Affordable Healthcare is Vital to Our Economic Prosperity
- NH Possible
- Dec 9, 2025
- 3 min read
Each morning when Carolyn begins her day, she feels a deep sense of gratitude. As a small business owner in rural Carroll County, a full schedule of clients means she can cover her expenses, sustain her livelihood, and enjoy a decent quality of life. But none of it would be possible without access to affordable health coverage.
A lifelong diabetic, Carolyn relies on insulin to manage her blood sugar. She could not survive without it. Without health insurance, the cost of her prescriptions and regular appointments with multiple healthcare providers would be out of reach. Affordable coverage enables her not only to manage her condition, but also to keep her business thriving. “It keeps me alive,” she says. “It’s extremely important.”
NH Navigator Program Offers Marketplace Enrollment Assistance
Carolyn is one of more than 70,000 Granite Staters who enrolled in health coverage through the Affordable Care Act (ACA) Healthcare Marketplace last year. Since the ACA’s establishment, the New Hampshire Navigator program has been a crucial resource for residents seeking to understand their coverage options and choose a plan that fits their needs and budget. Navigators provide free, unbiased guidance—especially helpful for people who find the online application process daunting.
“I have always sought a Navigator for help with Marketplace enrollment,” Carolyn says. She worked with Navigators again this November. “It was good to get it done quickly.”
New Hampshire’s Navigator program is currently facilitated by the Foundation for Healthy Communities. But in September 2025, — less than two months before Open Enrollment —a 92 percent reduction in federal funding led to the loss of six positions and nearly eliminated the program. Despite the setback, local partners and funders such as the Tillotson Fund and the New Hampshire Children’s Health Foundation stepped in with creative solutions to ensure core services remained available.
“The NH Navigator program provides free, unbiased assistance to help people identify the right insurance options,” said Peter Ames, Executive Director of the Foundation for Healthy Communities. “While these cuts impact our staffing and capacity, they do not change our commitment to helping people across the state get covered.”
The NH Navigator website offers online tools including an eligibility prescreening system and a request form for personalized assistance. Limited phone support is available at 1-877-211-NAVI (6284) on weekdays, though website contact is recommended due to staffing constraints.
Dedicated Navigator Services for the Greater Coös Region
This year, a new initiative funded a Navigator dedicated to serving families in the Greater Coös Region—an area where residents face lower rates of employer-sponsored coverage and higher poverty rates. The Navigator helps families understand their Marketplace or Medicaid options and enroll in plans that meet their needs. At the end of the program, an evaluation will determine outcomes and explore whether similar efforts should be expanded elsewhere.
Rural Residents Face Barriers to Care
New Hampshire’s rural geography creates barriers for many residents. Provider shortages, long travel distances, and long wait times are common. “Accessing healthcare in Carroll County can be very difficult,” Carolyn says. “There can be long waits to see a provider, and you have to schedule a long time in advance.” From her small town, it is roughly 28 miles in any direction to reach a hospital in North Conway, Wolfeboro, or Laconia.
Understanding Marketplace Premium Tax Credits
New Hampshire is one of 28 states using the federal ACA Marketplace. Under the ACA, no one can be denied coverage for pre-existing conditions, and all plans must cover certain preventive services. Premiums are capped as a percentage of income, and income-eligible enrollees receive Premium Tax Credits to keep coverage affordable.
In 2022, Congress created Enhanced Premium Tax Credits, expanding eligibility and gradually tapering subsidies rather than cutting them off at an income threshold—a fix to the “subsidy cliff.” These enhanced credits expire at the end of 2025 unless extended.
If they lapse, thousands of Granite Staters—especially adults ages 50–64, self-employed people, small business owners, and rural residents—could see significant cost increases. With New Hampshire having the second-oldest population in the country and 84 percent of its land classified as rural, many households would feel the financial strain.
Affordable Health Care Strengthens Our Economy
Our ability to thrive depends on our ability to stay healthy. Health coverage provides peace of mind and ensures people can get the care they need, when they need it. Access to affordable healthcare helps individuals remain active, sustain employment, and contribute fully to their communities.
A healthier New Hampshire is a stronger, more prosperous New Hampshire for all of us.
NH Possible is building a movement to make this vision a reality. Join us! Sign up for the NH Possible newsletter to stay up-to-date and learn how you can contribute to progress.
