The High Cost of Healthcare in New Hampshire: Insights from Lucy Hodder
High healthcare costs are a persistent issue in the United States, and New Hampshire is no exception. On a recent episode of The Legal Impact, a podcast by the University of New Hampshire Franklin Pierce School of Law, Lucy Hodder, a distinguished visiting professor and health law expert, discussed the complexities of our healthcare system and the factors driving rising health costs.
Professor Hodder, who directs the Health Law and Life Sciences Program at UNH, provided critical insights into the legal structures, market dynamics, and policies shaping our healthcare landscape. Her points are a reminder of why changes to lower costs and improve access to care are necessary, yet challenging.
Why Is U.S. Healthcare So Expensive?
Professor Hodder began by outlining the historical roots of the U.S. healthcare system, explaining how employer-sponsored insurance became the dominant model, with over 60% of the people in the United States getting their healthcare through insurance offered by their employer. This structure emerged during World War II as a way to attract workers despite wage caps, and it also represented the introduction of significant tax breaks for employers.
Unlike other countries where universal healthcare coverage is available, the U.S. relies heavily on private insurance, creating a fragmented system marked by inefficiencies and inequities. Although Medicare, Medicaid, and other federal insurance programs exist to cover vulnerable populations, a significant portion of Americans are uninsured or face insurmountable costs.
Despite spending significantly more per capita on healthcare than any other nation, the U.S. struggles with poor health outcomes. "Our life expectancy has dropped in the past five years, and our infant mortality rate is one of the worst among developed countries," Hodder noted. She highlighted unmanaged diabetes and maternal mortality as areas where the U.S. performs particularly poorly, despite the resources poured into the system.
The Burden on Individuals and Families
Professor Hodder emphasized the growing burden healthcare costs place on individuals. Rising premiums, deductibles, and out-of-pocket expenses force many to delay or forgo essential care and medications. In New Hampshire, data shows that nearly every resident has faced some form of healthcare affordability challenge in the past year.
This affordability crisis often spirals into larger health emergencies. When people skip routine and preventive care because it’s too expensive, they end up requiring more costly interventions later. As Hodder explained, “This cycle of deferred care leading to emergency room visits and more expensive treatment underscores the current inefficiency and inequity of our system.”
Additionally, as healthcare spending and costs grow faster than inflation and the economy, businesses also struggle to afford health insurance for their employees. In turn, this can impact wages, benefits, and business expansion.
What Drives Rising Health Costs?
Professor Hodder identified several key drivers behind the escalating costs.
Expensive Innovation Can Eclipse Cost-Effective Care: While advancements in biotechnology and pharmaceuticals have improved treatments for rare and chronic conditions, they come with steep price tags. “We produce groundbreaking studies, cures, and innovations in healthcare, like biologic drugs, which are often expensive and inaccessible to many,” said Hodder. “At the same time, a significant portion of the population struggles to access primary care, mental health services, and other essential day-to-day health needs.”
System Complexity: The U.S. healthcare system involves numerous players—insurers, hospitals, pharmaceutical companies, and government programs—all competing for a share of the trillions spent annually. This fragmented system breeds inefficiencies, including wasted resources and fraud.
Provider Consolidation: Increased mergers and acquisitions of hospitals and providers are a growing trend, which can lead to higher costs and restricted consumer choice. This is coupled with an increasing focus on high-margin specialty care, such as orthopedics, end-of-life care, and inpatient treatment while underfunding essential services like primary care, mental health, and pediatric care.
The Path to Lower Costs and Better Access to Care
Despite the challenges, Hodder remains hopeful about opportunities for healthcare reform. She pointed to initiatives aimed at improving transparency, reducing administrative waste, expanding consumer protection, and shifting the focus from high-cost specialty care to preventive and primary care. By prioritizing value over volume and addressing the systemic inefficiencies that drive costs, we can begin to build a healthcare system that truly serves everyone in the Granite State.
In New Hampshire, the rising cost of healthcare has spurred new education and community engagement efforts to address these issues. The New Hampshire Health Cost Initiative (NHHCI) is working to address the state's rising healthcare costs and improve access to care by educating consumers, policymakers, and businesses on the urgent need for greater cost transparency and policy reform.
By bringing expert voices like Lucy Hodder’s to the forefront, NHHCI is helping more Granite Staters understand the root causes of rising costs and explore practical solutions to a more affordable and efficient system. As Hodder concludes on the podcast, “Healthcare is not just an economic issue; it’s a moral one.”
About Lucy Hodder
Lucy Hodder, JD is a professor of law at UNH Franklin Pierce School of Law and a respected figure in health law, insurance markets, and health care delivery system dynamics in New England. She founded the Health Law and Policy program at the University of New Hampshire and currently directs the Health Law and Life Sciences program at the law school. She has practiced in health law for over 30 years, both as a shareholder at Rath, Young & Pignatelli, PC, in employment and corporate health law, and in the public sector as an Assistant Attorney General and legal counsel to Governor Maggie Hassan.
Listen to the full podcast and read more from Lucy Hodder here.