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Health Insurance Marketplace

Citizens Count Editor

Federal law currently requires each state to have a website for residents to purchase health insurance online. These online health insurance "marketplaces" or "exchanges" are supposed to be easy, “one stop shopping” for residents who are required to purchase health insurance under the federal Affordable Care Act, which became law in 2010.

How the online marketplace works

Any individual living in New Hampshire can shop for insurance through the health insurance marketplace.

Explore options and purchase insurance on the New Hampshire health insurance marketplace

Visit Covering New Hampshire more information about how to navigate New Hampshire’s marketplace or find out if you qualify for financial assistance

In 2012 New Hampshire passed a law that forbids the state from creating and operating any online health insurance marketplace. This law was intended to stop the Affordable Care Act, or at least save New Hampshire from the costs of creating an online health insurance marketplace.

Because of the 2012 law, the federal government actually operates New Hampshire’s online health insurance marketplace through its website.  This federal website is funded through a fee levied against premiums for insurance plans bought on the marketplace.  However, New Hampshire is still responsible for regulating the insurance plans offered on the marketplace website.

Rules for insurance on the marketplace

The Affordable Care Act has many requirements for insurance plans offered through the online health insurance marketplace.

In particular, insurance plans must cover ten “essential health benefits”:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity and newborn care
  • Rehabilitative and habilitative services and devices
  • Prescription drugs
  • Mental health and substance use disorder services
  • Laboratory services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

New Hampshire also has various regulations for health insurance.  For example, New Hampshire rules require insurance networks to include some providers within a certain distance of consumers.  Rules also give consumers a right to an external review if an insurer denies a claim.

A lack of choice on the marketplace

When New Hampshire’s online health insurance marketplace launched in 2013, only one insurer — Anthem Blue Cross Blue Shield — offered plans on the website.  In addition, Anthem used a limited network of health care providers.  Anthem said this narrow network lowered costs and ensured quality.  Opponents argued that the narrow network unfairly limited consumer choice. 

Since 2013, more insurers have joined New Hampshire’s marketplace, and Anthem has added more providers to its network. 

In 2019 there are three insurers offering 17 individual plans on the New Hampshire health insurance marketplace website. All of New Hampshire’s 26 hospitals are included in at least one insurance network.

The New Hampshire Insurance Department studied the network adequacy rules that allowed Anthem Blue Cross Blue Shield to use a narrow network in 2013. Network adequacy rules help define whether an insurer's proposed network of providers can meet the needs of patients across the state. A revised set of rules were issued in 2018. 

Financial help for consumers on the marketplace

Individuals who purchase insurance through the online health insurance marketplace may be eligible for financial help from the federal government.

  • Consumers at up to 400% of the federal poverty level are eligible for tax credits based on their monthly health insurance premiums.
  • Consumers at up to 250% of the federal poverty level may be eligible for additional savings on copyaments and deductibles.
  • Consumers at up to 138% of the federal poverty level may have all of their premium costs covered through New Hampshire’s expanded Medicaid program.

Learn about New Hampshire’s expanded Medicaid program under the Affordable Care Act

Efforts to slow rising premiums

Despite the financial assistance available to consumers purchasing health insurance through the online marketplace, health insurance is still very expensive. 

From 2017 to 2018, premiums on New Hampshire’s health insurance marketplace increased over 40%, an increase largely driven by uncertainty over whether the federal goverment would continue programs that have helped insurers cover the cost of newly insured, less healthy, and less wealthy individuals. (The Trump administration eventually decided to end some of those payments.)

The rates actually dropped in 2019, going down by an average of 15%. Analysts said the state's decision to move its expanded Medicaid patients out of the insurance marketplace, instead covering them through standard Medicaid plans, was a likely contributor. Insurers also said rates likely would have declined even further, if not for the decision in Washington to end the mandate for individuals to purcahse insurance or pay a tax penalty.

To help insurers weather uncertainty and pay for the influx of claims from new customers, in 2017 the New Hampshire Insurance Department proposed a reinsurance program.  That program would give payouts to insurance companies to cover the costs of unexpectedly high claims. However, the department's application for federal approval of the program was put on hold due to opposition from Gov. Chris Sununu. 

Uncertainty at the federal level

While Congress has thus far failed to pass a bill to revise the Affordable Care Act, President Trump has taken action to revise the ACA by executive order.  For example, in October 2017, Trump’s administration stopped payments to insurance companies to give discounts to low income individuals (cost sharing reductions).  The administration also says it will not enforce the individual mandate to buy health insurance. 

In Congress, there have been several proposals to change federal health insurance laws. Among them are moves to:

  • Extend premium tax credits to higher income levels
  • Charge older individuals more for insurance
  • Allow states to set different “essential health benefits” insurers must cover
  • Give states block grants to design their own health insurance reforms that would replace Affordable Care Act programs

State legislators do not have control over these federal proposals. If there are major changes at the federal level, New Hampshire legislators will have to choose whether they want to step in and continue to enforce some of the Affordable Care Act’s regulations at the state level or provide funding for plans purchased through the marketplace.

One such change might come through the courts. In December 2017, a federal court in Texas ruled that the Affordable Care Act was unconstitutional because the law did not contain a statement that if one of its provisions was removed, the rest remain valid. One such provision was removed when Congress eliminated the requirement that individuals purchase health insurance or pay a tax penalty. The ACA remains in effect as this case works its way through higher courts. 

Citizens Count Editor

“NH should continue to have the federal government run the online health insurance exchange/marketplace.”

  • It is less financially risky for New Hampshire to have the federal government operate the online health insurance marketplace website.  States running their own online health insurance marketplaces have faced ballooning costs and significant technological challenges. The federal government is even seeking money back from some state-run exchanges due to mistakes.
  • If New Hampshire takes over the marketplace, it may create a false expectation among users that the marketplace will continue to operate as-is, regardless of changes at the federal level.  However, the availability of affordable plans on the marketplace is almost entirely dependent on federal subsidies for consumers and insurers. 
  • Unlike the federal government, the state government is required to balance the budget every two years, and New Hampshire has a history of cutting social services when the budget gets tight. That arguably makes New Hampshire a riskier funding source for the online health insurance exchange than the federal government.  
  • According to data gathered the Henry J. Kaiser Family Foundation, the health insurance exchanges in all fifty states saw an average individual premium increase of about 24% in 2017. In contrast, the average employer-sponsored health insurance premium for an individual only increased 4%. Also, only 57% of enrollees on the health insurance exchanges had a choice of three or more insurers, down from 85% in 2016. This shows the marketplaces are failing to lower costs or increase choice, and New Hampshire should therefore stay as uninvolved as possible.
Citizens Count Editor

“NH should take over the online health insurance exchange/marketplace.”

  • With so much uncertainty about the future of health care reform at the federal level, New Hampshire should take over the online health insurance marketplace to make sure it continues to work for New Hampshire consumers.  The marketplace provides insurance for roughly 44,000 New Hampshire residents.  If the federal government shuts down the online marketplace, those 44,000 residents will have no way to sign up for coverage.
  • A state-run marketplace matches New Hampshire’s tradition of state and local control.  If New Hampshire has control over the marketplace, it will have the power to come up with unique, efficient ways increase access to affordable health insurance.  The Granite State demonstrated this ability to innovate through its unique Medicaid expansion, which uses private insurance rather than expanding traditional Medicaid rolls. New Hampshire is one of just a handful of states to expand Medicaid with private insurance.
  • According to an analysis from Bloomberg, states that run their own health insurance marketplaces tend to have more insurance companies offering consumers more choice on the marketplaces. 


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What do Libertarians mean when we talk about a free market economy and how can this be applied to something as well known as Health Insurance?


     The philosophy behind the free market system is easy to understand. The free market system simply believes that the the private sector (i.e. private citizens and businesses) can run any program or commodity better than the Federal Government.

     When we break down health care we must realize a few important details first. First, we have a customer; a person whom is in need of the commodity of health care. Secondly we have the commodity itself; doctors or hospitals. Under the free market system these are the only two parties present in the exchange. It is simple supply and demand; there is a need for a product and there is the person who provides the product to the customer.

     Now we must observe the current market system and how it operates. We still observe a costumer in need of a product and business/commodity which provides the product. The difference comes in that the current system adds a third party to the mix. This third party is represented by the health care insurance companies or now the federal government. The insurance companies and federal government act as a bridge or 'middle man' between the consumer and the provider. In a free market system a patient would simply go to his doctor for care and pay a doctor for the service provided. In the current system the consumer must pay an insurance company to connect to the services of the doctor whom then performs the service and then is compensated by the insurance company.

     The free market system argues that the third party is an unnecessary part of the natural business cycle and must be removed. The free market system argues that because there is an unnecessary third party involved, this increases the cost to the customer. It is very easy to explain how/why this occurs. We must realize that insurance companies are businesses within themselves. Insurance companies are actually very large and quite profitable businesses. Running a business naturally incurs great expenses. We must consider rent for insurance buildings/headquarters, electricity costs, overhead, marketing, employees, employee benefits,pensions, retirements etc. THE MONEY FOR ALL OF THESE EXPENSES IS BUILT INTO AND PAID FOR WITHIN THE PREMIUMS OF THE CUSTOMERS OF THAT INSURANCE COMPANY. So as a customer, rather than simply paying for a doctor to examine you like you would in the free market system, you are now also paying in part for the insurance company and their employees who process your information and interact with the doctor. Basically as a customer you are paying money to both the doctor and the insurance company/government rather than just the doctor them self. By eliminating the third party involved in the exchange of goods, the cost to the consumer for the good naturally decreases. It is as fundamentally simple as this.

     I believe spending less money for a commodity is something everyone in the United States would vote for and support. Unfortunately this concept is not explained often or at all and most people do not have an understanding of what Libertarians mean when we speak about the a free market economy and why this is a fundamentally better system than the one we currently operate. I also think this is a message everyone could get behind if they understood the mechanics involved.

     Critics of this system argue: How can we be sure it would remain fair? How would a free market economy regulate itself without federal regulations in place to control it? The answer is competition. A free market economy rewards the best product or product value at the best price. Furthermore, the more competition that exists for any product the more the price of that product is driven down by the market. A simple example of this can be found in common power tools. You walk into a Home Depot to buy a drill and are presented with brands like Dewalt, Makita, Milwaukee, Black and Decker, Craftsmen, Ryobi, etc. Lets say I buy Dewalt, although it one of the most expensive brands, I buy this because I view it as the best quality product at the most reasonable price. How is this an example of how the free market self regulates itself? When competition for a similar product exists prices drop and set themselves. Because Craftsmen and Ryobi offer a drill at much lower prices, this actually regulates the prices of the more expensive brands such as Dewalt or Milwaukee. If Dewalt got greedy and ignored the prices of their competitors by charging an exorbitant amount of money above their competiros they would most likely lose more sales and their business would suffer. In this way the prices of the bottom of the market set and control the prices at the top of the market. The more competition that exists within the market the more it benefits the consumers within the market. If we rid ourselves of all the federal regulations on all commodities this is the prosperity we could expect in all commodities in a free market economy.


Brian Dunn

Libertarian Party 2016

E Plurbis Unum, ensuring liberty for the future of New Hampshire


I recently used my Obamacare health plan for the first time in the middle of February.  When I went in for my appointment, the receptionist said because the health plan is so new and they don't know how long it will take them to get reimbursed by the insurance company for my visit, they are requiring a $100 deposit from each patient with the new health plan for EACH visit.  When they received payment from the insurance company, they will return the deposit by mail.  They said this is their office policy.

Is this legal?  I've  never heard of such a thing.  My plan shows that I only have a $5 co payment and I had to hand over $100??  I recently received the EOB showing that the insurance company is paying for the visit, so I should eventually receive my deposit back minus the $5 co pay. 

So....two questions.

Is it legal for them to require $100 from us before we see the doctor??

Can I demand interest on that $100 of mine that they kept for a month?

I'm very angry about this and I'm seriously considering changing my doctor because of this.

Any help?


New Hampshire had a single Health Systems Agency (UHSA-United Health Systems Agency) whose by-laws gave every NH resident over 18 years of age, a vote on the Representatives we had on the five "Sub-Area Councils" and the State-wide Board, as well as committee assignments (Project Review, "Certificate-Of-Need", etc.) which were all mandated under the National Health Planning and Resources Development Act of 1975 (Public Law 93-641) to have Consumer (as opposed to provider) Majorities. "Consumer representative" was well defined: You could not be a consumer representative if you earned more than 10% of your income from a "health related source", were married to a "provider", or were an indirect provider.

Is anyone familiar with why that portion of the old National Health Planning Act was not carried forward into the ACA, when remnants of the old Hill-Burton Act of 1946, which was included in the National Health Planning ...Act of 1975, and a similar provision is made for taxpayer subsidies to "Community Health Centers" as opposed to "Hospitals", in the Affordable Care Act (Obamacare)???  The Supreme Court has ruled that the ACA is a "Tax", yet I don't know who provides my representation in this process.


Affordable Care Act” is nothing of the sort, and more importantly it just affords government permission to deny care.


Obamacare is about unnecessary government intervention and, ultimately, it's all about government control.


Each step forward taken by champions of this socialist program would jerk back two steps from every free American and our God-given rights.


A bloated bureaucracy and weak-kneed politicians sent millions of Americans into financial distress, unseen in history, with this leftist scheme called Obamacare.


The Hippocratic Oath taken by our care providers is one of the oldest, most sacred binding oaths, it has never condoned the taking of innocent life through lack of care, and certainly not via direct action.


The statements above were from Sarah Palin.


Obama went around telling audiences in person and on television that people would realize a $2500. reduction in their healthcare costs. He promised if you liked your policy you could keep it. If you liked your doctor you could keep him. How many saw their policy costs drop? Ours went through the damn roof. Many people who liked their policies were forced to drop them and take the so-called ACA, more money and less benefits, paying more for less.


The trouble is people don’t listen to this socialist when he speaks, he will tell you the truth but it will be intermixed with lies. He, Reid and Pelosi said that Obamacare was not the end-all but just a skip in the rope to Single Payer, womb to the tomb care under the direction and control of the government, full blown socialism. Did anyone say “Death Panels? Oh yes they are here. Doctors are retiring early, some changing careers as they refuse to be ponds in the hands of the government. They refuse to have some government pinhead standing between them and their patients.


Obamacare is exactly what it was meant to be, chaos thrown into a running system, as the hook that would cause the government to have to step in, to bring order to their originated chaos, complete and total control of every man, woman and child under Single Payer.


For the sake of this country and the freedoms we leave to our children this damnable “ACA-Obamacare-SCOTUS Act” must be repealed and thrown in the garbage. Our healthcare in this country was the best in the world, now we are on our way, if not stopped, to being no better then any 3rd. rate socialist state.


I need to caresource health incrance

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