Cherokee Nation Outlines Stakes of Federal Health Policy for Tribal Health Systems

Cherokee Staff Report | Cherokee 411

TAHLEQUAH, Okla. — Cherokee Nation health leaders say ongoing federal debates over the Affordable Care Act and related insurance programs could carry significant consequences for tribal health operations and Native patients across the region.

The Cherokee Nation Health Services system, one of the largest tribal health networks in the United States, provides more than 3 million patient services each year across 12 facilities. Care is provided at no cost to citizens of federally recognized tribes who meet eligibility requirements. For eligible patients, the tribe also administers purchased and referred care , commonly known as contract health ,which uses federal funds supplemented by Cherokee Nation business revenues to pay for outside specialty services.

Approximately 75% of Cherokee Nation’s patients have some form of health coverage, including Medicaid, Medicare, Veterans Affairs benefits, private insurance, or plans purchased through the Affordable Care Act marketplace. Tribal officials say this coverage is a key source of “third-party revenue,” which is reinvested entirely into expanding services, hiring staff, and upgrading facilities.

Over the last two decades, third-party billing has become one of the major funding streams supporting Cherokee Nation’s health system, alongside federal appropriations and tribal business revenue. Federal funding, officials note, does not keep pace with population growth or demand for services, while tribal business revenue must be distributed across multiple priorities, including education, housing, government operations, and economic development.

Health insurance, including ACA plans, enables the tribe to bill insurers for covered Native patients as well as for non-Native family members who access care within Cherokee households. Leaders say this billing capacity has played a central role in expanding services and maintaining modern facilities.

Tribal officials also emphasize that many Cherokees , especially those living outside the reservation or away from federal or tribal health facilities , rely entirely on private or government-funded insurance to access basic medical care.

As Congress considers proposals related to the Affordable Care Act, including potential changes to premium tax credits, Medicaid expansion, and provisions of the Indian Health Care Improvement Act, Cherokee Nation leaders say they are monitoring how those decisions may affect Native patients and third-party revenues. Without congressional action, ACA premiums in Eastern Oklahoma are projected to increase sharply in January 2026, which could reduce the number of insured patients and decrease revenue available for tribal health services.

The Cherokee Nation is continuing to evaluate potential impacts from federal legislation and is urging citizens to stay informed as national health policy debates progress.