As Supreme Court takes up Affordable Care Act, advocates warn how repeal could affect New Hampshire

  • Signups for the Affordable Care Act begin Sunday, Nov. 1. Jonathan Van Fleet

Monitor staff
Published: 11/10/2020 4:39:50 PM

Oral arguments before the Supreme Court Tuesday in a lawsuit seeking to dismantle key provisions of the Affordable Care Act reignited alarm from Democrats and health care advocates in the state.

But what would happen in New Hampshire if the ACA actually were struck down?

State health care experts say it could upend the entire system.

A repeal of the 2010 law could have broad impacts on New Hampshire’s insurance markets, potentially driving up prices as carriers scramble to figure out what’s changed, a group of health care advocates and Democratic lawmakers noted at a press conference Tuesday.

It would mean the elimination of subsidies for both insurance carriers and individuals that have helped prop up certain plans.

And it would severely affect the state’s individual market – the market for those who don’t get their insurance through work – by driving up premiums after subsidies fell, and potentially pushing insurers out of the state, advocates argue.

“Insurance hates chaos,” said Lucy Hodder, a law professor and director of the health law and policy program at the University of New Hampshire. “It would create just a base level of chaos in our insurance marketplace.”

Hodder joined Dr. Patrick Ho the chief resident at Dartmouth-Hitchcock and president of N.H. Psychiatric Society; Rep. Chris Pappas, a Manchester Democrat; and state Sen. Tom Sherman, a Rye Democrat at a Zoom press conference hosted by Protect Our Care, an advocacy group dedicated to defending the health law.

Advocates said the impact would be vast.

Among the potential casualties, Hodder said, would be the risk pools set up by the state to help mitigate the cost of insurance, which Hodder said would be undermined.

New Hampshire would need to take over the individual market, which is currentkjointly overseen by state and federal officials, and would need to find a way to replace the subsidies with state-driven solutions.

Others pointed to the impact of Medicaid expansion, the massive program that since 2014 has provided additional federal support for low-income residents, whether through health insurance or through services.

Sherman, who is also a gastroenterologist, called the ACA “the most important congressional action impacting New Hampshire.”

And he said that the ACA, and Medicaid expansion in particular, had helped bolster two crises New Hampshire faced well before the pandemic: mental health and substance use disorder.

For instance, money from Medicaid expansion – which increased the number of people eligible by raising the income cap to 138% of the federal poverty level – has gone to community mental health centers since the ACA, Sherman noted.

Those providing substance use disorder treatment have also benefited from an expanded Medicaid and an enhanced reimbursement option for patients walking in.

“This population will be disproportionately impacted” should the law be struck down, Sherman argued.

The emergence of COVID-19 created an additional area where the funding through the ACA was effective, he added.

Sherman said that the state’s payment obligations to get Medicaid expansion funding – New Hampshire pays for 10% and the federal government pays for 90% – makes the program necessary for propping up New Hampshire’s budget and maintaining its health crises.

“This is the worst time to put in jeopardy not only the commercial insurance that’s available … but also the patients who are most at risk, most vulnerable, who would depend on the Medicaid expansion program,” he said.

Despite broad Republican opposition to the Affordable Care Act at its passage – and deep-set skepticism among New Hampshire Republicans over the prospect of entering the Medicaid expansion program in 2014 – the ACA and Medicaid expansion now has some high-profile Republican support.

Gov. Chris Sununu, who at one point supported the repeal and replacement of the ACA in 2017, has officially given the state’s support to the law this year. New Hampshire joined seven other states in submitting an amicus “friend of the court” brief in May to support California’s case.

“Medicaid expansion has saved lives: It has significantly decreased mortality rates among vulnerable populations,” the brief read, citing research by the National Bureau of Economic Research that estimated that about 4,800 fewer people have died each year on average across all states that expanded Medicaid.

“Eliminating Medicaid expansion could undo those gains,” the brief continued.

(Ethan DeWitt can be reached at 369-3307,, or on Twitter at @edewittNH.)

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