New Hampshire faces a health care affordability crisis driven by structural choices about how care is delivered, priced, and regulated. While only around 4.5% of state residents are uninsured, coverage does not guarantee access. More than half of commercially insured residents now face deductibles of more than $1,500, and many report delaying or forgoing care because of cost.
Health care spending in New Hampshire reaches roughly $13 billion annually, with more than half going to inpatient and outpatient hospital services alone. Premiums continue to climb, deductibles are growing, and out-of-pocket expenses are forcing difficult choices for households and businesses. Commercial medical costs are projected to rise sharply in the coming year, with pharmacy spending—particularly for high-cost specialty drugs—continuing to surge. Yet investment in primary care, which is consistently associated with better outcomes and lower long-term costs, remains stubbornly low.
Over time, consolidation has concentrated market power among a small number of hospital systems, many with out-of-state ownership and for-profit operations. Decision-making about care delivery and pricing is often removed from the communities most affected. The rise of private equity investment in physician practices and specialty providers adds complexity, as private investment can drive price increases when oversight is limited and market competition is reduced.
Recent federal changes compound these challenges. Reductions in Medicaid funding and changes to eligibility rules will place additional pressure on providers, employers, and patients. However, New Hampshire received more than $204 million for 2026 as part of the federal Rural Health Transformation Program—more than any other New England state—aimed at strengthening rural health care access, quality, and sustainability.
Addressing these challenges requires transparency around ownership and spending, a statewide approach to managing cost growth, stronger consumer protections, and increased investment in primary care, behavioral health, and prevention. Without accountability and clear priorities for state-level oversight, costs will continue to rise and public confidence will continue to erode.
This article is an AI-assisted summary. All facts and figures are drawn from the original report: https://www.unionleader.com/opinion/op-eds/lucy-hodder-how-nh-can-get-serious-about-health-care-costs/article_a8066823-d8d2-40d7-b524-2c4fcbbd3834.html