On May 8, the New Hampshire Senate will face a critical decision: whether to pass HB548, a bill that would legalize direct payment and membership-based hospitals in our state. This legislation is not some radical experiment. It is a long-overdue step toward restoring affordability, transparency, and autonomy to a healthcare system crippled by red tape, insurance middlemen, and bloated administrative costs.
New Hampshire already permits direct-pay and membership-based primary care and specialist practices. These models have flourished, offering patients predictable costs, real price transparency, and faster, more personalized care. Doctors, freed from the bureaucracy of insurance billing, spend more time with patients and less time on paperwork. The success of these practices proves that the model works—and it’s time to extend it to hospitals.
To see the future HB548 envisions, look no further than the Surgery Center of Oklahoma. There, patients can visit a website, see the price of a knee replacement or hernia repair clearly listed—no surprise bills, no opaque charges, and no need to play insurance roulette. In fact, many of the prices are significantly lower than what patients pay even with insurance, thanks to the elimination of third-party markups and billing departments that exist solely to navigate insurer labyrinths.
Opponents of HB548, including well-funded hospital lobbyists and medical associations, claim that such hospitals could threaten the viability of those accepting Medicare and Medicaid, particularly in rural areas. But this argument doesn’t hold up under scrutiny. No rational investor would open a membership-based hospital in a sparsely populated area like northern New Hampshire, where there simply isn’t the patient volume to sustain it. The market itself imposes limits.
Instead, a direct-pay hospital would naturally emerge in a dense area such as Manchester, where there’s a high concentration of privately insured or self-paying patients—people who are increasingly frustrated by skyrocketing premiums, narrow provider networks, and massive deductibles that render their insurance virtually useless. HB548 would give these individuals an option: pay for value and service directly, without gatekeepers or surprise bills.
Let’s be clear: HB548 is not an attack on traditional hospitals, nor is it a death sentence for safety-net care. Rather, it’s a free-market complement. Traditional hospitals will continue to receive state and federal support for taking care of the elderly, the poor, and those on government plans. But HB548 introduces competition, and with it, a powerful incentive for all providers to improve service, reduce costs, and deliver transparent care.
Why are entrenched interests so afraid of that?
The Senate committee’s vote to label HB548 “inexpedient to legislate” is a disappointing nod to those special interests. Instead of embracing a proven solution to our broken system, they chose to protect the status quo—a status quo that leaves too many patients drowning in medical debt, waiting weeks for appointments, and fearing the financial consequences of even routine procedures.
But there is still time. The full Senate will vote on HB548 on May 8. This is our moment to act.
If you believe that healthcare should be affordable, transparent, and accountable—if you believe that patients should be free to choose doctors and hospitals based on value rather than insurance contracts—then HB548 deserves your support. Call your state senator. Email them. Tell them to stand with patients, not monopolies.
HB548 is not a revolution. It’s a return to common sense. Let’s legalize innovation. Let’s unleash competition. Let’s make New Hampshire a leader in healthcare freedom.
Pass HB548.
