ACA Extension Critical to Addressing Health Disparities in Native American Communities

Native American communities in the United States continue to face significant health disparities, including shorter life expectancy and higher rates of chronic diseases such as diabetes, heart disease, and liver disease compared to the general population. These ongoing health challenges stem from historical underfunding, broken treaties, and systemic neglect of tribal health systems. The Indian Health Service (IHS), responsible for providing healthcare to many Native populations, has long been underfunded, resulting in limited access to specialty care and outdated medical infrastructure. The Affordable Care Act (ACA) has played a crucial role in improving healthcare coverage and access for American Indians and Alaska Natives by reducing the uninsured rate significantly. It also reauthorized the Indian Health Care Improvement Act and enabled Medicaid expansion, which have brought additional funding to tribal health services, allowing improvements in staffing, facilities, and medical equipment. This funding is vital for addressing mental health, substance use disorders, and chronic diseases within these communities. However, the ACA is currently at risk of not being extended, which could reverse years of healthcare progress for Native populations. Without continued ACA support, many tribal members could lose insurance coverage and access to affordable care, exacerbating existing disparities and leading to increased preventable disease and mortality. The potential loss of ACA subsidies threatens tribal health system revenues and the sustainability of essential healthcare services. The National Indian Health Board has emphasized the federal government's trust and treaty obligations to provide healthcare to tribal nations, noting that the expiration of ACA provisions would undermine these commitments. Extending the ACA is framed as a matter of justice and fulfillment of government responsibilities, with the goal of providing culturally competent care and narrowing health disparities. Maintaining and strengthening ACA protections is seen as critical for tribal sovereignty and improving health outcomes in Indigenous communities. Continued support and political will are necessary to address these disparities effectively, ensuring access to quality healthcare services and improving the overall well-being of American Indian and Alaska Native populations.