When I served as New Hampshire’s Insurance Commissioner in 2017 and 2018, the Affordable Care Act’s individual market was widely viewed as unstable. Premiums were rising rapidly, insurers were uneasy and enrollment growth had stalled across much of the country. In New Hampshire, we faced a choice: chase short-term fixes or focus on structural affordability.
We chose the harder path.
During that period, New Hampshire began designing a state-based reinsurance program and secured federal approval to implement it. That work involved close collaboration across administrations, including current Insurance Commissioner D.J. Bettencourt, who was serving as policy director for Governor Chris Sununu at the time and worked directly with me as the framework for reinsurance was developed. The goal was straightforward but ambitious, lower premiums by addressing the highest-cost claims, stabilizing the risk pool, and making coverage more affordable without relying on permanent subsidies or mandates. The program ultimately took effect in 2020.
The results were unmistakable. Premiums fell sharply. Insurer participation stabilized. Enrollment rose steadily for several years. Over time, New Hampshire became one of the most affordable individual markets in the country.
Fast forward to 2026, and that earlier decision matters more than ever.
This year marked the first real stress test for state health insurance markets with enhanced federal premium tax credits expiring. Across the country, policymakers warned of sharp enrollment losses and market disruption. Many states responded by replacing federal subsidies with state-funded assistance, spending significant taxpayer dollars to preserve enrollment numbers.
New Hampshire chose a different approach, and the market held strong.
Final enrollment data show that marketplace participation in New Hampshire remains stable, and still higher than it was in 2024, even as federal policy changed and the inherent flaws with the ACA remain unaddressed. More importantly, the data reveal several clear outcomes that distinguish New Hampshire from much of the rest of the country.
First, New Hampshire maintained enrollment levels comparable to or exceeding the national experience without replacing expired federal subsidies with state taxpayer dollars. While some states relied on new spending to preserve participation, New Hampshire achieved stability without emergency interventions or new mandates that raise costs.
Second, New Hampshire once again entered the year with the lowest average marketplace premiums in the nation. That distinction reflects underlying affordability and a stable risk pool, not temporary policy fixes. In higher-premium states, enrollment is far more subsidy-dependent and therefore more fragile. New Hampshire’s low-cost structure helped insulate the market when federal support changed.
Third, New Hampshire began this year with one of the smallest uninsured populations in the country. Approximately 95.5% of Granite Staters have health coverage. In a state where coverage is already that high, stability, not rapid growth, is the appropriate benchmark for success.
Lower premiums do increase enrollment, and in New Hampshire, they already did. After reinsurance was implemented, enrollment climbed steadily for years, reaching a record high in 2025. By the time federal subsidies changed in 2026, most of the people who could be attracted by lower prices were already covered. New Hampshire entered this period from a position of strength, not vulnerability.
There is another signal worth noting: carrier behavior. In 2024, a new health insurance carrier entered New Hampshire’s individual market. Insurers do not expand into markets they view as unstable or unsustainable. New entry is one of the clearest indicators that a market is functioning, competitive, and priced responsibly.
I’m pleased to see that in spite of pressures to make changes, Commissioner Bettencourt has chosen to stay the course and continue providing stability in the market. Preserving a working system under pressure is often harder than building one, and this year demonstrated the value of that restraint.
The true test of a health insurance market is not how it performs in boom years, but how it behaves when conditions change. In 2026, New Hampshire maintained affordability, avoided disruption and protected consumers without resorting to short-term fixes that raise long-term costs.
That is not average performance. That is maturity.
Years ago, New Hampshire chose durability over optics. This year, that choice paid off.
Roger Sevigny is the former New Hampshire Insurance Commissioner. He lives in Dover.