In the back room of a small metal parts factory in Hudson, New Hampshire, Adria Bagshaw runs her fingers along a tray of precision-cut components. They’re clean, sharp, and uniform, each one a product of careful labor and quiet pride. Her family’s business, W.H. Bagshaw Company, has been operating for over 150 years. It has survived wars, recessions, and the slow churn of industrial change. But this fall, the threat isn’t mechanical or economic. It’s bureaucratic. And it’s personal.
The company’s health insurance premiums are set to spike by nearly 38 percent next year. That number didn’t come from a market shift or a sudden change in employee health needs. It came from a letter. A notice from their insurance broker explaining that the increase is tied to the expiration of federal health care tax credits, subsidies that have helped small businesses and individuals afford coverage through the Affordable Care Act Marketplace. Without those credits, the math doesn’t work. And for Adria and her husband Aaron, who co-run the business, the consequences are immediate. They’re not just recalculating budgets. They’re reconsidering coverage.
Across New Hampshire, thousands of families and small businesses are facing similar decisions. The enhanced tax credits, originally expanded during the pandemic, are set to expire at the end of the year. For many, they’ve been a lifeline. A way to keep employees insured. A way to stay afloat. And now, with Congress gridlocked and the government teetering on the edge of shutdown, that lifeline is fraying.
Health care is often talked about in numbers. Premiums, deductibles, percentages. But behind every statistic is a story. A person trying to make sense of a system that feels increasingly out of reach. In clinics across the state, patients ask whether their coverage will change. Whether their prescriptions will still be covered. Whether they’ll have to choose between a doctor’s visit and a utility bill. These aren’t hypothetical questions. They’re daily realities.
For the Bagshaws, the decision isn’t just about their own family. It’s about their employees. About the people who show up every morning, clock in, and keep the machines running. Some have been with the company for decades. Others are just starting out. All of them rely on the health plans offered through the company. And if those plans become unaffordable, the ripple effects will be felt far beyond the factory floor.
The expiration of the tax credits is part of a larger debate about federal spending and health care policy. Lawmakers in Washington are divided. Some argue that the credits were always meant to be temporary. Others insist they should be made permanent. But while the debate continues, the impact is already being felt. Insurance companies are adjusting rates. Brokers are sending out warnings. And families are bracing for change.
In public health, we talk about access. About the barriers that prevent people from getting the care they need. Cost is one of the biggest. When premiums rise, coverage drops. When coverage drops, health outcomes worsen. It’s a simple chain of cause and effect. And it’s one that disproportionately affects low-income communities, rural areas, and small businesses like W.H. Bagshaw.
The Bagshaws have been vocal. They’ve spoken with representatives. Shared their story. Asked for help. But they’re not just advocating for themselves. They’re speaking for the many small business owners who don’t have the time or resources to navigate the policy maze. For the workers who don’t know why their premiums are rising. For the patients who just want to see a doctor without fear.
In the clinic where I volunteer, I see the consequences of policy every day. A mother skipping her own appointment to save money for her child’s. A diabetic patient rationing insulin. A teenager asking if mental health visits are still covered. These moments don’t make headlines. But they shape lives. And they remind us that health care isn’t just a political issue. It’s a human one.
The Bagshaws are still waiting. Still hoping that Congress will act. That the credits will be extended. That the system will bend toward fairness. But they’re also preparing. Running numbers. Exploring options. Trying to protect their employees from the fallout. It’s a quiet kind of resilience. The kind that doesn’t make speeches but keeps showing up.
As the year draws to a close, the urgency grows. Decisions will be made. Policies will shift. And people like Adria and Aaron will carry the weight. Not just of their business, but of their community. Of the belief that health care should be accessible. That work should be valued. That no one should have to choose between coverage and survival.
In Hudson, the machines keep humming. The parts keep moving. And in the back room, Adria keeps reading the numbers. Not just the ones on the invoice, but the ones that tell a deeper story. A story of care, of commitment, and of a system that needs to do better.
