Expanded insurance coverage opportunities and healthcare jobs created under the ACA has helped alleviate some of the financial strain on the Indian Health Service, which has struggled with under-funding for years. Now, Republican lawmakers' pledge to repeal and replace the ACA puts those gains at risk, according to NPR.
The expansion of Medicaid is largely credited with improved coverage rates among Native Americans in states that chose to enact that part of President Barack Obama's signature health reform law.
In Montana, the unemployment rate on Native American reservations is at least double that of the rest of the state, according to the report, and many of those with jobs don't receive employer sponsored health insurance.
After Montana expanded Medicaid in 2016, about one in seven people on the Blackfeet reservation were covered by the federal program, while many more residents bought subsidized health insurance on the exchange.
"Now you've got an opportunity for American Indian people to truly have access to private insurance," said Mary Lynn Billy-Old Coyote, Montana's director of American Indian Health, according to the report. "You have access to greater networks of providers and specialists, and all the things we generally don't see."
Medicaid expansion also played a hand in the 3 percent growth in healthcare jobs in Montana last year, and schools, including tribal colleges, have begun offering more healthcare-related courses. With the fate of how the ACA will change under the Trump administration, it is yet to be known what will happen to Medicaid programs in expansion states and the coverage for those who depend on it.