When doctors diagnosed her son with autism 15 years ago, Iraida Muñoz moved her family from Puerto Rico to the United States in hopes of accessing better health care.

With limited knowledge of English, she learned the system and got her son into therapy, which helped him learn to speak at the age of 5 after struggling in early childhood.

“We learned firsthand all the struggles of moving, of having to adapt to a new culture, having to adapt to new language … relearning everything,” said Muñoz, who has lived in Nashua since 2011.

She worries House Bill 392 could pose a threat to families like hers.

A handful of Republican state representatives hope to abolish the state’s Office of Health Equity, arguing that diversity, equity and inclusion programs like this one are “discriminatory, punitive and divisive.”

The Office of Health Equity, according to the Department of Health and Human Services, which houses it, works to eliminate barriers to healthcare access. Created in 1999, it provides communication services like sign language interpretation and coordinates transportation, and it helps people navigate and understand the health care system. It also runs the state’s federally funded refugee resettlement program, which helps “assist refugees in their quest for economic self-sufficiency and successful integration,” according to its website.

Muñoz, who now works as a public health equity officer for the city of Nashua, stressed that these programs don’t just apply to gender or people of color. They also serve elderly people, English language learners and people with disabilities, like those who are deaf or blind. She said getting rid of these services would have a big impact, not just for marginalized communities but for everyone.

“If we don’t provide voice for those populations that already are facing so many barriers, then we’re not serving our community in general at all,” Muñoz said. She also testified against the bill on Wednesday. “We are totally excluding and moving backwards in our society if we just get rid of programs like this.”

If the Office of Health Equity were dissolved, some programs might be cut, while others could be outsourced to nonprofits, like the federally funded refugee resettlement program. Leaders from the Department of Health and Human Services said government control of that money allows for better integration into the existing healthcare system and gives the state oversight power on those funds.

As the legislation puts civil rights and diversity, equity and inclusion efforts in New Hampshire in the crosshairs, a similar battle plays out on the national level. While attempting to overhaul immigration and LGBTQ policies, the Trump administration is also pushing to rid the federal government of DEI efforts and funding.

Wakefield Rep. Mike Belcher, who sponsored the bill, argued in his testimony that “equity” favors some groups over others based on their demographic identity and should be thought of as “both unlawful and unconstitutional.”

“Broadly, these concepts attempt to flip perceived hierarchies by elevating the marginal and punishing the privileged,” Belcher said. “In other words, it divides as supposedly oppressor or oppressed. Departing from the American Constitution, they lean on the social analysis of Karl Marx and Jean-Jacques Rousseau to justify this evil.”

Lawmakers on both sides of the aisle appeared skeptical of Belcher’s proposal, which six other Republicans signed onto. The bill would also prohibit the Department of Environmental Services from using any money on projects labeled “civil rights and environmental justice” and would prevent the Governor’s Advisory Council on Diversity and Inclusion from being re-established.

(Former Gov. Chris Sununu repealed his executive order that assembled the council on his way out of office, and Gov. Kelly Ayotte said this week she has no plans to bring it back.)

As they questioned Belcher, both Republicans and Democrats raised concerns about the legal precedent of eliminating such an office and the gap it could leave in healthcare access.

The two-hour hearing dabbled in a discussion on the origins and purpose of DEI, as well as a debate over the meaning of equity.

Gilmanton Republican David Nagel read Belcher an excerpt from the office’s website, which says it ensures “equitable access to effective, quality programs and services across all populations, with specialized focus on breaking down barriers to care for vulnerable New Hampshire residents.”

Nagel is an orthopaedic physician, having worked for Concord Orthopaedics for 34 years.

“In my experience, that’s a really important function,” Nagel said. “I’m just curious: If that goes away, how do we replace that?”

Belcher responded by drawing a difference between “equitable” and “equal” access to care.

“It is not access that looks determinably at who has the greatest need,” Belcher said. “Equity by definition looks at people based on identity characteristics, not based upon need.”

Ann Naughton-Landry, an associate commissioner at the Department of Health and Human Services, said the department views equity as “addressing the health needs of every individual.”

“[It’s] ensuring that every New Hampshire resident has access to care, whatever that means for that individual,” Naughton-Landry said.

Federal funding at stake

The state agencies in question underscored legislators’ concerns, which also extended to legal compliance. Naughton-Landry said the Office of Health Equity makes sure the entire health and human services department is following state and federal civil rights laws. For example, the state is required by law to provide communication services.

Adam Crepeau, the assistant commissioner for the Department of Environmental Services, said the state gets between $80 million and $90 million in federal funding that’s tied to compliance with civil rights laws. The bill would jeopardize that, he said.

Belcher disagreed, citing Trump’s recent executive orders.

“The position I staked out in this bill is now reflected in federal policy of the executive,” Belcher said. “Now, contrary to any suggestions that we might lose federal funding if we were to move forward with eliminating these offices, on the contrary, we’re far more liable to lose federal funding if we do not.”

Crepeau said his department doesn’t currently do much in the way of environmental justice. Over the past few years, the federal government required 40% of any discretionary grants to be put toward environmental justice, which Crepeau said his department took as any disadvantaged or low-income community. That executive order has since been repealed, but Crepeau said many of those values translate to good customer service.

“Historically what we’ve done is if someone asks for translation services for documents or a translator at a public meeting, we offer those services as a courtesy,” Crepeau said. “We think that’s good customer service, but at this point, that’s the extent of what we do under the auspices of environmental justice.”

An ‘everyday challenge’

As legislators debated the legality, funding and administration of these programs, Muñoz doubled down on their importance and value for communities who experience systemic barriers to health care. However, that doesn’t mean she doesn’t still experience some of those barriers herself.

Even with these state offices and services in place – and even working in public health herself – Muñoz said her family still faces hurdles to getting health care, often due to language. Though Muñoz has mastered English to use in a professional setting, her husband is still learning and one of her children is bilingual.

Her family faces an “everyday challenge” to access public services.

“My husband, still, every time he goes to get his medicine, to the pharmacist, it’s a nightmare,” Muñoz said. “He needs to explain himself 20 times before someone gets him someone who can speak Spanish for him so they don’t get misinterpretations. Trying to get his prescriptions is just always a constant battle.”

If the health equity office goes away, Muñoz said, people will miss out on their guidance and the state will lose a voice that takes care of all kinds of New Hampshire communities.

“The leadership of the Office of Health Equity is essential to fostering a healthy, safe and thriving community,” Muñoz told legislators. “When everyone has the opportunity to achieve good health, we all benefit.”

Charlotte Matherly is the statehouse reporter for the Concord Monitor and Monadnock Ledger-Transcript in partnership with Report for America. Follow her on X at @charmatherly, subscribe to her Capital Beat newsletter and send her an email at cmatherly@cmonitor.com.