Equal access to health care can be a reality

While standing on West Hollis Street in my Nashua district, you can just catch glimpses of the La Fama Barbershop, El Paisano MiniMarket, and the golden eagle atop our city hall. What's more difficult to see is the number of residents struggling to make ends meet. My district has the highest number of families enrolled in the state's Supplemental Nutritional Assistance Program (SNAP), or food stamps. Even though unemployment is lower than national averages, affordable health insurance is still out of reach for far too many neighbors in our community.

I know what it's like to struggle to make ends meet. I know what it's like to grow up on food stamps. I know what it's like to need health care, but not have the means to afford it. This is why I ran for office three years ago: to be the voice of so many Americans living on the margins. And this is why I speak out with that voice now as Congress decides the fate of critical federal assistance for millions of people to help pay for health insurance.

Congress created these subsidies when it passed the Affordable Care Act (ACA), then expanded them when it passed the American Rescue Plan Act (ARPA) earlier this year. These expanded subsidies brought down the cost of premiums for millions of Americans in the federal marketplace for insurance coverage. Millions more could actually afford the care they needed for the first time.

Sadly, those expanded subsidies are set to expire at the end of next year. If that is allowed to happen, millions of Americans will lose their health insurance coverage because they would no longer be able to afford it. Millions more would see hikes in their premiums. In hard numbers, around 12 million people would face premium increases of $600 per year, according to the Department of Health and Human Services. This would be tragic for every American living on the margins, especially our neighbors here in Nashua.

Across New Hampshire, around 5,500 residents signed up for health insurance through the federal marketplace during a special enrollment period this year from February to May. Subsidies have also gone a long way to reduce the number of uninsured in our state. Consider what the Urban Institute projects for next year: with expanded subsidies helping people pay premiums for health insurance, New Hampshire could go from 74,000 uninsured residents to 56,000 residents. That's a 25 percent drop. Allowing these expanded subsidies to expire would have a terrible impact on communities here and everywhere.

Yet – even as these subsidies help overcome hurdles to affordable, accessible care–there is one more hurdle for many in our community who need health insurance. Federal relief is largely based on household income. Broadly, lower incomes receive more help. But while this policy comes with the best of intentions, younger Americans with higher incomes are still priced out of the care they need.

We need to adjust how federal relief is calculated and one easy way to do this is add an age adjustment to the formula. That kind of adjustment lowers premiums for everybody, boosts enrollment in the federal marketplace, improves access to care for all, and fixes an unintended hurdle for younger Americans like me who are seeking affordable coverage.

New Hampshire's two U.S. senators can play a role in strengthening access to affordable care for the state's residents on the margins. Right now, Congress is considering a version of the next federal budget that includes an extension of the expanded federal subsidies for marketplace health insurance. Senators Hassan and Shaheen have always fought for equity in health care. They can extend that record by supporting subsidy extension in the final budget – and by including an age adjustment in that budget's final language.

We ask them to help us stand up for New Hampshire's communities because every resident of my district – and every American – deserves accessible, affordable coverage.

Manny Espitia represents Nashua's 4th Ward in the New Hampshire State Legislature. He also serves as president of the New Hampshire Young Democrats and Northern Regional director for Run for Something, a progressive political organization dedicated to recruiting and supporting young candidates in down ballot races across the country.