Sarah Chen thought she had planned everything perfectly. The 34-year-old Lebanon resident budgeted for rent, groceries, and her monthly student loan payment when she moved to the Upper Valley two years ago to work at a local nonprofit. What she didn’t anticipate was her health insurance premium jumping from $320 to $480 per month this year.
“I’m literally choosing between keeping my insurance and being able to afford groceries,” Chen said. “And I’m one of the lucky ones who even has employer-sponsored options.”
Chen’s struggle reflects a growing crisis across Vermont and New Hampshire’s Upper Valley region, where rising health insurance costs are forcing residents to go without coverage or delay essential medical care. The problem hits particularly hard in rural communities where healthcare access was already limited.
According to Vermont’s Department of Financial Regulation, individual market premiums increased by an average of 13.8 percent this year, marking the steepest rise in five years. New Hampshire saw similar jumps, with some plans increasing by more than 15 percent.
For Upper Valley families, these increases compound existing challenges in a region where the median household income trails state averages while housing and healthcare costs continue climbing. The result is a growing number of residents who fall into what health policy experts call the “coverage gap” – earning too much to qualify for subsidies but too little to comfortably afford insurance.
Dr. Maria Rodriguez, who practices family medicine in White River Junction, sees the impact daily in her clinic. Patients are spacing out appointments, skipping preventive care, and showing up in emergency rooms when conditions become critical.
“I have patients who are rationing their medications, postponing surgeries, and avoiding routine screenings because they can’t afford the copays,” Rodriguez explained. “We’re seeing people make impossible choices between their health and their financial survival.”
The healthcare access challenges align with broader community health initiatives across the region. Geisel Medical Students Honored for Community Service Impact highlights how future healthcare providers are already recognizing and addressing these gaps through volunteer work in underserved communities.
Local health centers report a 25 percent increase in patients seeking charity care or payment plans over the past year. The Upper Valley’s federally qualified health centers, which serve as safety nets for uninsured residents, are seeing unprecedented demand that strains their capacity.
“We’re serving more patients than ever before, but we’re also seeing them delay care longer,” said Jennifer Walsh, executive director of the White River Junction Community Health Center. “By the time people come to us, their conditions are often more severe and expensive to treat.”
The insurance affordability crisis particularly affects small business owners and independent contractors who lack access to group coverage. In the Upper Valley’s economy, which relies heavily on small businesses, seasonal work, and freelance employment, many residents must purchase individual market plans that offer fewer protections against rate increases.
Mike Thompson, who runs a small landscaping business in Norwich, dropped his family’s health insurance entirely after their monthly premium reached $1,200.
“That’s more than our mortgage,” Thompson said. “We’re healthy people who rarely go to the doctor, but now we’re one accident away from financial disaster.”
Health policy experts point to several factors driving the cost increases, including rising prescription drug prices, hospital consolidation, and the lingering effects of the COVID-19 pandemic on healthcare utilization patterns. In Vermont and New Hampshire’s small insurance markets, these pressures create particularly volatile pricing.
State officials in both Vermont and New Hampshire have proposed various solutions, from prescription drug importation programs to reinsurance pools designed to stabilize individual market premiums. However, these initiatives face federal regulatory hurdles and funding challenges.
The Vermont legislature is considering legislation that would create a public option for health insurance, potentially offering more affordable coverage for residents like Chen and Thompson. New Hampshire lawmakers are exploring similar measures, though political opposition remains strong.
For healthcare providers, the insurance affordability crisis creates ethical dilemmas about how to serve patients who cannot pay while maintaining viable practices. Some clinics have expanded sliding-scale fee programs or partnered with local organizations to provide care regardless of patients’ ability to pay.
“Healthcare is a human right, not a privilege,” said Dr. Rodriguez. “But our current system puts both patients and providers in impossible positions.”
The impact extends beyond individual health outcomes to broader community wellbeing. When residents delay preventive care, chronic conditions worsen, emergency room visits increase, and overall healthcare costs rise for everyone.
Public health officials worry that the trend could reverse decades of progress in managing chronic diseases like diabetes and hypertension, particularly in rural communities where access to specialists is already limited.
“We’re seeing people ration insulin, skip cancer screenings, and avoid mental health treatment,” said Lisa Adams, director of the Upper Valley Public Health Coalition. “These decisions have consequences that ripple through families and communities for years.”
For residents currently struggling with health insurance costs, several resources offer assistance. The state insurance marketplaces provide subsidy calculators and enrollment assistance, while community health centers offer sliding-scale fees based on income. Some hospitals also provide financial assistance programs for uninsured patients.
As the healthcare affordability crisis deepens, Upper Valley residents like Chen continue searching for solutions. She recently applied for a different job partly because of its better health benefits, a decision that reflects how insurance costs increasingly drive major life choices.
“It shouldn’t be this way,” Chen said. “Healthcare costs shouldn’t determine where you work, where you live, or whether you can afford to stay healthy.”
