One of my sons, who lives in another state, has unaffordable medical premiums. I am fortunate to be able to help him with his healthcare needs, but this also means I am aware of how changes to this system impact the ability of many people to pay for something that should not be financially out of reach. These changes also mean that services like scheduling doctor’s appointments, once easy, now require long waits, and filling prescriptions has become a game of chance: one never knows the price of the required drug, whether the insurer still approves it for reimbursement, or even whether it’s available at the pharmacy.
The negative effects of recent changes in healthcare funding are no different for those living in Wilton than for my son, or for anyone living throughout New Hampshire and beyond. They are nationwide and pervasive. Not just for the customer, but also for the provider.
When I spoke with the NH Navigator program representative for my first article on healthcare, the information she gave me is indicative of how changes to this system have impacted all the workers and organizations that serve the healthcare industry, no matter where they live. She began our conversation stating that she had been the sole representative for New Hampshire, but due to cuts and consolidations, she now handles both New Hampshire and Iowa from her office in West Virginia.
When I asked what recent healthcare-related budget cuts mean to her co-workers, she said, “When the cuts first were made, I lost my job for several months but was later called back to work with a much smaller team. Thirteen of the 20 employees I previously worked with were not rehired. This left me as one of only seven to handle the work for the 28 states relying on Healthcare Marketplace Medicare and Medicaid services.”
I later spoke with a Nashua doctor who specializes in pulmonary medicine. His main concern was the rising cost of drugs for his patients. “They just can’t afford them,” he said when I asked him why they weren’t taking them. He added, “This issue has grown much worse in recent years. I often must find ways to treat their life-threatening conditions without the drugs they most need.”
According to recent statistics published by The Healthcare Value Hub and Granite State’s New Futures based upon the Consumer Healthcare Experience State Survey (CHESS,) “More than 69% of all surveyed New Hampshire adults reported delaying or completely going without some form of necessary health care (including dental, primary, and specialist care) due to cost limitations within a single year or cut pills in half, skip doses of medicine, or do not fill a prescription.”
It’s not only patients needing pulmonary care who have felt the effects of these changes. The entire industry has been affected. This means recent healthcare policy changes initiated by the federal government and health insurance agencies, and passed down to states to administer, affect all healthcare-related organizations, suppliers, pharmacies, services, clinics, hospitals, rehab facilities, nursing homes, and the nurses and doctors who serve New Hampshire citizens.
The information I’ve gathered for this article is from The NH Hospital Association’s 2025 Report, an article published on Aug. 8, 2025 in the NH Bulletin, and from interviews I conducted with local providers.
The NH Bulletin article begins, “Recent state budget shifts, changing federal rules, and rising expenses have strained New Hampshire’s healthcare industry, increasing financial pressure on rural hospitals and altered patient coverage.” This means hospitals are vulnerable to Medicaid funding cuts, and rising costs force rural clinics to close or reduce services, increasing patient wait times and crowding emergency rooms.
Within the past few months, those living in the Monadnock region have witnessed the impact of these changes on our pharmacies. Three Rite Aid Pharmacies between Peterborough and Milford were among the 14 statewide casualties that closed because price restructuring “crushed profit margins on prescriptions.”
The report points out that dentists and private practice physicians are not protected from healthcare restructuring. Skyrocketing premium increases due to expiring federal tax credits drive up their overhead expenses. At the same time, they are caught between insufficient insurance and Medicaid reimbursements and a reduced client base, as patients skip elective dental and physical care and delay payments because of rising out-of-pocket costs.
I spoke with Ingrid Crowley, an administrator at Peterborough Family Dental, who said that rising premiums and the removal of dental benefits from at least the two largest Medicare Advantage plans make it harder for customers to pay “out-of-pocket” on time, or at all, for necessary dental care. She added that the primary difference for the office is the extra time it takes to fill out paperwork.
Karen Gomes, the new President and CEO of Home Healthcare, Hospice and Community Services, said, “From my perspective, the biggest challenge over the past several years has been the growing gap between what it costs to provide care and what providers are paid to deliver that care. … Healthcare has become increasingly regulated and administratively complex with new reporting requirements, auditing procedures, assessment tools, and mandated documentation.
“Particularly in rural communities like ours,” she said, “it is increasingly difficult to recruit and retain nurses, therapists, home health aides and other clinicians. … What concerns me is ensuring that, in the future, community-based providers have the resources necessary to sustain our deep commitment to helping people receive care where they most want to be: at home.”
The NH Bulletin article notes that durable medical equipment and service suppliers face severe pressure from state Medicaid policy changes. This means even critically needed items are rationed because of supply chain and reimbursement delays.
When I spoke with two employees at Charron Medical Supply in Amherst, they told me at least one reason they and other medical and dental practices are “bogged down with increased paperwork,” as several providers described.
These two employees explained, “We used to spend a lot of time on hold with insurance companies waiting for coverage verification, but now it is so much worse. Now we are referred to Chat instead of a real person. Once people were taken out of the equation, the answers we receive may differ from day to day for the same customer. Although there may be coverage for a specific need, each policy is different and the computer that replies doesn’t have access to individual policy details, so we repeatedly get conflicting answers to the same question. This means the accurate information we need to help people is harder and harder to gather, takes even longer to verify and sometimes even makes it difficult to be reimbursed for our services.”
In another area, hospital nurses, staff and medical professionals have been affected by staffing shortages due to the high cost of living and an aging state population. As hospitals consolidate, “nurses and staff report intense burnout from workforce restructuring, increased patient wait times, and a distinct loss of local workplace autonomy.” I can only guess what the loss of many of our immigrant community members who work in the medical field in hospitals and associated businesses means to this part of the healthcare industry.
The reports I read paint an even more inclusive picture: It’s not only rural hospitals that are suffering – 75% face imminent closure due to low reimbursement rates – and the state’s major hospitals are suffering multi-million-dollar deficits. The broader economy is affected by higher health insurance costs for small businesses, reduced consumer spending, and employers potentially slowing hiring or limiting wage increases.
Understanding that consumers are not the only ones feeling the impact of recent healthcare policy changes may not help in the short run, but it may help us be a little more tolerant of those providing the services by recognizing that they, too, are struggling.
Even though I have no idea where this information may ultimately lead, let’s hope it encourages reevaluation of the system in place and, perhaps, brings about further changes that will eventually benefit us all.