Bettencourt: Ayotte's Medicare Advantage Breakthrough Offers A Lesson In Leadership

By D.J. Bettencourt, NH Journal

There is a difference between explaining a problem and solving it.

Government often excels at explanations. Officials can identify who is responsible, which regulations apply and why nothing can be done.

Gov. Kelly Ayotte demonstrated another approach.

When thousands of New Hampshire seniors faced losing their Medicare Advantage options for 2027, the explanation was straightforward: Medicare Advantage is federally administered and regulated. Private insurers determine where to offer coverage. States cannot compel participation. In short, this is Washington’s problem.

Correct, but hardly comforting to seniors in Carroll and Coös counties facing a new year without a generally available Medicare Advantage plan.

Losing coverage can mean changing physicians, confronting different prescription drug costs or discovering that a nearby hospital is outside a new network. In the North Country, where medical care may require travel, these concerns matter.

Insurers’ withdrawals reflected difficult economics — health care costs, reimbursement, enrollment and provider contracting — and regulatory burdens. Government cannot compel financially unsustainable participation.

Only two existing New Hampshire Medicare Advantage insurers will continue offering plans in 2027, with availability varying by county. Neither offers a generally available plan in Carroll or Coös counties. Devoted Health, a new market entrant, was the only insurer to express interest to the New Hampshire Insurance Department in serving those counties, but complications in the federal approval process initially hindered its participation there in an already challenging regulatory and economic environment.

Gov. Ayotte recognized that distinction.

Rather than demand another government program, she aggressively engaged federal officials with authority to help. She personally contacted Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, whose team then responded at lightning speed to find a solution.

Working within existing federal authority, the governor helped CMS identify a pathway for discussions with Devoted to resume and move forward.

Without the governor’s intervention, CMS’s cooperation and Devoted’s willingness to reengage, seniors in Carroll and Coös would have entered 2027 without any Medicare Advantage plans. Now thousands will have that important choice.

This illustrates the distinction between effective government and expansive government.

Competition alone cannot guarantee that insurers will operate everywhere. Financial solvency and sustainability impose constraints. But administrative and regulatory impediments should not be mistaken for economic necessities.

There is nothing particularly free-market about government procedures preventing willing buyers and sellers from finding one another.

Gov. Ayotte did not attempt to suspend economic realities or legal requirements; she simply helped make private participation possible.

Some questioned the focus on Carroll and Coös counties and the election timing. But these counties faced the prospect of having no available plans, and Medicare open enrollment was underway. Delaying action to avoid criticism would hardly have served seniors.

The appropriate measure is whether seniors gained an important option they otherwise lacked. By that measure, Gov. Ayotte scored a significant achievement.

Medicare Advantage is not the best fit for everyone. Seniors should scrutinize provider networks, hospital access, prescriptions and plan quality. Original Medicare and supplemental coverage remain important alternatives. Competition should expand choice, not dictate it.

Long-term challenges remain. Federal Medicare Advantage reform is critically needed to address rural-market economics, regulatory burdens and seniors’ vulnerability to abrupt insurer withdrawals. Immediate action does not replace structural reform.

Gov. Ayotte’s commitment to practical solutions reflects New Hampshire’s regulatory approach: encouraging competition, protecting consumers and respecting the economic realities of insurance markets.

A recent Insurify analysis ranked New Hampshire lowest nationally for average personal auto insurance premiums. NerdWallet estimated comparable homeowners insurance premiums approximately 37% below the national average. New Hampshire also has the nation’s lowest average premium for individual-market health insurance in 2026.

These advantages, as well as the state-level leadership and regulatory approach that produced them, deserve recognition and preservation through predictable regulation, competition and policies that avoid unnecessarily increasing insurance costs.

Last year, more than 30 additional insurers entered New Hampshire’s marketplace across various coverage lines, expanding opportunities for choice.

Gov. Ayotte also signed legislation addressing surprise ground ambulance bills, provider termination notices and property-loss mitigation.

Government cannot eliminate risk or make insurance inexpensive by declaration. Excessive regulation can increase costs by restricting competition. Sound policy should remove unnecessary barriers, enforce contractual obligations and preserve consumer choice.

Gov. Ayotte’s leadership helped restore choices for thousands of seniors while advancing New Hampshire’s commitment to competitive insurance markets. The Insurance Department was proud to assist her.

Sometimes progress begins when public officials stop treating an explanation for inaction as a substitute for finding a solution.

D.J. Bettencourt is New Hampshire Insurance Commissioner. He wrote this for NHJournal.com.

This story was originally published by the NH Journal, an online news publication dedicated to providing fair, unbiased reporting on, and analysis of, political news of interest to New Hampshire. For more stories from the NH Journal, visit NHJournal.com.