Navigating Open Enrollment: Expanding Access to Affordable Healthcare
With the Open Enrollment period starting soon on November 1, 2024, and going through January 15, 2025, the opportunity for many Granite Staters to secure essential health insurance coverage is right around the corner. With healthcare equity and affordability as one of its policy priorities, the New Hampshire Center for Justice & Equity spoke with Peter Ames, Executive Director of the Foundation for Healthy Communities (FHC), which is the hub of marketplace navigation services in the state. Thanks to a new grant, FHC’s expanded assistance will ensure that everyone, especially those in historically marginalized communities, can access adequate health coverage.
Connecting Care and Community for a Holistic Approach
The Foundation for Healthy Communities (FHC) is a statewide quality improvement organization dedicated to enhancing health and healthcare in New Hampshire. “The Foundation looks to be a connector between clinical care and the broader community and environment that people live in,” explained Executive Director, Peter Ames. Recognizing that beyond access, factors like housing, education, economic stability, food security, and transportation can significantly impact health outcomes, FHC takes a holistic approach, partnering with various community organizations to address these social drivers of health.
“Our approach is to listen to our partners first to see what the needs are in the state, and then pursue different grants based on those,” said Ames. This emphasis on partnership ensures that the Foundation’s efforts align with the real needs of communities, addressing the disparities in health outcomes that are often rooted in structural inequities. A prominent example is acquired disease, like heart conditions, cancers, or diabetes, which affects communities of color at a higher rate than their white counterparts.
The FHC’s lead highlights that “we want everyone to have an optimal opportunity for health and well-being and that means applying an equity lens to all of our health improvement activities.” This commitment to equity is reflected in the FHC’s work to expand access to health insurance, including the New Hampshire Navigator program.
New Hampshire Navigator: Securing the Right Insurance Coverage
Since the Affordable Care Act (ACA) was enacted in 2010, marketplace navigators have played a crucial role in helping individuals find their insurance options and understand the complexities of health insurance coverage. A change in administration led to a defunding of these vital services a few years ago, but funding for marketplace navigators was restored under the current administration. As a result, the Foundation for Healthy Communities (FHC) was awarded a 5-year grant from the Centers for Medicare and Medicaid Services (CMS) to assist consumers across the state with enrollment in the federal Marketplace, Medicaid, and the Children’s Health Insurance Program (CHIP).
The expanded program includes five navigators who will provide in-person services throughout the state, ensuring that no matter where someone lives, they can receive individualized assistance. Additionally, enrollment assistance options are available online and via phone call, with a significant list of language options to broaden accessibility.
While most can enroll on their own without a challenge, some people are unsure about what subsidies or tax credits they may be eligible for. “That's when that conversation with a navigator would be particularly helpful,” Ames points out. “They listen to understand a consumer’s individual or family situation, help them identify their coverage needs, and then work through what insurance assistance they may be eligible for,” he added.
These navigators are trained to offer unbiased guidance, helping consumers find the best plan for their needs without any conflict of interest. Ames clarifies that “they're not trying to sell you an insurance product for a company; they're just trying to help you get the best care you can get.”
Addressing Barriers and Expanding Healthcare Access
One of the most significant aspects of the new navigator funding is its emphasis on health equity. “For this new grant, CMS highlighted that they wanted to focus on what they call priority populations,” explained Ames. “These are populations that historically have had barriers to accessing health insurance coverage and healthcare, including BIPOC, LGBTQ, pregnant people, new mothers and children, folks in rural New Hampshire, and people with mental health or substance use disorders,” he added.
The need for these targeted efforts is evident. Data cited by the University of New Hampshire (UNH) states that 11% of all people in New Hampshire and 26% of Granite Staters who identify as multi-racial reported that they could not see a doctor when they needed to because of cost. And as much as 40% of working-age adults report skipping medical care or prescription drugs due to cost, as reported in NHCJE’s Policy Platform.
Cost remains one of the most significant barriers to accessing healthcare, even though only 4.7% of New Hampshire residents were uninsured in 2023, according to the NH Fiscal Policy Institute. Even for those with insurance, high premiums, deductibles, and copays can still deter individuals from seeking the care they need. The same UNH report states that the average person in NH spends $11,793 on healthcare expenditures and the average family premiums and deductibles represent nearly half (49%) of the average wages in New Hampshire.
Additionally, Medicaid was a lifeline for 1 in 7 Granite Staters in 2023, as reported by the NH Fiscal Policy Institute. The state's Medicaid program allows adults and children with low incomes, individuals with certain disabilities or long-term care needs, and other specific populations to access the care they need. The expansion of Medicaid through the Granite Advantage Health Care Program has further broadened access, offering coverage to individuals and families who were previously ineligible.
The Open Enrollment period stands as the best opportunity of the year for most people to secure insurance coverage. Through the New Hampshire Navigator program, the FHC assists individuals in exploring a range of options, from ACA marketplace plans with subsidies to other local and federal programs that offer discounted care, ensuring residents can find the best fit for their needs.
For those who don’t exactly qualify for assistance under the ACA, Ames recalls that “there are other avenues when folks don't have insurance or have inadequate coverage.” He suggests working with local healthcare providers, and pharmacies, and exploring nationwide resources. Local healthcare systems may also offer charitable care programs tailored to their communities. Ames also encourages people to connect with patient financial services to learn about potential resources, as there are often ways to reduce costs even without full insurance coverage.
Building a Healthier, More Equitable New Hampshire
For FHC, the work does not end with Open Enrollment. Their broader mission is to ensure that every person, regardless of background or circumstances, has the opportunity to achieve their best possible health. This means addressing the systemic issues that lead to health disparities and working toward solutions that make healthcare more affordable and accessible for everyone.
“We lift these issues at a practice level,” explains Ames, “working closely with local community partners to build trust and improve care for all.” By listening and responding to the needs expressed by local leaders, FHC aims to be a supportive partner, helping healthcare systems enhance their delivery and create more equitable standards of practice and access to care.
As Open Enrollment begins, the Foundation for Healthy Communities is ready to help New Hampshire residents make informed choices about their health coverage, ensuring that more people can access the care they need, when they need it. This not only improves individual health outcomes but also contributes to the economic stability of our state’s families and communities.
To speak with a Navigator and get covered, call 1-877-211-NAVI or visit https://acanavigator.com/nh/home
About Peter Ames
Peter Ames, Executive Director, Foundation for Healthy Communities
Peter Ames is the Executive Director of the Foundation for Healthy Communities, an affiliate of the New Hampshire Hospital Association based in Concord. The Foundation serves as a convening entity for partners committed to improving health and health care for all through community engagement in New Hampshire. Prior to joining the Foundation, Peter spent 12 years in several roles with the American Cancer Society in New Hampshire, focusing on cancer prevention through education, health systems change, and legislative advocacy. Peter is a graduate of UNH and received his MPH from George Washington University. He resides with his family in Litchfield, NH, and enjoys active recreation outdoors whenever he has the chance.