For the first time in years, fewer Granite Staters are buying their health insurance through the Affordable Care Act marketplace. New data from the New Hampshire Insurance Department shows that enrollment in the individual marketplace fell 4.1% for 2026, with roughly 73,090 people signing up, down from about 76,251 in 2025. According to reporting from New Hampshire Public Radio, the drop ends a multiyear run of growth and lands at the same moment that pandemic-era subsidies, which made marketplace coverage dramatically cheaper for millions of households, have expired.
The decline is modest in percentage terms, but it carries real weight for the families it touches and for what it signals about the months ahead. Health coverage that becomes even slightly less affordable tends to push people who are healthy, young, or financially stretched to drop out first, and that is exactly the population the marketplace depends on to keep the broader risk pool stable.
What the Numbers Show
The 2025 enrollment figure of about 76,251 was a record for New Hampshire, the state insurance department noted, and it capped several years of steady increases in the number of residents using the marketplace. Marketplace sign-ups had been climbing in New Hampshire since the pandemic, according to data from the Centers for Medicare and Medicaid Services. The 4.1% decline for 2026 reverses that direction for the first time in that stretch.
The timing points to a clear driver. At the end of 2025, the enhanced subsidies that had been put in place during the pandemic to offset the cost of marketplace insurance expired. Those subsidies, structured as enhanced premium tax credits, had sharply reduced what many enrollees paid each month, and their expiration means a meaningful share of households are now facing higher costs for the same coverage. Premiums have risen nationwide in the wake of that expiration, compounding the pressure.
Andrew Demers, a spokesperson for the New Hampshire Insurance Department, characterized the decrease as relatively stable given the circumstances, including the Trump administration’s decision not to extend the enhanced health insurance tax credits. He attributed that stability in part to the fact that New Hampshire has the lowest ACA benchmark premiums in the country, which cushions the state’s market against the kind of sticker shock seen elsewhere.
Why a Strong Market Still Faces Headwinds
Demers said the state tracks a range of affordability indicators, including premiums, deductibles, cost-sharing, and enrollment trends. “Those measures continue to show that New Hampshire has one of the most competitive and affordable individual insurance markets in the country, although affordability remains a challenge for many families because healthcare costs continue to rise nationwide,” he said.
That dual message captures the state’s position. On paper, New Hampshire’s marketplace is among the healthiest in the nation, with low benchmark premiums and a competitive set of carriers. Yet a strong relative position does not insulate individual households from rising costs. When subsidies shrink and underlying medical prices keep climbing, even a well-run market can see people priced out at the margins.
The uninsured rate offers a baseline for what is at stake. The rate of people without insurance in New Hampshire was 4.5% in 2024, among the lowest in the country. The concern is that erosion in marketplace enrollment, if it continues, could begin to push that number up. The Congressional Budget Office, Congress’s nonpartisan budget agency, projects that the share of Americans without health insurance nationally will rise from 7.6% in 2025 to 10.1% by 2028, a trajectory shaped in large part by the expiration of enhanced subsidies and related policy changes.
A National Pattern, With a Notable Contrast
New Hampshire is not alone. A report released last month by KFF, the health policy research organization, found that the number of people enrolling in ACA plans during open enrollment dropped by more than a million nationally for 2026, the largest decline since the marketplace launched. That report drew on data from CMS, state-based marketplaces, and KFF’s own survey work. The national picture, in other words, is one of broad contraction as the subsidy cliff takes effect.
What makes the story more than a simple tale of decline is the contrast among states. New Hampshire’s neighbor Massachusetts actually saw its marketplace enrollment grow, after the state invested $250 million from a special state trust fund to offset the end of federal subsidies. Connecticut similarly saw sign-ups increase after directing state funds toward compensating for the lost federal support. The lesson is direct: where states stepped in with their own money to backfill the expiring federal subsidies, enrollment held or grew, and where they did not, it fell.
That contrast is likely to sharpen the policy debate in Concord. New Hampshire has not moved to replace the expired federal subsidies with state dollars, and the 4.1% decline is the first concrete evidence of what that choice looks like in practice. As lawmakers and the next class of statewide candidates weigh healthcare affordability, the Massachusetts and Connecticut examples will sit on the table as proof that state intervention can change the outcome, alongside the obvious counterargument about cost to taxpayers.
The Broader Squeeze on New Hampshire Health Coverage
The marketplace numbers do not stand alone. They arrive amid a wider squeeze on health coverage options across the state. New Hampshire has already seen disruption in its Medicare Advantage market, with plans leaving and seniors forced to navigate new choices during open enrollment. The marketplace decline and the Medicare turbulence are distinct stories, but they share a common thread of households being asked to absorb more cost and complexity in how they get covered.
The pressure also intersects with the politics of Medicaid. Federal Medicaid cuts have rippled into New Hampshire’s healthcare system, a dynamic we examined in our coverage of Dartmouth Health’s response to rural funding shortfalls and Medicaid cuts. Affordability of coverage has likewise become a recurring theme on the campaign trail, as documented in our reporting on the debate over Ayotte’s Medicaid record and premiums. The marketplace data adds one more data point to a year in which the cost and availability of health coverage has moved to the center of New Hampshire’s public conversation.
What Enrollees Should Watch
For residents who buy their own insurance, the practical takeaways are concrete. Households that saw their premiums jump when the enhanced tax credits expired should review their options carefully at the next open enrollment, including whether a different metal tier or carrier would lower their costs without sacrificing needed coverage. New Hampshire’s low benchmark premiums mean there may be more room to shop than in higher-cost states.
The bigger questions sit with policymakers. Whether the state chooses to follow the Massachusetts and Connecticut path of backfilling subsidies, whether Congress revisits the enhanced tax credits, and how fast underlying medical costs keep rising will all shape whether this 4.1% dip is a one-time adjustment or the start of a longer slide. For now, the data marks a turning point: after years of growth, New Hampshire’s marketplace has stopped expanding, and the reasons why are squarely tied to decisions being made well beyond the state’s borders.
