Dispute over vetting process for spending millions leads to removal of the panel’s two public appointees
By Meera Mahadevan-Granite State News Collaborative
A state health care commission — created to oversee millions of dollars in funding to benefit consumers following a recent wave of hospital acquisitions and consolidation — is being rocked by change in leadership and membership.
And two of the commission’s members are proposing to prevent the N.H. Executive Council from overseeing its expenditures and removing funding for academic research related to the hospital mergers.
Yvonne Goldsberry, a longtime community health advocate and president of the Endowment for Health, and Marie Ramas, a primary care doctor in Nashua, are the only two public members of the Healthcare Consumer Protection Advisory Commission, which has been meeting publicly since the summer of 2024 to advise the state attorney general’s office on matters relating to health care mergers and acquisitions.
But both have been notified that their two-year terms will not be renewed, effective immediately.
Goldsberry was chair of the seven-member commission, which was created by the attorney general’s office and established by the Legislature in July 2023.
Attorney General John Formella has been appointed as the new chair, and Goldsberry has been replaced with a new member, Dr. Mitchell Cohen, a physician in Nashua. It is not clear if a new member has been named to replace Ramas. The governor appoints members of the commission.
Ramas said the abrupt change in leadership and her departure were unwarranted and are a setback for health care consumers.
“Considering that I am a family physician and president of the New Hampshire Medical Society and have a very broad and deep knowledge from the industry side as well as from a public health and public policy side, I was surprised that the governor did not see my areas of expertise and the population and constituents that I have a direct voice to as beneficial for the purposes of this commission,” Ramas said.
A spokesperson for Goldsberry said that, under her leadership “and in partnership with other health policy experts, she succeeded in getting the commission started and inviting public participation. Several members of the commission continue to advocate for a thoughtful and fair process in the expenditure of funds managed by the commission.”
In a statement, Formella said the commission is grateful for the services and insight provided by Goldsberry and Ramas, but he declined to say why their terms were not renewed.
In addition to the two public members and the AG, the other four members of the commission are: N.H. Sen. Tim McGough, R-Merrimack; N.H. Rep. Julie Miles, R-Merrimack and McGough’s wife; a designee from the state Insurance Department; and a designee from the state Department of Health and Human Services.
The commission is tasked with managing funds from the Healthcare Consumer Protection Trust Fund, which are to be used solely for benefiting health care consumers and for supporting initiatives that enhance competition, access and quality in the state’s health care market.
As of December, the trust fund had a balance of about $4 million, Formella told the commission last month. The commission estimates the fund will receive an additional $1 million this year related to Massachusetts-based Beth Israel Lahey’s acquisition of Exeter Hospital in 2023. It will also receive about $1.75 million between 2027 through 2032 related to the Exeter deal, as well as from HCA Healthcare’s purchase of Catholic Medical Center in Manchester. Half of the money from the HCA-CMC transaction is required to be used in the greater Manchester area.
Contentious meeting
The changes in membership came as the commission was in the early stages of rolling out its stated purpose and discussing how best to get public input on the impact of several high-profile hospital acquisitions, including Beth Israel’s acquisition of Exeter Hospital and HCA’s purchases of Frisbie Memorial in Rochester and Catholic Medical Center.
McGough and Miles are sponsors of House Bill 1784, which calls for removing the Executive Council’s oversight of expenditures. It also calls for prohibiting the funding of academic research related to mergers and acquisitions. When the commission was established, funding decisions were supposed to be approved by the commission, the governor and the Executive Council.
Neither McGough nor Miles could be reached for comment.
The commission has already passed a measure awarding a four-year, $1.6 million contract to the University of New Hampshire to conduct research on health care consolidation and its impact on the state. It is not clear if the governor and the Executive Council have approved that funding yet, or if that funding is in limbo.
The UNH Center for Studying Healthcare Markets has already been created and is headed by Dr. Bradley Herring, a professor of health economics. Herring has made initial presentations to the commission and is expected to appear in front of it again soon.
For its part, the attorney general’s office said that, if HB 1784 is passed, it anticipates a significant increase in attorney and staff time to evaluate proposals and ensure compliance. It also said the bill would require hiring an assistant attorney general and a paralegal at a cost of between $100,000 and $500,000 per fiscal year.
The departures of Goldsberry and Ramas came after what has been described as a contentious meeting last October, when two proposals were made by entities seeking funding.
One was a request from the Plaistow Fire Department for about $1.4 million to replace advanced life support services for 18 communities that were eliminated in the fall of 2024 following the Beth Israel-Exeter hospital transaction. The request was approved unanimously.
However, a proposal for $182,500, submitted by Sen. McGough on behalf of Merrimack Adult Day Health Center, a for-profit senior center, passed narrowly on a 4-3 vote. Goldsberry, Ramas and Melissa St. Cyr of the state Department of Health and Human Services voted against the request.
McGough told the commission that the center allows for the socialization of seniors from seven communities and needs two additional vans with wheelchair lifts to reach four more communities.
According to draft minutes of the meeting, some commission members questioned the connection between the center’s request and the intent of the trust fund money. Supporters of the proposal said the center provides much-needed meals and meets other needs, while other members said the commission has not yet assessed how it will even accept proposals from the public, or even what criteria will be used, and said that opportunities have not been extended equitably to all potential grantees.
Ramas said it is unfair to allow proposals to be brought to just one person on the commission.
“I think those were fine ideas and fine intentions that were brought up,” Ramas said. “But we didn’t have a process in place to review the proposals. The group is very new, so it’s not a question of whether the proposal is good or bad. It’s that I don’t know what the process is.
“We need to be clear and equitable so that the public is informed. … It was not equitable for the couple of requests that came in to be directly associated with one person on the commission. We need to make sure we have a process so we can measure outcomes.”
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