Providers and insurers oppose bill to abolish New Hampshire Vaccine Association; sponsors say federal rules could replace role

The House Ways and Means Committee heard sharply divided testimony March 5 on House Bill 524, a proposal to repeal the New Hampshire Vaccine Association (NHVA) and change how vaccines for commercially insured children are purchased and paid for.

Laura Condon, who told the committee she was appointed to the NHVA board and served five years, urged repeal. "I do not believe that DHHS should be in the business of buying and selling vaccines for commercially insured children," she said, arguing that private purchasing would be cheaper and more efficient.

But dozens of providers and insurers said removing the association would raise costs for practices and families, increase administrative burdens and, in some cases, force small practices to stop offering vaccines. Patrick Miller, executive director of the New Hampshire Vaccine Association, described the association's role and its finances.

"The New Hampshire Vaccine Association is an independent not for profit 501(c)(3) voluntary corporation ... to ensure stable and equitable contributions from all health insurers and third party administrators," Miller testified. He told lawmakers the state purchases vaccines using a federal discount program only available to governmental entities, and the NHVA's collections allow the state to provide those discounted vaccines to providers for all children. "Our administrative costs are less than 1% and they're borne 100% by the payers, not the state," he added.

Insurers including Harvard Pilgrim, Anthem and Centene told the committee the association helps keep premiums lower by pooling purchasing and avoiding higher commercial prices for vaccine doses. Harvard Pilgrim's representative said vaccines bought through the NHVA are roughly 30% cheaper than commercially purchased doses and warned that higher provider acquisition costs would translate into higher claims and ultimately higher premiums.

Physicians and practice owners described the immediate cash-flow and operational challenges of a switch. Several pediatricians said they do not have the capital to buy months of vaccine inventory in advance and that private purchases would require new staffing, new billing negotiations with dozens of payers and extra refrigeration and inventory management.

Concord pediatrician Dr. Christine Snow said her small, independent practice faced a $26,000 increase on a single monthly order if it had to buy at commercial prices. She and other clinicians said the short timetable in the bill (60 days after enactment for some changes) would be unworkable.

Department of Health and Human Services officials told the committee they are opposed as well. Bureau chief Colleen Smith and legislative liaison Abby Rogers said HB 524 would upend a long-standing public-private purchasing partnership and could increase state costs in a public-health emergency because the state would lack an appropriation mechanism to purchase vaccines for insured children on short notice.

The committee heard direct, practical examples: a pediatric practice owner said an older single-doctor office could face a six-figure upfront bill to stock routine childhood vaccines, a change that could reduce access in rural areas where pharmacies do not provide pediatric shots. Other witnesses noted that the federal Vaccines for Children (VFC) program and state immunization grants would continue to cover uninsured and Medicaid children; the association facilitates using the VFC buying power to supply providers for all children.

Opponents urged the committee to vote ITL (inexpedient to legislate). Supporters said a private-market approach would restore competition and reduce perceived government overreach. The committee took testimony from more than 40 speakers and did not vote during the hearing.

Why it matters: The NHVA funds vaccine purchases that are delivered to providers at a federal government discount that, witnesses said, is not available to private purchasers. Testimony from pediatricians, nurse practitioners and pharmacy advocates focused on access and cash-flow implications for small practices and families; insurers highlighted premium effects.

What's next: The Ways and Means Committee closed public testimony and has not scheduled action. Committee staff and witnesses said they need more detailed fiscal and operational modeling: how many providers would need help financing upfront inventory, how quickly insurers would reimburse, and whether the VFC and state grant mechanisms would require additional state appropriations if the association were dissolved.