First published in NH Business Review, November 4, 2024
New data from the U.S. Census Bureau provides valuable insight into private and public health coverage across New Hampshire. About three in four Granite Staters (75.9%) received all or part of their health coverage through private means, while one in three residents (33.3%) received all or partial public coverage, predominately through Medicare or Medicaid. Employer-based coverage remained the largest source of health insurance for Granite Staters in 2023, with more than half (52.8%) of the state’s population receiving coverage solely through their employer. Although most residents had health coverage, approximately 4.7% of the state was uninsured in 2023, which is equivalent to the 2023 population sizes of Keene, Portsmouth, Claremont and Peterborough combined.
Although a smaller percentage of Granite Staters received public coverage compared to private insurance in 2023, enrollment in public health coverage has increased from the prior decade, while the percentage receiving private insurance has remained relatively stable. Increases in public coverage are due in large part to both federal- and state-level policy decisions, including the passage of the federal Patient Protection and Affordable Care Act and subsequent 2014 Medicaid Expansion in New Hampshire. The federal and state policy initiatives have been key for those who were unable to afford or otherwise obtain health insurance. As a result, the percentage of the state’s uninsured population declined by more than half between 2013 and 2023.
A temporary federal policy that kept Granite Staters continuously enrolled in Medicaid during the COVID-19 pandemic also increased access to public coverage. Since the conclusion of this policy, approximately one in four enrollees (27.2%) lost Medicaid coverage between March 2023 and September 2024. According to U.S. Census Bureau survey data, from April through September 2024, the most common reported reasons for losing Medicaid coverage were no longer qualifying (62.5%) and being unable to renew (10.4%).
Changing demographics may have also influenced higher enrollment in public coverage compared to a decade ago. U.S. Census Bureau estimates indicate the percentage of the state’s population aged 65 or older increased by about 5.5 percentage points between 2013 and 2023. As the state’s median age increases, ongoing efforts to support and expand health coverage and access to services will be crucial to supporting the well-being of residents, including those who may need assistance through Medicaid for long-term disabilities and for the one in 21 Granite Staters currently uninsured.
Jess Williams is a policy analyst with the Fiscal Policy Institute. The NHFPI Policy Memo is a partnership of the NH Fiscal Policy Institute and NH Business Review.