Healthcare coverage for New Hampshire residents is projected to decline over the next decade following cuts to Medicaid, Medicare and the Affordable Care Act Marketplace in the One Big Beautiful Bill.
Medicaid reductions will cause 17,000 to 29,000 residents to lose healthcare coverage by 2034, according to the Kaiser Family Foundation. An additional 34,000 residents are projected to lose healthcare coverage following the expiration of the Affordable Care Act’s enhanced tax credits, which lowered the cost of healthcare premiums for plans purchased under the ACA.
In July, Dartmouth Health CEO Joanne Conroy projected that close to 19,000 Dartmouth Health patients could lose coverage in a WUMR-9 broadcast.
Medicaid, the federal health insurance program for low-income Americans, is responsible for healthcare coverage for 13% of Granite Staters, according to the New Hampshire Fiscal Policy Institute. The One Big Beautiful Bill, signed into law by President Donald Trump on July 4, cuts $911 billion from Medicaid over the next decade, approximately 15% of the program’s budget.
Medicare, the federal program that provides aid to the elderly and people with disabilities, covers 20.3% of Granite Staters. The One Big Beautiful Bill cuts $536 billion of the program’s budget over the next decade. The two cuts combined are one of the largest retrenchments of public healthcare funding in American history.
Geisel School of Medicine professor Elliot Fisher said that hospitals in New Hampshire are “facing pressure” from insurance providers and employers to “keep their costs down and deliver the services that their patients need.”
“Medicaid has already been limiting what it spends, and Medicaid cuts are looming,” Fisher said. “Their costs are going up, so hospitals and clinics are in the middle of a squeeze.”
Geisel health policy professor Johnny Huynh, who researches inequality in U.S. healthcare and labor markets, said that cuts to federal healthcare programs will disproportionately impact veterans and low-income communities in New Hampshire, but even New Hampshire residents who aren’t on Medicaid will still “feel the impacts” of cuts.
According to the American Hospital Association, rural hospitals could lose more than $50 billion nationwide, leading to a projected loss of Medicaid coverage for more than 12,000 New Hampshire residents.
“Many rural hospitals in New Hampshire might not survive,” Huynh said. “Even if you’re on private insurance, if your local hospital closes down because they don’t have the resources coming from Medicaid, it affects the entire community.”
Critically, hospital closures translate to longer transport times, more ambulance diversion and higher mortality for time-sensitive patients, according to Huynh.
N.H. State Rep. Lucy Weber, D-Cheshire, ranking member of the Health, Human Services and Elderly Affairs Committee, said New Hampshire’s healthcare is at risk if coverage gaps continue to grow.
“With the combination of the new premiums required of some recipients and the larger copays, people will tend to forego routine healthcare,” Weber said. “That means they wind up in the emergency room, which is much more expensive. Hospitals that are already under severe stress will have less revenues and more critically ill patients.”
Weber added that similar patterns are already emerging in community health centers and mental health clinics, where cuts to routine care are depriving patients of life-saving services.
The 6.7 million elderly Americans — particularly rural Americans in states like New Hampshire — who rely on telehealth are expected to disproportionately experience the harms of Medicaid cuts, according to NBC News.
Following the federal government shutdown that began on Oct. 1, Medicare-funded telehealth was one of the first cuts as temporary pandemic-era waivers were not renewed by Congress. If the shutdown persists, funding for Medicaid overall is set to run out by October 2026.
However, Dartmouth Health vice president of government relations Matthew Houde wrote in an email statement to The Dartmouth that the Oct. 1 government shutdown “should minimally impact” Dartmouth Health’s services for those who continue to receive coverage.
“Patients covered by Medicare and Medicaid should continue to seek care as usual,” Houde wrote. “These programs remain in place and we are always committed to providing care that our patients need.”
