New Hampshire’s health insurance marketplace remains remarkably stable, offering the lowest average premiums in the United States, even as other states grapple with rising costs and market instability. This success is largely attributed to the Granite State’s reinsurance program, established several years ago to mitigate risk for insurers and maintain premiums affordable.
The state-based reinsurance program, initially authorized under Section 1332 of the Affordable Care Act through a waiver, helps to cover a portion of high-cost claims. This reduces the financial burden on insurance companies, allowing them to offer lower premiums to consumers. Roger Sevigny, writing in the Union Leader, highlighted the program’s preventative impact, noting that New Hampshire “built in health insurance stability before the storm” and is now reaping the benefits.
Unlike many states, New Hampshire proactively addressed potential market vulnerabilities. The reinsurance program functions by reimbursing insurers for a percentage of claims exceeding a certain threshold, effectively shielding them from catastrophic losses. This mechanism has proven particularly effective in attracting and retaining insurers in the state’s marketplace.
The stability of New Hampshire’s market stands in contrast to national trends. While the Affordable Care Act has expanded health insurance coverage, many states continue to face challenges related to affordability and insurer participation. The KFF, tracking Section 1332 waivers, notes that states are employing a variety of strategies to address these issues, but New Hampshire’s reinsurance model has emerged as a particularly successful approach.
Though, concerns remain about the long-term sustainability of the program and the potential for future premium increases. A recent opinion piece in the Concord Monitor acknowledges the current success but cautions against complacency. The Nashua Ink Link reported that New Hampshire residents currently enjoy the lowest health insurance costs in the nation, but warned that this advantage may not last indefinitely.
The National Federation of Independent Business (NFIB) has too weighed in, emphasizing the need for better health coverage options for small businesses in New Hampshire. While the current market is stable, the NFIB argues that more needs to be done to address the specific needs of small employers and their employees.
As of February 2026, the New Hampshire Insurance Department continues to monitor the performance of the reinsurance program and assess its impact on the market. No official statements regarding program adjustments or future waivers have been released.
