licensing board are required to complete a survey to help the state identify areas of need in the primary care workforce.

“The 2022 data points to an anticipated decline in the primary care physician workforce, especially in rural communities,” the Primary Care Needs Assessment concluded. “Despite these physician workforce challenges, the APRN (nurse practitioners) and PA (physician assistant) workforce demonstrate continued growth and primary care reinforcement.”

That logic, however, falls on deaf ears, for patients who want the expertise and training of a medical doctor.

“I’m not saying nurse practitioners don’t know what they’re doing, but it does seem there’s a level of training I’m not getting if I see a nurse practitioner,” said Ruth Sample, a Lee resident and an associate professor of philosophy at UNH whose family had the same family practitioner for about 15 years and now has been switched to a nurse practitioner. So far it’s been OK because I’m not a sick person, but I don’t have the same level of confidence.” 

She added: “I don’t know what this all means. If doctors retire, is this just how primary care is going to be?”

Hodder, the health policy expert at UNH’s Franklin Pierce School of Law, said nurse practitioners and physician assistants play a vital role in primary care, but “there is no possible way that a nurse practitioner can replace the need for internists and family practice physicians who’ve been trained in medical school,” Hodder said. “But good nurse practitioners who are well-trained and experienced in primary care will certainly help improve access. I think it needs to be a really careful and carefully planned reliance.”

Meanwhile, experts and patients worry that focus has shifted away from prevention and more on high-margin health care services. 

“The question is how are people going to afford the preventative care if we just end up making it more and more expensive,” said Hodder. “If the average working person is not able to get in to see their physician or are burdened with medical bills and not going to get the care, then we’re going to continue to support a system that focuses on specialty bells and whistles and acute specialty care and not prevention.”

And prevention begins with primary care. 

This story is part of Critical Condition: What hospital consolidation means for care, access, and your community, a special series co-produced by partners in the Granite State News Collaborative. These stories are being shared by media outlets across New Hampshire. We want to hear from you! Take our short survey athttps://tinyurl.com/3au39uctabout your healthcare experiences. For more information, visitcollaborativenh.org.