NIHB is asking for your help by contacting your Senators to urge them to extend the enhanced premium tax credits (EPTCs) and protect access to health care for Tribal communities!
Background
Last week, 17 House Republicans joined with all House Democrats in support of an extension of the enhanced premium tax credits. For that extension to become law, it must also pass in the Senate and be signed into law by the President. On December 31, 2025, the EPTCs that lowered monthly premiums for eligible individuals and made marketplace coverage more affordable expired. This expiration has led to considerably higher premium payments and led many to choose to no longer have insurance coverage.
Concerns for Tribal Communities:
American Indians and Alaska Natives (AI/AN) access the marketplaces for healthcare coverage like all Americans and rely on this coverage to support their access to healthcare both within and through referral by the Indian health system. Without an extension, premiums increased significantly, making coverage unaffordable for an estimated 126,000 AI/AN people, many of whom lost their Marketplace coverage. It is critical for Congress to pass an extension of the Enhanced Premium Tax Credits.
Key Points Highlighted by NIHB in December 2025 Letter to Congress:
- The Indian Health Service relies heavily on billing insurance companies for services provided to patients with coverage, including from Affordable Care Act marketplace insurance plans.
- Approximately 318,000 American Indians and Alaska Natives are enrolled in an ACA marketplace insurance plan utilizing the Enhanced Premium Tax Credits. An estimated 126,000 AI/AN people will lose their Marketplace coverage without an extension of the EPTC because coverage will no longer be affordable.
- It is essential for Congress to enact a straightforward extension of the Enhanced Premium Tax Credits to help the United States fulfill its obligations to Tribal Nations, communities, and citizens.
You Can Still Take Action:
- Identify and Contact Your Senators. Click here to confirm and call or email your state’s Senators to express your support for extending the enhanced premium tax credits and for fully funding the Tribal health system.
a. Send a Letter to Your Representativeb. Call Your Senator.
Here’s a recommended script: Hello, my name is [STATE NAME], and I am a citizen of [TRIBE] and a constituent of [CONGRESSIONAL MEMBER NAME]. I’m calling today to express my concern about the expiration of the enhanced premium tax credits. The Indian Health System relies heavily on third-party revenue, like that collected by marketplace insurance plans, to deliver high quality healthcare services to American Indians and Alaska Natives. The enhanced premium tax credits are a lifeline for our Tribal citizens staying on marketplace insurance plans and accessing healthcare services. Recently, the House passed a bill that would extend the credits, and the Senate needs to take action, too. I urge [Senator XX] to vote to extend the enhanced premium tax credits.
- Share Your Story: NIHB wants to hear from you! If you have a story about the impacts of the expired enhanced premium tax credits, please send to [email protected]. The more examples of impact we have, the easier it is to share your experiences with Congress.
