Hospital consolidation threatens New Hampshire’s health care safety net

Mergers can affect funding, staffing and patient populations at state’s federally qualified community health centers

By Kelly Burch-Granite State News Collaborative

Since Catholic Medical Center in Manchester was purchased by the national for-profit HCA Healthcare in February, Manchester’s low-income patients have faced some uncertainty. 

In the past, patients seen at Amoskeag Health, Manchester’s community health center, could get approved for reduced copays based on their income. Catholic Medical Center would honor those reduced copays, removing a hassle and streamlining patients’ access to affordable care at the hospital, said Kris McCracken, president and CEO at Amoskeag Health. 

Since the merger, the use of that program has been paused.

“I hope we can establish a similar arrangement with HCA … [but] I haven’t even met with them yet,” said McCracken. “You’ve got to rebuild that relationship.”

That’s just one example of the way that hospital mergers around the state are affecting New Hampshire’s 11 federally qualified community health centers. They are seen as the safety net of the health care system, providing primary care to everyone, regardless of their ability to pay. The centers are funded primarily by federal grants and Medicaid reimbursements, but also rely on community benefit grants from local hospitals — some of which disappear after a merger occurs, FQHC leaders say. 

In addition to affecting the grants, hospital mergers can lead to higher employment costs for the health centers, create a higher proportion of patients who are unable to pay (since for-profit organizations can decline to provide care for those people) and erode a sense of community cooperation between hospitals and the centers. 

“As some of these mergers occur, it feels like the senior leadership gets a little further away from the community,” said Gregory White, CEO of Lamprey Health Center, a federally qualified health center with locations in Nashua, Newmarket and Raymond. “Sometimes when that happens, instead of doing things with you, [things] happen to you.”

While the challenges are real, leaders of the health centers also emphasize that, with work, there can be functional and cooperative relationships with larger hospital systems. 

“Just because they’re a big health care system doesn’t mean they’re not a good partner,” McCracken said. 

Loss of local control and local grants

One of the touchiest subjects when it comes to hospital mergers and federally qualified health centers involves community benefit grants. These grants are provided by hospitals to serve a specific community need. They also are a way of acknowledging the role that the community health centers play in the health care system, McCracken said. 

If a community has two or three private practices, often linked to larger health care systems, the local community health center is “kind of taking the leftovers,” she said — patients who are uninsured or unable to pay for care. For the community health centers, there’s often no balance between paying patients and charitable care, she said. 

“You’re the safety net for the folks who are the neediest in the community,” she said. 

While that’s the role of the health centers, McCracken said, it requires support from the hospital systems that are benefiting from serving more profitable patients. 

“We’re here to be the safety net … but if all we have is safety net patients, that means we need more community investment,” she said. 

Amoskeag Health never received a community benefit grant from Catholic Medical Center, due to the hospital’s religious guidelines, and doesn’t anticipate receiving one from HCA, McCracken said. Amoskeag Health does receive grants from Dartmouth Health and Elliot Health System, which also gives a grant to Lamprey Health. 

In the past, however, when hospitals have gone through mergers, “it felt like we lost touch with them,” and community benefit grants have gone away, White said. He, like many community health center leaders who spoke to the Granite State News Collaborative, declined to elaborate; some of them expressed concern about jeopardizing their relationship with hospitals, and thus access to future grants. 

Changing patient populations and cost concerns

Ed Shanshala, CEO of Ammonoosuc Community Health Services Inc., has concerns about larger hospital organizations, especially for-profit companies, buying into the New Hampshire health care system. The ethical obligations to patients and legal obligations to shareholders are too difficult to balance, he said. 

Ammonoosuc Community Health Services Inc. has locations in Littleton, Warren, Whitefield and Woodsville. The organization recently announced its Franconia location will close soon because of funding concerns. 

Jillian Peabody of Amoskeag Health with a patient. Low-income patients at the federally qualified health center in Manchester have faced uncertainty about their health care since the for-profit HCA Healthcare’s acquisition of Catholic Medical Center. (Courtesy of Amoskeag Health)

If for-profit hospitals are "going to carve out the most beneficial and profitable [patients], those of us who serve the collective are going to be left unable to serve the most vulnerable population,” Shanshala said. 

Mergers can also affect where patients choose to receive care, and the services they have access to, said Robert MacLeod, CEO of Mid-State Health Center in Plymouth.

“We sometimes see increased costs and fewer choices, especially when systems prioritize keeping patients within their own network,” he said. “That can limit our ability to refer to the most appropriate or affordable specialty care, and in some cases, services like maternity care or certain specialties may be reduced based on financial pressures.”

MacLeod has another concern: that the buying power of large hospital systems could ultimately exclude federally qualified health centers from working with certain insurers. 

“As larger systems gain more negotiating power with payers,” he said, federally qualified health centers “may find it harder to compete or collaborate under the same terms. We may face tighter reimbursement rates or be excluded from certain payer networks, even when we offer high-quality, cost-effective care.”

Shanshala is likewise skeptical of the widespread claims from hospital systems that mergers reduce costs. 

“Although there’s been a promise of efficiencies through aggregation of health care, it’s not clear they’ve ever delivered on economies of scale, delivering on a lower price point for patients,” he said. “I’ve personally never experienced lower prices.”

Personnel costs are a massive burden for federally qualified health centers, taking up about three-quarters of operating budgets. Large health systems can make things even worse.

“With consolidation, especially very large players like Mass General, there’s pressure on salaries that we just can’t compete with,” said White. (Boston-based Massachusetts General Hospital acquired Dover’s Wentworth-Douglass Hospital in 2017.)

McCracken used an analogy: If federally qualified health centers are kayaks on a bay, large health care systems are like giant ocean liners, throwing such a wake that the kayaks are often rocked. 

“It’s not that they’re trying to do anything to any of us,” she said, “but their presence is so overwhelming in the health care space.”

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

Amid a ‘proliferation in services,’ N.H. lacks a thorough way to track health care industry’s growth

After scrapping its Certificate of Need Board, state has no ‘window’ into what drives ever-rising costs

By Paul Cuno-Booth-Granite State News Collaborative

Over the past decade, larger health systems — many based out of state —  have snapped up community hospitals in New Hampshire, touting flashy new investments, even as some residents voice concerns about other services being cut. 

Regional hospital groups have formed, and split up. Urgent care clinics, outpatient surgical centers and other independent facilities have proliferated. 

When the Certificate of Need Board was scrapped in 2016, New Hampshire also lost a key source of transparency into the state’s health care market, says Lucy Hodder, a professor at the University of New Hampshire Franklin Pierce School of Law who focuses on health law and policy. (Franklin Pierce School of Law photo)

What does all that mean for patients, employers and their ever-growing health care costs? It’s hard to say — because no one is really keeping tabs in a systematic way, some New Hampshire health care experts said.

“We have seen a proliferation of services that no one is even tracking,” said Lucy Hodder, a professor at the University of New Hampshire Franklin Pierce School of Law who focuses on health law and policy. “That results in duplication, high cost, patient frustration. We see investment in services that aren’t needed as opposed to those that are. We lack any real look into the future as to how we want to use our health care resources.”

Hodder and others say that lack of transparency hinders efforts to figure out how to preserve access to essential health services while controlling costs, which remain a major concern. In a 2024 survey from New Futures, a health policy organization, more than two-thirds of Granite Staters said they’d recently put off going to the doctor, skimped on medication or otherwise delayed or skipped medical care because of cost.

New Hampshire used to track the growth of health care services more closely, through a regulatory body known as the Certificate of Need Board, which reviewed proposed capital investments by hospitals and other providers.

Most agreed that the board process was flawed, and critics said it failed in its primary mission of containing costs, because it quashed competition from new market entrants that could offer care at lower prices. The Legislature dissolved the board in 2016.

Hodder agreed the Certificate of Need Board had issues — but, by scrapping it, New Hampshire also lost a key source of transparency into the state’s health care market

As part of its work, the board tracked metrics on everything from MRI machines to open heart surgeries, shedding light on where those services were located, whether they were enough to meet the community’s needs, how affordable they were, what wait times looked like, and whether services were being duplicated in a way that could drive up costs.

Today, no one is tracking that data in a coordinated way, she said. She worries the result has been a “clandestine arms race,” as large health systems try to stay afloat by investing in the most lucrative services, regardless of need.

“Our entire economy is reliant on accessible and affordable health care, and this [board] provided a window into whether we have it and what it looks like in New Hampshire,” Hodder said. “And we don’t do that anymore.”

‘It prevented competition’

The idea of requiring health care providers to obtain a “certificate of need” to justify major construction projects or service expansions stems in part from the work of a pioneering Dartmouth College researcher, Dr. Jack Wennberg. Wennberg found the supply of health care resources in an area — such as having more hospital beds — could lead to higher utilization, and therefore higher costs, without necessarily producing better outcomes. 

By the early 1980s, spurred by since-repealed federal requirements, nearly every state had a certificate of need process. But it’s questionable whether they had the intended effect, and more than a dozen states have since repealed their certificate of need laws. 

A systematic review published in 2020 in the journal BMC Health Services Research found the evidence is mixed on whether certificate of need laws reduce health care spending, but the costs — including the potential to restrain competition — generally outweigh the benefits.

In 2010, a legislative study committee concluded that New Hampshire’s certificate of need process was flawed in various ways. The dominance of large health care providers on the board created conflicts of interest, and loopholes sometimes allowed them to evade review, and there was no consistent consumer advocate voice. The report also found the board’s support staff was underfunded, and it lacked a larger plan for improving affordability and access.

The committee recommended replacing the board with a more robust, independent body. Lawmakers instead voted in 2012 to sunset the board four years later.

Nick Vailas, a health care entrepreneur and former state health and human services commissioner, says the Certificate of Need Board — which he at one point served on — ‘prevented competition.’ (Screenshot)

Nick Vailas, founder and CEO of the Bedford Ambulatory Surgical Center and a former state health and human services commissioner, cheered that decision. He had been appointed to the board, he said, for an unusual reason — the governor at the time wanted his help getting rid of it.

Vailas described the board as beholden to hospital interests that had an incentive to keep out lower-priced competitors. He experienced that firsthand, when HCA Healthcare — the country’s largest for-profit health system and parent company of Portsmouth Regional Hospital — fought his plans to open a freestanding surgical center in the area. The case eventually made it to the  state Supreme Court, where Vailas prevailed.

“It prevented competition, which we all know is a natural check and balance for keeping prices in check,” he said.

He credits the board’s repeal with ushering in a wave of imaging centers, labs and other independent facilities that offer patients lower-cost options. 

“You want the high-quality, highest-valued providers to survive,” he said. “So we need more free market in health care.” 

The problem, Vailas said, is there’s too little transparency about prices, so consumers have a hard time making informed decisions about which providers offer the best care for the lowest price. It’s something he’s trying to address through a private company he started, Delphi.

“Could we do better health planning and reviewing? Absolutely. It’s all based upon data collection,” he said. “Then what do you do with data? I don’t believe the government is sophisticated enough at this point to do that, and nor do I believe it’s absolutely necessary.”  

Bearing the brunt of rising costs

Without a body like the Certificate of Need Board, no one’s taking a hard look at how the growth of health care services is affecting costs in New Hampshire, says N.H. Sen. Cindy Rosenwald, D-Nashua. (Courtesy photo)

State Sen. Cindy Rosenwald, a Nashua Democrat who sat on the 2010 legislative study committee, said she thought the board should have been overhauled rather than scrapped. Without it, she said, no one’s taking a hard look at how the growth of health care services is affecting costs. 

“As a result, any hospital that wants to start doing X, if they can make their own business case for it, they’re free to do it,” Rosenwald said.

‘’We can have it all — but then we can’t keep saying, well, why is health care so expensive?’ says Maria Proulx, president of Anthem Blue Cross Blue Shield in New Hampshire, who served on the Certificate of Need Board briefly before it was disbanded in 2016. (Courtesy photo)

To Maria Proulx, president of Anthem Blue Cross Blue Shield in New Hampshire, the question is not whether the Certificate of Need Board was good or bad. It’s whether the state is addressing the questions it was set up to address — such as what services are actually needed and what’s unnecessarily inflating costs. 

“We can have it all — but then we can’t keep saying, ‘Well, why is health care so expensive?’” said Proulx, who served on the board briefly before it was disbanded.

For example, she said, it might be nice to have a lab every 5 miles, or a large array of services at every local hospital. But “in health care, convenience can be very expensive.”

The Certificate of Need Board may or may not have been the right way to wrestle with those tough questions of need versus convenience, she said — often, the market can sort those things out. What’s important is that those discussions happen. Otherwise, employers and patients will continue to bear the brunt of rising costs.

“Sometimes I feel like I can only get the attention of people when there’s a crisis, or when a hospital merger is proposed, then it’s like everybody cares,” she said. “But then it happens, and we all go on, and we sort of lose sight of it again until another big event happens.”

Hodder said the state’s launch of a new Health Care Consumer Protection Advisory Commission is a step in the right direction. That commission was set up by the New Hampshire attorney general’s office, with a mission to better understand the state’s health care market and how to make it work better for consumers. The commission recently announced it is funding a new center at the University of New Hampshire to study those issues.

“The attorney general decided, as it was reviewing bigger and bigger mergers and hospital consolidation, that it needed to fund an entity to look at the impact,” she said.

At the same time, she expressed concern about the recent elimination of the Prescription Drug Affordability Board in the recently approved state budget. It was formed in 2020 to look at the drivers of high drug costs and recommend ways the state can save money. 

Rosenwald sees that as a “missed opportunity” to control costs for taxpayers and, ultimately, patients.

“That is the only entity in the state that’s actually taking a comprehensive look at what the taxpayer dollars are paying for prescription drugs,” she said of the affordability board. “And that’s a significant driver in cost.”

Hodder said she wants state officials to declare that affordable and accessible health care is a priority, and set goals. 

“There are a lot of hidden incentives in health care,” she said. “The patients right now are left holding the bag.”

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

‘Critical Condition’: How has consolidation affected N.H. hospitals and patients?

The Granite State News Collaborative and its partners have undertaken a new series that explores who owns the hospital in your area, how that impacts your health and what kind of care hospitals offer. In addition to hosting “The State We’re In,” Melanie Plenda also serves as executive director of the Granite State News Collaborative, a group of more than 20 news organizations covering every corner of New Hampshire that tells stories that matter. The collaborative and its partners have been working on a new series, called “Critical Condition,” and it looks at the state’s hospitals, exploring how financial conditions impact the care we receive. Here to talk about the series is collaborative editor Jeff Feingold. 

This article has been edited for length and clarity.

By Rosemary Ford and Caitlin Agnew

Melanie Plenda:

Jeff, tell our audience about the series and what it will take a look at. 

Jeff Feingold:

It started with what's been going on in New Hampshire and all around the country actually — consolidation. In New Hampshire, larger hospital systems have been buying up hospitals over the last 20 years, but even more recently it's been more concentrated.

There used to be 26 independently owned acute care hospitals in New Hampshire, and now there are only five that are not affiliated. The rest are owned by Dartmouth Hitchcock, which has five other hospitals besides Dartmouth Hitchcock Medical Center,  and HCA Healthcare, which is a giant for-profit corporation that owns hundreds and hundreds of hospitals and other health facilities around the country. They own four hospitals in New Hampshire. Other hospitals are owned by Beth Israel in Beth Israel Leahy and Mass General as well as Concord Hospital, which owns Laconia, which previously bought Franklin Hospital. So we're in that situation now where there's just more and more concentration of ownership of hospitals.

Melanie Plenda:

Why does it matter who owns a hospital? Or how many hospitals are owned by the same parent company? 

Jeff Feingold:

There's a reason that these hospitals are merging. There have been financial problems in healthcare, as I'm sure all the viewers out there understand. The costs involved in health care have gone through the roof, and many hospitals can't really make it on their own anymore. So they find buyers, or buyers find them, and that's why there's consolidation. The consolidation allows them to streamline their services and look for more efficiencies with the goal of lowering costs and things like that. The issue in some cases, the owners are also making decisions to eliminate services at the hospital that they've acquired. 

A perfect example is what happened in Rochester with Frisbie Hospital, which was being acquired by HCA. What they did was, after two years, eliminate labor and delivery services. That means that all those patients in need of labor and delivery services or another service that was eliminated have to travel to Portsmouth, which also happens to be an HCA hospital, or another hospital and find a new doctor. They also might have transportation issues, cost issues, because the hospital that they were used to is no longer offering the same services or the services that they require. That can make a big difference in a patient's life.

Melanie Plenda:

How has New Hampshire been affected by these hospital consolidations already? 

Jeff Feingold: 

That is what the project is about. There was a piece in The Boston Globe not too long ago about how EMTs and other first responders are being trained in labor and delivery techniques up in the North Country, because there's no obstetric care there. As we know, New Hampshire is infamous for having an inadequate transportation system, so it's really difficult for someone who has a lower income, who doesn't have a car, is elderly or is a disabled person to obtain services when a hospital no longer provides those services that they used.

Melanie Plenda:

What does this mean for those seeking health care in the state?

Jeff Feingold:

It's making it more difficult. It also is making it more expensive, because what happens is that when a service is more concentrated in an area, the prices will go up. That's one of the major concerns of people who watch hospital consolidation trends — the cost of health care — and it is continuing to rise even with these supposed synergies, as they say in the business world, the streamlining of these efficiencies. 

Another concern is that insurance rates might also rise, because as these hospitals gain more power with the hospital systems they can negotiate rates differently than other hospitals with the insurance companies, and that means it's very hard to just keep track of that kind of stuff.

Melanie Plenda:

What role does the state government play in all this? 

Jeff Feingold:

That is a major piece in our series. The initial story was written by Meera Mahadevan on how this whole consolidation thing works. It is an excellent piece — I recommend everybody to read it. 

What she found is that one of the things we just don't know enough about is this hospital consolidation phenomenon because the state basically doesn't track this stuff. We used to have a process called a certificate of need process, and we had a Certificate of Need Board, which would approve all major acquisitions of technology, the big-high priced items, expansions and additions to hospitals. But back in 2016, the state eliminated it saying there were issues with the certificate of need process. 

But what happened is the state no longer has an entity that keeps track of all that’s going on. What that has left us with is basically all the oversight of health care systems is provided by the attorney general, John Formella. 

Melanie Plenda:

How is recent news impacting the series — or is it? For example, the recent cuts to Medicaid.

Jeff Feingold:

Unfortunately, New Hampshire hospitals rely on Medicaid funding because that's a steady flow of income. It's not as much money as they would get from a patient that has commercial insurance or can pay out of pocket, but it's still a steady flow of money. 

With Medicaid cuts, that flow of money will be lower, and that'll affect hospital finances once again. What would happen is it may risk putting another hospital in the kind of position where it has to be acquired — or the worst case would be if it has to close — because they don’t have an adequate stream of income. I'd say it's another pitfall for hospital financial people to get through. It's not a good thing. It's a stream of income that is going to be lower, and that's not what the hospitals need right now, especially hospitals on shaky ground.

Melanie Plenda:

What stories have been done so far? What’s coming next? 

Jeff Feingold:

The stories that have been done so far are the piece by Meera, and a second piece on the Health Care Consumer Protection Advisory Commission. She did a really thorough look at that, and that actually inspired us to do future stories, such as what's the deal with primary care in New Hampshire? Because a lot of primary care practices have shut down or there's just not enough primary care physicians in New Hampshire to provide for people to make appointments. She's  also looking at the state of primary care in New Hampshire and what is basically happening with labor and delivery and other services as they are being cut. 

Another piece that's coming up is an article by Paul Cuno Booth, formerly of New Hampshire Public Radio. We're lucky to have him working with us now. He's writing about the demise of that Certificate of Need Board, and, more specifically, what's going on with oversight. How is New Hampshire going to be able to get this information?

Another piece that we're working on is on the role of urgent care facilities, which is really interesting because it turns out because of this shortage of primary care physicians, people are going to urgent care, or they're even encouraged to go to urgent care, for what they used to go to for primary care support. That's a really interesting topic all by itself.

Melanie Plenda:

How can people follow these stories?

Well, they can certainly go to our website and check out our Critical Conditions page. But many of our partners are picking these stories up. I would encourage them to look there because I know that several of them pick up everything we've been writing on this, and just judging by the interest in these they're really eager to publish our work. 

It's a story that affects a lot of people. A lot of people are interested and I think that we're coming up with some great information that people will be happy to find out about.

Melanie Plenda:

Interesting! Jeff Feingold, editor with the Granite State News Collaborative, 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.

The state of mental health care amid an effort to end ER boarding

In 2023, the N.H, Department of Health and Human Services launched Mission Zero, promising to eliminate emergency department boarding — the practice of holding admitted patients in the ER while they wait for an inpatient bed to become available — by March of this year. Because of those practices, patients requiring care for mental illness often go to hospitals, with their experience resulting in hours, days and even weeks awaiting an inpatient bed. Have New Hampshire hospitals been able to fulfill this tall order of eliminating boarding? To discuss that are Lisa Madden, president and CEO of Riverbend Community Mental Health and vice president of behavioral health for Concord Hospital, and Susan Stearns, executive director of NAMI New Hampshire, the National Alliance on Mental Illness.

This article has been edited for length and clarity.

By Rosemary Ford and Caitlin Agnew

Melanie Plenda:

Lisa, to start us off, could you please tell us who is affected by emergency department boarding?

Lisa Madden:

What we have historically encountered is folks that are in the midst of a psychiatric crisis who come to the emergency department looking for some acute level of help. There haven’t been sufficient resources in the community to serve them, so they've been waiting in the ED for extended periods of time.

This had to do with not having sufficient number of beds to be able to meet the demand, but it also had to do with making sure we had the right community support programs to try to have places where people could go after they received the acute level of care they needed in the hospital and could be supported in the community. These are folks that are really dealing with an acute crisis and need a higher level of care, as would anyone else going to an emergency room for a medical condition that needed that level.

Melanie Plenda:

Susan, one of the reasons people go to NAMI NH is to get support, including support for ED boarding. As someone who has heard personal stories related to boarding, what are people going through in these situations?

Susan Stearns:

There are 26 critical access hospitals across the state, so I will give you a sense, but it isn't specific to any one hospital, and it's going to vary slightly from hospital to hospital.

The really common themes we hear are individuals who are considered to be at some risk to themselves or others, are there involuntarily so they're not able to leave, unlike you or I. They report having their personal belongings for safety removed from them. The very lucky ones have a television in the room where they're waiting, usually behind Plexiglass, but that isn't standard. I've heard from folks who tell stories of how a security guard actually proved to be their lifeline during an extended stay in the emergency department, because that security guard talked to them about movies that they liked in common. So we hear a lot of these real challenging stories. 

Another really common theme is the inability to choose, like when you might take a shower and practice your own basic hygiene — things that most of us don't think about when we think about someone who may be spending an excessive time waiting in an emergency department. These are folks who have really very limited things to pay attention to. We do hear from parents of kiddos who report restraints being used sometimes, and we certainly hear about that from adults as well. So these are experiences no one would want to go through. And I would say that our hospitals would agree — these are not experiences anyone wants to go through or watch your loved one go through, and that's why we’ve had so many folks being willing to try and make New Hampshire a real leader in reducing and eliminating this problem.

Melanie Plenda:

Lisa, as president and CEO of Riverbend Community Mental Health, can you please tell us more about what community mental health centers and certified community behavioral health clinics offer in New Hampshire?

Lisa Madden:

Community mental health centers are designated centers within regions of the state, and the catchment areas are designed by the state. I can speak to Concord, which is Region 4. We have nine other designated areas throughout New Hampshire. We provide the state-supported services for people who are acutely ill, for young people or adults — and that means people who are living with severe and persistent mental illness or severe emotional disturbance.

Our system of care is comprehensive. So not only are we able to do therapy, be it individual, group, family, couples, work, but we are also able to provide extensive case management and community support services, often referred to as functional support services. That's where folks can actually go into the community with the folks we work with and help them achieve the goals they need to be able to stay living in the community.

For young people, it means we're heavily involved in schools. We also have services for adults in which we help them get some employment through our supported employment program, and we have lots of different group activities to try and help people learn how to successfully manage their symptoms and stay in the community. 

We have everything from education and teaching people about mental illness all the way up to residential programming, where we, in fact, are part of the network of support for people who need to live in structured housing, and all the treatment in between. 

Melanie Plenda:

If people don't need as much help as what is offered at a hospital, a community mental health center or a certified community behavioral health clinic, what is available to them, Susan?

Susan Stearns:

Our community mental health centers offer a broad array of services, but if someone's in a crisis, there’s the 988 crisis system and our Rapid Response System. That is a resource that is available for everyone and can provide you with access. So it's a critical resource. 

We have crisis stabilization units in our state. Those are also available for folks who might need to not be alone but haven't reached that point where they really need to be under the supervision that you might see in an emergency department. We also have some places in our state where we have peer respite available that are run by peer support agencies. There are a number of alternatives for folks if they aren't meeting that level of acuity that they absolutely need to be in an emergency department. 

We don't think it should be a one-size-fits-all model. There should be multiple ways to access the care you need. NAMI New Hampshire offers various support groups. Our peer support agencies are wonderful resources in the community. We want to make sure, again, that folks are able to access support they need, but absolutely get that clinical care that our community mental health centers and now certified community behavioral health clinics are truly the experts in providing. 

Melanie Plenda:

Lisa, behavioral health doesn’t receive as much funding as other departments. Why, in your opinion, is that?

Lisa Madden:

I've been doing this for a really long time, and I wish I could answer that question. I mean, my passion is to give people access to health care that takes care of the whole person. My particular area of expertise tends to be within the behavioral health world, but I just think it's part of who you are. Why we don't get the same support, I think, still falls under people not understanding the full scope of the illnesses. There's certainly still some stigma. We're trying to work to educate people to understand medical conditions that require appropriate medical care. But you know, it's taken us a long time to be able to be seen and heard in a way that says this is an important element of whole person health, and we need to fund it appropriately and unfortunately.

Behavioral health is often one of the elements of treatment that's not adequately funded and is cut early in the process of cuts. I will say our state is very committed to our care and is very committed to the treatment of people with mental illness and addictions. Our work with the department has been very, very collaborative to try to find ways to keep people served, but I honestly don't know the answer why people won't fund us appropriately.

Melanie Plenda:

So, Susan, if someone is struggling, what should they do? What should their steps be?

Susan Stearns:

The best life skill is to be able to ask for help. Absolutely, there's not one of us who gets through this life without having been at a point in our lives where we have to ask for help. So I often tell parents, if your child is struggling, helping them reach out and access care is a really good life skill to have. So yes, absolutely, tell someone that you're struggling. Maybe you might pick the wrong person who doesn't know what to do with that, but try not to be shut down by that.

Also, if you have someone that you know, that you're concerned about — maybe it's a co-worker or a neighbor — ask them how they're doing. That communication is so critical. It doesn't mean you have to have a solution. I can tell you, if you're really concerned, anyone can call 988 so you can access assistance, so there's no reason to hesitate to engage in that conversation. 

I would tell anyone who is even thinking about calling 988 to do it. As soon as you question if you're at a place where you should call 988 the answer is yes. You can also chat with them online, and you can text 988, so it's a really critical resource. But remember that you're not alone, that there are folks who are there to help, and that there are many folks who are walking this walk as well, and that treatment is available for most people. 

Lisa Madden:

What Susan said is just so spot on, that nobody is alone, there are multiple avenues for support, and people exist in order to be able to offer guidance to recovery. That is why they’re there.

I’ll reflect a little bit on even my role as a parent. What I used to say to my son, and still say to my adult son anywhere along the line, is that when you feel like you don't have any choices or if there's any reasons to believe that, ask somebody who can help you see your choices. But never feel like you do not have choices, because you do, and you just might not see them that day, and someone else may be able to help you see them. 

Melanie Plenda:

Thank you to Lisa Madden, president and CEO of Riverbend Community Mental Health and vice president of behavioral health for Concord Hospital, and Susan Stearns, executive director of NAMI New Hampshire. If you or someone you know is struggling, help is available 24/7. Call, text, or chat 988, the national suicide and crisis lifeline.

“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 impact of massive federal Medicaid cuts on New Hampshire hospitals and patients

President Trump’s Big Beautiful Bill — recently enacted by Congress and signed into law — made sweeping changes to Medicaid, the government program that provides health insurance to low-income adults and children. These changes will affect not only the estimated 184,000 people on Medicaid in New Hampshire, but also every resident who accesses health care in the state. What are those changes and what will they mean for you? Here to discuss that is Matthew S. Houde, system vice president of government relations at Dartmouth Health. 

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Judi Currie:

First, let’s talk about what Medicaid is. Who’s on it and why?

Matthew S. Houde:

Medicaid is a health insurance program that is essentially a partnership between the federal government and state governments, and it's administered by the states. It covers approximately 72 million Americans, as you said, about 185,000 in New Hampshire. It does cover categories of people — so children, pregnant women, those with disabilities, as well as people based on income level, pursuant to the Affordable Care Act expansion provision which New Hampshire adopted as well. I'd also say, though, that it serves, or has served, as a vehicle to ensure coverage for most of the vulnerable population. So it's a really important health insurance program.

Judi Currie:

The new law charges premiums for those making more than 100% of the federal poverty line, and families making 225% of the federal poverty line. Those monthly premiums for an individual vary from $60 to $100, and $190 to $270 for families. It also raises prescription drug prices. What do you feel the impact will be?

Michael S. Houde:

I'm going to step back just a little bit. It's a major tax bill that has sweeping implications for health care, right? So I'd put the continuation of those tax cuts, plus increases in defense spending and increases in border security, cost a lot. In order to find the savings to implement the continuation of the tax cuts from the first Trump administration, Congress had to find significant dollars in terms of savings. So the place that they looked at was the Medicaid program. They're actually estimating up to a trillion dollars in savings from the Medicaid program over the next 10 years, which would be roughly a 10% cut. 

In terms of what it does, I'd put the implications into two buckets. It has beneficiary implications. You talked about the premium contribution or co-pay requirements. It also has new eligibility sequencing, so someone would have to prove their eligibility twice a year now, instead of once a year, if you're in the expansion population. It also has work-in-community-engagement requirements. So those are some of the beneficiary implications or changes in terms of financing. 

The financing bucket — I'd say there are pretty significant implications there as well. One is that it limits the amount that states can charge provider taxes in order to generate revenue for the Medicaid program. New Hampshire has a Medicaid enhancement tax to help fund its Medicaid program, and that tax is a 5.4% charge tax on net patient service revenue assessed on all hospitals. The state then takes that money, shows it to the federal government, and the federal government then matches those dollars, which helps further fund the Medicaid program. So there's that front-end limitation that's going to take the provider tax down to 3.5% over time. 

On the back end, it also limits the amount of the federal contribution in a way that I won't get into, other than saying state directed payments are going to be reduced, as well from what's an average commercial rate to an average Medicare rate. So there will be less dollars coming from the federal government to support the state's Medicaid program.

I guess the final piece that I put in that payment bucket would be the limitation on the amount of time that you can look back after someone qualifies for Medicaid. It's 90 days today, and in the future, it'll be either 30 days for some populations and 60 days for other populations. So that you will have potentially been providing care for people who have been sick — they get eligible, qualified for Medicaid, but you can't get reimbursed for the cost of that care. So those are kind of the big buckets that I put it in.

Judi Currie:

Let's focus on that 90-day look-back — that just means that the service that you've rendered is not eligible for reimbursement or they have sort of a lag till they can resume care?

Matthew S. Houde: 

When I refer to that, I refer to the time period from which a provider will receive reimbursement. So you can look back to say, today again — 90 days you've been providing care, or you provided care 90 days ago. Then someone gets eligible for Medicaid, and you get reimbursed. You could submit for reimbursement for that coverage, so that will change to a shorter window of time once someone becomes eligible.

Judi Currie:

You mentioned the expanded Medicaid pool. My understanding is that a lot of the benefit was going to be helping people dealing with substance use disorders. That kind of ties into the two questions of whether you know whether they'll be able to afford the premiums or meet the work requirement. Can you look at that expanded pool? Does it feel like this? This new bill is just going to sort of decimate that or wipe it out?

Matthew S. Houde:

Well, I'm really concerned about the implications for coverage for beneficiaries. We know that Medicaid, including Medicaid expansion, provides really lifesaving care for people — substance use disorder treatment, mental health treatment, primary preventative care, in addition to emergency care. So the implications of individuals — up to a third of New Hampshire’s expansion population that would be affected. According to the Kaiser Family Foundation's estimates on looking at the state's prior attempt to do work requirements, those people wouldn't have access to those coverages. 

Judi Currie:

What does that mean — not just reimbursement for the providers who would be providing that care, but for those people who need that care and would try to seek that care? Do they then delay? Do they then decide that they're not going to seek the care because they know they don't have insurance anymore or they can't afford it? And what are the implications of that? 

Matthew S. Houde:

I think it exacerbates problems, health problems, for people I trust. We're going to talk about this shortly, but there are also significant implications in terms of when people delay care, the condition can become significantly more acute. People still need care, and they will come to the emergency department or be brought to the emergency department to seek care. And what happens is that's probably the worst place to seek care because it's the most expensive and it's also considerably backlogged. There are access issues with respect to that care. So I hope that answers your question. 

Judi Currie:

We also often hear about people not being able to find care because organizations don't want to take on new Medicaid patients, and I think from the perspective of the hospital, they often don't have a choice in that. Are there differences between how the large southern New Hampshire hospital chains or connected affiliates are going to be impacted versus the rural hospitals up north?

Matthew S. Houde: 

I think there are significant concerns for rural providers. For Dartmouth Health, the proportion of patients that we serve that are Medicaid beneficiaries, is roughly 15% of the patients that we serve — that's a combination of New Hampshire and Vermont. Obviously, the medical center is located on the border of New Hampshire and Vermont, but I think about some of the further geographically located member hospitals and health care providers. Do they have a mix? What's their mix of patient population? 

I talked about the stressors with respect to access. I'll just elaborate a little bit on that. Today, hospitals are roughly at 90% capacity. Dartmouth Health, or Dartmouth Hitchcock Medical Center here in Lebanon — we’re over capacity. What does that mean? It means that we have patients who are waiting in hospital beds. They no longer need the acute care that we provide, but there's not an available post-discharge facility, long-term care unit that either has the capacity to take them, or if they're not Medicaid-eligible upon discharge, the willingness to take them take them because they can't survive based upon no reimbursement. So those people who no longer need to be in our beds really are taking up a considerable number of beds so when that accident happens on I-91 or I-89, do we have the ability to take that patient or do we have to send to a much further place — Albany, Austin, wherever?

So yes, I have genuine concern for what's going to happen in rural facilities. I think about the contraction of service lines. We know that there are maternity care deserts in the northern parts of New Hampshire and certainly parts of the northern New England region. That's only going to be exacerbated by the implications and the rollout of the bill, in my opinion.

Judi Currie:

There’s another part of this — the Rural Health Transformation Program. Can you tell us how that will affect New Hampshire?

Matthew S. Houde: 

As part of the act, there was $50 billion allocated to help anticipate the challenges to the rural health care system. They wanted the Congress to allocate some dollars to alleviate those concerns. Let's compare, however, $1 trillion over 10 years to $50 billion over five — just doing the math, the numbers available for those dollars aren't going to cover the holes that are created.

I'll use the New Hampshire example. The way that I understand that that provision works is 50% of those dollars go to the states equally. So say New Hampshire gets, per year, 1/50 of $5 billion because the second component of the relief is determined at the discretion of the administrator of CMS with a rural lens. So it's not a full $10 billion per year. It's $5 billion per year divided by 50. It's like $100 million per year. If the spend for New Hampshire Medicaid is over 10 years — call it $30 billion, so $3 billion a year. The two don't meet — the size of the bucket of the rural relief program just won't be able to plug the holes that are created by the shortfall that the underlying act creates. Do I think it will sustain some of the rural programs that we just talked about being in jeopardy? I hope so. Do I think it will do so completely? I'm skeptical.

Judi Currie:

What can you tell us about how you're preparing to have to take on this additional role or responsibility?

Matthew S. Houde:

You had suggested this earlier about hospitals not having a choice in terms of their federal laws that require, for example, when people show up in emergency departments — that you provide care regardless of care regardless of coverage. But we also are a nonprofit health care system whose mission is to provide, among other things, health care to people. We're not going to stop providing that health care, and we're going to help our communities and our region figure out how to navigate that space. It's going to be challenging, and more challenging to do so with fewer resources. 

When I think about this, I think of New Hampshire Medicaid. The state didn't reduce Medicaid reimbursement by 3% right? That proposal in the state House was rejected by the Senate and was accepted at the end of the day as flat rates — but it's flat rates. So it's not like costs aren’t increasing. Reimbursement is flat on the state level, and it's going to be shrinking and reducing on the federal level. So that just creates huge tensions and challenges to continue to meet the needs of the communities that we serve, including serving as a resource for the northern part of the state, and we have clinics in the southern part of the state, so to maintain the services that we do will be challenging. You're not going to expand them to meet rising access, because you're just not going to have that ability.

I think about programs that our obstetrics unit has implemented, for example, with federal grant support to equip EMT providers to know what what they need to know in order to deliver babies in the North Country, if they show up in an emergency department. It's going to be more and more important for us to work with the state and any of the federal resources that we might get through this rural fund as part of the bill to make sure that we just continue to provide resources for people, so that if people have to travel, at least they're stable locally before they travel. Can keep care local by using telehealth to connect with providers in the North Country and elsewhere? All of those are going to be really important things for us to consider as we pivot to addressing the new reality under the Medicaid program that this bill has instituted.

Judi Currie:

Matthew S. Houde, system vice president of government relations at Dartmouth Health — thank you for joining us.

As deadline gets ever closer, lawmakers try to agree on a new state budget

-By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Every two years, lawmakers approve a state budget. These laws do more than decide where your money goes. They also set policy ideas and objectives. What is in this year’s budget bills? Judi Currie discusses that with Phil Sletten, research director for the N.H. Fiscal Policy Institute, a nonpartisan, independent research nonprofit that looks into the financial well-being of the state and its residents, and 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.

Judi Currie:

Anna, can you talk about the recent history of state budgets? What sorts of things have been in them and what have they accomplished? 

Anna Brown:

The first thing to keep in mind is that New Hampshire is pretty different from the federal government in that we have to pass a balanced budget, so we have to keep our spending limited. In the past few budget cycles, there was a lot of federal money coming in, and business tax revenue was coming in strong. So we saw a lot of state spending and also some tax cuts, some business tax cuts. They also repealed the interest and dividends tax in New Hampshire, we're losing out on a lot of that federal funding that has been drawn down, clawed back, cut, and we're seeing some slowing on some of that business tax revenue. So that's a challenge that is different from previous years.

It's also worth noting, though, that a lot of what happens in the budget happens in a trailer bill, House Bill 2. There's policy changes in there that can be pretty significant. So, for example, we've seen a restriction on abortion after 24 weeks. We've seen a ban on e-cigarettes for people under a certain age, and so on. So that policy part of the bill has become more important in recent years. Ten years ago, it was maybe around 30,000 words, and this year we're looking at close to 100,000 words.

Judi Currie:

Phil, where are we at in the process with the current budget?

Phil Sletten:

We’re  in the last planned stage in the state budget process. That process actually formally began last year. New Hampshire, as you noted, Judi, has a two-year state budget. The majority of states actually have single-year state budgets, but New Hampshire is one of about 20 states that has a different timeline. 

The state agencies actually put together their budget requests last summer. This process has been going on for about half of the duration of the current state budget, which is in effect from July 1, 2023, through June 30 of 2025 — so the end of this month is when the current state budget expires. The governor looked at those state agency requests and then put together her version of the state budget that she introduced back in February. The House considered the governor's version, made the changes that it wanted to see and then passed its version in early April. 

The Senate was the next part of the process. The Senate looked at the House budget, made the changes that it wanted to see, and passed a different version, its own version, earlier this month. Now the House and the Senate have these two different versions of the state budget, and they have to reach agreement on them, because there can't be two state budgets that pass. There can only be one version. So the House didn't agree to the Senate's changes, and as a result they asked for a committee of conference. What that is a group of seven legislators, four from the House and three from the Senate, and they negotiate a final version of the state budget — or at least in the usual process what is a final version of the state budget. And that version is being negotiated right now in the committee of conference, and is going to go then for a vote ahead of both for both chambers. 

Both the House and the Senate have to agree on that one version and pass it, because it is a state law like other state laws. Then the governor would have to approve it before it became state law. Now we're towards the end of the process, because we're running out of time on the clock. The current state budget is only in effect through the rest of this month, so we are in the final stages of what you might consider the regular state budget process.

Judi Currie:

Anna, what have budget talks been like? Republicans hold the governor’s office, as well as majorities in the House and Senate. Did the Democrats get any proposals in? 

Anna Brown:

As you mentioned, there is party unity, technically, but there were divisions between Republicans in the House and Republicans in the Senate, as Phil noted.

For example, the House was interested in adding some policy changes — ending annual car inspections, limiting vaccine requirements, and so on. So it's not this perfectly unified vision under Republicans of what it should look like in the budget going forward. That being said, there are priorities in the budget that Democrats do support. I know that, for example, the Senate version of the budget restored Medicaid reimbursement rates, and that looks to be something that there's agreement on going forward. 

In New Hampshire, the budget is such a big piece of legislation — there usually are wins and losses for everyone. But the question is going to be: Can Republicans all get on the same page right at the end? It's interesting to note, Governor Ayotte has actually criticized some in the Legislature for their low revenue estimates and saying that that's not enough to cover what we need to pay for in state government and that it’s basically playing into the Democrats' hands by setting us up for tax increases in the future. So that was kind of an argument that I didn't expect to hear come forward, and it can show that it's not always party lines where things break down.

Judi Currie:

Where do things stand with reconciling those differences in the committee of conference?

Anna Brown:

As I said, the House has moved up on their revenue estimates. They're willing to meet the Senate — not quite at the fully high level that the governor was proposing, or even the Senate was proposing — but still much higher than they were.

A lot of tension, though, is over this Group 2 retirement benefits for police and fire. There's tension among the Senate, and I think that we will also see potentially in the House — is there enough money in the budget to do this? Is it the time to do it? Of course, if we can't come to an agreement on the budget in our state legislature, that's a real problem, because the fiscal year is ending, so then we'd have to be looking at some sort of continuing resolution or temporary holdover, which is pretty rare in New Hampshire.

Judi Currie:

What kind of impact will these proposals have on the state? 

Anna Brown:

One thing that I think we should talk a little bit about here, because it's been in the House version, the governor's version, the Senate version in some form, is expanded gambling and legalizing slot machines for New Hampshire. That is going to be a good source of revenue for the state going forward, and also a large cut of that revenue goes to nonprofits as part of the existing charitable gaming system.

But it's interesting to reflect. I remember less than a decade ago, there was huge resistance to expanded gambling in New Hampshire, and now we've sort of arrived there, and it doesn't even seem to be a central part of the debate. So people might be noticing, is that slot machine a real difference in New Hampshire's landscape or not? I don't know. So that's just something I think is worth highlighting.

On the immediate level, I think people might also notice tax and fee changes. You might notice a higher fee when you're registering a vehicle, but a lot of these changes are more long term when you're looking at changes to Medicaid or what's going on with university system funding, that has long term changes in terms of how our economy is moving, how much debt people are carrying, and so it wouldn't be an immediate impact.

Phil Sletten:

One of the places where there hasn't been a resolution yet in the committee of conference is around developmental services funding. That's a place where the Department of Health and Human Services identified — if developmental services were to be funded in the House version of the state budget — 278 people who are expected to need services over the next two years of the biennium who would then be on a waitlist for those services because there wouldn't be funding available. Now, the proposed versions of the state budget do allow, if there's revenue available, DHHS to seek additional funding during the biennium. However, we haven't seen a significant waitlist for developmental services in the state for most of the last decade because those services have been funded at levels needed to fund those budgets. That's not to say there aren't people waiting for those services, but those tend to be workforce challenges, as opposed to the nominal state funding challenge.

The university system component is, I think, important as well, because most of the funding that goes from the state budget to the university system is used to offset tuition for in-state students. So if that were to be reduced, that could have an impact on what tuition for in-state students does look like. 

There's a couple other areas of the budget that are specific to particular services, particularly those that the House is proposing cutting and the Senate is proposing folding back in some way that may be difficult to either duplicate or replicate in other parts of the economy. I’m thinking about things like the Office of the Child Advocate, which provides oversight over the Division of Children, Youth and Families, and the Human Rights Commission. These are organizations that the state funds that could have those operations shifted to other services within the array of services that the state provides or to other entities in the state that aren't funded by the state or aren't as directly funded by the state, but those could have particular impacts on specific populations that are served.

Judi Currie:

What else are you two following at the State House in the next few weeks? Let’s start with Anna, then to Phil. 

Anna Brown:

There's absolutely a lot of final bill negotiations happening in other conference committees, and those bills — whether they reach agreement or not in the Conference Committee —still would need to go before the full House and Senate again to agree with the committee recommendation.

A couple of issues that I'm watching allow evictions at the end of a lease. Right now, you have to have some sort of cause — you can't just say, “Hey, it's been nice knowing you. Goodbye.” That's been a major priority of Rep. Bob Lynn, the former chief justice of the New Hampshire Supreme Court. It's been a long brewing debate.

 And other bills — for example, outlawing puberty blockers or hormone treatments for minors. That's been another sticking point in how it might be implemented between the House and the Senate. 

Phil Sletten:

I'll be watching to see if the legislative chambers do also pass a House joint resolution that's a clear sign that they think that the budget may not be resolved by July 1, and to see in these last stages of committee of conference which separate policy bills as well as funding proposals are included or not included within the state budget, and how that might affect the committees of conference for other bills that are being wrapped up, in terms of developing their final proposals

But I’m really watching what happens in the budget and what the full Legislature considers, or what considerations the full Legislature has with regard to the committee of conference version of the state budget. Because, remember, it's a small group of legislators who are on a committee of conference, and then they have to convince their fellow legislators in both the House and the Senate that the committee of conference budget is something that they could support. That's a key variable, I think, going forward, but it'll all be wrapped up, or at least we'll know a little bit more by July 1.

Judi Currie: 

Interesting as always. Phil Sletten, research director for the N.H Fiscal Policy Institute, and Anna Brown, executive director of both Citizens Count and the Warren B. Rudman Center for Justice, Leadership, and Public Service at the University of New Hampshire’s Franklin Pierce School of Law, thank you both 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.

What does celebrating Juneteenth look like in today’s political climate?

New Hampshire is observing Juneteenth, a holiday that has evolved to commemorate the end of slavery in the United States after the Civil War. At the center of that commemoration is the Black Heritage Trail of New Hampshire. The organization promotes awareness and appreciation of African American history and life in order to build more inclusive communities. That’s a tall order in today’s society, when programs that discuss that history and appreciation are under fire. Here to discuss Juneteenth and more is JerriAnne Boggis, the executive director of the Black Heritage Trail.

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Melanie Plenda:

Let’s start with Juneteenth at the Black Heritage Trail. Can you tell us more about what Juneteenth is and what events you have coming up this weekend and beyond?

JerriAnne Boggis:

One of the things I do want to say about Juneteenth is just to make a correction. Juneteenth, the celebration of June 19, which is the derivative of Juneteenth, really doesn't celebrate the end of slavery across America. It does celebrate the end of slavery in Galveston, Texas. But we know that there were pockets of enslavement across the country long after that — long after two years after the Emancipation Proclamation was made. Juneteenth was just when the enslaved people in Galveston, Texas, heard that they were free, when an army came in to enforce proclamation. And so it's traditionally a Texas celebration, but it spread across the country and became what it is today, celebrating emancipation, but slavery really didn't end then. 

This year our focus is “The Reckoning: Reclaiming the Past, Remembering Black Voices, Reshaping the Future.” And this is a look at the stories that we tell about our founding fathers and really try to add the other side to that story — that the founding fathers were not exactly paragons of virtue. They did some amazing things, but America’s story is so complex and so one-sided, so we thought we’d look at the narratives of some of the black descendants of some of these founding fathers — the people they enslaved.  

Melanie Plenda:

Can you tell me about Ona Judge and her story? 

JerriAnne Boggis:

Ona Judge was born into enslavement with Martha Washington. She was what they call a “dowager slave” — she came into the marriage and was added to the enslaved people that George Washington had.

On her 18th birthday, she was told that she was to be given as a wedding present to Martha's niece. And I think before that, she might have thought that she was part of the family, but then she realized that she was this property, this tool for commerce, and so she decided to be responsible for her own life and her own well-being, to do what our founding documents say — to pursue her own happiness. So she escapes the presidential mansion with the aid of the black community in Philadelphia. She gets on a little ship that brought her to Portsmouth to the underground railroad.

We know she lives here for a while, and she ends her life in Greenland, New Hampshire. Her story is one of courage, fortitude, creativity, and defiance. She defied the most powerful man in the country.

Melanie Plenda:

What was it like putting this event together this year? I’d imagine there were more obstacles than usual. 

JerriAnne Boggis:

So when we started this early January, it was a different world than where we ended up now and where we ended up a few months after deciding on this theme.

We thought this was a brilliant theme, because we like to bring these thought-provoking themes to our population so we can have some critical thoughts about our history. Where we began, where we are now, and where we can go by really looking honestly at what our history is. It didn't prove to be that way, as we had hoped, because our political environment, our cultural environment, totally shifted. Last year, when we were bringing the Amistad [a 19th century slave ship that was the site of a historic slave revolt], we had about 500 students registered for the tours to come and see the Amistad.  This year, when we put out the information on this reckoning around the Founding Father —  to date, we have zero students signed up.

We were wondering what was going on. What is the story behind this? Historically, we bring a lot of students through our tours. After speaking with some of the teachers, what we found out is that, because of the environment — the assault on DEI programs, the assault on black history, the divisive concepts legislation — the teachers were very reluctant to send this information home with students, because all it would take is one angry parent or one person not believing that children need to know these stories, or that we're changing the notion of what the founding fathers were to open an investigation on the school and their whole curriculum. 

This whole thing had a very chilling effect on what teachers felt that they could do or wanted to do, the chances they wanted to take, the fear surrounding their livelihood, and so we ran smack dab up against this whole notion that we were telling a story that didn't put the founding fathers in the positive light that they needed to be in.

Melanie Plenda:

Were you surprised when the funding cuts and the anti-DEI fervor started happening?

JerriAnne Boggis:

I was totally shocked. I thought America had moved much further along this line than we actually did. It just made me see and believe that this was all window dressing. For what purpose? I'm not sure. I should probably say that it really depends on our leadership, the narrative, the way people fall around. We had an air, an aura around civility, the kind of values that we say we stand for. It was this thought that we all stood for those things, right? But within an instant, that changed. 

I don't want to talk about the people who believe this, because there is a pocket of us that totally believe in these values and principles. But right now, what I'm grappling with is the loud voice — are those the actions of the majority or just a loud group? Is it the one-third that believes this or the two-thirds that really are working towards equality, a just society, a country where those who want to thrive are allowed to thrive?

Melanie Plenda:

How would you sum up the overall impact on the Black Heritage Trail over the last few months? 

JerriAnne Boggis:

What we're seeing is this trickle-down effect of these orders, and we've had to rethink some of our strategic plans as an organization. I still think it's a little too early to say just what this is. I think a lot of us were shell-shocked, so we're still trying to figure out the environment that we're in. We're kind of in a bubble. We're kind of singing to the choir, so the people who support us are our choir, so we’re able to continue to go on. 

But what we're seeing is the damage that a long-term effect could do. We're not in the classrooms talking about this, engaging our students in critical thinking, where we can then be bridge-makers, break stereotypes — create these places for real intellectual dialogue and thought, then there's the danger of losing this generation.

One of our strategic plans was to bring our stories to New Hampshire seventh and eighth graders, when they study New Hampshire history. That's when we would bring the stories to them — the local stories, the stories that are right there in their backyards. They don't get that again after they leave, so then we lose that ability to tell them. Our community dialogues are in libraries or spaces where people gather, our community gathers. If we don't have our libraries anymore, then how do we gather? How do we communicate? 

We have to think about what we value, and our organization is committed to be truth-tellers, to telling these stories, because we can see what happens when we know these stories, how they break down barriers, how they break stereotypes. They distort the stereotypes and they give us a better understanding of how we got to where we are, and where we are going now. 

Melanie Plenda:

Despite all this, you’re still here, and your organization is still putting on events. Can you talk about the dedication it takes — from you and your volunteers — and what that means to you?

JerriAnne Boggis:

So I think for us as an organization, it’s what we value. Because you have made a commitment to these values, you're seeing it through. It's not just creating a program, it's not just writing something up — it's creating this sense of belonging. It's going beyond that narrative. It's going to the human story. 

We rely on our volunteers, we rely on our boards to keep us going. We rely on each other to keep optimistic about the environment that we are in, and we rely on the value and the impact that we can see. When we started this work eight years ago — and before, with Valerie Cunningham who started in 30 years ago — I can look back at our first conversations. They were very superficial — it was an early part of learning. Now, our tea talks are like a place for deep, meaningful dialogue on issues that are so complex that you get deeper into a subject. That’s what it takes — this building up of community, over and over.

Melanie Plenda:

For our audience, what would you like to tell them about celebrating Juneteenth this year? 

JerriAnne Boggis:

This year, we're going to be at the Portsmouth African Burying Ground on June 19 —  it is the 10th anniversary of the African Burying Ground Memorial Park. So we’re going to be celebrating this 10th anniversary.

Because of this really complex time that we're in, this troubled time, we thought we would also do a fun activity with our communities. There's a dance that's viral on Tik Tok called “The Boots on the Ground,” and we will end our celebrations with that, asking the community to come together in this dance. Dance and song and that joy have always been part of Black communities from African times — during times of hardship, during times of joy and sharing, the community came together and expressed that joy in being together. 

We can look at the civil rights movement. We can look at the enslaved people doing the stomp dance. It is protest, showing that we can get through this. You can't stop us. We will get through this. You can't erase us. We are here. You can't silence us. We're visible. We may not be able to say certain things, but our feet can. So we're asking our community to join in this dance, because we need all our boots on the ground now in understanding this environment that we are in and doing what we can towards justice and equality, equity and inclusion.

Melanie Plenda:

After Juneteenth, what’s next for you and the Black Heritage Trail?

JerriAnne Boggis:

We've got our tours throughout the season, people can come and join us — not only here in Portsmouth, but across the state. We're in four other towns across the state. We've got our marker projects going up.

And, for the Black New England Conference, which I'm really excited about — that is one of the programs that we really had kept as we head towards the 250th anniversary [of the United States]. So we're bringing together a group of young social media creators to discuss the state of African Americans over the last 250 years. Have we improved? Have we moved? What have they seen? We wanted to hear from the youth and their perspective. What has this march to 250 years brought and meant for African American history, African American culture, equity, enterprise, the media, how we're portrayed? What are they seeing and what are they thinking? 

Melanie Plenda:

Great talking to you, as always. Black Heritage Trail of New Hampshire Executive Director JerriAnne Boggis — thank you so much 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.

Public comments yield mixed results with legislators

Some legislation has passed despite vast public opposition, but advocates say personal stories from voters still have an impact

By Kelly Burch, Granite State News Collaborative

When Gov. Kelly Ayotte signed two pieces of legislation last week — universal expansion of the state’s school voucher program and a parental bill of rights — she did so even though thousands of Granite Staters submitted testimony in opposition to those bills. 

For some, the discrepancy was concerning. 

“At key moments during the legislative session, we observed a lack of alignment between what constituents were elevating from their communities and the policy that was advancing in our State House,” said Nicole Heimarck, executive director of Reaching Higher NH, a nonpartisan nonprofit focused on education policy. 

New Hampshire has the largest legislature among U.S. states, with 400 representatives and 24 senators, which "makes our lawmakers very accessible,” Heimarck said. Online streaming of legislative sessions and the ability to submit testimony online also increase accessibility, experts say, yet the results of the current legislative session show that lawmakers don’t always vote in line with what’s been expressed by constituents. 

“On a lot of really hot button issues that have clear partisan lines, it’s true that public testimony is not as impactful,” said Anna Brown, executive director of Citizens Count, a nonprofit that provides information on legislation and helps voters engaged with elected officials. 

What impact can voters have?

During COVID, the state moved to stream legislative sessions and allow for online testimony through the General Court website. 

This legislative session, online access led to a lot of public input, including 30,108 voters expressing opposition to a bill (HB 283) that would have cut subjects from the definition of an adequate education. That bill, which 71 voters testified in favor of, did not move forward. 

A bill (HB 524) that would have repealed the N.H. Vaccine Association — which purchases vaccines at a discount and has no impact on vaccine laws — was retained in committee after 3,552 people testified against the bill online, and just 193 testified in favor. 

In other areas, however, public opinion didn’t ultimately impact how legislators voted. For example, 3,414 people testified online against expanding the school voucher program, while only 791 testified in favor. Still, that bill (HB 115) moved forward and the expansion was signed into law June 10. 

The parental bill of rights law (HB 10) was also signed that day, despite testimony in opposition from 1,208 voters (174 were in favor). 

Brown said public input is sometimes less effective on issues that the party in power — the Republicans in New Hampshire currently — have identified as a priority.  

“Party pressure is a big factor,” she said. 

Brown noted that party unity — a metric used to track partisanship — has been steadily rising in New Hampshire and nationally. 

“There are more votes where there is a clear line drawn in the sand between the two parties,” she said. Party leadership can apply a lot of pressure to vote certain ways in those situations, she said, or legislators may feel that they’ve been elected on a party platform that includes voting for certain laws. 

“Their mind is already made up,” she said. 

Brown has also heard from lawmakers who are “a little suspicious of” online testimony. Some lawmakers say there’s no way to verify that online testimony is truly from New Hampshire voters, and they claim that special interest groups are disproportionately impacting public testimony online, she said. 

“Since you don’t have that person in front of you speaking, it's easy to dismiss,” she said. 

Voter input, especially personal stories, are still powerful

Despite concerns about whether voter voices are being heard, the public did affect some issues during the session, said Kate Frey, vice president of advocacy with New Futures, a nonprofit that pursues evidence-based policy solutions. 

“We saw that public input did make a lot of difference in outcome, especially on the Senate side,” she said. 

The state budget proposed in the House initially included a 3% cut in Medicaid reimbursement rates, but the Senate budget — approved June 5 — reversed those cuts, in large part due to public testimony, Frey said. 

“There was a lot of input,” she said. “The Senate Finance Committee said [it] heard negative opposition around Medicaid cuts.”

Brown also pointed to the major impact of public opinion on adding exceptions for fetal abnormalities to the state’s 24-week abortion ban in 2022. Sen. John Reagan, R-Deerfield, initially voted against the exception, but later changed his votes after listening to “the testimony of the moms and the almost moms.”

The abortion vote was a “super-polarized, hyper-partisan issue,” Brown said, and yet “that is an example where, yes, personal stories do still make a difference.”

How to effectively engage with legislators

When it comes to making sure legislators hear your voice, “that personal touch is key,” Brown said. Frey agreed, saying messages from lobbyists are “never as effective as that person who has that lived experience.”

If you submit testimony — even online — try to add your personal reasons for supporting or opposing a piece of legislation, they said. 

“It’s very easy for a legislator to come up with reasons to dismiss someone signing an online submission or quick online form,” Brown said. “It’s much harder if it’s a real voice: a person in front of them or a personalized email with a personal story.”

While there’s no sure-fire way to influence legislators, phone calls are often the strongest option. 

“When people get phone calls, they really listen,” Frey said. “Emails are effective, to a point.”

Still, if you only have the time or bandwidth to submit basic online testimony, do that.

“You have to meet people where they’re at,” Frey said. “Sometimes that’s all they can do.”

Submitting online testimony can be a great first step for people to get involved with the legislative process. After that, they might feel more comfortable sending a personal email or making a phone call, according to Frey. 

Heimarck said that, even if public opinion isn’t affecting legislative votes, organizations such as Reaching Higher are watching and listening to that testimony. That’s in part why the organization tracked the impact of public opinion this session, she said.  

Feeling that your voice isn’t being heard can be frustrating, Brown said, but voters should continue to express their opinions in whatever way they can. 

“Democracy only works when we all put in the hard work,” she said, “even when it feels like an uphill battle or like you’re not winning.”

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

(Full Version) New Hampshire’s ‘favorable’ conditions for hospital acquisitions

By Meera Mahadevan, Granite State News Collaborative

Why are big out-of-state hospitals eager to make a foray into the New Hampshire health care market? The answer partly lies in the fact that the state is uniquely situated, both geographically and politically.

Josephine Porter, strategic advisor for the N.H. Center for Justice & Equity, says when a community hospital is acquired, ‘there is concern that the benefit the hospital provides to the community no longer reflects the community needs.’ (N.H. Center for Justice & Equity photo)

Access to more patients just across the state border is attractive to hospitals in Massachusetts that have faced uphill regulatory battles in their own state, analysts say. New Hampshire also does not have large employers, like Massachusetts does, with the muscle to push for change in health care costs.

“New Hampshire, despite being small — the patient mix tends to be favorable,” said Josephine Porter, strategic adviser for the N.H. Center for Justice & Equity. “There’s good health insurance coverage (here), on the commercial side.”

Of New Hampshire’s 1.4 million residents last year, about 62%, 853,000 people, received private health insurance through their employer or by purchasing their own coverage, according to Lucy Hodder, director of Health and Life Sciences Law and Policy programs at the University of New Hampshire’s Franklin Pierce School of Law. Her data shows that 16% had Medicare and 9% Medicaid.

In addition, Porter said, “if I’m a big hospital system, and if there's an opportunity to explore a merger and acquisition, there is some benefit to looking at New Hampshire because the process isn’t as arduous here as it might be in someplace else.”

A decade ago, New Hampshire got rid of one big regulatory hurdle: the Certificate of Need Board. It required New Hampshire hospitals and clinics to get state permission before building or expanding facilities. New Hampshire formed the board in 1979 but shuttered it in 2016 after a long legislative battle over the board’s pluses and minuses. Critics said it created obstacles by requiring that, before a facility was built, evidence had to be produced to show it was needed. 

“There are other states where there are more stringent certificate of need boards and regulatory authorities,” Porter said. “There are certain parameters that have to be addressed that New Hampshire doesn’t have. There are many more steps in other states than what New Hampshire has.”

Lucy Hodder, director of the Health and Life Science Policy programs at the University of New Hampshire’s Franklin Pierce School of Law, says price pressures on hospitals could continue the consolidation trend. (Franklin Pierce School of Law photo)

Currently, the state Attorney General’s Office is the only entity overseeing hospital mergers through its antitrust bureau and charitable trusts unit. The state Insurance Department reviews health plan proposals for insurance premium increases and evaluates them, but it does not have a say over mergers. The Department of Health and Human Services licenses facilities, but also does not oversee mergers. 

The Attorney General’s Office has been ringing the alarm bell over hospital consolidations and their potential to reduce competition for the last several years. In fact, in 2022, it opposed Dartmouth-Hitchcock’s plan to purchase Granite One Health, a combined entity that included Catholic Medical Center in Manchester, saying the move would limit competition.

But earlier this year, Attorney General John Formella said he was compelled to approve HCA’s acquisition of Catholic Medical Center, in part because the Manchester hospital was in such dire financial situation that patients stood to lose services entirely if it shut down. So with the approval, the AG sought what he called compromises, including a requirement that hospital systems acquiring a New Hampshire asset would have to contribute money that would benefit New Hampshire health care consumers. 

The Legislature established a trust fund, known as the Healthcare Consumer Protection Trust Fund, and would direct the hospital that is doing the buying to contribute money toward the fund. Under that directive, Beth Israel Lahey, following its purchase of Exeter Hospital in June 2023, was required to deposit $10 million over 10 years into the trust fund. And HCA must pay $7.5 million over 10 years. 

“As we welcome a large out-of-state system into New Hampshire, we must be mindful of the potential risks the transaction poses to health care consumers,” Formella said after Beth Israel Lahey purchased Exeter Hospital two years ago.

In addition to the trust fund, the Healthcare Consumer Protection Advisory Commission was formed to help advise the AG on how to spend and manage that money. Expenditures from the fund need approval from the seven-member commission, the governor, and the N.H. Executive Council. The commission has been meeting monthly since July 2024. It is composed of the AG himself or a designee by him, two state lawmakers, a state insurance department designee, chief legal officer at the NH Department of Health and Human Services, and two members of the public, including one physician. 

Regulators have also stipulated that trust fund spending should prioritize forming a research entity to monitor, analyze and publicly report on the New Hampshire health care market. 

Toward that end, the advisory commission received proposals from the University of New Hampshire and Dartmouth College, and UNH was selected. Last November, the commission voted to spend up to $1.6 million from the trust fund for a three-and-a-half-year contract with UNH to create the Center for Studying Healthcare Markets. The governor and the executive council approved it on May 21. 

The goal is to evaluate the impact of health care consolidation and examine regional best practices from neighboring states in New England. Bradley Herring, a professor of health economics at UNH, will lead the research. 

In addition, commission members said transportation needs are atop New Hampshire patients’ concerns and they discussed whether a portion of the trust fund should be used to help people get to and from their appointments.

In light of consolidation, “we hope to look at things like, is it harder to get to a doctor? Does it cost more to get services I need? Can I have access to hospital-based services the same way I had before?” said Yvonne Goldsberry, chair of the commission. “Our goal is to get out there and hear different cases. We want to hear from consumers what the impacts have been from the consolidations and then hopefully we will be better informed about what to use the money for. “

Lobbyists have also asked the commission to explore the idea of what is known as a cost-growth benchmark, similar to policies in Massachusetts, Rhode Island and Vermont. It’s a cost-containment strategy that limits how much a state’s health care spending can grow each year. 

In addition, some are asking the state to establish a patient advocate office to help contain costs and hold the industry accountable.

In a statement to the commission in February, Jake Berry, vice president of policy at Concord-based health care advocacy group New Futures, said: “While New Hampshire has successfully implemented an Office of the Consumer Advocate to represent residential customers of the state’s regulated public utilities, and an Office of the Child Advocate to ensure the best interests of New Hampshire children are protected, the state does not have a similar independent agency to advocate on behalf of New Hampshire health care consumers and patients.”

Now, the health commission is beginning to study the impact of consolidations on consumers with a series of public hearings, including one planned in Exeter in June and one in Claremont in July.

The first hearing held by the state Healthcare Consumer Protection Advisory Commission on May 28 in Rochester attracted some 75 people, many of whom offered comments about the effects of the 2020 acquisition of Frisbie Hospital by the for-profit HCA Healthcare. Speakers included employees of the hospital, who praised the merger, and members of the public decried the deal, citing facilities closures and failure to be notified about changes in medical staff. (Photo by Meera Mahadevan)

The first hearing, held May 28 in Rochester, attracted over 75 people, with several HCA employees and a few members from the public showing up to speak. 

Nurses and hospital administrators at Frisbie praised the merger in their presentations to the commission, citing positive turnaround data, including shorter wait times at the ER. But members of the public who spoke said facility closures and patients not being properly notified of doctor departures following the Frisbie acquisition had been very difficult for them. 

“I’m a survivor of mergers and acquisitions,” said Marsha Miller, an 81-year-old Rochester resident who lives across from the hospital, but she added that Frisbie is no longer “her” hospital.

“I have institutional memory of what Frisbie used to be and what it is for my husband who is very ill. The lack of care in the ER is why we became patients at Wentworth-Douglass Hospital. … People who left took their institutional memory with them.” She said facility closures in Sanbornville and Barrington in 2021 – a year after HCA’s acquisition of Frisbie – were some of patients’ first introductions to HCA. 

“We have to deal with perceptions, which is that HCA is bad,” she told the commission. Referring to HCA employees’ favorable comments about the merger, she added: “Nobody knows all of these wonderful things. These changes are not a part of my reality. … I want to be clear. This community relies on Frisbie and its foundation.”

The commission hopes to hear more from people about how the hospital mergers have affected their lives.

“A lot has happened in the health care industry,” Formella told the audience in Rochester. “We are going to continue to see a lot of change. And we are going to need to be having a lot of conversation – a lot of thoughtful dialogue about where the state goes from here.” 

He told reporters after the hearing that asking the public to speak at a podium in front of a row of commission members might not be the most effective way of soliciting comments. He said it might be less intimidating and more productive for two or three commissioners to meet the public in a coffee shop. 

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.

(Full Version) Amid a flurry of hospital mergers, what is the effect on health care in New Hampshire?

Industry consolidation raises concerns about cost, access and impact on patients

By Meera Mahadevan, Granite State News Collaborative

Editor's Note: This story is part of Critical Condition, a special series co-produced by the Granite State News Collaborative and its local news partners. Together, we’re exploring how hospital consolidation is reshaping health care in New Hampshire—impacting costs, access, and the future of care in our communities. We want to hear from you: Tell us about your experience with health care in New Hampshire.

Map of Hospital Transactions 2025

Financial pressures, staffing shortages and scarce regulatory oversight have led to a  frenzy of consolidations among hospitals in New Hampshire in recent years.

That frenzy has raised significant concerns about reduced access to health care and the quality of that care at a time when patients are increasingly worried about ever-rising health care costs.

Of the state’s 26 acute care hospitals, only five remain stand-alones. And some of the state’s largest recent hospital acquisitions have been made by large out-of-state organizations, including a for-profit health company based in Tennessee and giant academic medical centers in Massachusetts, leaving some to wonder if they have their fingers on the pulse of New Hampshire residents’ health care needs. 

Further complicating the issue is that the Granite State has not routinely or formally tracked the impact of these mergers and acquisitions on patients and does not have research data that would shed light on cost, access and workforce implications. 

But that could soon change with the recent post-merger formation of the seven-member Healthcare Consumer Protection Advisory Commission, which will advise the state attorney general’s office on these matters.

Lucy Hodder, director of the Health and Life Science Policy programs at the University of New Hampshire’s Franklin Pierce School of Law, says price pressures on hospitals could continue the consolidation trend. (Franklin Pierce School of Law photo)

“I think the pressures on health care providers and health systems are significant,” said Lucy Hodder, director of Health and Life Sciences Law and Policy programs at the University of New Hampshire’s Franklin Pierce School of Law, and one of the state’s leading experts on health care policy.

“With policies reducing access to health insurance for many, and the costs and losses to health plans associated with specialty drugs like GLP1s (weight-loss drugs such as Ozempic and Wegovy), there will be lots of pressure on hospitals to reduce rates,” Hodder said. “This will result in more consolidations. Our biggest problem? We don’t have a plan.”

While hospitals say consolidations benefit patients and are inevitable amid rising costs, doctors on the front lines say their patients often feel left behind.

“There was this whole patient population which was totally devastated,” said Dr. Archana Bhargava, a medical oncologist who worked for 18 years at Frisbie Memorial Hospital in Rochester, which was bought in 2020 by Nashville-based HCA, the country’s largest for-profit health system.

HCA eventually whittled down Frisbie’s cancer unit and completely shut down its labor and delivery division. 

The closure of the cancer unit, Bhargava said, “was really hard. Every day there were only tears.They didn’t know how they were going to travel even beyond what they were already traveling to come to Frisbie.”

Access to care “is a very, very big issue” when hospitals consolidate, she said, and “when big systems decide to pick up a failing, smaller community hospital, there should be a certain level of responsibility for access to care.” 

A survey of 1,300 New Hampshire residents conducted by the Altarum Institute, a health care-focused research and consulting firm, revealed that Granite Staters are concerned about hospital costs, in addition to overall health care burdens.

Sixty-nine percent of survey responses identified hospitals as a primary contributor to rising health care costs, said Sam Burgess, health care policy coordinator at the advocacy group New Futures, which partnered with Altarum.

A look at the mergers 

HCA Healthcare Inc., which operates 182 hospitals in the U.S. with total revenue of $70.6 billion in 2024, established its New Hampshire presence in New Hampshire in 1983, when it acquired Portsmouth Regional Hospital and Parkland Medical Center in Derry. Its market share in the state grew bigger this year when the company’s purchase of Catholic Medical Center in Manchester was approved.

In addition, academic centers across the border in Massachusetts — which have faced tough opposition to expansion from their own state regulators — have been eager to add patients by dipping into the New Hampshire market. For example, Massachusetts General Hospital acquired Dover’s Wentworth-Douglass Hospital in 2017, and the Beth Israel Lahey health system acquired Exeter Hospital in 2023.

In addition, Dartmouth-Hitchcock, the state’s largest health system, which now owns five hospitals — Alice Peck Day in Lebanon, Cheshire Medical Center in Keene, New London Hospital and Valley Regional in Claremont — along with its flagship academic medical center in Lebanon. 

New Hampshire is not alone in the consolidation wave. Nationally, about 2,000 hospital and health system mergers were announced from 1998 to 2023, according to KFF, a California-based health policy research and polling organization formerly known as Kaiser Family Foundation. 

The percentage of community hospitals that are part of a larger health system increased from 53% in 2005 to 68% in 2022. And, the share of physicians working for a hospital or a practice owned at least partially by a health system increased from 29% in 2012 to 41% in 2022.

Health care mergers and acquisitions can take many forms and get quite complicated. They can happen when a health system acquires a hospital within the same market or state, known in the industry as horizontal mergers. When a hospital or an insurance company acquires an independent physician practice, it’s known as a vertical merger. A cross-market merger happens when two providers that operate in different geographic markets merge. And, entities can form affiliations without an outright ownership deal — known as soft consolidations. Moreover, corporations such as CVS, Amazon, and UnitedHealth, along with private equity firms, have acquired many physician practices.

Efficiencies and higher costs

Hospital officials say mergers offer benefits, such as efficiency in supply chains and shared resources among merged entities. And if an acquisition prevents an outright hospital closure, it may help preserve jobs and medical services that would otherwise be eliminated.

Steve Ahnen, president of the N.H. Hospital Association, says patients benefit when a smaller hospital partners with a larger institution because it provides access to specialists and specialty services. (N.H. Hospital Association photo)

Steve Ahnen, president of the N.H. Hospital Association, said patients benefit when a small hospital partners with larger institutions because it gains access to specialists and specialty services. 

“The cost of employing the high-quality level of doctors, nurses and technicians to provide lifesaving care continues to go up,” Ahnen said. “Our operating challenges have gone up. We also face a number of challenges from payers. 

“There has also been a significant consolidation in the payer market, which has given rise to significant challenges as hospitals negotiate rates. Plans are finding more and more ways of denying care, creating this mousetrap.”

But health care analysts say consolidations generally lead to higher prices and don’t always show clear gains in either access or quality of care. Costs often rise after consolidation because hospitals negotiate with insurers to determine prices, and a health system’s bargaining power increases when it owns several hospitals in the same market.

Burgess, the health policy analyst at New Futures, said, “HCA has a strong foothold in the state, and that’s likely to reduce bargaining power for health plans in the state,” perhaps leading to higher costs for insurers.

Not much data on patient care

A hospital’s quality of care can be measured in many ways, such as patient experience, one-year mortality rates, 30-day readmission rates, the rates of MRSA (a type of antibiotic-resistant bacteria) and other infections, safety problems, surgery problems, and what steps a hospital took to prevent errors. 

But data does not exist specifically on how mergers have affected quality of care at New Hampshire hospitals. 

As a KFF research brief notes, “There are many dimensions and measures of quality that have been or could be used to assess the effects of consolidation and it could take time for changes in quality to materialize.”

Hard data does exist, however, when it comes to costs going up after a merger or acquisition. For instance, Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University, testified in front of a U.S. House subcommittee in 2019 that consolidation leads to substantial price increases. 

Research has shown “that hospitals and doctors who face less competition charge higher prices to private payers, without accompanying gains in efficiency or quality,” Gaynor told lawmakers. “Research shows the same for insurance markets. Insurers who face less competition charge higher premiums, and may pay lower prices to providers.”

Gaynor said one analysis found that prices at hospitals acquired by out-of-market hospital systems increase about 17% more than prices at unacquired, stand-alone hospitals.

Consolidations can also result in workforce cutbacks, as the merged entities seek efficiencies that can take a toll in New Hampshire, where health care is the largest workforce sector. That status is a big change from 10 years ago, when retail and trade was the largest employment sector, said Annette Nielsen, an economist with the state Economic and Labor Market Information Bureau. As of March 2025, the health care sector employed 99,700 people in New Hampshire.

Most recently, in February — almost five years after announcing its intent to purchase Wentworth Douglass Hospital — Mass General Brigham announced a series of layoffs,  the largest in the health system’s history. About 1,500 non-clinical employees lost their jobs throughout its network of hospitals, including in New Hampshire.

Another concern about hospital consolidations, say doctors and analysts, is that out-of-state entities don’t always have an accurate picture of what a New Hampshire community needs.

Josephine Porter, strategic advisor for the N.H. Center for Justice & Equity, says when a community hospital is acquired, ‘there is concern that the benefit the hospital provides to the community no longer reflects the community needs.’ (N.H. Center for Justice & Equity photo)

“If you’re getting acquired by an organization that is not local, the decision-making authority for what community benefit looks like is also not local,” said Josephine Porter, strategic adviser for the N.H. Center for Justice & Equity, a nonprofit that advances issues of health equity. “There is concern that the benefit the hospital provides to the community no longer reflects the community needs. That community benefit does need to address hyperlocal priorities, and if those decisions are not being made locally, then there can be a problem.”

‘Nobody cares for us’

One of the biggest concerns for members of the state’s Health Care Consumer Protection Advisory Commission is the impact that mergers have on a patient’s access to care, including maternity and behavioral health services. 

They have good reasons to be nervous.

HCA shut down its labor and delivery services at Frisbie Memorial Hospital two years after purchasing it, even though it originally said it would not do so until five years after the merger. Obstetrics tends to be a high-cost venture for hospitals, with less-than-attractive returns. Birth rates are also going down in New Hampshire, making it harder for hospitals to continue to offer services, and making it difficult for patients to get access to the services elsewhere.

“You know how many patients I used to get at Frisbie who did not have a car that would function and be reliable?” said medical oncologist Bhargava. And, she said, even if they had a family member who could drive, that person would often be working and not be able to take time off. 

“There were many times we had patients who were completely unsupported,” Bhargava said, “and God bless these nurses; sometimes I’ve seen nurses slip in taxi money for these patients to get back home.

“You start traveling from Rochester until you hit a wealthy pocket in Wolfeboro and a wealthy population here and there, but the rest of New Hampshire is very underserved,”  Bhargava said. “There are very socially and economically challenged people. If they don’t have health care close to them, they are going to die in their homes. Imagine an elderly couple living on some measly Social Security income. Do you think they will have an hour and half to go to Dover or Portsmouth?

“I had a patient who used to live in Ossipee,” Bhargava said. “She said — literally with tears – ‘Nobody cares for us because we are poor.’ It was a very sad thing to hear. Many of these patients (fall) in the poor category but that doesn’t mean they are illiterate. They wrote a lot of letters to the governor asking why isn’t health care closer to home for them and obviously it didn’t get heard.”

Staff shortages 

But the hospitals argue they are facing enormous challenges of their own. More than one-third of nonprofit acute care hospitals in the state reported they’re running in the red, said Ahnen, the state hospital association president. 

He said workforce shortages have led to high job-vacancy rates across all hospital departments — 14% for nurses, 20% for surgical technicians, 22% for respiratory therapists — even as health-care needs have kept hospital beds full, to the point where they cause a backlog in the emergency department. 

Ahnen also said studies reporting that costs go up after a merger are skewed and are not always accurate. 

“That research relies on outdated studies,” Ahnen said. “Charles River Associates also does studies, and it shows that hospital consolidations resulted in higher quality and lower cost.”

While hospitals struggle, independent companies see an opportunity.

For instance, Derry Imaging — which has seven locations in New Hampshire — is working to attract patients to use its services by directly comparing its cost for an x-ray with what a hospital charges for the same service. 

The company advertises that patients can save 40% to 70% over “expensive hospital imaging costs.” On its website, it says the average cost of a chest x-ray at a Derry Imaging facility can cost $95, compared to what it says is an average cost of $390 at hospitals within 15 miles of the company’s facilities. It also lists average costs for ultrasounds, CT scans and MRI scans at its facilities — all lower than the cost it cites at hospitals.

“MRI services at other providers or hospitals can cost as much as $3,000,” the company says on its website. “At Derry Imaging, the same MRI scan can be 40-70% lower. For patients with large out-of-pocket costs, that price can make a huge impact on your budget.”

‘Difficult to survive’

Experts predict the hospital consolidation trend will continue in New Hampshire over the next several years.  

The first hearing held by the state Healthcare Consumer Protection Advisory Commission on May 28 in Rochester attracted some 75 people, many of whom offered comments about the effects of the 2020 acquisition of Frisbie Hospital by the for-profit HCA Healthcare. Speakers included employees of the hospital, who praised the merger, and members of the public decried the deal, citing facilities closures and failure to be notified about changes in medical staff. (Photo by Meera Mahadevan)

“The financing of the health care system is complicated — it causes a lot of pieces to have to move all at the same time in order to make change,” said Porter of the N.H. Center for Justice & Equity. 

“Hospitals have had a lot of change in the last 15 or 20 years, not just in treatments that are available, but the entire delivery system, with acquisition of physician practices,” she said. “We have had a movement from hospitals running a hospital to a hospital running a health care system that might have outpatient ambulatory care facilities or mobile X-ray units. 

“All these dynamics make for a complicated system, and we’ve seen a lot of change and seen a lot of struggle to keep up with that change and figuring out what the right financing model looks like.” 

The result, she said, is that “it’s going to continue to be difficult for a community hospital to survive without a larger infrastructure. My hope is that as it continues to happen, we solve for the need to have larger systems that can also solve for hyperlocal needs — the needs around transportation, which services are required. The recognition that lower volume, less profitable services have to be salvaged somehow. There’s room for innovation in these models.”

According to Hodder of Franklin Pierce School of Law, “We have always had a close relationship with health care providers in the community — our communities are attentive to hospitals. We have so many of them.

“It’s going to continue to put pressure on our hospitals to compete with each other, which will result in higher cost, which is eventually going to hurt the system, and there will be pressure to consolidate. Some are going to win and some are going to lose in the process.” 

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.

(Shorter Version) Amid a flurry of hospital mergers, what is the effect on health care in New Hampshire?

Industry consolidation raises concerns about cost, access and impact on patients

By Meera Mahadevan, Granite State News Collaborative

This story is part of Critical Condition, a special series co-produced by the Granite State News Collaborative and its local news partners. Together, we’re exploring how hospital consolidation is reshaping health care in New Hampshire—impacting costs, access, and the future of care in our communities. We want to hear from you: Tell us about your experience with health care in New Hampshire.

Map of Hospital Transactions 2025

Financial pressures, staffing shortages and scarce regulatory oversight have led to a frenzy of consolidations among hospitals in New Hampshire in recent years, raising significant concerns about reduced access to health care and the quality of that care at a time when patients are increasingly worried about ever-rising health care costs.

Of the state’s 26 acute care hospitals, only five remain stand-alones. And some of the state’s largest recent hospital acquisitions have been made by large out-of-state organizations, including a for-profit health company based in Tennessee and giant academic medical centers in Massachusetts, leaving some to wonder if they have their fingers on the pulse of New Hampshire residents’ health care needs. 

Further complicating the issue is that the Granite State has not routinely or formally tracked the impact of these mergers and acquisitions on patients and does not have research data that would shed light on cost, access and workforce implications. But that could soon change with the recent post-merger formation of the seven-member Healthcare Consumer Protection Advisory Commission, which will advise the state attorney general’s office on these matters.

Lucy Hodder, director of the Health and Life Science Policy programs at the University of New Hampshire’s Franklin Pierce School of Law, says price pressures on hospitals could continue the consolidation trend. (Franklin Pierce School of Law photo)

“I think the pressures on health care providers and health systems are significant,” said Lucy Hodder, director of Health and Life Sciences Law and Policy programs at the University of New Hampshire’s Franklin Pierce School of Law. “With policies reducing access to health insurance for many, and the costs and losses to health plans associated with specialty drugs like GLP1s (weight-loss drugs such as Ozempic and Wegovy), there will be lots of pressure on hospitals to reduce rates,” Hodder said. “This will result in more consolidations. Our biggest problem? We don’t have a plan.”

While hospitals say consolidations benefit patients and are inevitable amid rising costs, doctors on the front lines say their patients often feel left behind.

“There was this whole patient population which was totally devastated,” said Dr. Archana Bhargava, a medical oncologist who worked for 18 years at Frisbie Memorial Hospital in Rochester, which was bought in 2020 by Nashville-based HCA, the country’s largest for-profit health system.

HCA eventually whittled down Frisbie’s cancer unit and completely shut down its labor and delivery division. 

A survey of 1,300 New Hampshire residents conducted by the Altarum Institute, a health care-focused research and consulting firm, revealed that Granite Staters are concerned about hospital costs, in addition to overall health care burdens.

Sixty-nine percent of survey responses identified hospitals as a primary contributor to rising health care costs, said Sam Burgess, health care policy coordinator at the advocacy group New Futures, which partnered with Altarum.

A look at the mergers 

HCA Healthcare Inc., which operates 182 hospitals in the U.S. with total revenue of $70.6 billion in 2024, established its New Hampshire presence in New Hampshire in 1983, when it acquired Portsmouth Regional Hospital and Parkland Medical Center in Derry. Its market share in the state grew bigger this year when the company’s purchase of Catholic Medical Center in Manchester was approved.

Academic centers across the border in Massachusetts — which have faced tough opposition to expansion from their own state regulators — have been eager to add patients by dipping into the New Hampshire market. For example, Massachusetts General Hospital acquired Dover’s Wentworth-Douglass Hospital in 2017, and the Beth Israel Lahey health system acquired Exeter Hospital in 2023.

In addition, Dartmouth-Hitchcock, the state’s largest health system, which now owns five hospitals — Alice Peck Day in Lebanon, Cheshire Medical Center in Keene, New London Hospital and Valley Regional in Claremont — along with its flagship academic medical center in Lebanon. 

New Hampshire is not alone in the consolidation wave. Nationally, about 2,000 hospital and health system mergers were announced from 1998 to 2023, according to KFF, a California-based health policy research and polling organization formerly known as Kaiser Family Foundation. 

Efficiencies and higher costs

Steve Ahnen, president of the N.H. Hospital Association, says patients benefit when a smaller hospital partners with a larger institution because it provides access to specialists and specialty services. (N.H. Hospital Association photo)

Steve Ahnen, president of the N.H. Hospital Association, said patients benefit when a small hospital partners with larger institutions because it gains access to specialists and specialty services. 

“The cost of employing the high-quality level of doctors, nurses and technicians to provide lifesaving care continues to go up,” Ahnen said. “Our operating challenges have gone up. There has also been a significant consolidation in the payer market, which has given rise to significant challenges as hospitals negotiate rates. Plans are finding more and more ways of denying care, creating this mousetrap.”

But health care analysts say consolidations generally lead to higher prices and don’t always show clear gains in either access or quality of care. Costs often rise after consolidation because hospitals negotiate with insurers to determine prices, and a health system’s bargaining power increases when it owns several hospitals in the same market.

Not much data on patient care

Data does not exist specifically on how mergers have affected quality of care at New Hampshire hospitals. As a KFF research brief notes, “There are many dimensions and measures of quality that have been or could be used to assess the effects of consolidation and it could take time for changes in quality to materialize.”

Hard data does exist, however, when it comes to costs going up after a merger or acquisition. For instance, Martin Gaynor, a professor of economics and health policy at Carnegie Mellon University, testified in front of a U.S. House subcommittee in 2019 that consolidation leads to substantial price increases. 

Research has shown, he said, “that hospitals and doctors who face less competition charge higher prices to private payers, without accompanying gains in efficiency or quality.”

Consolidations can also result in workforce cutbacks, as the merged entities seek efficiencies that can take a toll in New Hampshire, where health care is the largest workforce sector. Most recently, in February, almost five years after announcing its intent to purchase Wentworth Douglass Hospital, Mass General Brigham announced the largest number of layoffs in its history.  About 1,500 non-clinical employees lost their jobs throughout its network of hospitals, including in New Hampshire.

Another concern about hospital consolidations, say doctors and analysts, is that out-of-state entities don’t always have an accurate picture of what a New Hampshire community needs.

Josephine Porter, strategic advisor for the N.H. Center for Justice & Equity, says when a community hospital is acquired, ‘there is concern that the benefit the hospital provides to the community no longer reflects the community needs.’ (N.H. Center for Justice & Equity photo)

“If you’re getting acquired by an organization that is not local, the decision-making authority for what community benefit looks like is also not local,” said Josephine Porter, strategic adviser for the N.H. Center for Justice & Equity, a nonprofit that advances issues of health equity. “There is concern that the benefit the hospital provides to the community no longer reflects the community needs.”

‘Nobody cares for us’

One of the biggest concerns is the impact that mergers have on a patient’s access to care, including maternity and behavioral health services. 

HCA shut down its labor and delivery services at Frisbie two years after purchasing it, even though it originally said it would not do so until five years after the merger. Obstetrics tends to be a high-cost venture for hospitals, with less-than-attractive returns. Birth rates are also going down in New Hampshire, making it harder for hospitals to continue to offer services, and making it difficult for patients to get access to the services elsewhere.

“You know how many patients I used to get at Frisbie who did not have a car that would function and be reliable?” said medical oncologist Bhargava. And, she said, even if they had a family member who could drive, that person would often be working and not be able to take time off.” 

She added: “There are very socially and economically challenged people. If they don’t have health care close to them, they are going to die in their homes.”

‘Difficult to survive’

The hospitals argue they face enormous challenges of their own. More than one-third of nonprofit acute care hospitals in the state reported they’re running in the red, said Ahnen. 

He said workforce shortages have led to high job-vacancy rates across all hospital departments — 14% for nurses, 20% for surgical technicians, 22% for respiratory therapists — even as health care needs have kept hospital beds full, to the point where they cause a backlog in the emergency department. 

Experts predict the hospital consolidation trend will continue in New Hampshire over the next several years.  

The first hearing held by the state Healthcare Consumer Protection Advisory Commission on May 28 in Rochester attracted some 75 people, many of whom offered comments about the effects of the 2020 acquisition of Frisbie Hospital by the for-profit HCA Healthcare. Speakers included employees of the hospital, who praised the merger, and members of the public decried the deal, citing facilities closures and failure to be notified about changes in medical staff. (Photo by Meera Mahadevan)

According to Hodder of Franklin Pierce Law, with so many local hospitals in New Hampshire, “it’s going to continue to put pressure on our hospitals to compete with each other, which will result in higher cost, which is eventually going to hurt the system, and there will be pressure to consolidate. Some are going to win and some are going to lose in the process.”

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.

(Shorter Version Critical Condition Sidebar) New Hampshire’s ‘favorable’ conditions for hospital acquisitions

By Meera Mahadevan, Granite State News Collaborative

Why are big out-of-state hospitals eager to make a foray into the New Hampshire health care market? The answer partly lies in the fact that the state is uniquely situated, both geographically and politically.

Josephine Porter, strategic advisor for the N.H. Center for Justice & Equity, says when a community hospital is acquired, ‘there is concern that the benefit the hospital provides to the community no longer reflects the community needs.’ (N.H. Center for Justice & Equity photo)

Access to more patients just across the state border is attractive to hospitals in Massachusetts that have faced uphill regulatory battles in their own state, analysts say. New Hampshire also does not have large employers, like Massachusetts does, with the muscle to push for change in health care costs.

“New Hampshire, despite being small — the patient mix tends to be favorable,” said Josephine Porter, strategic adviser for the N.H. Center for Justice & Equity. “There’s good health insurance coverage (here), on the commercial side.”

Lucy Hodder, director of the Health and Life Science Policy programs at the University of New Hampshire’s Franklin Pierce School of Law, says price pressures on hospitals could continue the consolidation trend. (Franklin Pierce School of Law photo)

Of New Hampshire’s 1.4 million residents last year, about 62%, 853,000 people, received private health insurance through their employer or by purchasing their own coverage, according to Lucy Hodder, director of Health and Life Sciences Law and Policy programs at the University of New Hampshire’s Franklin Pierce School of Law. Her data shows that 16% had Medicare and 9% Medicaid.

In addition, Porter said, “there is some benefit to looking at New Hampshire because the process isn’t as arduous here as it might be in someplace else.”

A decade ago, New Hampshire got rid of one big regulatory hurdle: the Certificate of Need Board. It required New Hampshire hospitals and clinics to get state permission before building or expanding facilities. New Hampshire formed the board in 1979 but shuttered it in 2016 after a long legislative battle over the board’s pluses and minuses. Critics said it created obstacles by requiring that, before a facility was built, evidence had to be produced to show it was needed. 

“There are other states where there are more stringent certificate of need boards and regulatory authorities,” Porter said. “There are many more steps in other states than what New Hampshire has.”

Currently, the state Attorney General’s Office is the only entity overseeing hospital mergers through its antitrust bureau and charitable trusts unit.

The Attorney General’s Office has been ringing the alarm bell over hospital consolidations and their potential to reduce competition for the last several years. In fact, in 2022, it opposed Dartmouth-Hitchcock’s plan to purchase Granite One Health, a combined entity that included Catholic Medical Center in Manchester, saying the move would limit competition.

But earlier this year, Attorney General John Formella said he was compelled to approve HCA’s acquisition of Catholic Medical Center, in part because the Manchester hospital was in such dire financial situation that patients stood to lose services entirely if it shut down. 

The Legislature established a trust fund, known as the Healthcare Consumer Protection Trust Fund, and would direct the hospital that is doing the buying to contribute money toward the fund. Under that directive, Beth Israel Lahey, following its purchase of Exeter Hospital in June 2023, was required to deposit $10 million over 10 years into the trust fund. And HCA must pay $7.5 million over 10 years. 

In addition to the trust fund, the Healthcare Consumer Protection Advisory Commission was formed to help advise the AG on how to spend and manage that money. Expenditures from the fund need approval from the seven-member commission, the governor, and the N.H. Executive Council. The commission has been meeting monthly since July 2024.

Last November, the commission voted to spend up to $1.6 million from the trust fund for a three-and-a-half-year contract with the University of New Hampshire to create the Center for Studying Healthcare Markets. The goal is to evaluate the impact of health care consolidation and examine regional best practices from neighboring states in New England.

In addition, some are asking the state to establish a patient advocate office to help contain costs and hold the industry accountable.

The health commission has begun holding a series of public hearings, including one planned in Exeter in June and one in Claremont in July.

The first hearing, held May 28 in Rochester, attracted over 75 people, with several HCA employees and a few members from the public showing up to speak. 

The first hearing held by the state Healthcare Consumer Protection Advisory Commission on May 28 in Rochester attracted some 75 people, many of whom offered comments about the effects of the 2020 acquisition of Frisbie Hospital by the for-profit HCA Healthcare. Speakers included employees of the hospital, who praised the merger, and members of the public decried the deal, citing facilities closures and failure to be notified about changes in medical staff. (Photo by Meera Mahadevan)

Nurses and hospital administrators at Frisbie praised the merger in their presentations to the commission, citing positive turnaround data, including shorter wait times at the ER. But members of the public who spoke said facility closures and patients not being properly notified of doctor departures following the Frisbie acquisition had been very difficult for them. 

“I have institutional memory of what Frisbie used to be and what it is for my husband who is very ill,” Marsha Miller, an 81-year-old Rochester resident who lives across from the hospital, told the commission. “We have to deal with perceptions, which is that HCA is bad.”

Referring to HCA employees’ favorable comments about the merger, she added: “Nobody knows all of these wonderful things. These changes are not a part of my reality.”

Attorney General Formella, told the audience, “A lot has happened in the health care industry. … And we are going to need to be having a lot of conversation – a lot of thoughtful dialogue about where the state goes from here.” 

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.

Yes, I have a felony. No, I won’t apologize.

By Shamecca Brown, Columnist, Granite State News Collaborative

First off, no I’m not angry.

My directness stems from self-awareness, not anger. I possess clarity, confidence and self-awareness, not attitude. 

Being unapologetic means owning my survival, voice and truth without shame or regret for my experiences. Labels like "emotional," "aggressive," or "too much" are attempts to control strength. Having been through difficult experiences leads to speaking out with wisdom and boldness. Protecting my peace, setting boundaries, and acknowledging my experiences are not things I apologize for.

And just because I’m not rich or famous doesn’t mean I owe the world an apology for surviving. Celebrities get to move wild and stay untouchable. But people like me? We get dragged for simply trying to stay afloat.

So let me tell you my truth:

Back in 2019, I was publicly humiliated and criminalized for something that came from trying to provide for my family as a struggling mother. I was charged with a felony for using my son’s Social Security and food stamp benefits. I hadn’t reported that I remarried; I didn’t know that was a problem until an investigator started knocking on doors, asking neighbors about me. 

It wasn’t fraud. It wasn’t a scheme. It was survival. I thought I could make it right by being honest from the start. I showed up without a lawyer and with my truth, but the system didn’t care. They twisted the narrative and made me a headline, just another statistic instead of a human being. I never thought I would have a felony conviction. I came with my truth, but without an attorney, my story was turned inside out. 

Being a single Black mother, I was reduced to a stereotype: the angry, struggling, bitter mom. People saw a caricature, not a full person. They didn’t see the late nights, the hard work or the deep love I have for my children. By making me that character, the system tried to erase my strength and silence my voice.

I was ashamed then because my children had to see me go through this, but not remorseless. I did not pity myself and I refused to let that narrow image define me. Threatened by jail time and overwhelmed by the system, I plead guilty to a felony. It shouldn’t have happened. But it did. 

And I started to work to overcome it. 

Even though it cost me professionally and personally, I didn’t fold. I didn’t let it define me. I learned. I rose. I kept moving, because I had children to raise, a life to live, and a purpose bigger than my pain.

I was bold then. But that version of me was hard, guarded and defensive. That was survival mode. Standing firm for my kids was tough but felt right, and that's why I won't apologize for something I believed in. I knew my worth, even when others tried to diminish it. 

Living with a felony made me realize I can overcome anything. Staying stuck isn't in my nature. Taking responsibility meant facing the consequences head-on: no excuses, no running. It meant owning it, learning from it, and doing the hard work to rebuild my life with integrity, not just for me, but for my children and everyone watching my journey. I take full responsibility and own my actions, but I don’t need society reminding me of them constantly.

Unapologetic now looks like freedom.

It looks like walking into rooms like I belong, even if someone wants to remind me of my past. It looks like advocating harder for single moms, for women navigating unjust systems, for people criminalized for surviving. It looks like helping survivors rebuild, supporting people with disabilities, and showing up every day with empathy, even when I could’ve led with anger.

Unapologetic now means I speak firmly and protect my peace. I don’t dim my tone, shrink my voice or edit my truth. I know how to walk in Jordans and still lead with power. I know how to carry wisdom and still sound like I’m from Queens. I don’t move messy, I move with purpose. And if that makes someone uncomfortable, that’s their issue, not mine.

I’m not loud, I’m heard. Not bitter, I’m built. Not intimidating, you’re just unfamiliar with someone who knows their worth.

I’ve walked into rooms not made for me and created space anyway. I’ve endured what would’ve broken others, and still choose joy, purpose and service. I carry the voices of ancestors who couldn’t speak. I stand for those still learning it’s okay to take up space.

I’m not seeking validation. I’m telling my story before someone else tells it for me, without the heart, the context or the truth.

So to every person who’s been labeled “too much,” “too real,” or “too complicated” you’re not the problem. You’re powerful. You’re necessary. And you don’t owe anyone your silence.

You owe the world your truth.

This is what being unapologetic looks like, then and now.

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

Growing up, I didn’t celebrate Juneteenth. As a Black mom, I make sure my kids do.

• Celebrating New Hampshire’s Black History

  Through the month of June, local organizations are celebrating New Hampshire’s Black history. Here’s how to learn more and participate:

  • UNH Juneteenth Guide

  • Juneteenth Events (from NH PBS)

  • Black Heritage Trail of New Hampshire, Juneteenth Celebrations

By Shamecca Brown, Columnist, Granite State News Collaborative

When I dance on Juneteenth, it will be for my ancestors. It is for every Black person who walked the path of slavery and discrimination. This is for those who never got to taste freedom, who dreamed of a day they’d never live to see. 

I’m bringing all of that to the stage with me. Every step, every turn, every breath, is a story. A real story. A Black story, My story.

I’m dancing at the Currier Museum of Art, in an event organized by the nonprofit Racial Justice Team. Yet this isn’t just a performance. This is us. Our history. Our pride. Our moment. And trust me when I say, everyone in that audience is going to feel it. 

Our performance will feature Sam Cooke’s “A Change Is Gonna Come,” a song that has long served as an anthem of hope and perseverance, along with African folk songs that connect us to the rhythms and traditions of our heritage. 

You know what makes this year’s Juneteenth even greater? My two youngest children will be right there with me, representing. My 12-year-old son and my 15-year-old daughter will be part of this moment, and that means everything to me. My son, especially, has so many questions. And I love that. 

As a child he couldn’t express himself much at an early age because of his delayed speech, but one thing he could do? Dance. Now, he’s the one who challenges the world around him, the one who asks his teachers, “Why are we celebrating St. Patrick’s Day so hard, but when it was February, Black history was barely even mentioned, maybe just once?” He knows what’s up, and he wants to share the stage.

Growing up, Juneteenth was a day like any other for me. I never heard anyone mention it, even though both my grandmothers were deep Southerners, living in Alabama and North Carolina. But there were no parades, no cookouts, no big community gatherings. I never heard my friends talk about it or my family to be honest.

This was a discovery for me and my family: The understanding about honoring those who came before us, those who struggled, and those who carried the torch to make sure future generations would one day know their freedom. It’s a learning experience for all of us, filling in the gaps that schools still don’t teach, and encouraging my kids to ask hard questions. 

When I was young, I wasn’t allowed to ask our elders certain questions. Even now, my 90-year-old grandma from Alabama keeps a lot to herself. When I ask about her experiences in the Jim Crowe south, she just gets quiet and says, “That’s my space, it’s not for y’all to worry about.” 

My grandma doesn't talk about the past because she’s been through and seen so much. She once told me, “I wasn’t free.” Those words never left me. Maybe–and this is just me thinking– my grandmother can’t justify Juneteenth as a holiday because some of her relatives and friends never made it to freedom. They were stuck. 

Caption: My grandma (far right) who is 90 today, with her mother (top left) and three of my great-grandmother’s 13 children. 

My grandmother had one thing going for her: she was a landowner, something many other Blacks weren’t able to become because of systematic oppression. Her own mother bought the land, earning money through sharecropping and making dresses. It’s still a source of pride, but I get teary eyes, thinking about the hardship that went into getting and keeping that land.  

In New Hampshire Juneteenth is not officially a state holiday, it has been acknowledged as a day of observance since 2019. Many organizations and communities across New Hampshire celebrate this day. I think the more we take the time to celebrate and truly recognize Black American history, the more we begin to understand just how rich, complex, and deeply connected it is to all of our lives. 

While writing this I was feeling overwhelmed thinking about what is happening in our world. I think about how my kids, and their kids, will have to struggle just to keep teaching the truth; how they’ll have to fight to make sure Black stories don’t disappear. But no matter what, being free from oppression and able to live with dignity is a reminder to all of us about the power of liberation, the importance of remembrance, and the responsibility we have to ensure freedom for all people, regardless of the color of their skin. 

So let’s continue to celebrate Juneteenth and keep it alive. I know once I’m on that stage dancing, that overwhelming feeling will disappear right through my feet. That’s my Juneteenth celebration: to share my movement and capture smiles.

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

Tackling the increase in New Hampshire’s motor vehicle crashes and fatalities (Copy)

Just a few months into 2025, the Granite State is experiencing a deadly surge on our state highways and roads. As of May 2025, there was a 9.68% increase in motor vehicle crashes from this time last year, along with a disturbing projection of possible fatalities to come. Rosemary Ford talks about the increase in motor vehicle crashes and fatalities in New Hampshire with Lt. Chris Storm, N.H. State Police commander of special services, and Tyler Dumont, the N.H. Department of Safety’s strategic communications administrator and public information officer.

By Rosemary Ford and Caitoin Agnew

This article has been edited for length and clarity.

Rosemary Ford:

Lieutenant Storm, you’ve been with the N.H. State Police for over 20 years. What have you seen that explains the reasons behind the increase in crashes? What are the leading causes?

Chris Storm:

​​First and foremost, our impairment. Second, our speeding. And third, distracted driving. These three continue to be the leading factors in our fatalities out here on our highways in New Hampshire.

Rosemary Ford:

From 2020 to 2024, studies have shown a 233% increase in fatalities among 16-to-21-year-old vehicle operators. Lieutenant Storm, that’s a steep statistic. During the pandemic in 2020, fewer people were driving. As things opened up, that obviously changed. Did that play a role in forming these statistics? 

Chris Storm:

We don't actually have any statistics that tell us that it was the absolute factor, but if you look at it holistically, it obviously contributed to some of that. I can't give you a specific number or tell you that, yes, that was the reason, but we have seen an increase in those youth and younger drivers that are seen to be crashing and dying on our highways.

Rosemary Ford:

What about other changes? During the pandemic, some 15-to-16-year-olds experienced driver’s ed over Zoom. Could there be a connection with some of this? 

Chris Storm:

I don't know if there was a difference between having it in a classroom or not having it in a classroom — the students still had to get out there and get all their driving hours. So it wasn't that they were just driving virtually. They were actually out on the roads, practicing and driving. They still had to do the required hours with that individual that's 25 years or older, so I don't have a good statistic on that and whether that was a factor or not.

Rosemary Ford:

What role has technology played in these increases?

Chris Storm:

Technology, even though it has some unbelievably great benefits, also can be very detrimental if you're taking and dividing their attention or being distracted while you're operating a motor vehicle anytime. A moment of inattention can easily lead to something that could be catastrophic.

Rosemary Ford:

Tyler, you are the New Hampshire Department of Safety’s strategic communication administrator, and public information officer, can you tell us about your role? 

Tyler Dumont:

My position here is really focused on trying to educate and inform people about issues that are going on in our state when it comes to highway safety issues. Really obviously, our target is drivers, pedestrians, cyclists — all different people who use the roads. We’re trying to get the message out about the risks of dangerous behaviors on the road and encourage safer behaviors.

Rosemary Ford:

So what’s the plan? How can the state prevent crashes and deaths? 

Tyler Dumont:

Our plan has really developed over the past year. I'd say we have started to integrate a lot of the work that we're doing with an external organization. In fact, we've hired a media vendor to work with us on creating New Hampshire-centric, homegrown campaigns to ultimately reduce crashes and save lives on our roads. We do that kind of in two different ways. It's really a data-driven approach that targets those two areas, which are deterrence and prevention.

Rosemary Ford:

Is there anything that the state Legislature can do that hasn’t been done already? Any new laws for seat belts, helmets or driver’s ed curriculum?

Chris Storm:

Currently, the Legislature actually has several bills before them to help increase traffic safety. First and foremost, there's a bill to increase the penalties for refusing to take a post-arrest chemical test if you've been arrested for DWI. There is a bill on the table right now to increase the penalties for individuals that are traveling over 100 miles an hour. There's also another bill on the table right now that will add penalties to aggravated driving while intoxicated if you were driving on a controlled access highway in the wrong direction, because we've also seen a spike in wrong way driving. 

And then we have another bill, right now, that would increase the license loss for youth operators for every time that they get a traffic summons and not only lose their license, but they would also have some educational mandates, and they would have to attend certain classes to help better their driving abilities.

Tyler Dumont:

My role is to really analyze the current crash data that we have, and not so much to really focus on the possible laws or ways that we could change. It's really focused on what we do have and trying to identify some of those issues and the ways that we can address them, as to what's currently in the books.

Rosemary Ford:

As we continue into the summer, when there are more drivers of all ages, and New Hampshire gears up for Bike Week on the 14th, are there some things that we can do as drivers to keep everyone safe on the roads? 

Tyler Dumont:

I think trying to get ahead of some of these issues. The lieutenant mentioned earlier that motorcycle crashes often trend up in the summertime — just in 2023, unfortunately, we had a near 20-year high in motorcycle deaths. Again, it's about monitoring the data and tracking the data. With Motorcycle Week arriving, along with warm weather, we've rolled out some motorcycle safety messaging for riders and drivers. We started that early, before the season even started, back in April, and we've tried to get that messaging to those who will be using the road.

Chris Storm:

We can encourage everybody to share the road. We want to make sure that people understand that — that motorcycles are everywhere, that we want people to be able to see them. It's not necessarily that the motorcyclists are always doing something that is wrong. Oftentimes they're not doing anything wrong, and it's because someone didn't see them, or they pull out in front of them. We want people to share those roadways with everybody. We also want our motorcyclists to remember to also drive safe as well and ride safe so that everybody gets home safely.

Rosemary Ford:

Lt. Chris Storm, N.H State Police commander of special services, and the N.H. Department of Safety’s strategic communications administrator and public information officer, Tyler Dumont — thank you so much 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.

Will Canadians boycott New Hampshire this summer?

By all accounts, Canadians are not happy with us. Could it be the talk of making them the 51st state? Or perhaps the 25% tariffs? Maybe it’s both. And because of that, they might not visit us here in New Hampshire this summer. In New Hampshire, fewer visits could mean millions in lost revenue and taxes. Here to discuss what’s going on and why is writer Granite State News Collaborative reporter Jonathan Decker. 

By Rosemary Ford and Caitlin Agnew

This story had been edited for length and clarity.

Melanie Plenda:

You recently wrote a story for the Granite State News Collaborative looking into how a Canadian boycott of the U.S. could affect the New Hampshire tourism industry. What inspired that? 

Jonathan Decker:

I was actually just having breakfast with my fiance, and we were both just kind of talking about tariffs and the economy. She actually asked me, “I wonder if it's gonna affect visitors from Canada,” and I thought “That’s a really good idea for a story.” Then I started looking into it and then I pitched it to the Collaborative. I thought there's really something here. It turns out there was.

Melanie Plenda:

What did the Canadians you talked to say about visiting the States this year. What are they thinking? Why aren’t they coming? 

Jonathan Decker:

The primary Canadian I talked to was a dual citizen, and because she travels back and forth from the U.S. and Canada all the time, I asked her about what people are saying. A lot of people are kind of boycotting travel, and even just spending in general, that is associated with the United States over the 51st state comments and the tariffs. 

I think it depends on which person you're talking to, but this source told me people were much more upset with the 51st state comment than the tariffs. The 25% tariffs were baffling — that’s the word she used — because Trump did come up with and sign the trade agreement between the U.S., Canada and Mexico in 2017-18, and now he's kind of reneging on that.

A lot of Canadians also expressed confusion, but it really seemed to be more of a personal thing that's really what's keeping people from visiting. It’s almost like a betrayal from a friend. I think a lot of Canadians think that things soured really quickly. It’s like having a friendship with somebody and then they say, “I don’t want to see you anymore” — that type of thing.

However, it does look like it's going to be more older people who are boycotting and younger people who still might come down, especially for hiking, outdoor recreation — that type of thing. 

Melanie Plenda:

There are even marketing campaigns in Canada advising citizens not to visit the States and buy Canadian goods. What’s going on there?

Jonathan Decker:

Yes, so that seems to be happening in various different businesses. It seems to be pretty grassroots. I first heard about this, actually, from my editor, Jeff Feingold, when he was traveling in Canada, when I was working on this piece. He actually wrote to me and said, “Hey, there's actually all these signs in the grocery store that say, ‘Buy Canadian,’ that products are labeled so you know if you're going to buy the U.S. product or the Canadian product, to encourage local consumption and production.”

Another one of my sources was Charlie St Clair. He's a state representative, but he's also the man behind Bike Week, and every year he goes on a big odyssey across the country to promote Bike Week in Laconia, sending out mailers and magazines. And he told me that when he was driving, he was listening to an AM radio station in Canada, and he heard an ad telling people to stay home, don't travel to the United States this summer, and spend your money in Canada. So it just seems to be a grassroots and populist movement to counter President Trump's rhetoric.

Melanie Plenda:

What will that mean for New Hampshire’s economy? What sort of an impact will that have? 

Jonathan Decker:

It's a little difficult to get exact numbers, because even the Division of Tourism here doesn't track specifically how many Canadians are coming in. Many of them come through Vermont. But we do know that the state raises a significant amount of tax revenue from the rooms and meals tax — I think in 2023, $450 million was raised. So if you just saw a 5% dip, that could be $22 million of lost revenue from Canadians not spending on those hotel rooms and those meals and restaurants. But again, we can't really know the exact big number of the year until it happens.

Melanie Plenda:

What about the local tourism industry? Do they see a way to adapt to this change? 

Jonathan Decker:

I think it depends on what region you're in. One of my sources mentioned that they might be able to adapt due to lower gas prices. So we might just get more American visitors willing to travel and drive into New Hampshire. That was probably the biggest adaptation I saw. But as far as replacing Canadians specifically, I didn't hear anything about that. But again, you might be able to make up for this with domestic travel.

Melanie Plenda:

What about repairing our relationship with Canada? What will it take? 

Jonathan Decker:

I think that's going to vary from individual to individual, but one theme that I noticed was that there seems to be just more blame at the higher levels. As far as Canadian and American citizen interaction goes, there doesn't seem to be that much bad blood. But when it comes to the top of the pile, the political class, I honestly think a change in American leadership would be a strong first step to that. 

One of my sources thinks it could take a generation to get over this. It depends from person to person, but a lot of Canadians do feel very hurt by this sudden turn on them as a trading partner and as an ally, especially with the rhetoric surrounding being the 51st state. 

I'm not sure what Trump is trying to achieve with that rhetoric. I don't know if the United States would actually like to manage Canada and add an additional 35 million citizens. His motivations surrounding the trade war are a bit difficult to splice as well, because if it's not a dissatisfaction with the initial trade deal — he said it's been to pressure them to do more about fentanyl trafficking. But according to the DEA, Canada is not a major supplier of fentanyl to the United States, it is Mexico, China and India. Canada already has its own huge fentanyl problem as well. They're much more of a consumer than an exporter of the drug and the components needed to make it. 

So I'm not sure what his strategy is in that sense. I understand pressuring Mexico — that makes a lot more sense to pressure Mexico and China, because that's where it's coming from, but we will see.

Melanie Plenda:

That was interesting. Granite State News Collaborative reporter Jonathan Decker — thank you so much 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.

What the first American pope means for Catholics and the world

The world’s 1.4 billion Roman Catholics now have a new leader, Pope Leo XIV. What does that mean for the future? The Very Rev. Jason Jalbert, one of the vicars general for the Roman Catholic Diocese of Manchester — which encompasses all of New Hampshire — and the rector of St. Joseph’s Cathedral in Manchester, discusses what the papacy is, former Pope Francis’ legacy and what lies ahead for his successor.

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Melanie Plenda:

For those who may be unfamiliar, can you briefly explain the role of the pope in the Roman Catholic Church?

Father Jalbert:

The pope is the head of the church, the Vicar of Christ. He has many different titles, but most importantly, he's the successor of the apostle Peter. So we call him the successor of St. Peter because Peter received that role from Jesus himself, and we read about it in scriptures. Jesus said, “You are Peter, and upon this rock I will build my church.” And so the church was built on him.

So each pope after Peter has been the successor of Peter. We respect him very highly because of who he is, the person that's chosen to be the pope then represents Christ on earth for us and for all the Catholics.

Melanie Plenda:

Popes usually pick new names upon their election. Can you explain this tradition and what it means?

Father Jalbert:

It goes back to St. Peter again. Peter, son of Simon, son of John, became Peter, the name that Jesus gave him. And so over the history of the church, those who have been elected as pope have taken on a name, and many of the names have been repeated over and over and over, just like Pope Benedict was the 16th, and now we have Leo, the 14th. Pope Francis was just Pope Francis, because no other Pope ever had the name Francis, and no other pope has ever taken the name Peter. So there will probably never be a Peter the second. They'll only just be one Peter.

The pope's name says a lot about who they are and how they look to the future. So it means a lot to choose that name, and it gives them a whole new identity, when you think about it.  It's very life-changing.

Melanie Plenda:

Let’s turn to Pope Francis, who, before becoming pope, was a cardinal in Argentina. He served as pope for 12 years. What impact did he have on the world and the church? What will his legacy be?

Father Jalbert:
Like all other popes, they have an impact with the role they have. Everything they say and do has an impact. Going back to the day that Pope Francis was elected — he came out on the front of St. Peter's Basilica in the square, in the white cassock, having just been elected, and he looked pretty serious, because it's a very serious role. There's a great weight to the role of being pope. He came out and he asked people to pray for him.

I think people remember that quite clearly. Then, at the end of his pontificate, after being sick, he went out on that same balcony in St. Peter's Square, asked people to pray for him again, but gave his final blessing — which we didn't think would be his final blessing — to Rome and the world, but then so many different things in between showed his desire to make Christ known. He was an evangelist, he preached, he taught Jesus Christ, and he traveled to many different places throughout his pontificate. He really cared for the poor, the elderly, the sick, the unborn. He had a great desire to lift up the dignity of human life.

During the COVID pandemic, when everybody was just in their homes and not traveling, there he was in the middle of St Peter's Square, praying for the world, praying for each and every one of us. He held the monstrance, which is a gold-looking object that looks like the sun, but in it is the host that we believe is truly Jesus Christ. He blessed the world that evening with Christ in his hands. There are so many different things.

Melanie Plenda:

Turning back to the current pope — what were your first thoughts when you learned about the election of Cardinal Robert Prevost, now Pope Leo XIV?

Father Jalbert:

I think it came quite quickly after the fourth vote on that Thursday afternoon. I was with a priest friend, and we had the television on, watching live coverage, just like so many people were — all eyes on the chimney and the seagull family that hung out by the chimney, just waiting for the smoke. And all of a sudden the smoke started, and it was white smoke, and we had a pope.

Then the cardinal announced his name in Latin. When I heard that name, Prevost, I wasn't exactly sure who it was, except for the friend I was with who said, “Oh my. That's Cardinal Prevost from the United States.” You wait to hear the name and he took the name Leo, the fourteenth. What is that going to mean?

Then he comes out onto the balcony and says his first few words, hearing him speak in Italian for that first greeting, and it kind of made me feel a little better, because it's just hard to think about an American pope as a typical American speaking English. I spent most of the day learning more about him as more news came out about who he was in interviews — people that know him, from priests to his own siblings, which was another interesting thing to hear from the relatives of the new pope, which we haven't really had that before.

Melanie Plenda:

Did you ever think you would see an American pope? And what do you think the impact of his papacy will be in the United States?

Father Jalbert:

I think, first, like so many other people, I never thought there would be a pope who was born here in the United States, or a pope from the United States. So that idea was something that I think most of us just sort of put in the back of our minds. I'm not even sure if many people hoped it would happen, but it has happened.

They say that out of all the American-born cardinals he's probably the most un-American, in the sense that he was born here, grew up here, and had his formative years here in the United States, but then served outside of the United States for so many years as the head of the Augustinian order, then as a bishop in Peru, then as a archbishop and cardinal working in Rome. So he's had a great experience, and it's not like he was just plucked from here to become pope.

As far as the impact in the United States — I think he will, and I think he already has had an impact. They say the number of searches online about the Catholic Church in the United States has skyrocketed. People are interested. The more that we get to know him, I think the more people are getting to love him, and if they love him and they see that he's a genuine, authentic man who has been elected to lead the church, people might be interested in learning more about the church and about how to become Catholic. We'll have to wait and see. But I think he’s really making a great impression already in the short amount of time that he has been the pope.

Melanie Plenda:

How have local Catholics reacted to the news of a new pope?

Father Jalbert:

From what I've heard in my own parish, people are excited. They're happy. It's very unusual to have a pope who can speak perfect English. So to hear him speak English is a little strange at first, but then to be able to hear the pope speak our own language very clearly feels like we should be proud. He's from here, he's one of us, just like the Polish people were so proud when Karol Wojtyła was elected Pope John Paul II, and they still are so proud.
Melanie Plenda:

As you mentioned, Pope Leo XIV comes from the Augustinian order. Can you explain what that means?

Father Jalbert:

It's an order that follows a rule that comes out of the teachings of St. Augustine. St. Augustine is an early saint. His mother prayed for his conversion for many years, and he became Christian, then became a priest and a bishop and wrote extensively, and his writings are very well known, especially the confessions. There’s an order that’s based on St. Augustine. They're best known for being teachers and educators in high schools and colleges — Villanova being one of them, and closer to us is Merrimack College.

Melanie Plenda:

Can you touch a little bit more on what you think his priorities will be?

Father Jalbert:

I don’t think the secular media wouldn’t fully understand his role and what his mission is as the pope. It's not to be political, but it is to be Christ here the world, the visible presence of Christ. He’s looking out for the people, from the unborn to the elderly and everyone in between. That’s not being political — that’s just being Catholic, being Christian, what we believe the human person to be.

He's already had quite a few opportunities to give homilies and give talks, and he really is focused on unity. He wants to be a bridge-builder, and that's also one of the roles of the pope. “Pontifex Maximus: is the great bridge, and so popes have been given that title. So unity, communion and just the love of Christ and the peace that Christ has come to offer — made that known right from the beginning as he offered Christ's peace to the people on the day of his election, as he came out for the first time as Pope Leo XIV.

Melanie Plenda:

That was so interesting. The Very Rev. Jason Jalbert, 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.

New Hampshire Humanities faces a new reality after abrupt withdrawal of federal support

Funding cuts have a ripple effect on cultural programming, communities across the state

By Kelly Burch, Granite State News Collaborative

Funding cuts have a ripple effect on cultural programming, communities across the stateThis spring, about 1,100 people — more than live in the entire town — visited a former elementary school in Jefferson to view a Smithsonian exhibit about rural America. 

Schoolchildren, elderly residents and everyone in between discussed the present and past of the North Country, creating new bonds within the community.

“We don’t know each other well, but we are starting to now,” said Joe Marshall, president of the Jefferson Historical Society, which orchestrated the event. “This brought a lot of people together, and everybody has really really enjoyed it.”

The exhibit, which has since moved to Plymouth, took place in part through a $3,000 grant from New Hampshire Humanities, a nonprofit that distributes federal funding to support humanities activities — those that explore culture, history and social values. Last year, grants from the organization touched 172 of New Hampshire’s 234 cities and towns, said Michael Haley Goldman, executive director of the organization.  

The Smithsonian exhibit, ‘Crossroads: Change in Rural America,’ drew hundreds of people to the North Country town of Jefferson this spring. The exhibit was ‘a real game changer’ for the community, says Joe Marshall, president of the Jefferson Historical Society. (Courtesy Jefferson Historical Society).

But similar programs across the state are facing an uncertain future — and some are already canceled — because of federal funding cuts. In April, the National Endowment for the Humanities canceled nearly all its grants, including to New Hampshire Humanities, to comply with requests from the Trump administration and the Department of Government Efficiency, or DOGE. In turn, NH Humanities has had to reduce its own grantmaking, canceling grants to a program exploring artificial intelligence in Hampton Falls and Holocaust education in Meredith, among others. 

“We’re already thinking about cutting back on the programs we’re going to offer next year because the funding has ceased,” said JerriAnne Boggis, executive director of the Black Heritage Trail of New Hampshire, which depends on grants from NH Humanities for its Tea Talks series exploring the Black experience.

At the same time, funding has been halted for Granite State organizations that had received grants directly from the National Endowment for the Humanities, including the state’s largest-ever humanities grant, awarded to support a library currently under construction in Mont Vernon. 

“It’s a betrayal,” said Cindy Raspiller, a trustee at the Mont Vernon Library. “It sounds harsh, but it’s an apt word.”

‘A real game changer’

Each year, NH Humanities has received about $900,000 from the federal endowment. A large portion of that money must be matched through private fundraising, bringing the organization’s operating budget to $1.6 million annually, said Haley Goldman. The organization doesn’t receive any state government funding.

NH Humanities then makes 20 to 25 grants each year to support organizations around the state, Haley Goldman said. That includes major project grants of up to $10,000 and mini-project grants of up to $2,000. 

In addition, NH Humanities provides ongoing programs for organizations like libraries, schools and community groups around the state. One of its most popular programs — Humanities to Go — is a speaker series.

With the funding cuts, many of those operations are on pause. So far this fiscal year, NH Humanities has awarded about two-thirds of its allocated grant funding, Haley Goldman said. Programs that have already been promised a commitment will go ahead, but the other third of grant dollars will not be given out, and NH Humanities is not accepting applications for in-house programs such as Humanities to Go or Perspectives, a book group. 

Instead, the organization is focused on making sense of its new funding reality. 

“We’re really trying to figure out what’s sustainable for next year,” Haley Goldman said. “There is a sustainable path forward, which relies on the support of the community."

Funding from NH Humanities has a ripple effect for communities. The Jefferson Historical Society, for example, used its $3,000 grant for the Smithsonian exhibit as a “springboard to generate all the other in-kind dollars,” Marshall said. It also led to community partnerships and connections that will continue long after the exhibit leaves. 

“This is a real game changer,” Marshall said. 

‘Deep conversations’

Last fall, the Cohen Institute for Holocaust and Genocide Studies at Keene State College received a grant from NH Humanities to host a series of book groups centered on the book “Treblinka: Archaeological and Artistic Responses,” which explores the response to human remains and artifacts found at the notorious Nazi concentration camp in Poland. 

The recent showing in Jefferson of ‘Crossroads: Change in Rural America’ led to community partnerships and connections that will continue long after the exhibit leaves, says Joe Marshall, president of the Jefferson Historical Society. (Courtesy Jefferson Historical Society).

Participants received the book for free and were invited to attend a lecture by author Caroline Sturdy Colls last September. 

The program “opened up deep conversations about the meaning of human remains (both historically and today), and it also inspired some of my own students at (Keene State College) to delve deeper into the field of forensic anthropology,” said Kate Gibeault, director of the Cohen Institute.

In addition, the funding allowed the Cohen Institute to partner with other libraries and schools across the state “in ways that otherwise wouldn’t have been feasible,” Gibeault said. 

Often, NH Humanities grants support programs that are replicable in other communities, amplifying the impact of the dollars spent. 

“It’s one of the things that is special about New Hampshire — being able to share this information freely,” said Erin Sniderman, outreach librarian at the Hampton Falls Free Library. 

Sniderman has used NH Humanities funding in the past to create events that weave together Hampton Falls’ past and present, including a 2023 historical display and expert lecture about indigenous artifacts in town, after a community reading of “Braiding Sweetgrass,” a book that brings together indigenous wisdom and science. 

“Being able to pull all of these elements in together … we wouldn’t be able to do that without the humanities funding,” Sniderman said. 

Sniderman was planning a similar community event this summer, exploring the impact of artificial intelligence and robotics. The program was meant to serve as a template that other libraries could use to open discussions about those technologies, but it’s been scaled back now that NH Humanities isn’t making new grants. 

Some elements — such as a robot petting zoo — have found other funding sources, but without funding from NH Humanities, “we lose those professional scholars,” Sniderman said. “We get the toys, but we don’t get the education.”

A small library forges ahead

Mont Vernon is a small town of about 2,500 people in Hillsborough County. It’s also the location of the largest National Endowment for the Humanities grant in New Hampshire’s history: $655,000 to support construction of a new library. 

“We were very impressed with ourselves that we won,” said Raspiller, the library trustee.

Winning the grant — one of 23 given out nationwide — was only the beginning, however. The grant required $4 in matching funds for each $1 of grant money. The community met the challenge, and last September broke ground on the new library, which is slated to be finished in the fall, Raspiller said. 

So far, the project has collected about $164,000 from the national endowment, but on April 29 Raspiller received a notification that the grant had been terminated. No appeals process was available, the notice said. 

Now, the town is left scrambling to finish the library without the federal funding. Luckily — with many adjustments and with contingency funding — the project remains on track, but the loss of the grant is a major upset. 

A Smithsonian exhibit came to Jefferson earlier this spring, in part thanks to a $3,000 grant from NH Humanities. Similar programs are now under threat due to federal funding cuts. (Courtesy Jefferson Historical Society).

“It’s a little like someone tripping you at mile 25 of the marathon,” said Bonnie Angulas, library director in Mount Vernon. “You know you’re going to finish, but you might crawl across the line.”

The substantial federal humanities grant wasn’t a win just for Mont Vernon, Angulas said, but for New Hampshire as a whole. Each day she was fielding calls from other librarians, asking for advice on their own grant applications. 

“They were so hopeful about this project,” she said. After the cancellation, “it’s a little disheartening to everyone. … The federal government should come through on their promise.”

Planning for the future

Previous grant recipients say less funding for NH Humanities could lead to fewer community events and deeper discussions that bring people together. 

“Grants like these are critical in ensuring that all community members have access to conversations about what it means to be human,” said Gibeault of the Cohen Institute. 

Boggis, of the Black Heritage Trail, said that, just as the grants have a ripple effect, so does their cancellation.

“The trickle-down effect of this loss of funds is more than that one grant,” she said. “It’s felt in the community.”

Small organizations that “can’t go one season without that support may never come back,” she added.

Nevertheless, NH Humanities will continue to exist, no matter what happens with federal funding, Haley Goldman emphasized. 

“We see a path to sustainability without the federal funding because of the type of support we’ve had within the state,” he said. “Not every state is feeling as fortunate.”

In April, the Mellon Foundation announced $15 million in emergency funding to state humanities councils, including NH Humanities. That infusion of about $200,000, plus possible matching funds, will allow NH Humanities “to start next financial year in a much better place,” said Haley Goldman. Yet the organization is still working hard to decide what its new normal will look like without federal funds. That loss remains “detrimental,” he said, especially at a moment when Americans are feeling increasingly disconnected from those around them. 

"The cultural work of our communities isn’t a nice bonus if we can do it,” he said. “It’s the core of what we do as a society.”

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

60 years later, Community Action Programs are still on the front lines of fighting poverty

Amid threats to their funding, CAPs around New Hampshire remain determined to provide assistance

By Scott Merrill, Granite State News Collaborative

Sixty years after President Lyndon Johnson declared a “War on Poverty” and launched his vision for a “Great Society,” the ideals of equal opportunity and human dignity can feel distant, especially amid moves right now to roll back the programs and initiatives enacted in the 1960s that were meant to uplift marginalized communities.

A Head Start classroom in Tamworth that’s run by the Tri-County Cap. (Courtesy Tri-County Cap)

Among programs in the crosshairs are the funding sources for over 1,000 Community Action Agencies across the country — including five in New Hampshire – that were created through the landmark Economic Opportunity Act in 1964. The agencies administer anti-poverty initiatives such as Head Start and the Low-Income Home Energy Assistance Program and distribute food to pantries and soup kitchens. 

In his 2026 budget request, President Donald Trump is seeking to eliminate the $770 million Community Services Block Grant program, a key funding stream exclusively for Community Action Agencies. Though relatively modest, the grants are highly flexible.They’re used to fill service gaps, support clients who fall outside typical funding categories and leverage additional resources. Last year, New Hampshire’s share of that block grant funding totaled nearly $4 million, helping local Community Action Programs attract an additional $152 million from federal, state, local, and private sources. Agency officials warn that losing the block grants could seriously undermine their ability to secure matching funds.

Trump’s budget request would eliminate the $4 billion Low-Income Heating Assistance Program,  and in March the U.S. Department of Agriculture announced a $500 million funding cut for the Emergency Food Assistance Program, which supplies USDA food to Community Action Programs for distribution.

Amid the uncertainty, the agencies still quietly carry out President Johnson’s vision of providing food, housing, job training and financial literacy services to thousands in the Granite State and millions across the country, and CAP leaders in New Hampshire remain committed.

“What I really love about community action is that we are built to respond to specific community needs,” said Betsy Andrews Parker, CEO of the Dover-based Community Action Partnership of Strafford County. “We are truly the backbone of keeping people fed, housed, warm and in jobs, and most people don’t even realize it’s us doing that work.”

Every corner of the state

The Community Action Partnership of New Hampshire  — a collaboration of the state’s five Community Action agencies — is celebrating its 60th anniversary in May. The agencies serve every corner of the state, from the North Country south to the Monadnock Region and the Seacoast, and provided services last year to 111,638 low-income individuals in New Hampshire. Last winter, the LIHEAP program alone provided fuel assistance to 28,235 low-income individuals — those who earn 60% or less of the state median income. They received an average benefit of $1,049.

• SIDEBAR: CAPs: At the heart of food distribution in New Hampshire

  In Berlin, 74-year-old George Sanschagrin volunteers for the Tri-County Community Action Program, which runs the Senior Center of Coös County’s Senior Meals Program. 

  He does everything at the center, from fixing doors to delivering hot meals, often offering a warm hello to folks who might not see anyone else that day.

  Sanschagrin, who retired from millwork at age 62, calls volunteering the best decision he ever made. “I started volunteering after retirement and I’ve been volunteering ever since,” he said. Much of his work involves serving and delivering food to North Country seniors.

  Among the most essential yet under-recognized roles Community Action Programs play in New Hampshire is food distribution, says Betsy Andrews Parker, CEO of the Strafford County CAP. 

  “If you want to see something incredible, watch the tractor-trailers roll up to our agencies and start distributing thousands of pounds of food,” she said. “That food is what supplements nearly every food pantry and soup kitchen in the state.”

  Much of that food comes through TEFAP — The Emergency Food Assistance Program — which supplies U.S. Department of Agriculture food to agencies such as Tri-County CAP. In March, the USDA paused half of TEFAP’s funding, $500 million.

  The scale of food distribution is massive, said Michael Tabory, chief operating officer of the Concord-based Community Action Partnership of Belknap and Merrimack Counties. “Last year, we distributed over 4 million pounds of food. That’s more than $6 million worth, reaching over 225 organizations and about 25,000 households each month.”

  Sanschagrin, born and raised in Berlin, worked for 32 years in the city’s once-thriving mills. His French-Canadian family was part of the town’s industrial fabric. 

  “Back in the day, you had to know someone to get a job at the mill,” he says. “It was a real community — French Canadians on one side of town, Italians and English on the other.”

  That community spirit lives on in Sanschagrin. At the senior center, he sharpens knives, assembles furniture, unpacks food, installs bolts and serves garlic bread — his specialty — on pasta days. “I have all kinds of tools. I can do a lot of stuff,” he says. “Whatever needs to be done.”

  Beth Daniels, CEO of Southwestern Community Services, the CAP based in Keene, says the impact of its food distribution goes well beyond groceries. “We’re also providing administrative infrastructure — completing the paperwork, organizing the distribution, making it possible for tiny volunteer-run pantries to exist,” she said. “It’s not just food. We’re supporting a whole system that delivers the food.”

  Food programs are especially vital for seniors, Tabory said: “Meals on Wheels, for instance, is more than just food. It helps seniors stay in their homes longer by providing daily welfare checks and socialization.”

  In Berlin, Sanschagrin’s dedication extends beyond the senior center. He also delivers meals to more than 100 seniors through the home-delivered meals program. For many, those visits are more than a delivery — they’re a lifeline.

  “You don’t just knock and leave the meal,” Sanschagrin said. “You knock, talk to them a bit. Sometimes it’s the only person they’ll talk to all day.”

From shelter beds to food boxes and job training, New Hampshire's CAPs offer a wide range of services, often using volunteers, and tailor their work to meet local needs. While offerings vary slightly across the state’s five CAPs, core programs remain consistent nationwide. All told, New Hampshire’s CAPs operate more than 70 programs. 

“We’re often the first point of contact when someone needs help,” said Andrews Parker.

“There’s fuel assistance, electric assistance, weatherization, Head Start, emergency food through TEFAP, WIC, senior housing, Meals on Wheels, housing stability services, and even public transit in some places,” said Jeanne Robillard, CEO of Tri-County CAP in Berlin. “No matter where you are in the U.S., there’s a CAP agency doing these things.”

Donnalee Lozeau, CEO of the Community Action Partnership of Hillsborough and Rockingham, was one among the first Head Start students in New Hampshire. She is shown here with her Head Start teacher at the White Wing School in Nashua in 1965. The Head Start program in New Hampshire is administered by CAPs around the state. (Courtesy Donnalee Lozeau)

CAP Hillsborough and Rockingham, based in Manchester, runs workforce development programs that help hundreds throughout southern New Hampshire, and it operates Head Start, Early Head Start and child care programs. CEO Donnallee Lozeau — who herself was part of an early Head Start class as a child in 1965 — said demand is high for the services.

Last year, she said, “we served a total of 432 children, and sadly we have a waitlist. Even if we were fully staffed and opened all the rooms, we would still have a waitlist.”

‘The glue that lets us do the work we do’

Statewide, CAPs serve one in every 13 New Hampshire residents; in the North Country, it’s one in six, Robillard said. According to the U.S. Census Bureau, Coös County has a 13.1% poverty rate, the highest in the state. The statewide average is 7.6%.

Beth Daniels, CEO of Keene-based CAP Southwestern Community Services, said her agency provides hundreds of affordable housing units and operates six shelters, with a seventh in winter. In Strafford County, the Community Action Partnership runs almost all homeless services, including a new shelter, rapid rehousing and outreach. 

Daniels’ agency had revenue of $23 million, including money from Community Services Block Grant funds that were shared among all five CAPs statewide. “CSBG is the glue that lets us do the work we do,” she said.

George Sanschagrin is a volunteer for Tri-County Community Action Program in Berlin. Much of his work involves serving and delivering food to North Country seniors. (Photo by Scott Merrill)

CAP leaders say that, while people may know about programs like Head Start, they rarely understand those services fall under the Community Action umbrella, or how interconnected they are.

“We’re helping to keep fuel vendors’ accounts current, reassuring landlords their tenants’ pipes won’t freeze, making sure people have IDs so they can apply for housing,” said Andrews Parker. “None of that would happen without CAPs.”

“Not all the money gets handed directly out the door to clients,” said Michael Tabory, chief operating officer of CAP Belknap-Merrimack in Concord. “A lot of the money stimulates local economies. We hire local contractors for weatherization projects and support fuel providers — money goes back into communities.”

In total, the CAPS in New Hampshire employ a total of over 1,114 staff members and have over 5,000 volunteers.

CAPs receive a mix of federal, state and local funding, along with private donations, to carry out services. The federal block grants are a key source of funding, allowing them to leverage other funds, Robillard said.

The block-grant program “isn’t tied to a specific service area and that’s part of what makes it so powerful,” said Robillard. “Betsy [Andrews Parker] might use hers for a shelter start-up. I might use mine for our low-cost dental clinic. It’s tailored to what the community needs.”

Doris McDonald is another volunteer at the Tri-County CAP’s Berlin Senior Center. (Courtesy Tri-County CAP)

In 2024, New Hampshire Community Acting Programs received $3,965,243 in federal block grants, and a total of $152 million from a variety of sources — other federal funds, private industry, and state funding — all leveraged from CSBG dollars. The state provided CAPs with $6,043,729 last year, which helped fulfill state contracts for a variety of services, including child care and shelters.

As legislators continue their state budget work, it’s unclear how much money will go to the Community Action Programs over the next two years. While the overall N.H. Department of Health and Human Services budget would increase under Gov. Kelly Ayotte’s spending plan, 13 of the 28 sub-agencies within those departments would get less money than they got this fiscal year, according to the N.H. Fiscal Policy Institute. Two of those agencies include child behavioral health and child development.

‘Stability and dignity’

As an example of the flexibility of the block grant funding, Parker pointed to an initiative being undertaken by the Strafford County CAP. It has been awarded money for a new bus to expand bus routes, but needs to make a 5% match. “If we don’t have CSBG dollars, we’ll need to find the match somewhere else,” she said. “Without those funds, we won’t be able to do a lot of the work we do, including training for child care workers, which the state depends on.”

In rural areas, philanthropic support is thin, Robillard said, which makes the block grants even more important. “There are fewer large businesses and wealthy donors to shoulder the burden,” she said. “You can only tap a small donor pool so many times.”

The Community Action executives warn that federal cuts in programs such as LIHEAP and the block grants would harm efforts to lift people out of poverty. Still, they remain hopeful.

“LIHEAP was zeroed out,” Lozeau said, “but I have confidence elected officials have seen the benefit of those dollars and how they help people.”

Adds Robillard: “We’ve been doing this for 60 years. We take a nonpartisan approach to advocacy, but we’re clear: These services are essential.“

Betty Gilcris, health and nutrition director at Tri-County CAP in Berlin remains optimistic about the future of Community Action Programs in New Hampshire. ‘We’ll weather the storm,’ she says. (Photo by Scott Merrill)

Betty Gilcris, health and nutrition director at at the Tri-County CAP in Berlin, also remains optimistic. “We’ll weather the storm,” she said, noting contingency plans are being developed for state-subsidized child care and other programs.

As funding questions loom, CAP leaders say their mission — connecting dollars to human need — has never been more vital.

“We’re helping people move toward stability with dignity,” Andrews Parker said.

Tabory, who worked in the corporate world earlier in his career, said his community action work has set an example for his children. “I look at them and they are sensitive to the needs of other people. They’re conscious of inequalities,” he said. “The fact that I've been able to instill in them the values of community action makes me feel they’re going to be good contributors to society.”

“When it comes right down to it, ” said Robillard, “Community Action Programs are about helping people and changing lives. Our goal is helping families become self-sufficient.”

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

The impact on New Hampshire of potential massive cuts in public funding for the humanities

Art, culture, literature, thought — collectively, these disciplines and others make up what’s known as the humanities. Recently, the Trump administration’s Department of Government Efficiency, or DOGE, cut 80% of the National Endowment for the Humanities’s staff, also cutting almost all grant programs and rescinding grants and program contracts that have already been awarded. Why are the humanities important, and how does public funding help society — and you? Here to explain that, we have two guests — Michael Haley Goldman, executive director of New Hampshire Humanities, and Joe Marshall, president of the Jefferson Historical Society. 

By Rosemary Ford and Caitlin Agnew

This article has been edited for length and clarity.

Melanie Plenda:

Michael, can you give us some background on the cuts? What happened and when? How did you find out?

Michael Haley Goldman:

This has all taken place in just the last few weeks, really. April was when we got notice of the changes in policy. 

It's probably important to take a step back and think about how this federal funding has been coming. New Hampshire Humanities is an independent nonprofit, so we're a little bit different from some of the other groups that have been seeing changes to the federal funding coming in the state, like the State Library or the State Council for the 

We aren't part of the state government, but we do have an affiliation with the National Endowment for the Humanities, meaning that, even though we're a nonprofit, we receive federal funding that is matched by private funding here in the state of New Hampshire. That federal funding is something that we usually get in about a five-year contract, and we received notice late on April 2nd that an email came out from the National Endowment for the Humanities indicating that our existing grants in contract had been fully canceled. 

So that means all funding before April 1st was stopped, which is about $500,000 of funding for New Hampshire Humanities to support the cultural sector of New Hampshire that was pretty much unavailable in the middle of our year.

Melanie Plenda:

What impact has this had so far on New Hampshire Humanities and New Hampshire?

Michael Haley Goldman:

I’ve been proud to say that we've been able to head off a lot of the worst possible impacts. But that doesn't mean there's not been a lot of damage here in New Hampshire from this change. We've been as careful and clever as we can be in using the funding that we have available. All of the grants that we give out — we usually give out more than $100,000 in direct grants each year — that we had already scheduled are going out, but there's about $40,000 that we were planning to, with the second half of the year, that's just not going out to New Hampshire. 

We had to reduce it by a little less than 100 programs this year. That's usually hundreds of programs that we do around the state that we basically fund in what you could call mini-grants.

Melanie Plenda:

Joe, please tell us about the Jefferson Historical Society and its work with New Hampshire Humanities. 

Joe Marshall:

The Jefferson Historical Society is also an independent nonprofit, and we are staffed entirely by volunteers. Our mission is to preserve and promote the town of Jefferson's history.

In regards to Michael and his staff and our deepening relationship with them over the past couple years, we applied for us to be able to present an exhibition, “Crossroad Changes in Rural America.” We worked with Michael and his team through that application process. 

Through the process as we were ultimately chosen to be one of the venues to host the exhibit,our relationship with the humanities has deepened, and it is become extremely obvious to us as to how important it is for organizations like ourselves, to be able to bring what is really quite a large event to our community, and it's all been through the help of the New Hampshire Humanities.

There's been a tremendous, tremendous amount of training in personal work and site visits and just overall support and encouragement through the humanities to essentially help all of us bring our communities together up here.

Melanie Plenda:

And Joe, that exhibit is going on now. What impact has the society or Jefferson seen from it?

Joe Marshall:

In regards to Jefferson, we have been through quite a little bit, as with everybody else, during the tail end of COVID. We lost our town hall to a fire in February of 2021, and with that, we had to find a new home for the town to do its work. We are now situated in what's known as the Jefferson Community Center, and it's a very large building, a former elementary school, and is being repurposed to house the community. 

That is when we applied for the exhibit. It was kind of a crossroads moment for us as a community, with this type of venue becoming available to us. As far as I'm concerned, and I know there are many others that feel the same way, it has enhanced our ability to function as a community and brought people together in a way that we have not been able to do previously. So we're pretty excited about that and what it opens up to us for the future. 

Melanie Plenda:

Let’s talk more about the benefits of the humanities. What are the tangible, or perhaps in tangible, benefits for having the humanities and these public programs? 

Michael Haley Goldman:

People get hung up on this idea of “what is the humanities?” and you can go through this laundry list of academic subjects, but what I think is really important, what's often maybe intangible, is what the humanities does, and at the heart of that is how it brings people together in community. Just like what's happening in Jefferson, just like what's going to be happening around the project at the Museum of the White Mountains at Plymouth State University.

It's really about the way that we come together to talk about who we are as individuals, talk about who we are as communities, and talk about where we're going. The humanities is the fabric within which all of that happens. When we go into communities, we are trying to help those communities do what they want to do as a group. We are about how they come together to talk about the problems they have, about what's important to them, about how they see their challenges and their solutions — all of those things come naturally out in the kind of humanities program that we do. We've been learning over the last 50 years as an organization, how to create the environment for that to happen. 

Joe Marshall:

We've had this fantastic run of togetherness within our community. This has been something that has built a great deal of anticipation over the past two years, brought the community together, and that has been a wonderful thing to see. I believe it's helped us as an organization, and it will help us in the future. We cannot thank the humanities enough for what they've done to help us move forward. 

Michael and his group have promoted and made available to us some of those “New Hampshire Humanities To Go” programs. We've had four of them here, and it has brought in incredible audiences and tremendous speakers, and it is really bringing that community aspect, and I can’t say this enough. I can just see this after all this happening just moving forward exponentially.

Melanie Plenda:

Michael, you mentioned investing in the humanities. Can you talk about the economic impact of that?  

Michael Haley Goldman:

There's a lot of different numbers, and I will talk about the economic impact, because that  knowledge is really important and a really big part of why it's necessary to have cultural investment within the state. But I also want to remember that economic value is only one value, as we are investing in New Hampshire.

But economically, we know that we have a pretty much a 2-1 investment. So for every dollar of investment from the federal government, there's $2 invested privately to respond to that. And if you look at the creative economy, which we’re a part of and is an affiliated, but not identical, part of what we do, that's more of an average of 5-1.

Even for what we're talking about with Jefferson — this is a small Smithsonian exhibit that my organization and organizations like mine bring to the entire country, and they talk about even larger investments around the idea that this little exhibit is really having something like a 7-1 impact in terms of what it brings to a community, because people come to see an exhibit, and then they spend their time in town spending money that they wouldn't otherwise spend.

So this is really not something that we should see as a free meal that is being given to New Hampshire. It is an investment that brings back far more local investment than what it actually costs us to do in the state.

Melanie Plenda:

Michael, what happens next for New Hampshire Humanities? How will it deal with these cuts going forward?

Michael Haley Goldman:

I think the most important thing for me to say is that we are not going away. We have been in the state for 50 years, and we intend to be here for the next 50 years. But I also can't say that that is going to be as easy as it would have been under other conditions, and that we really need the community to show its support for New Hampshire Humanities and show its support for the cultural sector at large. 

This is a really difficult time for all of the cultural organizations within the state as we look at the possibility that the State Council for the Arts might be dropped from the state budget. I realize that is not final yet, but the fact that we're even talking about that as a real concern. The fact that the Institute for Museum and Library Services, which is one of the least-known federal groups but is a huge underpinning of libraries across New Hampshire through the State Library, is talking about having that funding lost to the state. This is an incredibly important time for groups like mine to be present and to be supporting amazing groups like Joe's and other groups in every city and community. All these places in New Hampshire that need their support to keep these cultural touchstones, these incredible organizations that underpin our communities alive and well and active within New Hampshire, and we intend to do that. But we are going to need culture, we are going to need the support, and we aren't going to do the work at the level that we've been doing if we have half the budget that we had last year. We won’t be in 172 communities next year. We will still be there, but it will be on a much lower level. It’s going to be felt town by town in New Hampshire.

Melanie Plenda:

Well, good luck to you both. Michael Haley Goldman, executive director of New Hampshire Humanities, and Joe Marshall, president of the Jefferson Historical Society. 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, visitcollaborativenh.org.