The expiration of enhanced Affordable Care Act subsidies threatens to deepen already severe health disparities facing Native Americans, with premium costs doubling for tribal health insurance programs that serve as a lifeline for thousands.
Native Americans continue to face disproportionately high rates of chronic diseases, and their median age at death is 14 years younger than that of white Americans. Now, tribal health insurance programs created to fill gaps in the chronically underfunded Indian Health Service are struggling to survive after enhanced subsidies expired on December 31.
The Fort Peck Tribes in northeastern Montana, which covers roughly 1,000 tribal citizens through their insurance program, is now limiting who has access to that coverage. Rae Jean Belgarde, who directs the program, said the higher costs leave tribes with one option: start limiting who gets help. Tribal leaders sent a letter to Montana’s congressional delegation noting that their program is saving lives.
The Blackfeet Nation recently stopped enrolling people in a similar program, warning that funding will run out before year’s end. Lyle Rutherford, a Blackfeet Nation council member, said premiums have increased by 100-plus percent.
A.C. Locklear, CEO of the National Indian Health Board, said reducing access to even just general primary care has a significant impact on those disparities. The Urban Institute estimates that 125,000 Native Americans will become uninsured in 2026 due to higher costs. Jerilyn Church, CEO of Oyate Health Center in Rapid City, warned there will be people that will not be able to get the care they need, potentially meaning people losing their lives.
See: “End of enhanced Obamacare subsidies puts tribal health lifeline at risk” (February 14, 2026)
