The federal sequestration has bore down hard on the Indian Health Service, but now Indian health providers are angling to use the Affordable Care Act to expand access to private health insurers through Cover Oregon and help these beleaguered providers remain solvent.

Healthcare has been a right guaranteed to Indian tribes since the federal government took away most of their land in the 19th century. But the Indian Health Service, set up to provide for them, has been chronically under-funded, often only able to cover basic and emergency care.

The deep and capricious cuts of federal sequestration, which President Obama signed in August 2011 to avoid the House Republicans’ threat of a default on the country’s debt obligations, has further devastated the system. While Medicare and Medicaid have been exempt from the budget cuts that took effect in March 2013, the Indian Health Service has not.

In Oregon, it’s been a $15 million loss, out of a budget of about $290 million, forcing some tribes to reduce service hours, pare back non-essential care and cut employees, according to Jim Roberts of the Northwest-Portland Area Indian Health Board. “For some of our tribes … you don’t receive care unless you have a life or limb test of services.”