End of enhanced Obamacare subsidies puts tribal health lifeline at risk

Published: Friday, February 20, 2026 at 3:10 pm

Tribal Health Programs Face Funding Crisis After ACA Subsidy Expiration

The expiration of enhanced Affordable Care Act (ACA) subsidies is jeopardizing crucial health insurance programs for Native Americans, leaving tribal communities struggling to maintain access to vital healthcare services. These programs, often run by tribal nations, help cover the costs of ACA marketplace plans for tribal citizens, providing access to care outside of the often-underfunded Indian Health Service (IHS).

The enhanced subsidies, which expired on December 31st, significantly lowered healthcare costs for millions of Americans during the COVID-19 pandemic. Their removal has led to a rise in premiums and a drop in enrollment in ACA plans. This financial strain is particularly acute for tribal health programs, which are now facing increased costs and are forced to limit enrollment or cut back on services.

Tribal leaders are expressing concern that the subsidy expiration undermines the federal government's commitment to providing adequate healthcare for Native Americans. The U.S. government made promises to provide for the health and well-being of tribes in exchange for tribal land. The IHS, while providing free healthcare, is often underfunded, leading to limited access to care and long wait times. Tribal programs have stepped in to fill these gaps, but they are now facing a funding crisis.

The situation is dire, with some tribes already halting new enrollments in their programs. The Urban Institute estimates that 125,000 Native Americans will become uninsured in 2026 due to the higher costs. The impact extends beyond insurance programs, potentially straining the IHS's already limited resources and leading to delayed or denied care for those who need it most.

BNN's Perspective: The situation highlights the complex challenges of healthcare access for Native Americans. While the expiration of the ACA subsidies has created a financial crisis for tribal health programs, the underlying issue is the chronic underfunding of the IHS. A sustainable solution requires a multi-pronged approach, including extending the subsidies, increasing funding for the IHS, and exploring innovative healthcare models that address the unique needs of tribal communities.

Keywords: Affordable Care Act, ACA, subsidies, tribal health, Native Americans, Indian Health Service, IHS, healthcare, insurance, enrollment, premiums, funding, healthcare access, Blackfeet Nation, Fort Peck Tribes, healthcare crisis.

Full Story