James Pindell - The most important relationship in Concord

CONCORD — Now what will we tell fourth-graders when they visit the statehouse?

For decades tour guides have pointed out to endless groups of fourth-graders who visit the statehouse on field trips the House chamber, the Senate chamber and the governor's office. These guides said that important things happened in those rooms.

Someone should brief the New Hampshire state house tour guides that things have changed.

When the election results came in there appeared to be an interesting, but elementary dynamic of the state house. All legislation would need to somehow get support from three equally strong elements: a Republican-dominated House, a Republican-dominated Senate and a Democratic governor. Power in all three rooms mattered.

This changed last Wednesday when the New Hampshire House fell into all-out civil war among House Republicans. Instead of choosing the expected path, they ended up with Hudson Republican Shawn Jasper as House speaker instead of Mont Vernon Republican Bill O'Brien. By rejecting O'Brien's return to the gavel, the House created new infighting divisions that render the House such a hot mess it is irrelevant on larger policy issues. House votes on issues like the budget obviously matter, but the House won't be driving any policy issues.

This means that the most important relationship in Concord is the one between Democratic Gov. Maggie Hassan and Senate President Chuck Morse.

That duo and their deputies will decide what does and doesn't happen in state government this year. Will the state legalize marijuana? Will the death penalty be repealed? Will the university system get more money? All these questions are basically answered with where Morse and Hassan stand on the issues.

Probably the two biggest results of the House out of the picture this week could be on casino gambling and on reauthorizing Medicaid expansion. If O'Brien had become speaker he was open to doing the first and deeply against doing the second. He would whip votes and shape legislation to conform to his wants. A powerless Speaker Jasper may try to do the same things, but it is unclear if a majority of any sort will follow his lead.

To be sure, Jasper is trying to change this by developing his own power center. He is an 11-term veteran of the House and served in his party's leadership last session. He understands the ways of Concord.

But power exists with leaders who have the power to implement. Right now there are only two people with the power to follow through on their words: Morse and Hassan.

State House guides would be smart to just skip showing the House side of the building. What they see inside there might not be appropriate for children to see anyway.

(James Pindell covers politics for WMUR. You can see his breaking news and analysis at WMUR.com/political scoop and on WMUR-TV.)

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Henry D. Lipman & Andy Patterson - Spreading inaccurate info about Critical Care Hospitals is harmful to patients and the community

A recent New Hampshire Public Radio (NHPR) story by reporter Jack Rodolico, "Lack of Transparency Leaves Some Medicare Patients in Dark at Half of N.H.'s Hospitals," was picked up by a local writer to the editor of the Laconia Daily Sun. As in the NHPR story, the author misses the mark on the value that New Hampshire's Critical Access Hospitals (CAHs) provide to the patients and communities they serve, and encourages unfortunately the spread of information that is inaccurate.
Quoting from a recent blog of the N.H. Hospital Association President Steve Ahnen . . ."(a)ll of New Hampshire's hospitals, including our 13 CAHs, take very seriously their responsibilities in sharing information with their patients about their hospital bills and the patient's portion of that bill. The story further misses the point by implying that CAHs get reimbursed anything more than the actual cost of care. They do not. The final payment received by a CAH is a reflection of their allowable costs that are paid by Medicare and the beneficiary. The story further implies that those Medicare beneficiaries without supplemental insurance don't get substantial financial assistance for what they can't afford. " (for the full blog, see http://www.nhha.org/index.php/blog/1157-nhpr-story-misses-the-mark-on-the-value-of-new-hampshire-s-critical-access-hospitals)
Here are five key points:
1. The financial difference to the patient cited in the letter and story is only for those who don't have secondary/supplemental insurance. Statewide that applies to about 26,000 people according to the NHPR story; that is out of an estimated 231,444 Medicare beneficiaries (http://kff.org/medicare/state-indicator/total-medicare-beneficiaries/).
2. The reality is that most of those who can't afford secondary/supplemental insurance get help from hospitals, including CAHs, in the form of charitable care or they don't pay. Medicare patients who don't have secondary/supplemental insurance in actuality pay Franklin Regional Hospital $0.07 on a dollar of the charges, a figure we suspect is similar for most of N.H. CAHs.
3. By federal statute and via audit by the Federal Government, a CAH's reimbursement is limited to cost; CAHs can't, and don't, inflate billing to get more than their actual cost.
4. A patient might wrongly infer from the billing accusations that they should avoid seeking care from a CAH. If people delay or avoid treatment, it can have greater costs to themselves and society in the form of greater illness, injury or even shorter lifespan.
In the Federal Government's budget, the funds spent on the CAH program are minimal, compared to the overall Medicare budget, but the benefits to rural communities are substantial by ensuring access to high quality of care for their residents.
No comprehensive research has been has been done to date that would support the potential savings to the government of eliminating the CAH program without negatively impacting our rural communities. The CAH program has ensured continued necessary hospital-level services to rural communities throughout the country and it is a program that should be maintained into the future.

5. Franklin Regional Hospital and Lakes Region General Hospital have a staff member dedicated to provide written price estimates for services that we will guarantee within a narrow range. Moreover, we have multiple staff to help patients obtain financial assistance readily for those patients who need help with covering the cost of their care.
In closing, we as a community (quoting from the N.H. Hospital Association's President Steve Ahnen's blog post) ". . . can't expect rural access without the real cost of care coming from a combination of payment from Medicare and beneficiaries. The allocation between the two is the real public policy issue." And we welcome the opportunity to find solutions that address concerns of patients and that protect access to care in our rural communities.
Moreover, we would submit that for our regions' Medicare beneficiaries, assuring and preserving that the right care at the right time and the right place is available is the more substantive issue to the vast majority of Medicare beneficiaries both in terms of their health and finances.
The community at large should also see the CAH program as an important source of economic development to attract businesses and industry to open or relocate to New Hampshire.
Please spread this important information!

(Henry D. Lipman is chair of the New Hampshire Hospital Association and senior vice president for Financial Strategy and External Relations at LRGHealthcare in Laconia; Andy Patterson is senior vice president of Provider Relations and Contracting and executive director of the Laconia Clinic.)

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Sanborn — Generate a sale?

The recent snowstorm over the Thanksgiving Day holiday was a reminder to a lot of people that lost their power of just how important electricity is. There's nothing worse than a cold bird especially when you have a whole house full of people coming. And the fact that you quite possible don't have any heat creates a less than perfect holiday atmosphere. So how do you prevent this and be able to cook the bird, have some heat, and watch the ball game all at the same time? The obvious answer is, of course, a generator. Another possible answer would be to move to Florida, but they have hurricanes, so you still might need a generator.

Having a generator can really be a life saver, but it can also help in the sale of your house. I can't tell you how excited some buyers get when they see that a generator is included in the sale of a home. I don't necessarily think it will make or break a sale, but it sure does come as a valued added bonus.

If you don't have a generator for your house and want to buy one there are two types; portable or stationary. A portable is generally less expensive, is gasoline powered, and has to be wheeled outside to use. They generally have limited fuel capacity so you have to keep fueling them up if the power is out for a long time. You can buy a 4,000 watt generator for as little as $300-400 at any of the home improvement big box stores. These won't power much but the very basics just to get you by. A larger 10,000 watt unit will run you around a grand and a whole house portable unit of 17,500 watts could run you $2,500 or so. The important thing is that you don't wait until the power is out to go buy one. Remember the ice storm of '98? In a very short period of time there weren't any generators anywhere left to be found... and I do mean anywhere.

Obviously, once you have a generator you need to be able to hook it up to the things you want to run. For years I got by running extension cords from my small portable to run the TV and refrigerator. As long as I could watch the ball game and keep the refrigerator going I thought we were pretty good shape. My generator wasn't large enough to run the furnace but our propane fireplace kept the house warm enough. There's also something to be said for having running water but unless you have a bigger generator you won't if you are on a well. Water pumps take a lot of juice when they start. But the real way to get power into your house is through a generator transfer switch and that should be professionally installed to provide power to the circuits that you want to run. One of those will run you anywhere from $200 to $350. I had one of those babies installed and Murphy's Law has held true; I haven't lost the power for more than an hour since I put it in.

The Cadillac plan, of course, is to have a stationary generator that comes on automatically the minute that tree comes down on the wires in the middle of the night. They are really nice when you are away over the Christmas holiday in Barbados and you aren't around to wheel out old Nellie and hook it up. It really saves a lot of worries to for homeowners that are here just seasonally. These units are fueled by propane and will start themselves up periodically to make sure they're running correctly. They can provide service to just few chosen circuits or your entire house if sized correctly. Costs for these units vary depending on the size but you are likely to pay around $5,000 for a 20KW generator plus installation. Like everything else, you'd want to shop around but choose an industry professional that installs these for a living. You should also not put the cart before the horse and buy the generator before you have that professional size it for your exact needs. Hey! Maybe this would make a great Christmas present for yourself??

As of December 1, 2014 there were 952 residential homes on the market in the towns represented in this real estate market report. The median price point came in at $259,900. As of Nov 1, 2014 there were 1137 homes on the market. The somewhat large drop in inventory this month was due to the large number of listings that expired and have not yet returned to the market. The current inventory represents an 11.7 month supply of homes on the market.

​P​ease feel free to visit www.lakesregionhome.com to learn more about the Lakes Region real estate market and comment on this article and others. Data was compiled using the Northern New England Real Estate MLS System as of 12/1/14. Roy Sanborn is a realtor at Four Seasons Sotheby's International Realty and can be reached at 603-677-7012​.​

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E. Scott Cracraft - What about 'snake handlers'?

Some conservatives have charged that the government is interfering with "religious rights" because the Affordable Care Act requires insurance companies to cover contraception, which, while objectionable to certain religious groups, is not to all and is a matter of basic health care. In the Hobby Lobby case, we have seen the judiciary side with the right of a religious employer to deny certain types of contraception in their insurance policies. How far will the courts go? As we know, a "right" ends where the rights of others begin.

Actually, the ACA does not require that employers agree with any medical procedure; it simply requires insurance companies to cover certain types of care. Government is well within its rights to impose reasonable standards on any business, including insurance companies. Nor does the ACA require that any employee use contraception or seek any other type of medical care.

Actually, coverage of contraception might hold down health care costs. The insurance companies should be delighted. After all, contraception is much less expensive to them than a pregnancy and delivery!

Unless I am mistaken, the law already recognizes the right of purely religious employers of priests, ministers, nuns, pastors, and other religious workers to deny some types of medical coverage based on religious beliefs. After all, they are employees of religious bodies that have certain expectations of their members and they are unlikely to seek such treatment anyway.

This is very different than businesses, non-profit organizations and even colleges and other institutions with some connection to religious bodies but which are not purely religious in nature. After all, these institutions and enterprises may, and often do, employee people of different faiths or differing opinions on these matters. Not all people, including very religious people, object to contraception, including those forms that some consider abortificants.

If this trend and logic continues, it may lead to a very dangerous "slippery slope." This is especially true when we talking of businesses whose owners may adhere to a particular religious belief but whose purposes are non-religious in nature. Such an employer may employee people who are not of the owners' faith. In that case, an employer's right to object to a particular medical procedure or prescription may interfere with an employee's legal right to seek such treatment.

Where do we draw the line? Although much of this controversy deals with certain types of contraception what about companies whose owners oppose all forms of birth control? Should employers who are Christian Scientists and who do not believe in doctors be able to "opt out" of any care for their employees except that provided by Christian Science practitioners? Should employers who are Scientologists be allowed to refuse coverage for mental health and psychotropic medications? Should Jehovah's Witnesses be permitted to refuse coverage for employees in need of a blood transfusions or an organ transplant even when the employees do not share the beliefs of that faith regarding these procedures?

Or, what about the "snake handling" Holiness churches in parts of the American South? Snake handlers believe they are commanded by God to pick up venomous snakes and that if they have enough faith and are in the right relationship with God, the snakes will not bite them. If they are bitten anyway, they believe that one should not go to the ER but should instead rely on divine healing. Should an employer of that faith should be able to refuse his or her employees medical treatment for snakebite?

The precedent of exempting employers from the law due to "religious belief" could even go further and interfere with other civil rights and liberties. For instance, a number of faiths stand in strong opposition to gay and lesbian people. Should owners of businesses who feel that way be allowed to discriminate on the basis of sexual orientation? Should they be allowed to deny coverage to the same-sex spouse of an employee? What about those whose faith teaches that women should not work outside the home or engage in certain occupations? And, what about those that embrace racist ideologies as a tenet of their faith?

(Scott Cracraft is a U.S. citizen, taxpayer, veteran, and resident of Gilford.)

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Michael Barone - Putin losing oil price war. . . and that's good

Free enterprise is proving to be Russian dictator Vladimir Putin's most potent foe.

Moscow's February 2014 invasion of Ukraine's Crimean peninsula and its immediate annexation drastically altered international diplomatic calculations. In a year marked by the homicidal rise of the Islamic State and Chinese probes of East Asian maritime borders, Putin's destruction of post-Cold War security arrangements is the most dangerous challenge to global peace.

Yet U.S. and Western European attempts to penalize the Kremlin its Crimean theft and blunt its relentless "slow war of moral attrition" in Eastern Ukraine have been erratic. Though France's decision to halt its sale of assault ships to Russia sent the message that business is not as usual, it was seven months late in coming. E.U. and Obama administration government-directed economic sanctions have been incrementally effective. Financial sanctions directed at key oligarchs in Putin's inner circle might undermine his power base, but that remains speculative.

However, the free market attack on Russian energy exports has hit the Kremlin hard.

The stunning surge in U.S. and Canadian energy production spurred the assault. Improved drilling and production techniques created the surge. The key technique is hydraulic fracturing, better known by its media nom de plume, fracking. Fracking has opened previously untapped "tight" gas and oil reservoirs. The U.S. has reduced its energy imports and in some markets is now exporting energy.

Oil has dropped from $110 to $75 a barrel. Even low-information American car owners see the wallet-level payoff. A gallon of gas now costs about a buck less than it did last year.

Private investment and commercial companies spurred the fracking revolution. If anything, the Obama administration, kowtowing to its hard-left environmentalist base, has attempted to hamstring the U.S. energy industry innovation. Radical enviro hypocrisy pollutes rational debate; at one time, many in their clan touted natural gas as a wonder fuel.
Well before Crimea, European nations resented Russian natural gas price gouging. The Kremlin used pricing threats to bully Ukraine, Poland and even Germany into political concessions.

After the Crimean travesty, the Baltic States and Poland demanded alternative gas supplies. The Obama administration quietly agreed to permit U.S. gas exports and the development of a liquefied natural gas exporting facility.

American LNG supplies might reach Poland in three years. That's good news. Here's the bad news: Putin has three years to exploit E.U. divisions and politically split NATO.

Or he had three years. Enter Saudi Arabia. America's "fracking" success challenges Saudi global oil dominance. What's the price point where fracking becomes unprofitable? Estimates run from $55 to $70 a barrel for oil. The Saudi oil ministry intends to find out and says it will not cut production. The market will determine price.

Though Russia can strangle Ukraine by denying gas supplies, the stunted and corrupt Russian economy survives on energy sales. Without its cash crop of oil, and gas, Russia is a big cabbage farm with a second-rate armaments industry. Cabbage, tanks, ICBMS and nuclear weapons mean Russian is not quite a petro-emirate writ large, but the cruel analogy has instructive utility.

If Russian nukes mean open war with Moscow is too risky, then attacking the Kremlin's cash generator is war by appropriate means.

Are the Saudis trying to defend Ukraine? I doubt it. The Saudis suspect they will be fencing with North American frackers for decades. It is very much in the Saudis' economic interest to retard the fracking revolution. It is also in their geo-political interest. Lowering oil prices sends a message to Washington that the Saudis matter; it also harms rival Iran.

The geo-political damage to Russia in ancillary but so welcome and so richly deserved. If the Obama administration wants to practice some truly smart diplomacy, it should expand oil and gas exploration on U.S. federal lands.

(Syndicated columnist Michael Barone is senior political analyst for The Washington Examiner, is a resident fellow at the American Enterprise Institute, a Fox News Channel contributor and co-author of The Almanac of American Politics.)

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