Michelle McEwen et al: Keeping care local is challenged under the Big, Beautiful Bill

To The Daily Sun,

In recent weeks, the Speare Memorial Hospital leadership team has heard from many patients, neighbors and friends, asking how recent federal and state legislation might affect Speare Memorial Hospital and the services we provide. The questions are heartfelt, and so is our response, because we know these changes aren’t just numbers on a page — they’re about people’s access to care.

While there are close to a dozen potential policy changes that could impact our financial health, two key provisions of the federal One Big Beautiful Bill Act (OBBBA) are estimated to negatively impact Speare by $1.5 million:

1. Medicaid work requirements: Both the OBBBA and New Hampshire House Bill 2 add a new rule: in order to receive Medicaid benefits, individuals will need to routinely prove they’re working. Estimates suggest that between 17,000 and 19,000 Granite Staters could lose Medicaid coverage as a result. For many of these individuals, Speare will still provide needed care, but much of it will go unreimbursed.
2. The PAYGO Act: The PAYGO Act requires cuts to programs like Medicare whenever new legislation increases the federal deficit. The Office of Management and Budget expects OBBBA to add to the national debt, which would trigger PAYGO. For Speare, this could mean an additional reduction in Medicare reimbursement.

Rural hospital support in OBBBA: OBBBA includes $50 billion over five years for the Rural Healthcare Transformation Program — intended to help rural hospitals adapt after the bill’s passage. While this is welcome, it’s unclear how these funds will be distributed. National estimates show Medicaid spending in rural areas could decrease by $155 billion over the next decade, so while the funding is helpful, it won’t erase the challenges ahead.

What this means for us — and for patients: These changes, combined with other pressures on rural health care, put hospitals like Speare in a difficult position. But we want readers to know we are not just focused on balancing budgets — we are focused on caring for people. Every reduction in funding translates into a harder path to care for someone in our community. That’s why the choice to receive care at Speare matters so much. Every visit here, every kind word, every partnership strengthens our ability to keep high-quality, compassionate health care close to home.

Speare isn’t just in the community — we are part of the community. We live here, we work here and we’re dedicated to healing here. Together, we can weather these challenges and keep care local, personal and strong.

Michelle McEwen, president & CEO

Joe Caristi, chief financial officer

Daniel Sherman, clinical services officer

Meaghan Smith, chief nursing officer

Mike Reilly, senior director of human resources