Not long after the federal government shutdown ended, Keene resident Lou Robinson’s monthly health insurance premiums jumped from $120.84 in December to $254.36 in January.
Lou Robinson stands outside Cheshire Medical Center on Jan. 27 in Keene. Learning their health insurance premium was increasing “was terrifying because I’m already living paycheck to paycheck, so $100 is not insignificant,” Robinson said.
Bailey Stover / Sentinel Staff
Robinson, who purchases health insurance through the Affordable Care Act marketplace, had been following the government shutdown. At the center of the 43-day deadlock were pandemic-era enhanced subsidies for ACA plans that made insurance affordable for Robinson, a full-time child care worker who lives paycheck to paycheck. When U.S. Sens. Jeanne Shaheen and Maggie Hassan, both D-N.H., helped broker a deal to end the shutdown without extending the subsidies, Robinson felt betrayed by the political system.
“It hurts, it’s sour, it’s shameful,” said Robinson, whose bank account now frequently goes into the negatives. Robinson needs the insurance for ADHD and depression medications that have been “life changing and life saving,” and has considered getting a second job to offset the higher premium costs. But “having to use up what little of my personal time I have to do more work would be so crushing.”
Robinson is not alone: While rising health insurance costs are a perennial issue, residents and employers throughout the Monadnock Region and beyond are seeing a particularly large increase in 2026. The most dramatic hike is occurring to premiums within the ACA marketplace, which the health policy nonprofit KFF estimates are increasing enrollees’ premium payments an average of 114 percent. Meanwhile, employers with group plans were projected to face an average 9 percent increase in health insurance costs for 2026, the highest increase in 15 years, according to a September survey by the consulting firm Mercer. This has resulted in smaller paychecks for employees, budget-cutting by employers, and the downgrading of insurance policies.
Lou Robinson holds a handful of 27 mg methylfolate extended release pills, medication they take for their ADHD, on Jan. 27 outside Cheshire Medical Center in Keene. Robinson said they once purchased their ADHD medication without insurance. For 30 capsules, Robinson said they paid more than $1,000. “I want to be able to live happy and healthy and do all the things everyone else is doing,” Robinson said. “But it’s getting harder and harder for people on the lower end of the financial spectrum … to be able to survive and have basic everyday pleasures that people deserve.”
Bailey Stover / Sentinel Staff
Individuals and employers The Sentinel spoke to are being affected differently, with the cost increases being manageable for some and detrimental to others.
It’s become “a struggle that all of our clients are grappling with,” said Jessi Jacobs, a client executive at the financial services firm The Richards Group in Brattleboro, which helps employers manage insurance benefits for hundreds of local employees. For some employers, Jacobs said, the increases have meant switching to cheaper plans with narrower networks or higher deductibles, or cutting other expenses to pay for health insurance. For instance, at the Jaffrey-Rindge Cooperative School District, Superintendent Reuben Duncan said in developing next year’s school budget, the costs of health insurance is having “an impact on everything we do.”
Keene resident Ailliea Carle gets insurance through her employer, and this year, Carle said her insurance premiums for a UnitedHealthCare family plan went up by $53 per week. She said she now pays $384 per week for insurance.
When she found out, “I was in tears to be honest,” Carle said. Between the rising cost of premiums and out-of-pocket expenses for medical care and medications, Carle described a situation where “I’m basically working to cover my health care.”
Carle struggles with multiple health issues and worries the stress of dealing with rising health insurance costs and denied care is making her health issues worse. She is currently considering traveling to a pharmacy in Canada to save money on medications.
In employer-sponsored insurance, both employers and employees make contributions to health insurance premiums. In its 2026-27 budget plan, the Jaffrey-Rindge school district included $439,789 for increases in health and dental insurance for its employees.
Lou Robinson stands outside Cheshire Medical Center on Jan. 27 in Keene. “You’re not put on this earth just to try and survive,” Robinson said. “We’re not put on this earth just to try and make enough money to have a house, have food, support our families. We’re supposed to experience the world, too. And it is becoming increasingly harder to do that.”
Bailey Stover / Sentinel Staff
The new costs of health insurance “means we’re not putting those funds toward other important aspects of the educational experience for all of our kids and for the community,” Superintendent Duncan said. He described how health insurance costs have forced the school district to have difficult budgetary conversations. At one point, the district was discussing cutting a universal pre-K program to offset the rising cost of health insurance.
Cheshire County has a self-insured plan, a common type of health insurance for employers. When one of its roughly 320 employees on the plan requires care, the county pays medical bills for them up to $175,000. After that, the county has reinsurance, a type of insurance for insurers to cover excess risk. For 2026, the county had a 10 percent increase in its insurance costs, the first time in years that the percent increase has been in the double digits, according to Cheshire County Finance Director Sheryl Trombly. Employees on the county’s plan also had to absorb part of the increase through their premiums.
“It’s hard when you have to tell an employee that you’re raising the rates,” Trombly said of employees’ contributions. And since taxpayers fund wages and benefits for county employees, “there’s no doubt that the 10 percent is having to be passed off to taxpayers.”
Lou Robinson sits outside Cheshire Medical Center on Jan. 27 in Keene. “At home I am not able to fully function in my personal life without those supports,” Robinson said of relying on their ADHD medication to get through the day.
Bailey Stover / Sentinel Staff
Monadnock Community Hospital in Peterborough has over 900 employees on its self-insurance plan. Between the 2024 and 2025 fiscal years, the independent hospital faced a 25 percent cost increase in claims, according to Chief Financial Officer Richard Scheinblum. He’s preparing to see another major increase in fiscal year 2026.
For now, Scheinblum said, the hospital has been able to manage the rising costs. But “all it’s gonna take is a handful of large claims to turn this around.”
Individual marketplace plans
The ACA’s enhanced premium tax credits allowed Emily Aborn, a Temple-based freelance copy editor, to get health insurance while being self-employed. President Joe Biden signed the credits into law in in March 2021, and they helped drive the number of people in New Hampshire with ACA insurance to a record high of 70,337 in 2025, per data from the N.H. Insurance Department.
The enhanced subsidies kept the cost of insurance within reach for Aborn and her husband during the pandemic. After they expired and Aborn saw what she’d be paying for her monthly premiums in 2026, she decided instead to switch to a cheaper plan that covers less to save money.
In 2025, her deductible was $1,500. Now, in 2026, her deductible is $15,000. With her copays also twice as expensive as they were last year, Aborn is cutting back on medical care. Recently, when her hands unexpectedly became numb, she wanted to go to urgent care but instead decided to take her chances and avoid going to see a doctor.
Lou Robinson holds two of their ADHD prescription medication bottles on Jan. 27 outside Cheshire Medical Center in Keene. Robinson, who is a preschool teacher, said they don’t have an extra $100 to spend on medication without sacrificing other expenses. “I’ve got to cancel my Internet because it’s gotten bumped up every month,” Robinson said.
Bailey Stover / Sentinel Staff
She also plans to end sessions with her therapist, who she started seeing in 2025 to get help for anxiety. “We built a long-term relationship of trust, which takes a long time in therapy for someone like me,” Aborn said. With a limited number of therapy sessions left, “we’ve kind of compressed the amount of time we have left to work on that, so it almost feels more anxiety producing.”
In a late January interview with The Sentinel, U.S. Rep. Maggie Goodlander, D-N.H., said there is bipartisan support in the House of Representatives for extending the subsidies. A deal to extend them for three years was passed by the House on Jan. 8. but has since stalled in Senate negotiations.
“The ball is very much in their court when it comes to this issue of extending the tax credits,” Goodlander said of the Senate.
In a statement to The Sentinel, Sen. Hassan blamed the failure to extend the tax credits on President Donald Trump and Republicans, and said she has been engaged in bipartisan conversations to extend the subsidies.
“If my Republican colleagues decide to reverse course, I remain ready-as-ever to actually get to the work of lowering health care costs including by advancing the bipartisan proposals already on the table to help lower prescription drug costs, end unfair hospital facility fees, and more,” Hassan wrote in the statement.
Similarly, Shaheen attributed the expiration of the subsidies to Republicans in the Senate. “I stand ready to find a solution that would restore the ACA enhanced premium tax credits for the millions of Americans who are facing unaffordable health care costs,” she wrote in a statement.
In voting against extending the enhanced subsidies, Senate Republicans have cited how large health insurance companies have profited off the ACA’s subsidies. Congressional Republicans have offered a number of proposals for changes to health policy, like federal funding for Health Savings Accounts or extending the enhanced subsidies while capping eligibility.
The number of Granite Staters enrolled in an ACA marketplace plan fell to 65,152 in 2026, a decline of 4,313 people. Similar trends are occurring throughout the country; 1.4 million fewer people are enrolled in ACA plans in 2026 than in 2025, according to recent data from the Centers for Medicare and Medicaid Services.
Goodlander said she and other members of Congress worry this could trigger a “death spiral,” a phenomenon in insurance where low-risk policyholders choose to change policies or go uninsured as a result of high prices, further driving up prices. This scenario, Goodlander said, was raised by House Republicans who supported extending the enhanced subsidies.
“The fact is, across our state, across this country, people are either having to lose health insurance altogether or make some of the most painful choices a person could be asked to make in order to keep their health insurance,” Goodlander said, referring to changing jobs or downgrading coverage.
For now, Jacobs of The Richards Group believes there’s “not imminent risk of a death spiral” in the local and state health insurance markets. However, she said, the downgrading of what insurers refer to as “the richness of coverage” is putting new risk into the community for health insurance enrollees.
Lou Robinson stands outside Cheshire Medical Center on Jan. 27 in Keene. Robinson said they pick up their prescriptions at the hospital, but since their insurance changed they don’t make as many medical appointments as they used to because of the increased cost of receiving care. “It’s hard,” Robinson said of trying to function without ADHD medication. “It becomes insurmountably hard for no reason.”
Bailey Stover / Sentinel Staff
“Somebody will downgrade from like a gold or silver [plan] to a bronze, [and] the tradeoff is they pay less of a premium, but they’re going to assume a bigger portion of the cost of their care when they engage their insurance,” Jacobs said.
Just one month into the new year, this is already having an impact at the local mental health provider Maps Counseling Services. Some patients who struggle with panic and anxiety have begun rationing mental health care by changing from weekly therapy sessions to sessions every other week in order to keep costs down, according to Executive Director Gina Pasquale.
“People are kind of depleted on so many levels right now — financially depleted, emotionally depleted,” Pasquale said. Maps is now relying more on its Hope and Healing Fund, a philanthropically funded revenue source for people without insurance.
“I feel really saddened that we have to pick and choose which aspects of our wellbeing are going to be attended to,” Pasquale said. “How as a society are we allowing that to happen?”
