I read a proposal on Slate to set up low cost health clinics on reservations, though they suggested employing foreign born Indians as doctors.
But doctors setting up clinics on reservations would provide local jobs, care and legal protection from Obamacare.
The classic respone I’ve seen is that doctors who do this and are not affiliated with an insurance practice lose their admitting priveledges at the hospital/s in the area. The hospital boards either buy out the clinic to close it or the doctor goes back to taking insurance in order to retain admitting priveledges.