For many Granite Staters who rely on the Affordable Care Act Marketplace to access health insurance, premium tax credits from the federal government represent the difference between coverage and catastrophe.
But that lifeline is about to fray.
In New Hampshire, nearly 50,000 residents benefit from premium tax credits that help them afford health coverage through the ACA Marketplace. That’s approximately 70.7% of all ACA Marketplace enrollees in the state. These are residents who don’t have access to traditional employer-sponsored insurance — like a parent who works part-time while their child is in school, the waiter at your favorite restaurant, freelancers, your hair stylist, small business owners and older adults not yet eligible for Medicare. Premium tax credits cut average monthly premiums nearly in half — from $469 to $230 — making health insurance attainable for many.
Open enrollment for 2026 begins on Nov. 1. Unless Congress acts swiftly to extend these tax credits, Granite Staters will face staggering premium hikes. According to new data released recently by New Futures, New Hampshire’s leading health policy organization, in conjunction with Families USA, a couple in their early sixties earning $90,000 could see their annual premiums jump by over $14,000. A single individual in their mid-40s making $31,300 would pay $1,344 more per year. Nationally, experts warn that up to one-third of Marketplace enrollees could lose coverage as a result of the expiring tax credits.
For one New Hampshire resident and her family, the enhanced premium tax credits have made health insurance affordable. She works part-time while her partner works at a local bakery; neither have access to employer-provided health insurance. Thanks to the tax credits, their family pays $99 monthly for coverage. Without the tax credits, that cost would nearly triple to $291 according to a Kaiser Family Foundation calculator. This represents a significant jump, and one she says would be challenging for them to cover. “With two young kids, life is expensive, and the expiration of the premium tax credits will set us back at a time when we’re hoping to save up for a home,” she explains. For families like hers across New Hampshire, the stakes could not be higher.
This isn’t just a policy failure, it’s a looming affordability crisis.
New Hampshire is the second-oldest state in the country, and one of only 11 where adults now outnumber children. Midlife and older adults (ages 45 to 64) make up 48% of Marketplace enrollees in New Hampshire, and they are especially vulnerable to premium spikes.
A 2024 Altarum survey of Granite Staters revealed the impact of rising health care costs in the state. The survey showed that 71% of respondents delayed or went without care due to cost in the year prior, 53% worried about affording prescription drugs and 41% struggled to pay their medical bills.
These numbers aren’t abstract — they represent neighbors, coworkers and loved ones
already rationing care.
Without federal action extending the enhanced premium tax credits, health care will become even further out of reach for many of our residents.
Please join New Futures in calling on Congress to extend the ACA enhanced premium tax credits before it’s too late. Health care should never be a luxury. It’s time to protect the progress we’ve made and ensure that every resident can access the care they need when they need it.
Samuel Burgess, Esq., is the health care policy coordinator at Concord-based organization New Futures.