Sarah Chen postponed her mammogram for eight months last year. The 54-year-old Windsor resident couldn’t afford the $400 screening after her Vermont health insurance deductible jumped to $6,000 — double what she paid three years ago.
“I kept telling myself I’d get it done next month, when things were less tight,” Chen said. “But next month never came until my sister basically dragged me to the appointment.”
Chen’s story reflects a growing crisis across Vermont and New Hampshire’s Upper Valley, where rising health insurance costs are forcing residents to delay or skip essential medical care. Vermont insurance premiums have increased an average of 13% annually over the past three years, according to state data, while New Hampshire residents face similar pressures with deductibles averaging $4,200 for individual plans.
The impact reaches beyond individual families to affect the entire Upper Valley healthcare ecosystem, including patients who rely on Dartmouth-Hitchcock Medical Center and its network of community clinics.
Dr. Maria Santos, who practices family medicine at a federally qualified health center in White River Junction, sees the consequences daily. “Patients are coming in sicker because they’ve waited months to seek care,” Santos said. “We’re seeing diabetics skip insulin, people ignoring chest pain, and families choosing between groceries and prescription medications.”
The problem is particularly acute in rural communities surrounding Dartmouth College, where many residents work in service industries without employer-sponsored health benefits. Nearly 23% of adults in Windsor and Orange counties report skipping medical care due to cost, compared to 18% statewide, according to Vermont Department of Health surveys.
For students and recent graduates staying in the Upper Valley, the insurance landscape presents additional challenges. Many lose coverage under parent plans at age 26 and face premium shock when shopping for individual policies. Young adults earning too much to qualify for subsidies but too little to comfortably afford premiums — often called the “coverage gap” — represent the fastest-growing uninsured demographic in both states.
This healthcare access crisis intersects with ongoing community health initiatives in the region. Local programs, including those involving Geisel Medical Students Honored for Community Service Impact, focus on addressing these systemic barriers through direct patient advocacy and community outreach.
The financial strain extends to healthcare providers. Community health centers report increased demand for charity care and sliding-scale payment programs, stretching already limited resources. Some patients qualify for hospital financial assistance but remain unaware of available programs, creating additional barriers to care.
“We spend significant time helping patients navigate insurance denials and appeals,” said Jennifer Torres, a social worker at Upper Valley Primary Care. “The administrative burden takes time away from actual patient care, but it’s necessary because people literally can’t afford to be sick.”
Mental health services face particular challenges, with many therapists and psychiatrists not accepting insurance due to low reimbursement rates and complex prior authorization requirements. This creates a two-tiered system where those who can pay out-of-pocket receive timely care while others wait months for appointments or go without treatment.
The ripple effects reach into academic and professional communities. Faculty, staff, and graduate students at regional institutions increasingly factor healthcare costs into career decisions, with some choosing positions primarily for insurance benefits rather than professional fit.
State legislators in both Vermont and New Hampshire are exploring solutions, including prescription drug cost caps and insurance market reforms. Vermont’s proposed public option plan aims to increase competition and reduce premiums, while New Hampshire focuses on price transparency requirements for medical procedures.
Community organizations are stepping up to fill gaps. Free clinics report 40% increases in patient visits over the past two years, while prescription assistance programs help patients access medications at reduced costs. Some healthcare providers offer direct primary care models, charging monthly membership fees instead of accepting insurance, making routine care more predictable and affordable.
For Chen, early detection made the difference — her delayed mammogram revealed early-stage breast cancer, now successfully treated. But her experience highlights the dangerous gamble many residents feel forced to make.
“I was lucky,” Chen said. “But nobody should have to choose between paying rent and getting a cancer screening. That’s not the kind of healthcare system we deserve.”
The crisis demands comprehensive solutions addressing both immediate affordability and long-term healthcare system sustainability. Until then, Upper Valley residents continue navigating an increasingly complex landscape where health outcomes depend not just on medical need, but on financial capacity to access care.
Residents struggling with healthcare costs can contact the Vermont Health Connect helpline at 1-855-899-9600 or New Hampshire’s Get Covered Connector at 1-855-664-2638 for assistance with insurance options and subsidies. Many regional hospitals also offer financial counseling services to help patients understand available assistance programs.
