When Granite Staters call 911, they are not thinking about hospital designations, reimbursement formulas, or federal acronyms. They are thinking about survival. They are thinking about their child struggling to breathe, their neighbor injured in a crash, their parent showing signs of a stroke. In many parts of our state, the first door that opens in those moments belongs to a Critical Access Hospital (CAH).
New Hampshire’s Critical Access Hospitals — 13 small rural facilities that provide around-the-clock emergency care — are the backbone of our statewide health and trauma system, but more importantly, they are at the center of many Granite State communities. They are the safety net for communities where no other medical facility exists. They open the door for preventative care and provide jobs for many of our family members. Yet despite their essential role, these hospitals operate on razor-thin margins and are vulnerable to even small financial or policy shifts. If we lose them, we lose much more than local convenience, we lose jobs, access to health care, and lives.
The argument for supporting CAHs is simple: geography should never decide someone’s fate. In rural regions of New Hampshire, a delay of even 10 minutes in treating trauma, stroke, a complicated obstetrical case or cardiac arrest can mean the difference between recovery and tragedy. CAHs ensure that when the worst happens, immediate care is close to home, not an hour away.
These hospitals do far more than stabilize emergency patients. They provide primary care, behavioral health services, preventive care, imaging, lab work, and chronic disease management. They treat injuries before they escalate. They offer mental health support that keeps crises from becoming emergencies. Every day, they lighten the load on our regional medical centers by caring for patients who would otherwise have nowhere else to go.
The economic impact of these hospitals is equally significant. In many towns, the CAH’s are one of the largest employers. It provides stable jobs that keep young professionals in the community, supports local businesses, and helps maintain the economic vitality of rural regions. When rural hospitals close, the economic consequences are swift and severe: businesses leave, populations decline, and communities weaken.
Despite their critical role, CAHs are under constant financial pressure. They face rising labor costs, shrinking reimbursements, outdated infrastructure, and growing demand for services. Here in New Hampshire, unlike large systems, they do not have the financial buffers to absorb shocks. When a rural hospital closes, it almost never returns. The loss is permanent.
New Hampshire lawmakers should act now to ensure these hospitals have the support they need to survive and thrive. That means protecting reimbursement structures that keep them viable, investing in workforce development to help them recruit and retain staff, supporting telehealth and technology upgrades, and recognizing that their value cannot be measured solely in dollars. The cost of losing a Critical Access Hospital is far greater.
Rural communities deserve the same level of safety and health security as every other part of the state. Our trauma system depends on these hospitals. Our emergency response depends on them. And thousands of families depend on them for everyday care that keeps them healthy, working, and connected.
CAHs represent the best of what health care should be: local, responsive, personal, and deeply tied to the wellbeing of the community. Supporting them is not a subsidy. It is an investment in New Hampshire’s people, its economy, and its future.
When Granite Staters reach out in a moment of crisis, these hospitals are there. Now they need us to be there for them.
Sen. Sue Prentiss, D-West Lebanon, represents represent District 5 in the New Hampshire State Senate.
