Steve Ahnen joined the New Hampshire Hospital Association as president in October 2008 after serving in various roles at the American Hospital Association in Washington, D.C., for 16 years. The association serves as the primary advocate for the Granite State’s acute care community and specialty hospitals.

Ahnen holds a bachelor of arts degree in political science and German from the University of Kansas, and an executive MBA in health administration from the University of Colorado.

He recently appeared as a guest on the “Down to Business” podcast with NH Business Review’s editor, Mike Cote, and managing editor, Amanda Andrews. This article was adapted from the interview. Listen to the podcast at nhbr.com or on your favorite streaming service.

Q. You spent 16 years in Washington with the American Hospital Association, and more than that here. What brought you to New Hampshire, and how does it compare to working at the national level?

A. Working in Washington was a great experience and opportunity. But we often spent more time in Washington arguing over the size and shape of the table than we did the problems that we were trying to address.

As I thought about moving out of Washington and looking at different parts of the country of where I might want to go, I had the opportunity to see regions of the country, and many were very polarized.

My experience in New England was very different. New England didn’t necessarily seem to run to government to solve problems. They didn’t run away from government, but they tried to find ways to partner, to work together. How do we solve problems? Sometimes government can help. Sometimes government gets in the way, and things should be done in the private sector.

New Hampshire was a very unique opportunity. It was a state that was small enough that you could put 26 to 30 hospital executives around a table and try to come to consensus on some big challenges. That’s certainly what we’ve tried to do since I’ve been here.

Q. Colleges have been working directly with hospitals to increase the health care workforce. What are the challenges that you’re still seeing in that regard?

A. We have had a workforce challenge for many years prior to the pandemic; the pandemic certainly exposed those and has exacerbated them. Workforce shortages and vacancies have come down a little bit since the pandemic. They’re still significantly high. We have a vacancy rate of almost 17% for nurses. That’s over 600 vacancies in hospitals across the state.

That means we have to bring temporary contract traveler staff so that we can meet the demand in patient care. And it’s not just nurses; it goes across the spectrum. That drives up the cost of providing care. We’ve seen labor costs go up about 36% since the pandemic. I don’t necessarily see that turning around anytime soon as we continue to see significantly high demand for care in New Hampshire.

There was a study that came out of UCLA earlier this year that tracked nationally that hospital capacity prior to the pandemic was about 64%. Since the pandemic, it’s 75%. Well, what we’re seeing in New Hampshire is closer to 90% plus.

It’s workforce shortages out in the community. People can’t access care on an ongoing basis. Maybe they don’t have a primary care physician. Maybe they can’t get in to see a specialist. And so those conditions worsen and they end up in the emergency room.

But it’s also a problem on the back end.

Nursing homes, skilled nursing facilities, home health agencies struggle with staffing, so when a patient is ready to be discharged and they don’t need inpatient care anymore … we can’t move them.

The other piece of that is we’re no longer getting reimbursed for that patient who no longer needs hospital level care, so we’re losing out in that sense.

Q. Cost pressures have been pushing consolidation among hospitals, which is affecting rural areas. What do you think the state needs to do?

A. I think we need to make some stronger investments in (maternity, women health) but we also need to find ways to partner and collaborate. Smaller hospitals can work with larger hospitals who offer those services.

The following is the transcript of the interview with Sen. Jeanne Shaheen, Democrat of New Hampshire, that aired on “Face the Nation with Margaret Brennan” on Nov. 16, 2025.

MARGARET BRENNAN: We go now to New Hampshire Democratic Senator Jeanne Shaheen. Good morning to you, Senator.

SENATOR JEANNE SHAHEEN: Good morning. Nice to be with you. 

MARGARET BRENNAN: Well you have spent a good part of the past year trying to get legislation through to extend those Obamacare tax credit subsidies. Last Sunday, you crossed the aisle. You agreed to reopen the government, end the shutdown without a guaranteed extension, but with a promise to have some kind of vote on an ACA bill of Democrats’ own choosing. Do you have consensus among Democrats that this needs to be a vote simply to extend the tax credits as they stand now or are you open to a broader reform of Obamacare?

SEN. SHAHEEN: Well from the beginning of this shutdown I’ve had two goals. One is to get government up and running again to end the suffering that too many Americans were experiencing because they lost food assistance or they weren’t getting paid federal employees, and the second was to address the high cost of premium- health insurance that people are looking at because insurance companies are setting rates based on the fact that those premium tax credits are not- are supposed to go away at the end of this year. I think people are now very aware of the fact that they are going to see huge rate increases double for so many people, and an unaffordable cost of health insurance if those premium tax credits go away. And what I think we need to do, and these are conversations that we need to have, is we need to work with our Republican colleagues to try and get a bill that can be supported. That can get through both houses of Congress where we’ve been talking to our Republicans, Senator Cassidy, throughout the shutdown, about what we might be able to agree to. We’ve been talking to House members on both sides of the aisle, and so now we need to work together. I agree with Senator Cassidy. This should be a bill that is not partisan, but it should be a bill to extend those premium tax credits, because, as everybody has talked about, there is real urgency to get this done. And if we don’t address it, then people are going to see huge rate increases. —

MARGARET BRENNAN: — Yeah. — 

SEN. SHAHEEN: — So we can work together, we can extend the credits, but we probably can’t implement significant reforms that Senator Cassidy was talking about in the time frame that we’ve got. So we need to look both in the short term and in the long term for how we address the cost of health care.

MARGARET BRENNAN: Okay, so that’s an important point. So the 26 billion or so that he talks about as the cost for extension of these that he wants to redirect into these cash accounts, these flexible accounts. You’re saying you can’t get that done in six weeks time.

SEN. SHAHEEN: No, you can’t. —

MARGARET BRENNAN: — Okay. — 

SEN. SHAHEEN: — And again, there’s real urgency to do this. There’s some good, bipartisan legislation that has come out of committee in the Senate that I think we should take up. Things that would expedite approval of generic drugs and biosimilars, that would address PBM reform, which is a huge cost increase for health care, but that’s a longer term issue. Right now, we need to address what people are facing in terms of those high rate increases because of the threat that these premium tax credits are going to end.

MARGARET BRENNAN: Just to put a fine point on it, when we heard the Congressman at the top of the program talk about, you know, caps on income and restrictions on who can benefit from those tax credits. Can you get your fellow Democrats, who, by the way, are pretty angry at each other, angry at you as well, about this decision to reopen the government? Can you get everyone on board? Or can you at least get to 60 votes to be able to extend those subsidies with tweaks?

SEN. SHAHEEN: Well, first of all, we need to put the shutdown behind us in the circular firing squad and remember why we’re in this situation. We’re in this situation because Donald Trump and Speaker Johnson and the Republican majorities in the House and Senate have refused to address cost, the cost of health care, and are trying to throw people off their health care. Can we get to consensus? Well, we need to, if we’re going to get a bipartisan bill out of the Congress. I think we’ve seen and heard from health insurance companies that implementing significant changes in the first year is going to be really difficult to do, almost impossible. But we ought to be able to agree on some changes like capping the income of people who receive those premium tax credits. Right now, 94% of people who get the credits earn under $200,000 a year, and the average income for a single recipient is about a little over $30,000 a year. So most people who are getting these tax credits are not in that high income level — 

MARGARET BRENNAN: — Yeah. — 

SEN. SHAHEEN: — And so we should be able to agree on that. We should be able to agree that we don’t want any fraud and abuse in the program. — 

MARGARET BRENNAN: — Right. — 

SEN. SHAHEEN: — That’s something Republicans and Democrats believe in. So let’s focus on what we can agree to. Let’s look at what we can get done in the time frame we have, and recognize there is real urgency to get these premium tax credits extended.

MARGARET BRENNAN: So you’re going to have this vote around the second week of December, but premiums are already notified out. They are already — 

SEN. SHAHEEN: — Right. — 

MARGARET BRENNAN: — sort of baked in here for- certainly for Americans who buy government health care. Is it too late to extend open enrollment? I mean, Senator Cassidy was saying like ship has sailed here.

SEN. SHAHEEN: No, we could actually decide that we were willing as part of this legislation to extend open enrollment. Obviously, we need support from the administration, but insurance companies, in meeting with the insurance industry, they’ve indicated that while it would be difficult, they could address some of the challenges around not getting agreement until December. Again, that’s why there’s urgency to get this done. 

MARGARET BRENNAN: I want to ask you about another matter. Survivors of convicted child sex offender Jeffrey Epstein, as well as some of the families of those survivors, wrote a letter to lawmakers supporting the release of Justice Department internal communications in regard to his case. In that letter, they said there was no middle ground here. There was no hiding behind party affiliation. We will remember your decision at the ballot box. You know, this House vote is set to come up this week. Should there be a vote in the Senate? And would you support it, to see the release of these documents?

SEN. SHAHEEN: Absolutely. We need to release the documents. The American people need to see what’s in them. And if President Trump says there’s nothing there that he’s concerned about, then why doesn’t he support release of the documents?

MARGARET BRENNAN: Well, we will see if the Republican leader in the Senate takes up your proposal there. There has not been a commitment to have that kind of vote. But on Venezuela, since you are ranking member on Senate Foreign Relations, I want to make sure I ask you, the President said he has sort of made up his mind on what to do about Venezuela. You were one of the very few senators who have received briefings within the past few weeks from Secretaries Rubio and Hegseth regarding the strikes that are being carried out on these small, fast moving boats. Is there a clear end game here and is your understanding that ousting Nicolas Maduro from power is part of the administration’s plan? 

SEN. SHAHEEN: I don’t think it’s clear what the end game is for this administration with respect to Venezuela. They’re relying on a legal opinion, excuse me, in terms of the boat strikes that they have not released. They have finally made it available to members of Congress, but they haven’t released it to the public. They are escalating in a way that talking about a land strike through special operations that puts at risk our men and women in the military. We have so much firepower now in the Caribbean, the Gerald R. Ford has been taken from the Red Sea, so that now we don’t have any firepower, really, in the Middle East as we look at the threats there. We don’t have what we need, I think, in the Indo-Pacific or in Europe. And so what the President has done here is to put at risk other parts of the world and Americans in other parts of the world for this fascination on trying to get rid of Nicolás Maduro in Venezuela, who clearly is — 

MARGARET BRENNAN: — Yeah. — 

SEN. SHAHEEN: — a bad character. He’s been involved in drug — 

MARGARET BRENNAN: — Yeah. — 

SEN. SHAHEEN: — illegal drugs. But he is not a threat to the United States of America. — 

MARGARET BRENNAN: — Okay. — 

SEN. SHAHEEN: — And what the President is doing is raising real questions.

MARGARET BRENNAN: Senator Shaheen, thank you for your time this morning. We’ll be back in a moment. 

A New Hampshire man who shot and killed another man after a terrifying road rage incident was cleared of wrongdoing, with the state attorney general ruling the shooting was in self defense.

“I’ve got a flat tire, this mother (expletive) keeps ramming me, and I’m about to shoot him in his (expletive) face,” Shane Miller told dispatchers shortly before his car was disabled and the two men faced off on Pleasant Street in Littleton, New Hampshire.

The 911 call recording from around 11:15 p.m. on Sept. 16, 2024, then “captured squealing tires … the sounds of a vehicle crash, a car door opening, and then ten gunshots being fired in rapid succession.” It also recorded Miller’s voice saying “I didn’t want to kill you! … I’m sorry, I didn’t (expletive) mean that.”

Eric Rexford, 38, would die of multiple gunshot wounds. Miller, 44, said he acted in self defense, which the attorney general’s office affirmed following an investigation.

“The use of deadly force by Shane Miller was justified,” the investigation report concludes. “In addition, even if the shooting was not justified, there would be insufficient evidence to disprove Mr. Miller’s claim of self-defense beyond a reasonable doubt. As such, no charges will be filed against Shane Miller in the shooting death of Eric Rexford.”

The tension between the two men began at a mutual friend’s house at Coreys Mobile Home Park in Littleton, when Rexford accused Miller of sleeping with his girlfriend, according to the report. As the discussion escalated, Miller decided to leave and “drive to a local convenience store for cigarettes and beer.”

But Rexford wasn’t done with him. When Miller called Rexford to explain that there was no cheating going on in an effort to prevent further “drama,” Rexford told him he was waiting for him in his driveway. As Miller, behind the wheel of a Chevrolet Equinox, cautiously approached his house, Rexford pulled up behind him in his Subaru Impreza and began a chase that got as fast as 60 mph.

Police would find Miller lying next to his Equinox, which had at least one popped tire and extensive body damage. Another 911 caller reported that a bumper was lying in the road in front of his house.

Miller told police that Rexford had chased him “all over town” before the conclusion in front of the laundromat. Rexford, he said, had just kept ramming his vehicle, causing him to spin out every time and that Miller kept varying his speed so that there wouldn’t be a high-speed collision. With the final ramming, Rexford had Miller’s disabled car pinned firmly up against a sidewalk and there was no more room for Miller to maneuver.

The report includes extensive summaries of interviews with multiple eye witnesses, which back up Miller’s claims that Rexford was chasing him and ramming his vehicle. That includes a male passenger in Rexford’s vehicle during the entire ordeal, who said “he felt unable to do anything once Mr. Rexford saw Mr. Miller’s car, and began chasing Mr. Miller and repeatedly ramming into him.”

He said that Rexford would drive in the op[posing lane or on the grass so he could get at Miller’s vehicle better and that Rexford ignored his repeated requests to be let out of the car.

A medical examiner said that Rexford suffered eight gunshot wounds: to his right cheek, his chest, his abdomen, his right arm, his right thigh, his left knee, and his right index finger. A toxicological report revealed that Rexford had amphetamine, cocaine, methamphetamine, marihuana, alcohol, and processed metabolites of the same drugs in his system. His blood alcohol content was tested at 0.16, double the legal limit.