"There's a huge gap in access to services, so being enrolled in the marketplace is going to make a big difference in terms of accessibility to healthcare," Church said.
The Indian Health Service, a branch of the U.S. Department of Health and Human Services, provides free healthcare to enrolled members of tribes, their descendants and some others as part of the government's treaty obligations to Indian tribes dating back nearly a century.
Critics long have complained of insufficient financial support that has led to constant turnover among doctors and nurses, understaffed hospitals, sparse specialty care and long waits to see a doctor.
The Great Plains Tribal Chairmen's Health Board received $264,000 in South Dakota and $186,000 in North Dakota to assist with Native American signups on the states' reservations and urban areas.
The new law healthcare law will especially benefit people who seek treatment at urban Indian health clinics, which collectively are funded by just 1 percent of the IHS budget, said Ashley Tuomi, executive director of the American Indian Health and Family Services clinic in Detroit.
"Our resources are extremely limited, even more so than the tribes," Tuomi said. "What we have within our walls is what we can offer for free."
The clinic has seen a lot of patient interest in the healthcare marketplace, but "navigators" helping with signups have had to cancel many appointments because of continued issues with the federal healthcare.gov website, Tuomi said.
The Ponca Tribe of Nebraska has received about $38,000 in federal grant funds to encourage signups for tribal members scattered in 12 counties in Nebraska, two in Iowa and one in South Dakota.
The tribe's IHS-contracted clinic in Omaha, Neb., has a medical doctor and two nurse practitioners, but the X-rays, specialists and prescriptions that are outsourced are not covered, said Jan Henderson, the tribe's navigator project director. "And if they don't have insurance, they have to pay for it themselves," she said.
Tribes across the country get some federal money for referrals, but the small pools run out quickly, Henderson said.
She views the new healthcare law as a great step for Native Americans, but the greatest challenge is educating tribal members who are weary from decades of promises of improved healthcare.
"Education is very important in this right now to get people to be open to actually hearing about it," Henderson said. "We hear a lot of people who say they don't need this, they don't want this."