Rising Health Care Costs Challenge New Hampshire’s Businesses

From left to right: Ryan Poplaski, owner of Bodywise Physical Therapy & Wellness; D.J. Bettencourt, Commissioner of the New Hampshire Insurance Department; Cass Walker, Chief Human Resources Officer at Greater Seacoast Community Health; Lucy Hodder, Professor of Law, Health and Life Sciences at UNH Franklin Pierce School of Law, and NHHCI Board of Contributors member; Deborah Fournier, Director of Health Law and Policy at the UNH Institute for Health Policy and Practice; and Jennifer Wheeler, President of the Exeter Area Chamber of Commerce.

Local employers are feeling the strain of rising health care costs, and the ripple effects are touching every corner of New Hampshire’s economy. That was the central message of the 2025 Health Care Costs and the Local Economy forum, hosted by the Exeter Area Chamber of Commerce (EACC) in partnership with the New Hampshire Health Cost Initiative (NHHCI) on November 7th at the Seacoast School of Technology.

The event brought together business leaders, policymakers, and health care experts to discuss the pressures driving health care costs and explore potential solutions. Panelists included D.J. Bettencourt, Commissioner of the New Hampshire Insurance Department; Deborah Fournier, Director of Health Law and Policy at the UNH Institute for Health Policy and Practice; Cass Walker, Chief Human Resources Officer at Greater Seacoast Community Health; and Ryan Poplaski, owner of Bodywise Physical Therapy & Wellness. The discussion was moderated by Lucy Hodder, Professor of Law, Health and Life Sciences at UNH Franklin Pierce School of Law, and NHHCI Board of Contributors member.

Health Care Costs Are Limiting Choice

Nationwide, employer-sponsored health premiums climbed again in 2025, reaching $9,325 for single coverage and $26,993 for family plans, according to the Kaiser Family Foundation’s 2025 Employer Health Benefits Survey. Workers contributed an average of $1,440 for single coverage and $6,850 for family coverage toward the cost of the premium, but the wages have not kept pace with rising costs.

To better understand how these pressures are affecting Seacoast-area businesses, the Exeter Area Chamber partnered with NHHCI to survey its members. Of the 48 EACC members who responded, 62% of whom represent companies with fewer than 100 employees, the majority identified health care costs as a major concern, with an average rating of 4.5 out of 5.

The findings reinforce what many employers already know firsthand: Rising health care costs limit choices for businesses and employees alike.

Employers Face Difficult Decisions

Only half of survey respondents reported offering coverage to both employees and families, while 33% do not offer any employer-sponsored health insurance. Among those who do provide coverage, businesses reported spending an average of $9,012 per year for single coverage and $14,484 for family plans. 

Employers also described how high health insurance costs affect nearly every business decision. Almost 30% of respondents said rising costs limit their ability to offer salary increases, while others noted that benefit affordability impacts the ability to retain and recruit new staff. Ryan Poplaski, owner of Bodywise Physical Therapy & Wellness, shared how he navigates this balance as a small business owner.

“Every year, our decisions depend on what health care costs will bring. We want to give our employees the coverage they deserve, but we’re faced with higher premiums, higher deductibles, and fewer plans to choose from,” he said.

Most said they offer plans with deductibles of $2,500 or more, and many employees report struggling with affordability, prior authorization requirements, and access to care. Coverage for primary care and mental health services was identified as the most important benefit for employees.

Exploring Alternative Models

While New Hampshire is “better positioned than much of the country,” with regard to the rate of cost growth, said D.J. Bettencourt, Commissioner of the New Hampshire Insurance Department, affordability in the small-group insurance market remains a pressing problem.

He pointed to innovation and new models as the path forward, while maintaining transparency and consumer education. “The most successful cost-containment strategies begin with education and company culture,” Bettencourt said, highlighting the state’s NH HealthCost website as a key tool for consumers to compare prices.

Cass Walker, Chief Human Resources Officer at Greater Seacoast Community Health, shared how her organization has adapted to escalating costs by exploring individual coverage health reimbursement arrangements (ICHRAs).

“From an employer perspective, our ICHRA plan for 2024 and 2025 offered significant cost savings, but it’s becoming more difficult for employees to afford coverage in the current market,” she said.

One of the organization’s most innovative approaches has been wage-banding, which adjusts employee premium contributions based on income. “This ensures that employees with the lowest pay have the best opportunity to afford coverage,” she said.

A System Under Pressure

The rising cost of care is reshaping both the economy and the health care landscape. Deborah Fournier, Director of Health Law and Policy at UNH’s Institute for Health Policy and Practice, noted that employer-sponsored insurance, once seen as the “gold standard” of benefits, is no longer delivering the same protection.

“Health insurance premiums are rising faster than wages, and even insured people are skipping or delaying care due to cost,” she said. According to a 2025 KFF survey, approximately 40% of insured adults reported skipping or postponing medical care due to high costs.

Fournier also pointed to consolidation in hospital systems as a driver of health costs, with only five independent hospitals remaining in New Hampshire. “Prices in the hospital arena have been going up the fastest and the most,” she said. “When the market consolidates, competition and affordability decline.”

The Changing Landscape in Exeter

When Exeter Hospital announced its affiliation with Beth Israel Lahey Health (BILH) in 2022, it was billed as a historic investment in local care—a $375 million commitment to strengthening community services and sustaining key departments such as labor and delivery. Yet in the early years since the merger there are increasing affordability pressures and access barriers for consumers and employees in the community.

The policy concerns raised by Fournier about hospital consolidation were echoed by local businesses and health care providers who are experiencing rising prices, narrower networks and reduced access to specialty care providers and ambulance services in the region.

Finding a Way Forward

Despite the sobering statistics, the forum closed with optimism and a call to action. Poplaski reminded attendees that the conversation shouldn’t end in Exeter. “We need to continue this dialogue in our offices, organizations, and communities,” he said. “We all have a role to play.”

The discussion underscored a shared belief: while health care affordability is a complex issue, progress is possible when communities, employers, and policymakers work together toward practical, data-driven solutions.

As Lucy Hodder, Professor of Law, Health and Life Sciences at UNH Franklin Pierce School of Law, and NHHCI Board of Contributors member, emphasized in closing, “We need to start by asking the right questions: why are our health costs so high, and how can we share responsibility for addressing them? Real progress will require shared accountability from everyone.”

The NH Health Cost Initiative plans to continue convening conversations like this one, fostering the sustained engagement and partnership needed to make health care more affordable and accessible for all Granite Staters.