With ACA open enrollment, residents have more choices, greater cost uncertainty

With the onset of open enrollment for the Affordable Care Act (ACA) Marketplace, public health advocates warn uncertainty over the future of expanded tax credits for some of the state’s 52,000 residents who get coverage is likely to overwhelm the sign-up process, especially after the federal government shutdown ends.

With ACA open enrollment, more choices, greater cost uncertainty

Public health advocates and state officials are urging the 52,000 individuals getting insurance on the marketplace under the Affordable Care Act to explore their options and choose a plan for 2026 by Dec. 15. Jayme Simoes (pictured) is a spokesman for Protect Our Care New Hampshire, a public health advocacy group, that sponsored a virtual briefing on the topic last week.

The tax credits, created by Congress during the COVID-19 pandemic, will expire at year’s end without congressional action and it’s the main reason U.S. Senate Democrats refuse to vote to end the shutdown without assurances they will continue.

State Insurance Commissioner D.J. Bettencourt and health care officials agree, however, that the time is now for all those on the program to examine their options.

“New Hampshire’s insurance market continues to deliver stability, affordability, and choice for Granite Staters,” Bettencourt said. “Our disciplined, data-driven approach — rooted in free-market principles, sound oversight, collaboration, and supported by our state-designed reinsurance program waiver — has made New Hampshire a model for how states can protect consumers while fostering competition and solvency.”

While enrollment for the ACA runs until Jan. 15, Jayme Simoes with Protect Our Care New Hampshire, a public health advocacy group, urged all to sign up by Dec. 15 because that would ensure their new coverage plan can kick in on Jan. 1.

“Not all plans are created equal so it’s important for everyone to do their homework,” Simoes said during a press conference call last week.

Those who could lose these tax credits can expect sticker shock.

“Across the country, people are seeing big increases in the cost of care — and if these subsidies go away, families will face an even bigger burden,” said Tory Jennison, a registered nurse who is executive director of the New Hampshire Public Health Association.

GOP views tax credits as too expensive, prone to fraud

Ed Shanshala is CEO of Ammonoosuc Community Health Services, a community health center that offers support for their 100 employees including himself so they can buy coverage in the marketplace.

“If we lose the enhanced premium tax credits, our family’s Silver plan would jump more than 20% — to over $2,000 a month, or $24,000 a year. That’s simply not sustainable. We’d have to move to a Bronze plan, paying less now but getting less coverage later. It’s a gamble many families can’t afford,” Shanshala said.

The Trump administration and many GOP leaders in Congress have said the tax credits were prone to fraud and too expensive for taxpayers.

During COVID, Congress voted to lift what had been since 2011 a cap on eligibility so the tax credits were only available to families that make no more than 400% of the federal poverty level or $128,600 annually for a family of four.

“Republicans were elected to reverse the Biden era inflation. Meanwhile, Democrats continue to push the same tax-and-spend agenda that increases costs and reduces access to quality health care,” New Hampshire House Majority Leader Jason Osborne, R-Auburn, said in a statement.

“Hopefully, D.C. Republicans will stick to their guns and forestall the inevitable economic collapse set in motion by Democrats’ unsustainable policies.”

U.S. Sen. Jeanne Shaheen, D-N.H., said nationally on average those who lose tax credits will face a 20% hike, but these can run up to 1,000% more or higher, especially for lower-income residents who have expensive, chronic health problems.

“As I’ve said for more than a month, we ought to be able to keep the government open and work together to protect access to affordable health care,” Shaheen said in a statement. “I’m going to keep working around the clock to negotiate a solution that achieves just that.”

Sen. Maggie Hassan, also D-N.H., agreed. “Families shouldn’t have to worry about how they will get care and if they will be able to afford it, and President Trump’s actions make it even harder for Granite Staters to access care.”

All that said, the upheaval isn’t expected to be as chaotic as for the nearly 90,000 senior citizens with individual Medicare Advantage plans in New Hampshire who have to deal with their insurer that is leaving that market or one that will significantly increase rates. Seniors face a Dec. 7 deadline to make their choices.

For example, seniors in the North Country in 2026 will have only one insurance carrier left offering an advantage plan.

Seniors have flooded a network of community service programs set up to offer assistance for them to choose an option.

Last week, the Merrimack County provider informed seniors that all its appointments were booked through the calendar year.

Bettencourt is urging seniors who need help to reach out for it directly to his agency.

Meanwhile, the four insurance firms currently in the ACA marketplace — Anthem Health Plans of New Hampshire, Matthew Thornton Health Plan, Ambetter from NH Healthy Families and Harvard Pilgrim Health Care — are all staying put. And in 2026, there’s a fifth player — WellSense Health Plan — a Boston-based insurer that for years has offered managed care insurance for those in the state’s Medicaid program.

“Many of these plans are getting creative and you may even find some offer additional benefits to get you to sign up,” Simoes said.

According to the Kaiser Family Foundation, New Hampshire’s average benchmark premium of $401 per month for those in the ACA marketplace is the lowest in the nation.

“New Hampshire’s success stems from disciplined regulation, responsible policymaking, and our shared belief that competitive markets deliver the best outcomes,” said Deputy Insurance Commissioner Keith Nyhan.

Shanshala said he’s most worried the loss of the subsidies might prompt younger, healthier workers or those with seasonal jobs to drop coverage entirely.

Many observers credit the tax credit expansion with helping reduce the state’s uninsured rate to a modern-day record low of 4.7%

Advocate: Debt spiral could be on the way

A higher uninsured population could lead to what Shanshala called a “China Syndrome for health care” or a financial debt spiral as greater use of hospital emergency rooms for care would not only strain the budgets and capacity of health care providers, but often lead to worse health outcomes for patients.

“I don’t like what I see coming down the road. It’s disconcerting to say the least,” he said.

What makes the process still more challenging is the Trump administration cut by 90% the budget for the Navigator program that offers free advice for those select plans for the marketplace and access that care after they’re enrolled.

“I would strongly encourage consumers who have questions about acquiring health insurance to call 1-877-211-NAVI or visit its website,” said Mariana Poore, coordinator of the Health Insurance Navigation program within the N.H. Foundation for Healthy Communities.

Even before this budget cut, the program had difficulty helping everyone who asked for it, Jennison said.

“The system works well when people trust the messages they are getting. In this case, we don’t know what to tell you because your situation could be dramatically different than it is right now,” she said.

Shanshala urged residents waiting for a navigator to consider seeking assistance from local libraries and human service providers.

“It’s a bit of a tidal wave that was self-inflicted,” he added. “Nobody asked for this, but here we are.”

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