The case advocates make for reauthorizing expanded Medicaid is exactly the same as the case for rejecting it: Nearly 53,000 Granite Staters are now dependent on the program.

Supporters don’t use the word “dependent.” They say people “rely on” Medicaid. Functionally, the meanings are the same, like “inebriated” and “intoxicated” or “asparagus” and “disgusting.” Expanded Medicaid has made 52,726 Granite Staters (as of March 31) dependent on government health insurance.

Of course, as the dart said to the dartboard when it complained about the pain, “that was the point.”

When New Hampshire passed expanded Medicaid in 2014, state Sen. Andy Sanborn, R-Bedford, said “I have never seen, in the political realm, any entitlement program ever end. And I think the suggestion that they would end is frankly ludicrous.”

The votes for expanded Medicaid would appear to bear that out.

In 2014, Medicaid Expansion passed the Republican-controlled state Senate 18-5 and the Democratic-controlled House 202-132.

In 2016, Republicans controlled both chambers. Reauthorization passed 216-145 in the House and 16-8 in the Senate.

This year, with Republicans again in charge, reauthorization passed 17-7 in the Senate and 222-125 in the initial House vote, with the final outcome this week so obvious that the House passed the bill on a voice vote.

Such consistent support can be explained by the program’s constituency of dependents, which reaches every community. Supporters on Wednesday roamed the State House wearing T-shirts that stated how many people in their town were on expanded Medicaid.

It doesn’t matter that the Medicaid population is not static. A UNH study found that 29 percent of New Hampshire’s expanded Medicaid population stayed in the program for two full years. The biggest reason people left was that a rising income made them ineligible. (Watch for this to eventually be the basis for an argument to further expand eligibility.)

What matters is that tens of thousands of people at any given time depend upon the government, rather than the private sector, for their health insurance. That’s enough to make it permanent.

There are only two ways New Hampshire legislators will rethink keeping this program. One is if the federal government announces a reduction in federal support so large and so sudden that the state cannot absorb the cost or reduce eligibility enough to avoid the immediate creation of a massive broad-based tax. Even then, it might stay.

The other is if the health insurance markets are reformed to the point that competition explodes and premium prices collapse, falling to levels that are affordable for low-income families. Again, even then it might stay.

OK, there’s also a third way expanded Medicaid could end. SMOD could strike New Hampshire and destroy everything.

Housing and utilities comprise the largest portion of household budgets. In only nine other states and the District of Columbia do residents spend more on those two items than Granite Staters do, per Bureau of Economic Analysis data. Yet legislators have not been keen to reduce those costs for the people who elect them.

On the contrary, they often prefer to pass laws that make those items more expensive.

So the release this week of a new 10-Year State Energy Strategy that set cost efficiency as its primary goal was a big deal. The previous strategy, set in 2014, focused on manipulating energy markets to favor expensive and inefficient priorities such as renewable energy, with little attention given to the cost that would fall to consumers.

To understand the magnitude of the shift, imagine a hippie folk rock act ditching the acoustic guitars, cutting their hair and putting out an R&B album — a good R&B album.

“Addressing energy costs is a critical goal for New Hampshire. Expensive energy – or pursuing policies that raise the cost of energy – directly and negatively impacts New Hampshire families and businesses and the quality of life in our state,” the new energy plan states. “As such, the priority of this Strategy is to organize goals around cost-effective energy policies.”

The plan does not oppose all subsidies for renewable energy initiatives. It does advocate limiting any such subsidies to the start-up period to prevent ongoing cost-shifting.

This consumer-focused approach to energy policy is at odds with several bills in the Legislature this session to continue or expand subsidies of inefficient biomass power plants. Senate Bill 446 would further subsidize biomass facilities and solar arrays. Senate Bill 365 would further subsidize biomass facilities. Senate Bill 577 would further subsidize biomass facilities.

The permanent ratcheting up of electricity rates by compelling ratepayers to subsidize politically favored businesses is a long-standing New Hampshire practice. The new energy strategy discourages this. Its focus on lowering rates has drawn praise from the state’s ratepayer advocate. Whether legislators will respond by reconsidering their support for higher rates is the question.

Local housing regulations vs. consumers

As with energy, housing costs are rising when they could be stabilizing. There is huge demand for new housing in New Hampshire, and builders are eager to fill it. The problem is that local regulations make it extremely difficult to build new homes or apartments to respond quickly to surges in demand.

Those regulations also add costs that make it hard, if not impossible, in many communities to build residences that lower-income families can afford.

New Hampshire’s average monthly rental rates are higher than Maine’s, Vermont’s and Rhode Island’s and are comparable to Connecticut’s. Average rental rates in Connecticut are only $68 higher than in New Hampshire for a one bedroom and $63 higher for a two-bedroom. Median rents in Manchester are higher than in many larger cities such as Philadelphia, Atlanta and Orlando.

With a booming economy, thousands more jobs than we can fill, and a statewide rental vacancy rate below 5 percent for 18 of the last 20 years and below 2 percent for the last years, the rate of home construction in the state should be rising aggressively. It is rising, but not at rates that would come close to filling demand. Local housing restrictions are in the way.

A fix to help builders navigate these restrictions more quickly and less expensively is offered in Senate Bill 557. It would create a housing appeals board to which developers could appeal decisions of local boards, committees and commissions. Now, appeals go to the superior court. It often takes years for an appeal of a local housing decision to reach a resolution in court.

The housing appeals board would take these appeals out of the court system and resolve them quickly. The board would be required to hold a hearing within 90 days of receiving an appeal and make a decision within 60 days of the hearing. This would dramatically speed the appeals process while eliminating expensive legal costs for both builders and municipalities (taxpayers).

At a hearing in the House Finance Committee this week, no one spoke against the bill and the New Hampshire Municipal Association did not oppose it. Nonetheless, the committee voted to refer it to interim study. It will come before the full House on Thursday.

If legislators followed the lead of the Office of Strategic Initiatives and made reducing costs a top priority in both of these areas, the impact on Granite Staters could be dramatic. Making the state a lower-cost place to live and work would bring economic benefits far exceeding any that could come from propping up obsolete power plants or ignoring the costs of local land use regulations.

Can you define “art therapy?” More specifically, can you define it well enough to criminalize the unauthorized practice of it?

The state Senate thinks it can.

This coming Wednesday, the House Executive Departments and Administration Committee continues its hearing on Senate Bill 535, to establish state licensure of art therapists. (The bill passed the Senate on March 15.)

If SB 535 becomes law, it will be a misdemeanor for any individual to practice art therapy for pay without a state license. For corporations, it would be a felony.

What is art therapy? According to Art Therapy Journal, the practice originated in the 1940s when artist Adrian Hill, being treated for tuberculosis, thought to teach art to his fellow sanitarium patients as a means of therapy. Early practitioners were not therapists, but artists who realized that the artistic process had various therapeutic uses. Only much later did art become adopted as a treatment method by therapists, as the journal recounted.

SB 535 assumes, contrary to the history of art as therapy, that highly specialized training is an essential foundation for blending art and therapy. To get a license under the bill, one would have to obtain a master’s or doctorate in art therapy and accumulate “not less than 2 years, with a minimum of 2,000 hours, of supervised experience in art therapy.”

One need not try to practice unlicensed psychology to fall afoul of the law under this bill, but merely use integrate basic psychotherapeutic principles into the creative process for the purpose of helping people feel better or cope with stress or trauma.

Not all of these techniques are a part of a new, highly specialized scientific field. “Throughout recorded history, people have used pictures, stories, dances, and chants as healing rituals,” a major 2010 review in the American Journal of Public Health concluded.

No doubt there are highly trained specialists who can do wonders with art therapy and who deserve handsome compensation for their services. The problem with this bill, as with so many licensing bills, is its assumption that anything short of the work of the most highly trained expert is so dangerous that it must be banned.

Importantly, SB 535 does not ban the unlicensed practice of psychology. That is already illegal. The bill makes it illegal to apply the principles of psychotherapy to art instruction.

In the beginning of this legislative session there was hope that lawmakers would reduce licensing burdens. Part of that hope came from the huge shortage of licensed substance abuse counselors relative to demand.

New Hampshire’s opioid addicts are going without treatment in part because state licensing requirements have kept the supply of counselors artificially low. Senate Bill 487, which mandates that the state waive licensing requirements for substance abuse counselors who have licenses from other states, was, surprisingly, not killed by the Senate. It is slowly making its way through the House.

But despite shortages in other fields, the Senate has killed bills that address similar problems. This week the Senate killed House Bill 1217, which would have reversed the mandate, passed in 2016, that all school nurses have a bachelor’s degree. Nurses in any other setting need only an associate’s degree. School officials testified that they face serious nursing shortages and that the bachelor’s requirement has made the problem worse. They were no match for the lobbying power of Big Nurse.

And as this Unnamed Newsletter has noted before, the Senate killed House Bill 1685, which would have reformed the occupational licensing process to make it less burdensome.

Maybe, like a Rolling Stones fan who unwittingly hopped into an Uber driven by a Beatles obsessive, you’re tired of hearing this tune. Fine. We’ll cue up something cooler. In just a second. First, we’ll remind you that, unlike John Lennon’s songwriting ability, occupational licensing remains a huge issue, as the number of bills dealing with it suggests. And highlighting its problems is the only way for people to understand how damaging licensing can be. Roughly a third of the U.S. workforce faces occupational licensing requirements. That figure was only about 5 percent in the 1950s. By contrast, about 11 percent of the workforce is unionized.

Licensing can be a significant barrier to upward mobility and economic opportunity. In New Hampshire, legislators continue to block reform and pass new requirements, making these problems worse. Relief typically comes only when a crisis develops, as in the case of licensed substance abuse counselors.

There are real consequences to inaction. Schools are short of nurses. Opioid addicts get worse while waiting for counselors. But requirements keep being piled on, as if everything is fine.

Things aren’t fine, and they’re getting worse. Without some action by legislators to control the growth of these requirements, they will continue to spread like a plague of job-eating, wage-eroding, state licensed locusts.

On Tuesday, the august members of the New Hampshire House of Representatives will consider House Bill 287, which would create a commission to study legalizing prostitution. It comes with an “ought to pass” recommendation from the House Criminal Justice and Public Safety Committee. (The jokes really are so obvious, you’ve probably already thought of a better one than this newsletter would.)

HB 287 is part of a growing trend toward legalizing behavior once considered taboo or at least distasteful. From same-sex marriage to marijuana use to prostitution, government-imposed restrictions on private behavior are being abolished. There is even a new movement to make marijuana use a 10th Amendment issue and get the federal government out of it altogether.

(Honestly, 10th Amendment advocates are making a big strategic mistake here. Marijuana should be at the end of the list. It does the 10th Amendment movement no good for everyone to be too complacent after the first victory to put down the Doritos, get off the couch and continue fighting.)

While Granite Staters this year hear a lot about the pros and cons of legalizing “sex work” (that’s what it’s called in the bill), lots of other non-controversial occupations will remain illegal to practice for pay without state approval. For instance, auctioneering.

RSA 311-B makes it “unlawful” for any person to “knowingly engage in, or offer to engage in, auctioneering for a fee, commission, or other consideration unless such natural person has a valid license under this chapter or such other person is an authorized business organization.”

Unless you have a license, you break the law just by claiming you are “able to perform auctioneering.”

In New Hampshire, this is a criminal offense. Auctioneering for pay, or merely claiming the ability to perform auctioneering, is a misdemeanor for an individual and a felony for a business.

The “Occupations and Professions” section of state statutes is peppered with criminal penalties for working without state permission.

RSA 314 makes it a misdemeanor to practice eletctrolysis without a license.

RSA 323 makes it a misdemeanor to sell lightning rods without a license. (We are not making this up.)

RSA 328-H makes it a violation on first offense, a misdemeanor on second, to practice “Asian bodywork therapy” without a license.

RSA 331-A makes it a misdemeanor to engage in real estate brokerage without a license.

RSA 332 makes it a misdemeanor to “practice veterinary medicine” without a license. The statute defines “practice of veterinary medicine” as: “To diagnose, treat, correct, change, relieve, or prevent animal disease, lameness, deformity, defect, injury, or other physical or mental conditions….”

It is not always a criminal offense to work in certain fields without permission. Sometimes the state just makes it really hard to enter the field.

To become a cosmetologist, one must complete 1,500 hours of schooling or 3,000 hours of training under a licensed cosmetologist.

To become a pastoral psycotherapist, one must have a master’s in divinity, a Ph.D. in pastoral therapy, and 3,000 hours of supervised experience.

To become a “shampoo assistant apprentice,” one must first “work under the direct supervision of a licensed barber or cosmetologist for at least 150 hours” and pay a $25 fee. This is for a job that consists exclusively of “shampooing, rinsing and removing rollers or permanent rods, rinsing treated or untreated hair, and other cleansing or sink-related functions not requiring the skill of a cosmetologist or barber.”

If not the state, who will save us from unregistered shampoo apprentices?

Thankfully, some people have noticed that the state’s occupational licensing regime has become exceedingly burdensome. Rep. Bill Ohm, R-Nashua, has introduced a bill to create an occupational regulation review commission that would examine whether licensing boards use the least restrictive means to achieve their goals. It’s not as sexy a media topic as prostitution, but (presumably) it would have a bigger impact on the average Granite Stater.