Post on 23-Jan-2015
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Welcome to theLegislative Symposium
January 10, 2014
Greater Nashua Chamber of Commerce
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Seminar 1: Overview of Medicaid Expansion in NHTime: 1:00-2:15pm
Mr. Steve Norton Mr. Tom Wilhelmsen, Jr., Mr. Charlie Arlinghaus
Executive Director of the NH Center for
Public Policy
CEO of Southern NH Health Systems
President of The Josiah Bartlett Center
Greater Nashua Chamber of Commerce
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MR. STEVE NORTONExecutive Director of the NH Center for Public Policy
Overview of Medicaid Expansion in NH
Greater Nashua Chamber of Commerce
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“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”
New Hampshire Medicaid Expansion
January 10, 2014Nashua Chamber of Commerce
Panel
Board of DirectorsSheila T. Francoeur, Chair
David Alukonis
William H. Dunlap
Eric Herr
Dianne Mercier
Richard Ober
James Putnam
Stephen J. Reno
Stuart V. Smith, Jr.
Donna Sytek
Brian F. Walsh
Michael Whitney
Martin L. Gross, Chair Emeritus
Todd I. Selig
Kimon S. Zachos
Directors Emeritus
Greater Nashua Chamber of Commerce
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ACA and coverage? • Affordable Care Act
i. Expand publicly subsidized coverage for those up to 400% of the federal poverty level.
ii. As originally conceptualized, cover 0-138% of the federal poverty level via the Medicaid program.
iii. Supreme court decided that while the ACA was constitutional, state’s could opt in or opt out of the expansion of Medicaid coverage.
• Effective October 1st, all those above 100% of the federal poverty level are eligible for subsidized insurance coverage via the federal health insurance exchange (marketplace).
• States have the option of expanding coverage up to 138%.
Greater Nashua Chamber of Commerce
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New Public Coverage138% of the Federal Poverty Level
40% of the Poverty Level
$4,596 in annual income
$15,856 in annual income
$45,960 in annual income
$11,490 in annual income
400% of the Federal Poverty Level
100% of the Poverty Level
Medicaid Expansion Subsidized Private Insurance
Greater Nashua Chamber of Commerce
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Who are the Uninsured?
NameUninsured Adults 19-64 Male
Age 18 to 40
Age 41 to 50
Age 51 to 64
Belknap 2,063 52.2% 51.1% 24.0% 24.9%Carroll 1,951 55.5% 42.1% 27.4% 30.4%Cheshire 2,641 55.0% 57.1% 21.8% 21.2%Coos County 1,497 56.5% 46.8% 25.4% 27.8%Grafton 2,910 56.2% 52.7% 21.7% 25.6%Hillsborough 10,922 53.3% 59.5% 20.8% 19.7%Merrimack 4,192 55.8% 53.1% 24.8% 22.1%Rockingham 6,603 52.4% 48.9% 25.0% 26.1%Strafford 4,538 54.5% 63.0% 19.4% 17.7%Sullivan 1,496 53.5% 52.2% 23.2% 24.6%
Source:NHCPPS calculations using Small Area Health Insurace Estimates
NH's Uninsured Adults with Incomes Less than 138% of FPL, 2101
Percent of Uninsured Adults
Greater Nashua Chamber of Commerce
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Impact on the State? Costs and Coverage • How much would a
Medicaid expansion decrease the number of uninsured? ~25,000
• This would reduce out of pocket costs for those individuals to zero.
• How much would that expansion cost the state in 2014-2015 biennium? Approximately $8 million
• What about over the 2014-2020 period?
i. $85,488,000 for the stateii. $2,510,922,000 for the
federal government.
Additional State Expenditures (Lewin Repor: Baseline Medicaid Expansion to 138%)
$3,603 $4,322
($9,138)
$9,143
$13,141
$17,371
$47,046
($15,000)
($5,000)
$5,000
$15,000
$25,000
$35,000
$45,000
$55,000
2014 2015 2016 2017 2018 2019 2020
in 1
,000
Other offsets to state expenditures are possible, but it is difficult to assess the
likelihood and timing
Greater Nashua Chamber of Commerce
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Major Policy Debates• Coverage – Estimates from Lewin - An estimated 23,000
individuals who would not otherwise have coverage. i. An estimated 32,000 would shift from employer and
individual coverage to Medicaid. • Cost to the state –
i. Aside from limited administrative costsii. 100% federal participation, to be phased down to 90%
in 2017 (with an estimated cost of ~$30 million in out year
• Financial boon to hospitals, mental health centers, community health centers.
• Does it materially impact the health and well-being of New Hampshire Residents?
• If we were going to do this, can we maximize private coverage?
Greater Nashua Chamber of Commerce
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Current Status - Areas of agreement• Expand health insurance coverage for low income
individuals with incomes less than 133% of the federal poverty level who are not already covered by Medicaid for other reasons (such as disability).
• Maximize the use of the private insurance through the use of the state’s Health Insurance Payment Program
• Maximize the use of the private insurance market through an individual premium assistance plan where federal dollars are used to purchase private insurance coverage on the exchange.
• The program will end in the event of a change in federal financial participation.
Greater Nashua Chamber of Commerce
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Areas of Disagreement• Which populations? 0-138% or 100 to 138%?
• When will this be effective? January 1st 2015? If the state is unable to develop a waiver, the Senate plan goes away. Timing is important. i. Senate bill (less time)ii. House bill (more time for market, systems
and waivers to adjust)• Who will manage (health commission versus
DHHS and DOI)
Greater Nashua Chamber of Commerce
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Want to learn more?
Online: nhpolicy.orgFacebook:
facebook.com/nhpolicyTwitter: @nhpublicpolicyOur blog: policyblognh.org(603) 226-2500
“…to raise new ideas and improve policy debates through quality information and analysis on issues shaping New Hampshire’s future.”
Greater Nashua Chamber of Commerce
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MR. TOM WILHELMSEN, JR.
CEO of Southern NH Health Systems
Overview of Medicaid Expansion in NH
Greater Nashua Chamber of Commerce
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MR. CHARLIE ARLINGHAUS
President of The Josiah Bartlett Center
Overview of Medicaid Expansion in NH
MEDICAID EXPANSION CONCERNS AND COMPROMISE
2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120.0
5.0
10.0
15.0
20.0
25.0
30.0
Uninsured in Maine and NH(and Arizona and New Mexico)
Maine NH NM AZ
Expansion Didn’t Affect Charity CareNH was 60% higher, now only 11%
Hospital Charity Care
50
70
90
110
130
150
170
190
210
230
250
2004 2005 2006 2007 2008 2009 2010 2011
Maine New Hampshire
Uncompensated Care is 2.3% of Total Spending
2011 National Health Spending (billions)
$2,638
$62
Other expenditures Uncompensated care
Greater Nashua Chamber of Commerce
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Seminar 2: Is It Time for a Gas Tax in NH?Time: 2:30-3:45pm
Commissioner Chris Clement
Representative David Campbell
Mr. Charlie Arlinghaus
NH Department Of Transportation
(D – Nashua) President of The Josiah Bartlett Center
Greater Nashua Chamber of Commerce
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COMMISSIONER CHRIS CLEMENT
NH Department Of Transportation
Is It Time for a Gas Tax in NH?
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The Roads toNew Hampshire’s Future
Greater Nashua Chamber of Commerce
Greater Nashua Chamber of Commerce
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Mission
Transportation excellence enhancing the
quality of life in New Hampshire
Greater Nashua Chamber of Commerce
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Strategic Direction – 4 Step Approach
• Preserve Existing Infrastructure – bridges, roads
• Maintain Mobility • Improve Safety • Support the Economy
Greater Nashua Chamber of Commerce
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Transportation Factoids• Roads in need of repair cost each NH motorist an
average of $330 annually in extra vehicle operating costs - $300 million statewide.
• China invested last year; $108B or 9% of GDP into Transportation Infrastructure, vs. USA will spend 1.7% GDP, with Canada 4%. GDP
• – Message is USA continues to lag behind competing countries.
• NH “Highway Fund” includes gas tax “road toll”, registrations and court fines:
• NH “Turnpike Fund is a separate fund (Enterprise Account)
Greater Nashua Chamber of Commerce
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Key Facts About DOT • 1,650 permanent employees (FY14) – 20% steady decrease since 1992• Responsible for:• 2,143 State Bridges
• State Red List – 145 (8%)• State Near Red List – 261
• 1,685 Municipal Bridges• Municipal Red List – 353 (21%)• All bridges are inspected at least once every two years• State red list bridges are inspected twice every year• Municipal red list bridges are inspected once every year
• 4,559 centerline miles of roadway maintained (additional 290 town maintained)
• 8,868 lane-miles of roadway maintained• Annual paving totals 200-300 miles per year (40,000 tons asphalt)• Maintain 100,000 highway signs
Greater Nashua Chamber of Commerce
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2015 - 2024 Ten Year Transportation Plan
Governors Advisory Commission on Intermodal Transportation
(GACIT)
Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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GACIT Process
i. DRAFT Plan, Financially Constrained• Work in progress
ii. Public Hearing Input • Regional priorities and needs
iii. GACIT Recommendation to Governor – December 2013
iv. Governor Recommendation to Legislature – January 2014
v. Legislative approval – June 2014
Greater Nashua Chamber of Commerce
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I-93 Funding NH’s #1 Priority
No Current Financing Plan• $250 M Unfunded Remaining Needs Not in Ten Year Plan – Capacity
Improvements Exit 3 NB to I-293 split (excl. Exit 5)
• Financial plan delivered to FHWA – remaining I-93 project in jeopardy without statement of legislative intent to fully fund project
• Environmental Permits lapse in 2020
• Exit 4A – not funded
• Continuing Negative Impact on Ten Year Plan – 2030
Greater Nashua Chamber of Commerce
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Prioritizing ResourcesNH Road System (4,559 mi)
1. National Highway System (NHS)(790 mi-18%)
• Turnpikes• Interstates• Select US Routes• Select State Numbered Routes
2. US Routes and State Numbered Routes (2,799 mi – 61%)
3. Unnumbered State Roads (970 mi-21%)
Greater Nashua Chamber of Commerce
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New Hampshire Pavement Conditions: 1996-2016
ADDITIONAL $12M PER YEAR NEEDED
Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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Average Price of Asphalt Cement 1992 to 2012
• The cost of asphalt cement increased 460% over this period
• Diesel, gasoline, road salt increases…..
Greater Nashua Chamber of Commerce
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Statewide Pavement Condition
• 19 % good condition - 828 miles• 44 % fair condition - 1,867 miles• 37 % poor condition - 1,565 miles• $615 million would be needed to bring all poor
condition pavements to good condition (not including drainage, guard rail & bridges)
• $3.7 billion is the estimated total value of the state-owned pavements
• Pavements are the State’s most valuable asset other than land and bridges
(4,559 total centerline miles 299 unrated)
Greater Nashua Chamber of Commerce
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4,559 Miles• The DOT Maintained road network would stretch from
Concord, NH to Anchorage, AK
A VERY LONG DRIVE!
Anchorage, AK
Concord, NH
Anchorage, AK Concord,
NH
Fargo, ND
Lake Watson, Yukon
Would your car survive?
GOOD
FAIR
POOR
Poor Road Conditions
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NH Bridge ConditionRed List – Bridges where one or more
major structural element is rated as poor condition or worse, or require weight limit posting.
Near Red List – Bridges where one or more major structural element is rated as fair condition.
Good – Bridges where no major structural element is rated as fair or poor.
New Hampshire Red List Bridges
• Total Number of State owned bridges in 2011 = 2,143
• Additional Investment of $15m per year would repair as many as 10 bridges depending on size and conditions
Greater Nashua Chamber of Commerce
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2012: 11 Municipal Bridges Closed
Greater Nashua Chamber of Commerce
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Status and Estimated Costs – State Red List
• Ten Year Plan rehab/replace 98 of the 140 State Red List bridges.
• $680 M (2012 dollars) to rehabilitate or replace the current State Red List bridges.
• 100 State bridges were replaced last 10 yrs. • Current 10-Year Plan, 98 State bridges to be
replaced =10/yr.• +200 years to replace all 2,143 State bridges. • $7.82 Billion is the estimated total value of the
state-owned bridges
Greater Nashua Chamber of Commerce
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Turnpike System Overview• 3 Turnpike Segments• 89 Miles Long• 170 Bridges• 10 Toll Facilities• Enterprise Fund – All Turnpike
revenue must be used on the System• Turnpike Revenue pays for:
–Operating & Maintenance Costs–Debt Service–R&R Work–Capital Improvements
• FY12 $108.7M transactions and $116.6M toll revenue
Greater Nashua Chamber of Commerce
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Unfunded Projects in Current Capital Program form HB 391 – Session 2009 Authorization:• Bedford ORT - $18M (FY15 Adv)• Dover End of N-D Project - $80M (FY14 Adv)
Proposed Expanded Capital Program• Bow-Concord: I-93 Widening (I-89 to I-393) - $195M (FY18 Adv)• Nashua-Bedford: FEET Widening (Exit 8 to I-293) - $70M (FY17 Adv)• Manchester: Reconstruction of Exit 6 & FEET Widening - $88M (FY17 Adv)• Manchester: New Interchange at Exit 7 - $54M (FY 18 Adv)• Spaulding Turnpike Toll Facilities (ORT or AET) - $15M (FY16 Adv)• Spaulding Turnpike Maintenance Facilities - $8M (FY14 Adv)• Turnpike Administration Building - $7M (FY15 Adv)• Nashua-Bedford ITS Infrastructure - $4M (FY15 Adv)• Merrimack Exit 12 Toll Plaza Removal - $2M (FY15 Adv)• Sarah Mildred Long Bridge ($2M Annual Capital Contribution) - $18M (FY14 Start)• TYP 2013-2022 includes PE & ROW for Bow-Concord ($13.0M) and for Manchester Exit 6 & 7
($14.0M)
*Reference: Transportation Infrastructure Report 2011 – Building America’s Future: Falling Apart & Falling Behind
Proposed Turnpike Expanded Capital Program
Potential to create 14,000 jobs* over a ten year period
Greater Nashua Chamber of Commerce
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FUNDING OUTLOOK
Greater Nashua Chamber of Commerce
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Challenges Ahead• Federal Reauthorization MAP-21 expires September 2014
• Shrinking revenue from fuel efficient vehicles and less miles traveled due to recession
• One-time solutions–Not Sustainable Funding
• Rising Costs - Petroleum based business
Greater Nashua Chamber of Commerce
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Increased Fuel Efficiency = Less HWY Revenue
Greater Nashua Chamber of Commerce
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DOT FUNDING SOURCES• Highway Fund (road toll tax a.k.a. gas tax, motor vehicle fees, court fees, misc.) $260 m/ year)
• -$48 m deficit FY16, -$105 m FY17 Operating Budget
• Federal Aid ($143 m/year) – Capital Budget
• General Funds: Aeronautics, Rail, Transit ($900,000/year)
• Turnpike Fund: Turnpikes only (subject to covenants to bondholders): $117m/year tolls
Greater Nashua Chamber of Commerce
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One-time Non-Sustainable Operating Funding
• FY 06-07 Surplus from Highway Fund
• FY 08-09 Bonding $60m
• FY 10-11 Registration Surcharge $90m
I-95 Transfer $50m
• FY 12-13 I-95 Transfer $52m
• FY 14 -15 I-95 Transfer $ 30m
• FY 16 -17 Deficit -$48m & - $105m
Greater Nashua Chamber of Commerce
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Summary
• $22m / yr. : Complete I-93 widening project $250m
• $15m / yr. : Red List Bridge additional funding
• $12m /yr. : Road Paving to repair poor roads
• $35m / yr. : Maintenance & Operations of entire
transportation system
• $20 / yr. : Municipal Road & Bridge Repair
Greater Nashua Chamber of Commerce
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In light of the recent Global Competitiveness Report rankings from the World Economic Forum on infrastructure quality which has listed the United States at 25th place—down from 9th place in 2009—such a major disruption to federal transportation investment will produce serious losses that threaten the gradual macroeconomic recovery seen in the last few years.
Greater Nashua Chamber of Commerce
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The Roads toNew Hampshire’s Future
Greater Nashua Chamber of Commerce
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Transportation Briefing
Rep. David B. Campbell (D – Nashua)
Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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Greater Nashua Chamber of Commerce
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2013 Red List Bridges 145 State Owned Bridges 353 Municipal & Other Owned
Bridges
Greater Nashua Chamber of Commerce
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Pavement Conditions 2000 2010
Red = Poor Condition
Greater Nashua Chamber of Commerce
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LegendGT = Gas TaxDT = Diesel Tax
GT= 31.5 cents DT= 32.7 cents
GT= 26.5 cents DT= 26.5 cents
GT= 33.0 cents
DT= 33.0 cents
GT=49.3 centsDT=54.9 cents
GT= 32.3 cents
DT= 31.0 cents
GT= 19.6 cents
DT= 19.6 cents
Investments in Transportation
Greater Nashua Chamber of Commerce
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MR. CHARLIE ARLINGHAUS
President of The Josiah Bartlett Center
Is It Time for a Gas Tax in NH?
NEW HAMPSHIRE TRANSPORTATION FUNDING
Spending Tracks With Inflation
1998
2000
2002
2004
2006
2008
2010
2012
2014
300.00
350.00
400.00
450.00
500.00
550.00
600.00
DOT Spending and Inflation
DOT SpendingLinear (DOT Spending)Inflation
2004 2005 2006 2007 2008 2009 2010 2011 2012 201350.00
100.00
150.00
200.00
250.00
Gas Tax and Other Revenue
Other Highway Fund Revenue Gas TaxInflation
2004 2005 2006 2007 2008 2009 2010 2011 2012 201390.00
110.00
130.00
150.00
170.00
190.00
210.00
230.00
The Last Decade
Other Highway Fund Revenue Gas TaxInflation
2012-13$0.00
$100.00
$200.00
$300.00
$400.00
$500.00
$600.00
Gas Tax:$246.5
Vehicle Fees:$225.7
Tpk Robbery $52
Other $44.8
2012-13 Highway Fund Revenue
OtherTurnpike RobberyRegistrationGas Tax
Greater Nashua Chamber of Commerce
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Seminar 3: Why Divestiture of PSNH Assets Matters to Southern NHTime: 4:00-5:00pm
Mr. William J. Quinlan
Mr. Daniel Allegretti
President/Chief Operating Officer of
PSNH
Vice President of State Government
Affairs with Exelon Corporation
Greater Nashua Chamber of Commerce
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MR. WILLIAM J. QUINLANPresident/Chief Operating Officer of PSNH
Why Divestiture of PSNH Assets Matters to Southern NH
2014 Greater Nashua Chamber of Commerce Legislative Symposium
Bill Quinlan, President & COOPSNH
January 10, 2014
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New England’s Growing Over-Reliance on Natural Gas
Wind
Other
Hydro
Biomass
Oil
Coal
Natural Gas
Nuclear
0.0%
0.0%
5.1%
7.6%
22.3%
18.3%
14.9%
31.7%
Wind
Other
Hydro
Biomass
Oil
Coal
Natural Gas
Nuclear
1.0%
0.3%
5.8%
5.4%
0.2%
3.2%
52.8%
31.2%
2000 2012New England Generation Mix (MWH)
Source: ISO-NE, Net Energy by Source
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New England Natural Gas Delivery Prices are Increasing Significantly Compared to New York
• Historical prices => daily settlement average, 2013-14W => ICE Forward Financial Basis
Natural Gas Delivery Costs
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A Significant Amount of Generation Assets are at Risk of Retiring
• ISO-NE projects 8000 MW of generation are at risk of retiring by 2020
• More than 3000 MW of generation has already announced plans to retire
• Vermont Yankee – 604 MW• Norwalk Harbor – 342 MW• Salem Harbor – 749 MW • Brayton Point – 1535 MW• ISO-NE has cited the
region’s over-reliance on natural gas as one of the most significant challenges to grid reliability
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What’s Being Proposed for New Generation? More Natural Gas and Wind
Source: ISO-NE Energy by Fuel Type 2012 & Generator Interconnection Queue January 2014
Proposed New GenerationNatural gas and wind make up vast majority of new proposed
generation
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What’s Being Done…
• New England Governor’s Regional Energy Agreement
• PSNH’s Generation Fleet – reliable, diverse & serving NH customers
• Merrimack Station (coal) – 434 MW
• Newington Station (oil and gas) – 400 MW
• Schiller Station (coal and biomass) – 150 MW
• 9 Hydro Stations – 67 MW
• Total: 1050 MW
• The Northern Pass Project – 1200 megawatts of hydroelectric power
Greater Nashua Chamber of Commerce
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MR. DANIEL ALLEGRETTI
Vice President of State Government Affairs of Constellation Energy
Is It Time for a Gas Tax in NH?
Greater Nashua Chamber of Commerce
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Our Upcoming Events
Date: Wednesday, January 15, 2014Time: 12:00 PM – 2:00 PMLocation: Holiday Inn, Nashua
Date: Friday, February 28, 2014Time: 6:30 – 9:30 PMLocation: Crowne Plaza, Nashua
Date: Friday, March 7, 2014Time: 5:30-7:30 PMLocation: Sky Meadow Country Club, Nashua
Economic Outlook
Luncheon
Giggles & Nibbles
Comedy Night
The 11th Annual Greater Nashua
Chamber of Commerce Eminence
Awards