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Repeal of New Hampshire Vaccine Association splits public health groups and advocates
Summary
Supporters of House Bill 524 urged repeal of the New Hampshire Vaccine Association to cut costs and return vaccine purchasing to private providers; DHHS, providers, community health centers and public health officials warned repeal would raise costs, disrupt access and increase burdens for clinics and public health networks.
Representative Granger presented House Bill 524, which would repeal the statutory authority that created the New Hampshire Vaccine Association under RSA 126Q and return commercial vaccine purchasing to private providers. Proponents argued the association is an unnecessary government role, lacks transparency and that private purchasing can be less expensive or more efficient for adult and commercial vaccine procurement.
Several proponents raised concerns about the association's governance and auditing. A frequent witness argued the association and DHHS had not been subject to a program audit and accused the program of opaque practices. The repeal supporters suggested private group purchasing organizations and market discounts could achieve similar or better prices without state involvement.
State public health officials, hospital representatives, the New Hampshire chapter of the American Academy of Pediatrics, AARP New Hampshire, community health centers and county organizations strongly opposed repeal. Patrick Miller, executive director of the New Hampshire Vaccine Association, said the current pass'through structure pools private payer and federal funds to allow providers to furnish vaccines to children and other eligible patients at no cost; he said the program saves roughly 27'30 percent on vaccine purchases and had administration costs below 1 percent.
Colleen Smith, Bureau Chief for Infectious Disease at DHHS, and Anne Marie Mercury, the department's immunization section chief, explained that the department manages the actual vaccine inventory, splits federal Vaccines for Children funds from commercial funds, and that the association reimburses the department for commercial vaccine doses distributed to enrolled provider sites. Mercury said DHHS leverages the federal CDC contract as a volume purchaser and that the department applies provider'level VFC/non'VFC splits when allocating doses.
Speakers from federally qualified health centers and community health centers said FQHCs could not afford to purchase and inventory vaccines up front and that removing the association would increase uncompensated care burdens and create access barriers in rural areas. Patrick Miller and DHHS noted the association's reported administrative cost was $154,000 on roughly $18.3 million in vaccine purchases last year (about 0.84%). DHHS described a fiscal note scenario that would require a modest appropriation only to ensure the department could respond to outbreaks if the association were repealed.
The committee heard dozens of speakers on both sides. Supporters argued repeal would reduce government'run purchasing and increase competition; opponents said the association lowers costs, removes billing burdens for providers and protects vaccine access for children and the uninsured. The committee did not vote on HB 524 at the public hearing.
