New Hampshire’s ACA Market: A Model of Stability and Affordability

New Hampshire’s health insurance marketplace has emerged as a success story, demonstrating resilience and affordability even as other states grapple with challenges following changes to federal premium tax credits. A long-term strategy centered on a state-based reinsurance program, initially implemented in 2020, has insulated the Granite State from the disruptions experienced elsewhere.

The Road to Stability: Reinsurance as a Solution

In 2017 and 2018, the Affordable Care Act (ACA) individual market faced instability nationwide, with rising premiums and insurer hesitancy. New Hampshire, under then-Insurance Commissioner Roger Sevigny, opted for a structural solution: a state-based reinsurance program. This program, securing federal approval, aimed to lower premiums by addressing high-cost claims, stabilize the risk pool and enhance affordability without relying on ongoing subsidies or mandates. [News-USA Today] Current Insurance Commissioner D.J. Bettencourt, who served as policy director for Governor Chris Sununu during the program’s development, championed this approach. [News-USA Today]

2026: A Critical Test and Positive Results

2026 presented a significant test as enhanced federal premium tax credits expired. While many states responded by introducing state-funded assistance, New Hampshire maintained stability without such interventions. Final enrollment data reveals that marketplace participation in New Hampshire remains stable and exceeds 2024 levels, despite the federal policy changes. [News-USA Today]

Key Outcomes Distinguishing New Hampshire

• Enrollment Stability: New Hampshire maintained enrollment levels comparable to or exceeding the national experience without replacing expired federal subsidies with state taxpayer dollars.
• Lowest Average Premiums: New Hampshire continues to have the lowest average marketplace premiums in the nation, reflecting underlying affordability and a stable risk pool.
• High Coverage Rate: Approximately 95.5% of Granite Staters have health coverage, one of the highest rates in the country. [News-USA Today]

Carrier Confidence and Market Functioning

The entry of a new health insurance carrier into New Hampshire’s individual market in 2024 signals confidence in the market’s stability and sustainability. Insurer expansion is a clear indicator of a functioning, competitive, and responsibly priced market. [News-USA Today]

Looking Ahead

New Hampshire’s success demonstrates the value of prioritizing durability and structural solutions over short-term fixes. By maintaining its course and continuing to provide stability, the state has protected consumers and avoided the disruptions seen in other markets. This approach represents a mature and effective health insurance market, well-positioned for the future. [News-USA Today]

Roger Sevigny is the former New Hampshire Insurance Commissioner.