{"id":2151252,"date":"2026-02-11T05:00:00","date_gmt":"2026-02-11T10:00:00","guid":{"rendered":"https:\/\/kffhealthnews.org\/?post_type=article&#038;p=2151252"},"modified":"2026-02-13T16:14:11","modified_gmt":"2026-02-13T21:14:11","slug":"tribal-health-enhanced-obamacare-subsidies-funding-shortages","status":"publish","type":"article","link":"https:\/\/kffhealthnews.org\/news\/article\/tribal-health-enhanced-obamacare-subsidies-funding-shortages\/","title":{"rendered":"End of Enhanced Obamacare Subsidies Puts Tribal Health Lifeline at Risk"},"content":{"rendered":"\n<p>Leonard Bighorn said his mother tried for two years to get help for severe stomach pain through the limited health services available near her home on the Fort Peck Reservation in northeastern Montana.<\/p>\n\n\n\n<aside class=\"block--sidebar alignright \">\n\t\n\n<p><\/p>\n\n\n\n<div class=\"wp-block-kaiser-health-news-partner block--partner\">\n\t\t\t\t\t\t<a class=\"partner__image--link\" href=\"https:\/\/www.dailyyonder.com\/\">\n\t\t\t\t<img decoding=\"async\" class=\"partner__image\" src=\"https:\/\/kffhealthnews.org\/wp-content\/uploads\/sites\/2\/2022\/07\/daily-yonder-logo.png?w=120\" alt=\"Partner logo\" \/>\n\t\t\t\t\t<\/a>\n\t\t\t\t\t<p class=\"partner__content\">\n\t\tThis story also ran on <a href=\"https:\/\/dailyyonder.com\/end-of-enhanced-obamacare-subsidies-puts-tribal-health-lifeline-at-risk\/2026\/02\/09\/\">The Daily Yonder<\/a>. It can be <a href=\"https:\/\/kffhealthnews.org\/news\/article\/tribal-health-enhanced-obamacare-subsidies-funding-shortages\/view\/republish\/\">republished for free<\/a>.\t<\/p>\n<\/div>\n\n\n\n<div class=\"is-style-classic  wp-block-kff-common-promo\">\n\t\t<div class=\"wp-block-kff-common-promo__inner\">\n\t\t\t\t\t<h3 class=\"wp-block-kff-common-promo__title\">\n\t\t\t\t<a class=\"wp-block-kff-common-promo__link\" href=\"https:\/\/kffhealthnews.org\/help-us-report-on-rising-insurance-costs\/\">\n\t\t\t\t\tShare Your Story\t\t\t\t<\/a>\n\t\t\t<\/h3>\n\t\t\t\t\t\t<p class=\"wp-block-kff-common-promo__excerpt\">Are you struggling to afford your health insurance? Have you decided to forgo coverage? <a href=\"https:\/\/kffhealthnews.org\/help-us-report-on-rising-insurance-costs\/\" target=\"_blank\" rel=\"noreferrer noopener\">Click here<\/a> to contact KFF Health News and share your story.\u00a0<\/p>\n\t\t\t\t\t\t<a class=\"wp-block-kff-common-promo__read-more wp-block-kff-common-promo__link\" href=\"https:\/\/kffhealthnews.org\/help-us-report-on-rising-insurance-costs\/\">Contact us<\/a>\n\t\t\t<\/div>\n<\/div>\n\n<\/aside>\n\n\n\n<p>After his mom finally saw a specialist in Glasgow, about an hour away, she was diagnosed with stage 4 colon cancer, Bighorn said.<\/p>\n\n\n\n<p>Now, 16 years after his mother\u2019s death, Bighorn has access to regular screenings for cancer and other specialty care that she didn\u2019t have, through a health insurance program the Fort Peck Tribes created in 2016. The program, which covers most of the costs for the roughly 1,000 tribal citizens enrolled, is among a growing number of tribally sponsored health insurance programs.<\/p>\n\n\n\n<p>Such programs vary by tribe, but they essentially screen and enroll people living within tribal boundaries in Affordable Care Act marketplace plans. They allow participating Native Americans flexibility to go to outside doctors and clinics when care through the Indian Health Service is unavailable.<\/p>\n\n\n\n<p>\u201cI\u2019d be in a bind otherwise,\u201d said Bighorn, a 65-year-old tribal game warden and member of the Dakota community.<\/p>\n\n\n\n<p>But the Fort Peck Tribes now limit who has access to that coverage. Other tribal organizations that offer Native Americans similar coverage are struggling with rising costs, too.<\/p>\n\n\n<div\n\tclass=\"wp-block block--newsletter  \"\n\tdata-type=\"kaiser-health-news\/newsletter\"\n\tdata-align=\"center\"\n\tstyle=\"\"\n>\n\t<h4 class=\"newsletter__title\">\n\t\t<a href=\"\/email\/\">\n\t\t\tEmail Sign-Up\t\t<\/a>\n\t<\/h4>\n\t<p class=\"newsletter__description\">\n\t\tSubscribe to KFF Health News&#039; free weekly newsletter, &quot;The Week in Brief.&quot;\t<\/p>\n\t\n<form\n\taction=\"\/email-signup\/\"\n\tclass=\"kaiser-hubspot-mini-signup-form\"\n\tmethod=\"post\"\n>\n\t<input type=\"hidden\" id=\"kaiser_hubspot_nonce\" name=\"kaiser_hubspot_nonce\" value=\"dc9818bd64\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/wp-json\/wp\/v2\/article\/2151252\" \/>\t\t\t\t<label\n\t\tclass=\"kaiser-hubspot-mini-signup-form__label--email\"\n\t\tfor=\"kaiser-hubspot-mini-signup-form-email\"\n\t>\n\t\t<span class=\"screen-reader-text\">\n\t\t\tYour Email Address\t\t<\/span>\n\t\t<input\n\t\t\tautocomplete=\"email\"\n\t\t\tclass=\"kaiser-hubspot-mini-signup-form__input--email\"\n\t\t\tid=\"kaiser-hubspot-mini-signup-form-email\"\n\t\t\tname=\"kaiser_hubspot_email\"\n\t\t\ttype=\"email\"\n\t\t\t\t\t\t\tplaceholder=\"Your email address\"\n\t\t\t\t\t\/>\n\t<\/label>\n\t<button class=\"kaiser-hubspot-mini-signup-form__submit\">\n\t\tSign Up\t<\/button>\n<\/form>\n<\/div>\n\n\n\n<p>The financial crunch began when congressional lawmakers allowed enhanced subsidies under the Affordable Care Act to expire on Dec. 31. Those tax credits, created under the Biden administration during the covid-19 pandemic, expanded subsidized health coverage for millions of people. By late 2025, ACA plans saw about 24 million enrollees, more than twice the number of pre-pandemic annual sign-ups. The cost of coverage shot up for most of those people as the expanded subsidies expired, and enrollment <a href=\"https:\/\/www.kff.org\/quick-take\/aca-signups-are-down-but-still-an-incomplete-picture\/\">so far<\/a> has dropped by <a href=\"https:\/\/www.cms.gov\/newsroom\/fact-sheets\/marketplace-2026-open-enrollment-period-report-national-snapshot-2\">more than 1 million people<\/a>, according to federal health officials.<\/p>\n\n\n\n<p>The subsidies had also boosted tribal health insurance programs, like the one Bighorn is enrolled in. The programs pay the price of each person\u2019s share of premiums after subsidies, and the coverage lowers patients\u2019 treatment costs. Now that premium prices have ballooned, so have tribes\u2019 costs.<\/p>\n\n\n\n<p>Rae Jean Belgarde, who directs Fort Peck Tribes\u2019 program, said the higher costs leave the tribes with one option at this point: \u201cStart limiting who gets help.\u201d<\/p>\n\n\n\n<p>The tribes are helping people shift to other insurance options and, in some cases, find state programs to cover their premiums. Tribal leaders also sent a letter to Montana\u2019s all-Republican congressional delegation asking them to support extending the subsidies.<\/p>\n\n\n\n<p>\u201cOur program is saving lives,\u201d the letter read. Belgarde said she didn\u2019t know whether the lawmakers responded.<\/p>\n\n\n\n<p><strong>Scrambling<\/strong><strong> for Solutions<\/strong><\/p>\n\n\n\n<p>U.S. <a href=\"https:\/\/www.cnbc.com\/2026\/01\/08\/obamacare-subsidies-extension-congress.html\">House members approved<\/a> a temporary extension of the enhanced subsidies in January. But that measure <a href=\"https:\/\/www.axios.com\/2026\/01\/12\/democrats-health-deal-aca-subsidies-gop\">stalled in the Senate<\/a>. Lawmakers are scrambling for an alternative after President Donald Trump <a href=\"https:\/\/www.reuters.com\/business\/healthcare-pharmaceuticals\/trump-says-he-may-veto-extension-obamacare-subsidies-2026-01-12\/\">threatened to veto<\/a> an extension if a bill reaches his desk. On Jan. 15, the president released <a href=\"https:\/\/apnews.com\/article\/trump-health-care-insurance-congress-savings-accounts-b7b4caae9ad14fda4646c42d3858202b\">an outline of a health care proposal<\/a> that includes creating savings accounts for people to pay their health costs \u2014 an idea Senate Republicans <a href=\"https:\/\/www.usatoday.com\/story\/money\/2026\/01\/04\/could-health-savings-accounts-change-how-obamacare-works\/87837768007\">previously floated<\/a> as an alternative to the subsidies.<\/p>\n\n\n\n<p>A.C. Locklear, CEO of the <a href=\"https:\/\/www.nihb.org\/\">National Indian Health Board<\/a>, a nonprofit that works to improve health in Native communities, said tribes are \u201clooking at ways to cut back just as much as everyone else.\u201d<\/p>\n\n\n\n<p>Native Americans as a group continue to face disproportionately high rates of chronic diseases. Their median age at death is <a href=\"https:\/\/kffhealthnews.org\/news\/article\/native-americans-shorter-life-spans-health-care\/\">14 years younger<\/a> than that of white Americans.<\/p>\n\n\n\n<p>\u201cReducing access to even just general primary care has a significant impact on those disparities,\u201d Locklear said.<\/p>\n\n\n\n<p>Tribal leaders have said letting the subsidies expire further undermines the federal government\u2019s duty to ensure adequate care for Native Americans.<\/p>\n\n\n\n<p>In exchange for taking tribal land through colonization, the U.S. government made long-standing promises to provide for the health and well-being of tribes. Native Americans are guaranteed free health care at clinics and hospitals operated or funded by the Indian Health Service. But that agency\u2019s chronic underfunding has created massive blackouts in care. It sometimes pays for patients\u2019 outside care through its Purchased\/Referred Care program, but that\u2019s limited too. Due to <a href=\"https:\/\/kffhealthnews.org\/news\/article\/indian-health-service-patients-out-of-network-purchased-referred-care-program\/\">funding shortfalls<\/a>, the agency prioritizes which treatments it will pay for.<\/p>\n\n\n\n<p>To help fill the coverage gaps, some tribal nations have built their own health insurance programs. When tribes pay health premiums, clinics and hospitals in their areas can bill for services that might otherwise go unpaid. Some tribes have leveraged that money to expand services.<\/p>\n\n\n\n<p>\u201cI don\u2019t see tribes getting rid of these programs,\u201d Locklear said. \u201cBut it will drastically shift how much tribes can really put back in their community.\u201d<\/p>\n\n\n\n<p>For example, Tuba City Regional Health Care Corp., in northern Arizona within the Navajo Nation, is unique in providing comprehensive cancer treatment on a reservation, Locklear said. The corporation, he said, estimates its costs to cover patients this year are increasing by roughly 170% to nearly $38,000 per month without the enhanced subsidies.<\/p>\n\n\n\n<p>One of the newer programs is on the Blackfeet reservation in northwestern Montana, where basic health services can be hard to find. Medical visits are often offered on a first-come, first-served basis, and services vanish when staff positions go unfilled, said Lyle Rutherford, a Blackfeet Nation council member.<\/p>\n\n\n\n<p>\u201cSome of it is just getting a regular eye appointment, or a primary care appointment,\u201d Rutherford said.<\/p>\n\n\n\n<p>The tribe has been slowly building its health insurance program since launching it in 2024. Rutherford said the enhanced subsidies made that possible. Fewer than 400 people are enrolled out of an estimated 3,000 who qualify. In January, the tribe paused the employer-sponsored coverage portion of its insurance program, which at the time included 52 people.<\/p>\n\n\n\n<p>He said tribal leaders are seeking extra funding to keep the program afloat, and he hopes Congress finds a solution.<\/p>\n\n\n\n<p><strong>Lives on the Line<\/strong><\/p>\n\n\n\n<p>The impact goes beyond tribes\u2019 insurance programs. The Urban Institute, a Washington, D.C.-based economic and social policy research nonprofit, <a href=\"https:\/\/www.urban.org\/research\/publication\/48-million-people-will-lose-coverage-2026-if-enhanced-premium-tax-credits\">estimates that 125,000 Native Americans<\/a> will become uninsured in 2026 due to the higher costs.<a href=\"https:\/\/www.nihb.org\/wp-content\/uploads\/2025\/12\/NIHB-Letter-to-Congressional-Leadership_EPTC_12.04.2025_FINAL.pdf\"><\/a><\/p>\n\n\n\n<p>Patients at the Oyate Health Center in Rapid City, South Dakota, are already reporting sky-high premium increases for ACA plans. CEO Jerilyn Church said it\u2019s too soon to know how many will forgo coverage. But she said more uninsured patients would further strain the IHS Purchased\/Referred Care program \u2014 with officials raising the bar for how sick patients must be to cover care outside of tribal health sites.<\/p>\n\n\n\n<p>&#8220;There will be people that will not be able to get the care they need,&#8221; Church said, adding that could translate to \u201cpeople losing their lives.&#8221;<\/p>\n\n\n\n<p>Bighorn, the game warden on the Fort Peck Reservation, is among those still covered by the tribes\u2019 insurance program. He has put it to use.<\/p>\n\n\n\n<p>Soon after enrolling, Bighorn needed two hip replacements, surgeries that require off-reservation care and are ranked as low-priority procedures by the Indian Health Service. Bighorn said that in pre-surgery tests, specialists found the cause for his long-standing, dangerously high blood pressure. The diagnosis: untreated lifelong asthma and sleep apnea.<\/p>\n\n\n\n<p>\u201cI was a miserable man, tired all the time,\u201d he said.<\/p>\n\n\n\n<p>Without the tribe\u2019s coverage, Bighorn may have eventually gotten those diagnoses but said it would have likely taken years to get help through the Indian Health Service. That would have meant getting much sicker before receiving care.<\/p>\n\n\n\n<p><em><em>KFF Health News correspondent Arielle Zionts contributed to this report.<\/em><\/em><\/p>\n\n\n\n<p><em>Are you struggling to afford your health insurance? Have you decided to forgo coverage? <\/em><a href=\"https:\/\/kffhealthnews.org\/help-us-report-on-rising-insurance-costs\/\"><em>Click here<\/em><\/a><em> to contact KFF Health News and share your story.<\/em><\/p>\n\n\n","protected":false},"excerpt":{"rendered":"<p>Tribal insurance programs give Native Americans access to affordable health care when the Indian Health Service falls short. Those plans are threatened by the expiration of enhanced Affordable Care Act subsidies.<\/p>\n","protected":false},"featured_media":2152271,"template":"","meta":{"_cr_original_post":"","_cr_replace_post_id":"","_cr_replacing_post_id":"","jetpack_post_was_ever_published":false,"kff_featured_video":0,"kff_show_featured_video":false,"kff_show_mute_audio_button":false,"custom_shortlink":"\/MjE1MTI1Mg","kaiser_health_news_byline_override":"","kaiser_health_news_can_republish":true,"kaiser_health_news_featured_image_caption":"","kaiser_health_news_header_overlay_color":"","kaiser_health_news_header_theme_slug":"","kaiser_health_news_hero_image":0,"kaiser_health_news_backdrop_padding":115,"kaiser_health_news_hide_partner":false,"kaiser_health_news_kicker":"Priced Out","kaiser_health_news_kicker_background_color":"","kaiser_health_news_kicker_text_color":"","kaiser_health_news_kicker_url":"https:\/\/kffhealthnews.org\/priced-out\/","kaiser_health_news_nav_theme_slug":"compact","kaiser_health_news_nav_transparency":false,"kaiser_health_news_sharing_title":"","kaiser_health_news_show_featured_image":true,"kaiser_health_news_subheadline":"","kaiser_health_news_suppress_kicker":false,"kaiser_health_news_suppress_subheadline":false,"kaiser_health_news_update_time":"2026-02-13T15:40:11","kaiser_health_news_vertical_image":0,"kaiser_health_news_title_align_left":false,"kaiser_health_news_custom_header_image":0,"photo_byline":[],"story_update":"<p><em>[<strong>Correction:<\/strong> This article was revised\u00a0at 3:45 p.m. ET on Feb. 13, 2026,\u00a0to correct that the Blackfeet Nation halted\u00a0only the employer-sponsored coverage\u00a0component\u00a0of its tribal insurance program and that average premium increases\u00a0were\u00a0approximately 70%.]<\/em><\/p>","update_position":"bottom","kaiser_syndication_sites":[],"apple_news_api_created_at":"2026-02-11T10:10:52Z","apple_news_api_id":"048f7bc0-5a5e-4a74-8e66-c233a1c70f4d","apple_news_api_modified_at":"2026-02-13T21:14:10Z","apple_news_api_revision":"AAAAAAAAAAAAAAAAAAAAAg==","apple_news_api_share_url":"https:\/\/apple.news\/ABI97wFpeSnSOZsIzoccPTQ","apple_news_cover_media_provider":"image","apple_news_coverimage":0,"apple_news_coverimage_caption":"","apple_news_cover_video_id":0,"apple_news_cover_video_url":"","apple_news_cover_embedwebvideo_url":"","apple_news_is_hidden":"","apple_news_is_paid":"","apple_news_is_preview":"","apple_news_is_sponsored":"","apple_news_maturity_rating":"","apple_news_metadata":"\"\"","apple_news_pullquote":"","apple_news_pullquote_position":"","apple_news_slug":"","apple_news_sections":["https:\/\/news-api.apple.com\/sections\/20265c01-23d7-4d15-96e0-0691b89c3772"],"apple_news_suppress_video_url":false,"apple_news_use_image_component":false,"footnotes":""},"categories":[12498,439525647,439525648,439527200,10314551,31304,36835],"tags":[24592,3837,206783467,303298089,439524171],"primary-topic":[],"partners":[439526681],"funder":[439527044,439528999,439525512,439527043],"coauthors":[439527331,439529013],"class_list":["post-2151252","article","type-article","status-publish","has-post-thumbnail","hentry","category-insurance","category-midwest-bureau","category-mountain-states-bureau","category-race-and-health","category-rural-health","category-states","category-syndicate","tag-arizona","tag-montana","tag-obamacare-plans","tag-south-dakota","tag-trump-administration","partners-the-daily-yonder","funder-headwaters-foundation","funder-helmsley-charitable-trust","funder-missouri-foundation-for-health","funder-montana-healthcare-foundation"],"apple_news_notices":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v25.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>End of Enhanced Obamacare Subsidies Puts Tribal Health Lifeline at Risk - KFF Health News<\/title>\n<meta name=\"description\" content=\"Tribal insurance programs give Native Americans access to affordable health care when the Indian Health Service falls short. 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