IndigenousNetwork was able to attend a closed-door policy briefing hosted by American Community Media this week, where several leading healthcare analysts presented an urgent and data-rich update on the pending expiration of enhanced premium tax credits under the Affordable Care Act (ACA). The stakes, they emphasized, go beyond individual policyholders and reach deeply into community health infrastructure, particularly in rural and Indigenous communities already reeling from healthcare disparities.
The enhanced tax credits, which were introduced during the pandemic to shield lower-income Americans from soaring healthcare premiums, are set to expire at the end of the year. This policy shift comes amid a broader government shutdown crisis, leaving millions at risk of losing coverage or facing unaffordable premiums just as open enrollment begins. While this is a national issue, it resonates uniquely with Indigenous communities, many of whom are navigating healthcare systems that already suffer from chronic underfunding and fragmentation.
Anthony Wright, newly appointed Executive Director of Families USA and longtime consumer advocate in California, issued a stark warning: “This is a double whammy. This both increases the cost, and because people don’t have the tax credits to shield them, it will be an even more expensive cost.” Wright pointed to the cascading impact on rural hospitals, many of which serve tribal populations. Without stable coverage rates, these facilities could be forced to scale back services or shut down altogether. “It’s not just about the people losing coverage, it’s about the healthcare system we all rely on,” Wright added.
Jennifer Sullivan, Director of Health Coverage Access at the Center on Budget and Policy Priorities, emphasized the specificity of harm to low-income communities. “People will be out of the game if they have to pay even a dollar. For some folks, a zero-dollar premium is the only way they can access coverage,” Sullivan said. She noted that many tribal citizens living in non-Medicaid expansion states rely on these subsidies to access marketplace plans in the absence of IHS facilities or state-funded programs.
In many Indigenous communities, especially in Alaska, the Dakotas, and the Four Corners region, healthcare is not just a policy issue. It is a survival issue. Tribal citizens often fall through gaps in Medicaid, private insurance, and Indian Health Service networks. The ACA had, for a time, helped bridge those gaps by lowering out-of-pocket costs. According to Sullivan, the withdrawal of these enhanced subsidies would disproportionately impact Native families who have historically had the highest uninsured rates in the country.
Dr. Ashley Kirzinger, Associate Director of Public Opinion and Survey Research at KFF, brought public sentiment into the fold. Her latest polling indicates that although awareness of the tax credit expiration is low, with only four in ten have heard of it. There is overwhelming bipartisan support for their extension. “What the public hates more than the ACA is high healthcare costs,” Kirzinger stated. “Among Republicans, 59 percent support extending the credits. Among MAGA supporters specifically, it’s 57 percent.”
This contradiction between widespread support and lack of awareness was not lost on the panelists. They acknowledged the complexity of healthcare policy and the challenge of breaking through in communities dealing with food insecurity, housing instability, and systemic racism. Indigenous newsrooms have a unique role to play here, not only in translating the policy into local context but in underscoring how federal inaction intersects with generations of healthcare inequality in Indian Country.
The briefing did not focus specifically on Native populations, but the implications were unavoidable. The IHS remains chronically underfunded, often operating at per-capita funding levels far below the national average. In that vacuum, ACA subsidies have become essential tools for coverage and care. Their erosion now threatens to widen already gaping health disparities.
In closing remarks, all speakers returned to one theme: this is not an unavoidable crisis. It is a policy choice. And like all policy choices, it is reversible. “The expiration of these enhanced tax credits,” Kirzinger said, “is not inevitable. But the damage, if allowed to proceed, will be.”
For Indigenous communities, already weathering a web of underfunded systems and political marginalization, the stakes of that damage are life and death. Whether Congress acts in time remains to be seen, but the call to elevate this issue, especially in tribal media, is clear.
RESOURCES:
Paper: Five Key Changes to ACA Marketplaces Amid Uncertainty Over Premium Tax Credit Enhancements
Map with audio clips from current marketplace enrollees: Marketplace Enrollees Rely on Enhanced Premium Tax Credits for Affordable Health Coverage
Blog on $0 premiums: https://www.cbpp.org/blog/people-with-low-incomes-may-lose-0-premium-plans-a-lifeline-unless-congress-acts
