Women in New Hampshire are struggling to get timely health care because there are not enough providers, because cost gets in the way, and because many do not understand what their insurance actually covers, according to a state study released this week.
The New Hampshire Insurance Department published the findings on August 3. The study identified provider shortages, affordability and coverage confusion as the principal barriers. It was funded by the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services under a $610,871 grant through the Expanding Access to Women's Health Program, and was commissioned to examine barriers to women's health services with particular attention to preventive care, maternal health and state compliance with federal market reforms.
Those three barriers are not separate problems. A woman who cannot find a participating obstetrician, is unsure whether a visit is covered, and faces a long drive to reach anyone is making one decision, and it is frequently to wait.
Three Barriers the Study Identified
Provider shortages emerged as the central access problem, and the department's response is aimed at making them visible.
Michelle Heaton, director of Life and Health at the state insurance department, said the goal of the department's transparency work is to highlight where shortages are actually occurring, including which types of providers are short and in which parts of the state.
Affordability was the second finding, encompassing both premiums and out-of-pocket costs at the point of care. The third was low understanding of insurance coverage among participants, which is a distinct problem from lacking coverage. A woman who does not know that preventive services are covered without cost sharing may skip a screening she is entitled to receive at no charge.
The study also flagged concerns extending beyond insurance regulation, including hospital closures, rural broadband access affecting telehealth, Medicaid policy design, the health workforce pipeline and culturally aligned care.
On benefit design, the study found New Hampshire's Essential Health Benefit benchmark plan on the marketplace comparable to other New England states, with fertility treatment as the exception.
Method That Captures What Claims Data Cannot
The study combined online surveys, focus groups, and community listening sessions with other data sources, and that design was a deliberate choice.
Insurance claims show what care was delivered and what it cost. They cannot show what did not happen. A claim does not record the woman who called six practices and found none accepting new patients, the appointment scheduled four months out, the visit skipped because it required a day off and a long drive, or the confusion about whether a service was covered.
Those experiences are what qualitative methods capture. Participants raised transportation, hospital capacity and geographic challenges, concerns falling outside the department's scope of work as an insurance regulator.
That admission is worth noticing rather than glossing over. An insurance department can address network adequacy, benefit design and coverage transparency. It cannot open a closed labor and delivery unit or extend broadband to a rural county.
The study's origin reflects some contention. New Hampshire's Executive Council initially rejected the contract before reversing its decision and approving it unanimously two months later, following advocacy from women's health organizations and from two councilors, Republican Janet Stevens and Democrat Karen Liot Hill. The council approved a second contract at the same time, giving state insurance regulators tools to verify that carriers are actually covering women's health services required by state and federal law.
Limits of a Qualitative Sample
This limitation should be stated clearly rather than buried. The findings reflect the experiences of the people who participated, not a statistically representative sample of all New Hampshire women.
Focus groups, listening sessions, and online surveys attract people motivated to participate, who are frequently those with the strongest experiences to report. That makes the findings useful for identifying what barriers exist and how they operate, and unsuitable for estimating how many women face them.
Nobody should read the study as establishing that a particular percentage of New Hampshire women experience care delays. It does not measure prevalence, and the department did not present it as doing so.
What it can do is direct attention. Qualitative work identifies problems worth measuring, and the department's stated next step, mapping where shortages exist and which specialties they affect, is exactly the kind of quantitative follow-up the findings point toward.
Resources for Granite Staters Facing Delays
Women encountering these barriers have more recourse than most realize, and several options do not require a lawyer.
Health plans sold in New Hampshire must meet network adequacy standards, meaning they must provide reasonable access to participating providers within reasonable distances and wait times. Someone who cannot find an in-network provider within a reasonable distance can contact the New Hampshire Insurance Department's consumer services line at 1-800-852-3416 to file a complaint or ask about an out-of-network exception, which plans sometimes grant at in-network cost sharing when no participating provider is available.
Most preventive services, including well-woman visits, screenings and contraception, are required to be covered without cost sharing on most plans. Anyone billed for a preventive service should ask the plan why, since coding errors are common and appealable.
Federally qualified health centers and community health centers across the state provide care on a sliding fee scale regardless of insurance status, and many offer prenatal care, family planning and primary care. Telehealth can close distance gaps for follow-up visits and some prenatal care where broadband allows.
Anyone pregnant should not delay care over cost or coverage uncertainty. Warning signs during pregnancy requiring immediate attention include severe headache, vision changes, upper abdominal pain, sudden swelling, decreased fetal movement, bleeding or fever.
The bottom line: the study identified provider shortages, affordability and coverage confusion as the main barriers women face in New Hampshire; its qualitative design captures experiences claims data misses but cannot measure how widespread they are, and the department's stated next step is mapping where shortages occur.
Key Questions Answered
What did the study find? Three principal barriers for women seeking care in New Hampshire: provider shortages, concerns about affordability, and low understanding of what insurance covers.
Who conducted and funded it? The New Hampshire Insurance Department, with funding from the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services under a $610,871 grant.
How was the study conducted? Through online surveys, focus groups, and community listening sessions combined with other data, a design was chosen to capture experiences that insurance claims cannot show.
Is it statistically representative? No. The findings reflect participants' experiences and are not a representative survey of all New Hampshire women. The study does not measure how common these barriers are.
Was the study contested? Yes. The Executive Council initially rejected the contract before approving it unanimously two months later, following advocacy from women's health organizations.
What did it find about benefits? New Hampshire's Essential Health Benefit benchmark plan on the marketplace was comparable to other New England states, with fertility treatment as the exception.
What can someone do if they cannot find an in-network provider? Contact the New Hampshire Insurance Department consumer services line at 1-800-852-3416 to file a complaint or ask about an out-of-network exception at in-network cost sharing.
