Support has emerged on both sides of the aisle for the organization, which buys vaccines at a discount at no cost to the state.
By Kelly Burch, Granite State News Collaborative
The N.H. House of Representatives has voted to do away with the N.H. Vaccine Association, a nonprofit that buys vaccines at a roughly 30% discount at no cost to the state.
But people who oppose the bill — including doctors, public health experts, and some Republican lawmakers — say that repealing the N.H. Vaccine association would result in higher costs to the state (and thus, taxpayers), inflict a financial burden on doctors’ offices, increase insurance premiums, and ultimately result in fewer vaccinated children in the state.
“This program has worked extremely well for a long time and hasn’t cost the state any money,” said Rep. David Nagel, R-Gilmanton, who is also a physician. “What’s problematic about this bill [is] from the very beginning, virtually no stakeholders supported it. That should be a red flag for everybody.”
The bill — HB 524 — passed the House on a vote of 189-181 on March 6. This week, it was considered by the House Ways and Means Committee, which evaluates all bills that affect state spending. The committee retained the bill, meaning it will be reconsidered later in the legislative session.
Rep. Mary Murphy, R-Francestown, initially voted for the bill, but later testified against it during the committee meeting, after conducting hours of research that she said shows the bill would result in higher insurance premiums and thus greater cost to the state.
“We don’t want to support any bills that are going to add to the tax burden of the public,” she said. “That’s where I’m coming from and why I decided to try and sustain this organization.”
What is the N.H. Vaccine Association?
The N.H. Vaccine Association is a nonprofit that buys vaccines in bulk at a 30% discount from what doctors’ offices would otherwise pay, according to Dr. Julie Kim, president of the New Hampshire chapter of the American Academy of Pediatrics.
“It has nothing to do with policy or requirements to get a vaccine,” she said. “All it is, is a buying discount.”
The nonprofit was established in 2002 by state law (RSA 126-Q) and had bipartisan support at the time, said Patrick Miller, executive director of the N.H. Vaccine Association. The cost of running the association — including the price of vaccines and a 0.84% administrative cost — is paid entirely by assessments levied on health insurers who operate in the state.
These funds — roughly $24 million last year — are then given to the state and combined with federal funding that covers vaccines for children who are uninsured or on Medicaid. Using those two funding sources, the state then buys vaccines at a 30% discount and makes them available to all doctors’ offices in the state, Miller said.
The state has no cost in operating the program.
“We’re not requiring vaccines, we’re not impacting vaccines policy, and we’re not taking state dollars,” Miller said.
The impact of repeal
Repealing the vaccine association would impact the economy, taxes and public health, experts say.
“Vaccines are crucially important to maintaining the health of our population and, honestly, the economic prosperity of our communities,” said Dr. Sally Kraft, population health officer for Dartmouth Health System.
The most immediate impact of a repeal is that vaccines would no longer be available at a discounted rate to providers, and thus patients. (The state would still be able to buy at a discount for children on Medicaid or who are uninsured, Miller said.)
“There’s no question that the cost of vaccines will go up,” Kraft said.
That would likely result in higher insurance premiums, which affects individuals who have commercial insurance and businesses that pay for insurance for their employees. The N.H. Insurance Department has estimated there will be an increased cost of $7.19 million annually to the private insurance market if the vaccine association is repealed.
The state would incur greater costs to provide insurance to its employees because of rising premiums, which could impact taxes, experts say.
"We’ll all be spending more money,” Kraft said.
In addition, providers would need to buy vaccines on their own, which might mean that some clinics — particularly small clinics in rural areas — have fewer vaccines available, experts say. That’s one of the reasons Murphy, who represents towns of Deering and Francestown, testified against the bill.
“I’m concerned about the effect it would have on the doctors,” she said.
Rather than keeping vaccines on hand in their clinics, doctors might order vaccines as needed, meaning that patients may need to return for a second appointment to get a vaccine, creating a barrier to timely vaccination, experts say. In addition, offices would need to shoulder the administrative and financial burden of ordering and billing insurers for vaccines.
“It took a long time to build up such an efficient framework that runs pretty smoothly and takes a lot of the administrative burden off of providers,” said Tory Jennison, a registered nurse who is executive director of the N.H. Public Health Association.
People in favor of keeping the N.H. Vaccine Association say that payers, providers, patients and taxpayers all benefit.
“This is a win, win, win, win,” said Nagel. “There are four wins in this and no losses.”
What’s the reason for the bill?
Rep. Michael Granger, R-Milton Mills,, and Rep. Mike Belcher, R-Wakefield, two of the bill’s seven Republican sponsors, did not return requests for comment about the impetus behind the bill.
In a March 7 press release, Rep. Jim Kofalt, R-Wilton, senior adviser to House Speaker Sherman Packard, said, “Contrary to the fearmongering we have heard from the bill’s opponents, it will have zero effect on the cost and availability of vaccines. What it will do is make government more accountable to New Hampshire taxpayers, who are currently footing the bill for a costly program run by a quasi-governmental organization.”
Experts who spoke with the Granite State News Collaborative said that’s a fundamental misunderstanding of the N.H. Vaccine Association.
“There's a misconception that this is costing the state money, and it’s not,” Miller said.
Some lawmakers have raised concerns about transparency, but Miller said the vaccine association has addressed those in recent testimony and has always been entirely transparent.
“The website has every document that we’ve ever created,” he said.
Nagel, one of the Republican lawmakers who voted against the bill, said any concerns he had about transparency were addressed in a different bill, which he supported.
“The people who have opposed [the vaccine association] have never given a good argument to what the problem is,” he said.
Nagel was recently removed from his post on the House Health, Human Services and Elderly Affairs Committee in part, he says, because of his stance on vaccines and other health-related issues. He said he needs to prioritize his knowledge as a physician over party lines.
“People taking on legislation … that have virtually no expertise in this area, that aren’t willing to listen to the people who have the expertise – that’s a problem,” he said. “As a physician, I’m really struck with how often the Legislature wants to tell me how to do my job. And what’s really concerning to me, increasingly, is they’re not willing to listen to me explain to them … what the unintended consequences [of legislation] will be.”
Health care workers, including Kim, Nagel, Kraft and Jennison, said those unintended consequences of removing the vaccine association could include higher health care costs and more Granite Staters with preventable disease. The full economic consequences could be seen a decade or more down the road, as hospital systems in the state face increased costs of caring for unvaccinated individuals, Jennison said.
That’s why there’s such strong bipartisan support for the N.H. Vaccine Association among people who understand its function, they say.
“This vaccine association highlights the best parts of New Hampshire,” Kraft said. “It’s innovative. It puts that Yankee ingenuity into effect, and it’s incredibly effective.”
These articles are being shared by partners in the Granite State News Collaborative. For more information, visitcollaborativenh.org.