Greg White and Sue Durkin are Chief Executive Officers at Lamprey Health Care, a federally qualified health center serving 16,775 patients in Nashua, Newmarket and Raymond.

As the co-CEOs of Lamprey Health Care, New Hampshire’s oldest community health center, we are writing to educate lawmakers about the devastating impacts of funding cuts that were included in the state budget that recently passed the House of Representatives.

These cuts, if passed by the Senate, will reduce access to essential health care services and supports for our patients. They include decreased reimbursement for Medicaid providers, eliminating the 53-year-old Family Planning Program and freezing funding for the State Loan Repayment Program, our #1 recruitment tool.

Additionally, one of Lamprey’s vital programs, the Southern New Hampshire Area Health Education Center, which has been recruiting and training primary care physicians since 1997, is at risk of having its grants eliminated by the federal administration. Our safety-net system’s survival is in jeopardy.

Community Health Centers make up the largest primary care system in the country.

CHCs have been a staple in New Hampshire since the 1960s, receiving federal funds to operate in areas where the federal government has determined that people lack access to health care services. CHCs deliver integrated preventive and primary care services under one roof, including dental, behavioral health, pharmacy, vision and chronic disease management.

In some rural communities, CHCs are the only primary care provider in the area.

Across the state, CHCs are part of a network of safety-net organizations, including hospitals, community mental health centers and social service organizations. For example, Lamprey partners with our local community mental health centers, the Greater Nashua Mental Health Center and the Center for Life Management. Lamprey is co-located with these partners to meet the community’s need for access to primary and behavioral health care. These partnerships break down the systemic silos and deliver the best health outcomes for patients with multiple health care needs.

The current financial situation our health centers are experiencing has been described as “death by a thousand cuts.” Not only have CHCs seen grants we’ve relied on for years abruptly eliminated – including public health funding that supports the work of our community health workers and our efforts to increase vaccination rates – but we’ve also had no meaningful increase in our federal mandatory funding since 2015. At the same time, we are dealing with medical care inflation, increasing operational costs, and workforce shortages.

Any loss of revenue makes budgeting and planning incredibly difficult for our businesses. The proposed 3% Medicaid rate reduction included in the House budget will cost CHCs nearly a million dollars. Lamprey will lose $150,000 from this reduction. Lamprey will lose an additional $422,857 from the proposed elimination of NH’s Family Planning Program.

Simultaneously, we are experiencing a demand for health care across all our medical sites: 2024 brought a record-setting number of patients to Lamprey, 16,775, and our number of patient visits increased by 28% between 2023 and 2024.

The proposed Medicaid cuts — which we are facing at both the federal and state levels — completely disregard the fact that patients will still come to see us, and we are legally required to provide care regardless of whether they have insurance. Of course, New Hampshire residents will continue to get sick: Patients with asthma need to breathe; patients with diabetes need insulin to live; and patients with disabilities need supports to live and work.

When patients lose access to Medicaid and become uninsured, we still treat them, but we will no longer get reimbursed for providing their care. Neither the federal nor the state legislature’s proposed budgets addressed the amount of uncompensated care (or charity care) provided by CHCs.

Making sure patients have access to primary care so they can stay healthy is the right thing to do, and it is important for our overall health care system and the economy. Cutting Medicaid will only shift the cost and burden to other parts of the system.

Our health centers care for 1 in 6 Medicaid patients. Thirty-one percent of New Hampshire CHC patients have Medicaid coverage, and 35% of CHCs’ patient revenue comes from Medicaid. If that revenue is reduced, our uncompensated care costs will grow, forcing our organizations to cut back on services and reduce staff.

With further budget reductions, entire facilities may close. This is when patients have no choice but to seek more costly care outside of their communities, in emergency rooms.

The bottom line is that if the state budget makes any of its proposed reductions, including reducing Medicaid funding, eliminating the Family Planning Program, freezing the State Loan Repayment Program or reducing funding for behavioral health services, health centers and our patients will suffer the negative effects. We ask our policymakers to prioritize the health and well-being of their constituents.