New Hampshire’s health care system is facing unprecedented challenges that could have major economic and personal consequences in the coming years.
Changes in federal and state policy, combined with broader market pressures, are projected to result in significant coverage losses, higher costs, and reduced access to care — particularly in rural areas.
Nationally, that more than 15 million Americans could lose their health coverage in the coming year, including thousands of Granite Staters. Without insurance, individuals and families are more vulnerable to overwhelming medical bills when illness or injury strikes.
Rising costs may also push more households into medical debt, strain family budgets, and limit access to lifesaving care. With nearly 184,000 Granite Staters — about 13.4% of the state’s population — relying on Medicaid or the Children’s Health Insurance Program (CHIP), cuts to Medicaid and ACA programs could cause thousands to lose access to essential care, destabilizing rural hospitals and escalating costs for everyone.
Coverage losses and rising costs
Proposed funding reductions to Medicaid — estimated at $1 trillion nationally over the next decade — could lead to increased out-of-pocket expenses for enrollees, including copays of up to $35 for doctor visits. This change would be particularly difficult for low-income families, people with disabilities, and rural residents who already face limited health care options.
Older adults may also face higher costs for prescription drugs and premiums. Without continued support for Medicare drug price negotiations, taxpayers could shoulder billions in additional costs, while low-income seniors may pay thousands more each year for necessary medications and services.
For individuals and families purchasing insurance on the open market, industry estimates suggest that premiums could rise by an average of 18 percent in the coming year. Without offsets such as tax credits, some households could see their coverage costs increase by more than 70%.
Economic ripple effects
When people lose coverage or face higher costs, they often delay or skip care. A survey of more than 1,300 New Hampshire adults, conducted in 2024, found that over two-thirds (69%) said they delayed or went without health care due to cost. This can lead to more severe health issues and greater long-term expenses.
Half of New Hampshire’s acute care hospitals — or 13 of 26 — serve rural communities and survive largely on Medicaid support. Those hospitals and clinics — especially in rural parts of New Hampshire — may be forced to close or reduce services, driving patients to more distant facilities. As demand concentrates in fewer locations, wait times and costs can increase for everyone.
Emergency rooms, often the provider of last resort, could become overcrowded with uninsured patients, adding financial pressure on hospitals and contributing to rising premiums for insured patients. Employers may also face higher health benefit costs, which could limit wage growth or lead to reduced hiring.
Credit and financial stability
Medical debt remains a leading cause of personal financial hardship in the United States. Recent changes at the federal level have reduced protections for consumers, meaning unpaid medical bills may continue to appear on credit reports. A lower credit score can make it more expensive — or impossible — to secure a loan, rent a home, or start a small business. For families already living paycheck to paycheck, a single medical emergency can create a cycle of debt that is difficult to escape.
A New Hampshire challenge
New Hampshire’s aging population, rural geography, and reliance on a mix of small and regional health care providers make the state particularly vulnerable to these pressures. Many communities have only one hospital or primary care clinic within reasonable distance, and staffing shortages in areas such as maternity care and behavioral health already strain the system. Since 2000, nine hospitals have ceased labor and delivery services, doubling travel time for women in many New Hampshire rural areas.
If coverage declines and costs rise sharply, the impact will not be confined to the health care sector. Small businesses could face steeper health insurance bills, employees may delay necessary care, and towns could see reduced economic activity as household budgets tighten. The state’s ability to attract and retain a healthy workforce could also be affected, with long-term implications for growth.
Looking ahead
The future of health care in New Hampshire will depend on how policymakers, health care providers, insurers, and communities respond to these challenges. Transparency in health care pricing, support for rural providers, and collaborative problem-solving among stakeholders will be critical to ensuring that residents continue to have access to affordable, quality care.
The choices made in the next year will shape the health — and economic well-being — of Granite Staters for decades to come. Without real solutions and collaboration, these pressures will dismantle access — especially in rural communities. Protecting coverage, preserving rural hospitals, and ensuring equity in access are crucial steps toward securing health and economic stability for all Granite Staters.
Jayme H. Simões heads Louis Karno & Co., the communications agency he founded in 1999, growing it from two clients to more than 30. Jayme also serves with Protect Our Care NH to fight for accessible, affordable health care. Originally from Chicago, he is a Boston University graduate and a fluent Portuguese speaker. He lives in Concord with his wife, Laura.