First published in NH Bulletin, October 9, 2023

Beyond the formalized health care system in New Hampshire, the health of Granite Staters is influenced by, and has an impact on, many population-level and individual factors.

The social determinants of health are defined as “the conditions in which people are born, grow, live, work, and age that affect a wide range of health risks, health outcomes, and quality of life,” according to the New Hampshire Department of Health and Human Services. They include education, housing, food security, geography, access to financial resources, and other factors.

Income is a good indicator of the resources families and individuals have access to, which can significantly influence health. Having a stable and sufficient income makes it easier to afford basic necessities, such as housing and healthy, nutritious food.

Among families and individuals with low or poverty-level incomes, paying for housing, food, prescription drugs, and preventative and emergency health care can be a challenge. Public services and resources for housing, food access, and health coverage help ensure that families across the socioeconomic spectrum are better able to meet these needs.

New Hampshire’s Medicare and Medicaid programs help many Granite Staters with low incomes access health care through a collaboration with the federal government.

In 2022, approximately 68,000 Granite Staters did not have health coverage, while about 95.1 percent of adults had coverage statewide, according to U.S. Census Bureau data. This 95.1 percent is a statistically significant increase from New Hampshire’s 93.7 percent 2019 pre-pandemic rate, likely reflecting increased enrollment in Medicaid due to policy expansions.

During the early months of the COVID-19 pandemic, when more than 100,000 Granite Staters lost their jobs and even more lost some portion of their employment income, Medicaid expansion allowed many families and individuals with low incomes to retain access to medical care during a public health crisis.

Since its inception in August 2014 through November 2022, the program provided access to health care for more than 219,000 Granite Staters. In the five years after the program’s implementation, the number of uninsured residents dropped by 42 percent relative to the five years before the program’s existence. Public health care policy, as was particularly exemplified during the COVID-19 pandemic, can and does have a significant influence on expanding access for many Granite Staters to essential health care services.

The current state budget for state fiscal years 2024-2025 boosted Medicaid reimbursement rates through a $134.2 million investment of state funds. Every state dollar will be matched by at least one federal dollar for eligible services, which will flow into the New Hampshire economy. Higher reimbursement rates can impact the health care field in New Hampshire by giving employers more financial capacity to increase compensation packages, which can help address workforce shortages in a highly competitive job market. Helping address health care workforce shortages expands the capacity of providers to offer essential preventative and immediate care to Granite Staters, including access to mental and behavioral health, substance misuse, and emergency room care.

For the Granite State workforce, residents with access to health care have an easier time finding and keeping employment. With a large number of residents aging out of the Granite State workforce and a statewide median age behind that of only Maine’s population, helping ensure New Hampshire’s residents who are still in the workforce are healthy and fit enough to work will be important to support a thriving economy.

Moreover, health care and social assistance is the largest employment industry in New Hampshire. As the Granite State’s population continues to age, the need for key health care services will increase even more and become a larger component of the New Hampshire economy.

A healthier Granite State that helps enable all of its residents to thrive will contribute to a more equitable, inclusive, and resilient economy.

The staff of the New Hampshire Fiscal Policy Institute contributed to this column.

Join NHFPI on Oct. 16 to be a part of the important policy dialogue on health care in New Hampshire. Register for the conference and learn more at nhfpi.org/conference. Registration is $50 per person, but scholarships covering registration fees are also available for those whom cost is a barrier. Learn more at nhfpi.org.