Gov. Kelly Ayotte has signed into law a slate of health-related legislation this year that includes both promising steps forward and deeply concerning setbacks. For many Granite Staters, particularly low-income families and rural residents, 2025 is shaping up to be a year of mixed messages on healthcare.

There’s no doubt that some of the new laws represent real improvements. For example, Senate Bill 18 expands pediatric intermediate care capacity here in New Hampshire. This is a quiet but deeply impactful change for families; being able to stay closer to home while receiving specialized care means less disruption, less stress and better outcomes.

Another bright spot is House Bill 73, which defines and integrates harm-reduction approaches into our state’s substance-use framework, instructing the governor’s Commission on Alcohol and Drug Abuse Prevention, Treatment and Recovery to incorporate strategies like needle-exchange, drug-checking services and naloxone distribution. This bill is a crucial step toward protecting vulnerable Granite Staters, reducing overdose deaths and supporting healthier communities. These are good laws that deserve recognition.

While the legislature and governor deserve credit for these advances, we cannot ignore the darker side of this year’s health policy agenda. In particular, the budget includes a monthly premium for Medicaid recipients and higher copays. While these expenses may sound modest on paper, they can quickly add up for working families managing chronic conditions. Granite Staters need continuity of care, not red tape.

The contrast in this year’s legislation is stark. On one hand, we’re rightly expanding care options and investing in family health. On the other hand, we’re erecting new barriers that may cause people to delay care or fall through the cracks entirely. Throughout the state, real people will feel the effects of these policy choices. A mother caring for a disabled child may lose coverage due to a missed document. A rural resident managing depression may not be able to afford the increased cost of medication. A telehealth appointment might become useless if the patient can’t afford follow-up care. Our elected leaders have proven they can make practical, compassionate decisions when they choose to. The challenge ahead is ensuring that every policy reflects that commitment.

As we move forward, let’s build on what’s working. Let’s expand pediatric care, empower pharmacists and grow our telehealth infrastructure. We also need to confront the parts of our health policy that may undermine these efforts and speak up when good health is put at risk.

A healthier New Hampshire is still possible, but we can’t get there by giving with one hand and taking away with the other.

Jennifer Mandelbaum is a public health scientist and represents Portsmouth and Newington in the New Hampshire State House.