End of enhanced Obamacare subsidies puts tribal health lifeline at risk

Native American health programs face funding crunch as premium costs soar after pandemic-era aid expires

Published on Mar. 1, 2026

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The expiration of enhanced Affordable Care Act subsidies is putting a strain on tribal health insurance programs that have helped expand access to care for Native Americans. These programs, which allow tribes to enroll members in ACA marketplace plans, are now facing rising premium costs that are forcing them to limit enrollment and coverage. The loss of this health coverage lifeline could exacerbate longstanding disparities in health outcomes for Native communities.

Why it matters

Native Americans as a group continue to face disproportionately high rates of chronic diseases and a median age at death that is 14 years younger than white Americans. Tribal health insurance programs have helped fill gaps in care left by the chronically underfunded Indian Health Service, but the end of pandemic-era ACA subsidies threatens to undermine this progress and further widen health disparities.

The details

Tribal health insurance programs, like the one on the Fort Peck Reservation in Montana, pay the premiums for ACA marketplace plans for their members, allowing them to access care outside the Indian Health Service system. However, the expiration of enhanced ACA subsidies has caused premium costs to skyrocket, forcing tribes to limit enrollment and scale back coverage. The Blackfeet Nation in Montana recently stopped enrolling new members in its program, and the Fort Peck Tribes are now having to 'start limiting who gets help.' Tribal leaders warn that the loss of this coverage could mean 'people losing their lives' as more Native Americans become uninsured.

  • The enhanced ACA subsidies expired on December 31, 2025.
  • In January 2026, the U.S. House approved a temporary extension of the subsidies, but the measure stalled in the Senate.
  • By late 2025, ACA plans saw about 24 million enrollees, more than twice the number of pre-pandemic annual sign-ups. Enrollment has since dropped by more than 1 million people.

The players

Leonard Bighorn

A 65-year-old tribal game warden and member of the Dakota community who is enrolled in the Fort Peck Tribes' health insurance program, which has provided him access to regular screenings and specialty care that he did not have before.

Rae Jean Belgarde

The director of the Fort Peck Tribes' health insurance program, which is now facing higher costs and having to limit who receives coverage.

Lyle Rutherford

A Blackfeet Nation council member, whose tribe recently halted new enrollments in its health insurance program due to the pending expiration of ACA subsidies and the resulting 100-plus percent increase in premiums.

Jerilyn Church

The CEO of the Oyate Health Center in Rapid City, South Dakota, who says more uninsured patients would further strain the Indian Health Service's limited Purchased/Referred Care program.

A.C. Locklear

The CEO of the National Indian Health Board, a nonprofit that works to improve health in Native communities, who says tribes are 'looking at ways to cut back just as much as everyone else' due to the loss of the enhanced ACA subsidies.

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What they’re saying

“Our program is saving lives.”

— Rae Jean Belgarde, Director of the Fort Peck Tribes' health insurance program (Letter to Montana's congressional delegation)

“Reducing access to even just general primary care has a significant impact on those disparities.”

— A.C. Locklear, CEO of the National Indian Health Board (KFF Health News)

“At this point in time, we just have to hold off. Premiums have increased by 100-plus percent.”

— Lyle Rutherford, Blackfeet Nation council member (KFF Health News)

“There will be people that will not be able to get the care they need. That could translate to people losing their lives.”

— Jerilyn Church, CEO of the Oyate Health Center (KFF Health News)

What’s next

U.S. House members approved a temporary extension of the enhanced ACA subsidies in January 2026, but the measure stalled in the Senate. Lawmakers are scrambling for an alternative after President Donald Trump threatened to veto an extension if a bill reaches his desk.

The takeaway

The expiration of enhanced ACA subsidies is putting a critical health coverage lifeline for Native Americans at risk, threatening to exacerbate longstanding disparities in health outcomes for tribal communities. Tribal leaders are calling on Congress to find a solution to extend the subsidies and preserve these vital insurance programs that have expanded access to care.