The ongoing health care workforce shortage in New Hampshire is well documented, as are its many impacts on the overall system and access to care. It is also emerging as a serious cost driver. These upward pressures on health care costs are seen in several areas, including wage inflation, ability of providers to operate efficiently, and costs of delayed care.

Wage inflation is very much driven by a shortage of critical health care staff. Personnel shortfalls are being addressed as key business resource costs in the form of escalating wages, recruitment costs, signing bonuses, and — largest among these — the need to pay inflated labor costs by using staffing agencies to fill major health care needs. Personnel shortages also necessitate some level of triaging of care, where more emergent needs are addressed first, and less acute care and wellness checks can be delayed. In these instances, patients’ conditions worsen or are not diagnosed in a timely fashion. Sicker patients with more complex conditions are more expensive to cover.

Income impacts of health care workforce shortages offer a downward spiral when shortages limit a health care organization’s ability to bill for enough services to cover costs. Delayed care based on access challenges is a serious health care issue and a real cost driver for the system. 

Although quantifying the health care workforce shortfall is not a perfect science, the problems it creates are clear. And as the existing workforce needs to function within a stressed system, and as employees begin to age out of their working years, problems run the risk of accelerating. It is estimated New Hampshire needs to bring as many as 40,000 new workers into the system.

Fortunately, there are steps that can be taken to invest in the health care workforce pipeline and address the crisis. Many of the basic structures are in place, but additional support is needed to allow them to thrive and expand. The New Hampshire Legislature is rightly focused on this issue and will dig into the matter in 2024 with legislation developed by health care providers and advocates: SB 403, relative to health care workforce investments.

SB 403 offers a multi-part solution based on making early, one-time investments in programs designed to bring more individuals into the system and make regulatory changes to meet the new needs of the health care workforce. These investments come at a good time, when our state government has some financial resources to make short-term investments, which we strongly believe will have long-term cost reduction impacts.

Workforce pipeline programs proposed in SB 403 include:

A Family Medicine Residency Program in the North Country. This is intended to increase the number of family physicians trained in the state and access to primary care in the region of the state that has some of the highest rates of chronic disease, substance misuse, and behavioral health disorders.

Community Health Worker Voluntary Certification and Deployment. Voluntary certification of CHWs will help to validate this workforce and allow employers to seek Medicaid and eventually commercial reimbursement for services provided by CHWs, resulting in a more sustainable workforce.

Area Health Education Center Workforce Pipeline Development. AHECs are a statewide network that works to improve health care and access to it, particularly in rural and medically underserved areas.

Expansion of the State Loan Repayment Program. Expanding SLRP to include health care staff with bachelor’s degrees will help employers recruit and retain other key employees, including case managers. Additionally, because individuals with federal student loans were recently required to resume loan payments, little funding remains in SLRP and more financial support from the state is critically needed.

Funding for Nursing Student Supervisors (Preceptors) and Financial Support for Host Organizations. This investment will provide necessary support to nursing preceptors and health care organizations that function as training sites for interns and apprentices.

New Hampshire Needs Caregivers. This workforce pipeline program promotes, recruits, and finds training for individuals interested in a career in health care as a licensed nursing assistant (LNA).

SB 403 was crafted by a broad stakeholder group, which came together in 2018 to move the workforce crisis to the top of the legislative agenda. Great strides have been made since then, the most historic and meaningful of which were Medicaid reimbursement rate increases enacted in the 2023 state budget. But the critical need to address the workforce shortage remains, and we see this continued effort and passage of SB 403 as an opportunity to invest in success.

For more information, visit www.investinnhhealth.org.

This op-ed is submitted on behalf of the Business & Industry Association, Greater Manchester Chamber, Greater Nashua Chamber of Commerce, the Chamber Collaborative of Greater Portsmouth, Hampton Area Chamber of Commerce and the Upper Valley Business Alliance.