New Hampshire
Massachusetts doctors opt for New Hampshire imaging centers – Valley News
This past summer, one of Dr. Amy Boutwell’s patients needed an imaging test done, but Lahey Hospital and Medical Center, which is down the road from her practice in the Boston suburb of Lexington, Mass., told her it would be a five-month wait.
“And I said, ‘Gosh, there’s got to be a better way,’” Boutwell said. “The question that came to my mind was, ‘Isn’t there some sort of independent imaging center where I don’t have to send her through the big, expensive, and busy health care system?’”
Her search turned up nothing nearby in Massachusetts. But located 30 miles north, just over the state line in Nashua, she found Tellica Imaging. She learned the newly opened independent imaging center could take her patient the next day and at a much lower cost. It worked out so well, she began sending more patients there. Boutwell’s status as an independent doctor made it possible. Doctors working in big health systems, she said, typically send patients to the imaging facilities within their own system.
“We live in Metro Boston. We’re used to using large health care systems,” Boutwell said. “This patient might have said, ‘I know and trust the health care infrastructure of Massachusetts,’ but instead, I think it’s really telling in this day and age, patients want access. They want transparency around pricing. They want easy and convenient. Of course, we need to know that the quality is going to be high and trustworthy. But for me as a doctor, and for my patient, in this case, we both were really compelled by, ‘It’s quick and it’s easy and it’s inexpensive,’ so let’s go to New Hampshire.”
For the longest time, Boutwell was perplexed as to why she couldn’t find centers like Tellica closer to her.
“I just thought, how’s it possible here in the medical mecca of the world, I don’t have an independent imaging center?” Boutwell said. “And I didn’t really know why.”
Many point to a primary culprit: “certificate of need” laws, which require health care providers to seek permission from state regulators for any new services they’d like to provide.
Under the laws, providers must prove to regulators that any new proposed services are necessary. Certificate of need laws also allow would-be competitors to weigh in and contest applications by arguing they already offer the service and, as such, a new provider is unnecessary.
The laws have been in place in some states since the 1960s, but the 1974 National Health Planning and Resources Development Act mandated every state institute them. Proponents believed the laws would restrain health care costs, increase quality, and provide better access to care for traditionally underserved communities. However, many experts in the field argue they’ve done the opposite. Congress repealed its federal certificate of need mandate in 1986, but 35 states, including Massachusetts, still have the laws on the books, according to the National Academy for State Health Policy. The laws vary based on what types of care are subject to the laws and how the process works.
New Hampshire is the only New England state without certificate of need laws.
Dr. Jeffrey Gold, a direct primary care physician in Salem, Mass., is another Bay State doctor who sends patients to independent New Hampshire imaging centers. He said Derry Imaging, which is roughly 45 miles away from his practice, might charge around $700 for an MRI. However, Gold said that at one of the large health systems in Massachusetts, such as Mass General Brigham, “you’re shooting a dart in the wind.” He said a patient won’t know exactly what they’re being charged until after the MRI is complete. In some cases, Gold said, once insurance and the health system finish negotiating the patient could be asked to pay roughly $1,500 (while insurance pays another $1,500).
Gold provides a unique type of care called direct primary care, where patients pay a monthly fee out-of-pocket for unlimited access to his services. He said this allows him more time with patients and to consider patients’ costs, among other things. He often advises patients to go to independent imaging centers in New Hampshire, even if their insurance won’t cover it, because paying Derry Imaging out-of-pocket is often cheaper for patients with high-deductible insurance policies. Though he notes he can sometimes get good prices at private orthopedic centers for some services, those facilities are increasingly being purchased by larger health systems.
In Massachusetts, Gold argues certificate of need laws have constrained the free market because when big health systems like Lahey and Mass General already offer imaging, it makes it harder for smaller providers to prove their services are needed. However, New Hampshire repealed its certificate of need laws in 2016 and so this phenomena hasn’t occurred here.
Indeed, analysis from the Mercatus Center, a think tank based at George Mason University, estimated in 2020 that Massachusetts nonhospital providers would’ve likely performed 80,388 MRIs annually if the state had no certificate of need laws as opposed to the 58,960 it did perform. The organization also estimated that without certificate of need laws, nonhospital providers would’ve performed 758 PET scans as opposed to 420. The researchers found no statistically significant change for hospital providers, suggesting the laws could be protecting hospitals from competition. The analysis estimated that, across all services subject to certificate of need laws, annual health care spending would’ve fallen $320 per capita without the laws.
“Neither theory nor evidence suggest that CON (certificate of need) laws work as advertised,” researcher Matthew Mitchell wrote in a 2024 report in the academic journal Inquiry. “While advocates for the regulation have offered several rationales for its continuance, the balance of evidence suggests that the rules protect incumbent providers from competition at the expense of patients, payors, and would-be competitors.”
In New England, this has created an interesting dynamic. Patients in southern New Hampshire often travel to the Boston area for treatment at larger hospitals. However, as costs and wait times rise in Massachusetts, doctors say it makes sense to go the opposite direction for certain services. Boutwell said the “cost of care in Massachusetts and access to care in Massachusetts is at an all time high and an all time low.”
“This is not a story of people who can’t afford care going to New Hampshire,” she said. “With the classic cycle of people from the north coming into Boston, you might think, ‘Well, maybe people who are price sensitive will be people who don’t have access, you know, people who don’t have the money.’ But in this case, we’ve got all the benefits of who we are, and we’re making an educated choice to say, ‘You know what? Let’s go to New Hampshire.’”
Mass General and Lahey declined to comment.
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A bill that would add elements to judicial performance evaluations for all state judges and make those evaluation reports public, cleared the New Hampshire House along party lines Thursday.
The bill’s backers, including Rep. Bob Lynn of Windham, former Chief Justice of New Hampshire Supreme Court, promoted the new requirements as a way to “invigorate” judicial performance, and said fully disclosing the reports is crucial.
“I have to emphasize this provision in the bill as well as the other provisions of the bill were adopted in consultation with the Chief Justice of the Supreme Court,” Lynn said
Under the bill, which was written with input from Supreme Court Chief Justice Gordon MacDonald, all judges – including part-time judges and retired judges who sometimes hear cases – would undergo evaluation at least every three years. Evaluations would include courtroom observations and analyses of how efficiently they process cases. Right now, judicial performance reviews remain confidential unless a judge receives two consecutive subpar evaluations.
The proposal comes at a time of tension between the judicial branch and lawmakers, spurred by recent court rulings finding the state isn’t meeting school funding obligations, and by judicial branch spending and management practices.
Democrats who criticized the new judicial evaluation bill say it goes too far and that the legislature should resist the urge to meddle in court operations.
“Many of us have been frustrated by recent activities coming out of the judicial branch – this is probably a bipartisan sentiment,” said Rep. Mark Paige of Exeter. “But to the extent that this bill appeals as a means to scratch your judicial frustration itch, consider other available remedies.”
Democrats also argued that making judicial reviews public could pose safety risks in an era of increased political violence including against judges.
“Publication would do real harm, inviting harassment of judges as violent threats against U.S judges have surged 327 percent since last year,” said Rep. Catherine Rombeau of Bedford, citing research from the Global Project Against Hate and Extremism.
But Republicans disputed such arguments, and said public reviews are also one of the few tools lawmakers have to make sure judges are performing their duties effectively.
“Judges are appointed once and serve until the age of 70,” said Rep. Ken Weyler of Kingston.
“All employees, including judges, benefit from constructive evaluation.”
The New Hampshire State House, where tradition often reigns supreme, is scarcely more technologically savvy than a couple of still cameras streaming hearings to YouTube.
But like a lot of places these days, political power — and attention — there is increasingly shaped by what’s happening online.
And while plenty of New Hampshire lawmakers maintain busy Facebook feeds and X accounts, perhaps no public official better exemplifies the high speed, high volume, digital-ready approach to politics than Republican Rep. Joe Sweeney.
As the House’s deputy majority leader, Sweeney’s job is to make sure fellow Republicans show up in Concord and support caucus priorities. In many ways, it’s about as old-fashioned as political work gets in 2026. And to see Sweeney in action is to observe a politician who still embraces plenty of his party’s traditional priorities.
“Let the voters see that we oppose income taxes now and forever,” Sweeney proclaimed from the House floor earlier this month.
But Sweeney didn’t stop at merely pledging to oppose income taxes inside the walls of the State House. Soon after, he also posted the video of himself doing so to social media. Sweeney isn’t the first — or only — state politician bent on cultivating an online presence. But his position of power in the Republican Party means he is well-positioned to amplify what he chooses. It could be AI-generated graphics promoting nuclear power, photoshopped images supporting ICE, or Sweeney himself talking straight into a camera.
According to Sweeney, to succeed on social media in politics, it’s best to keep messages short, sharp — and sometimes trollish.
“It’s kind of this perverse incentive to present that sort of profile online, because that’s what’s going to get people engaged,” Sweeney said in an interview last week.
Politics as personal
At 32, Sweeney came of age in politics and on the internet. He started earning paychecks for political work in 2012, on the campaign of former Congressman Charlie Bass. Sweeney was a University of New Hampshire student at the time, and won election to the New Hampshire House that same year. Back then, he courted voters on social media with an earnestness that seems far removed from the politics of 2026, welcoming voters of all stripes to reach out and support his candidacy.
“I am running as a Republican, but I promise to represent all of my Salem constituents when elected,” a baby-faced Sweeney said in a YouTube video from that race.
A lot has changed for Sweeney since then. He’s now a top Republican lawmaker in Concord, vice chair of Salem’s town council, and also operates Granite Solutions, a political advocacy and fundraising group.
According to filings with the state, Granite Solutions’ purpose is “Electing Fiscal Conservatives in New Hampshire.” It essentially operates as Sweeney’s personal PAC, raising money, running ads, pushing policies, and urging lawmakers to sign pledges.
As New Hampshire PACs go, Granite Solutions is not exactly flush with cash: It’s reported raising about $60,000 over the past few years. Notable receipts include a $10,000 donation from a trust connected to Joe Faro, the developer of Salem’s Tuscan Village; a contribution from Churchill Downs, which owns the casino at the Rockingham Park Mall; and a smattering of Concord lobbyists.
A state lawmaker running what amounts to a one-man political advocacy organization is unusual, to say the least. But Granite Solutions also serves to boost Sweeney’s personal brand.
Last week, after Sweeney debated tax policy on WMUR’s political talk show, he sent an email to the Granite Solutions’ mailing list, urging people to stream the debate and donate to Granite Solutions.
Sweeney says he sees the work of his personal political committee as an extension of his public service: “I view Granite Solutions as supporting the economic agenda of Republicans in the state.”
‘Until the voters don’t want me’
The GOP fiscal agenda — from tax cuts to eliminating red tape for development projects — is a steady focus for Sweeney.
On other political issues, his social media-forward approach can serve to capture attention, more than enact measurable change. When lawmakers debated higher education funding last year, Sweeney strenuously alleged that undocumented students were depriving eligible Granite Staters from admission to UNH. After university officials released data that undercut his claims, Sweeney moved on.
Last fall, Sweeney told reporters to expect him and other Republicans to target specific state judges for misconduct. But such plans never materialized.
There was also Sweeney’s push to impeach Democratic Executive Councilor Karen Liot Hill over her use of a state email account to assist a legal challenge to a voter registration law — even though the New Hampshire Attorney General had cleared Liot Hill of any wrongdoing. Just hours before a public hearing on Sweeney’s impeachment effort, he scuttled the bill without bothering to show up for the hearing.
To hear Sweeney tell it, when his political ideas lose traction, he’s willing to let them slide.
“Some things can start off with a lot of fire and passion and then as it goes through the system it just sort of dies out,” he said.
But as Sweeney’s shown in Concord, and as a town councilor, he can also push policies that others see as provocative or radical — or even theatrical. When Salem’s town council and budget committees were at odds over the town budget, Sweeney proposed eliminating the budget committee altogether.
“I thought it was the most ridiculous proposal I’ve ever heard. It was a bad idea, said Steve Goddu, a Republican who sits on Salem’s budget committee, and generally considers Sweeney a political ally. “It was a bad idea, and sometimes we make bad ideas and suggestions, and I think this was just his folly on this one.”
But not everybody who’s been on the receiving end of Sweeney’s politics, folly or otherwise, is as forgiving. Liot Hill says she had to waste time and money to prepare for potential impeachment proceedings that she always saw as frivolous, and believes Sweeney’s style of politics is destructive.
“There is a price to our politics when politics becomes more focused on spectacle than on substance and really it’s really the public that pays,” Liot Hill said.
Sweeney, for his part, says he sees himself pursuing his approach to politics — in real life and online — for the foreseeable future.
“I have an ability to create solutions for folks. I have an ability to sort of understand things and kind of communicate with people on it, Sweeney said. “I feel this responsibility to continue to be involved until the voters don’t want me to be involved anymore.”
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