Op-Ed

Op-Ed: We All Benefit When Families Can Access Care: Why Medicaid Premiums Threaten More Than Just Budgets

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Kris McCracken

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By: Kris McCracken, President & CEO at Amoskeag Health

Imagine living on $1,304.17 a month. For many Granite Staters, this is not a hypothetical—it’s their reality. That’s the monthly income for an individual at the 2025 federal poverty level. Now consider that the median rent for a studio apartment in New Hampshire is $1,297. That leaves $7.17 for food, transportation, medical needs, heat, clothing, and other necessities. Seven dollars. For an entire month. No amount of creative household budgeting can cover all individual expenses at that rate.

Under the current state budget proposal passed by the Committee of Conference, individuals receiving Medicaid assistance through the Granite Advantage health care program, earning at or just above the poverty line, would be required to pay a flat monthly rate determined by their household size. For someone at the federal poverty level, earning $1,304.17 a month, that’s $60 each month—nearly ten times what they have left after rent. This leaves individuals in the impossible position of falling deeper into debt just to access the care they need to survive. On top of this, prescription copays would rise from $1 to $2 to $4 per medication. For someone managing chronic conditions such as diabetes or high blood pressure, this makes affording lifesaving medications like insulin a wish rather than reality.

At first glance, families earning 255% of the federal poverty threshold may not seem financially strained. But under the proposed budget, they would be required to pay $270 per month in premiums for their children’s health insurance. For a family of four earning $6,831.88 per month—the exact threshold—that cost adds up quickly.

Now consider their monthly expenses: Childcare for two young children averages over $2,655 (NH Fiscal Policy Institute), rent for a two-bedroom apartment is about $1,833, and transportation costs total roughly $1,319 (MIT Living Wage Calculator). After covering just these essentials, only $754 remains for food, utilities, medications, and all other household needs. In this context, the $270 premium is far from manageable—it pushes families to the brink and may force them to choose between health coverage and basic necessities.

Unsurprisingly, when families can’t afford health care, they don’t have it. Research from the Kaiser Family Foundation confirms what we already know: Even modest premiums and cost-sharing discourage enrollment, reduce access, and worsen health outcomes. In states like New Hampshire, this not only harms the families directly affected—it puts immense strain on hospitals and clinics forced to absorb growing uncompensated care costs. We’ve seen it before. When the Children’s Health Insurance Program (CHIP) premiums were raised in the past, enrollment among children dropped dramatically.

Policies like these don’t just affect working families living in poverty—they have a ripple effect across the entire health care system. If families are uninsured, they wait longer to get needed health care and then go to the emergency department rather than a primary care provider. This puts a strain on hospitals and contributes to long wait times. Waiting for health care leads to more severe health conditions leading to lengthier hospital stays. This strains the very systems we all rely on to stay healthy. We must remember—Medicaid expansion and CHIP in New Hampshire have been a success. They have helped reduce the uninsured rate, kept individuals, children and families connected to care, and provided stability for families and health care systems alike. Rolling back that progress would be a mistake with far-reaching consequences.

The truth is, we all benefit when children see doctors regularly, when parents can fill prescriptions, and when working people can stay healthy enough to retain employment and housing and contribute to our communities. This isn’t just a budget line—it is a strength of our communities and our economy. 

In tough financial times, we all need to tighten our belts—but we must be thoughtful about where and how tight. Cutting access to health care doesn’t save money—it shifts the cost, often with greater harm and less accountability. And it undermines the very principles of care and community we claim to uphold.

If we want children to succeed, if we want families to thrive, and if we want a strong economy and thriving communities, then health care must be protected—not rationed. New Hampshire is at a crossroads. Let’s choose stability and success. Let’s choose a system that works for all of us by removing the Medicaid cost-sharing provisions from the budget.

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