Māori health advocates in Taranaki are optimistic they will retain their new power in the public system even if the National wins October's election.
Last year's reforms included a new Māori health authority Te Aka Whai Ora to make the system work better for Māori.
The Pae Ora (Healthy Futures) Act also established Iwi Māori Partnership Boards with decision-making powers at a local level, including jointly signing-off regional plans with Te Whatu Ora - Health New Zealand.
On Tuesday Taranaki's partnership board Te Punanga Ora held its first community hui to discuss how to put the reforms into action.
Recent polls showing National and ACT could form the next government were a big talking point at Aotearoa Pā as both parties say they would scrap Te Aka Whai Ora.
The acting chair and Ngāruahine representative on Te Punanga Ora Linda Elgar said the Pae Ora Act was well-established and the new boards were built into that law as true partners.
"That on its own is a very good defence for keeping the new reforms… because you're going to have to take on 15 Independent Māori Partnership Boards.
"That's going to be a big call for the government. I think we've got enough mana as a collective now to keep on the way we're wanting to go."
She said Te Aka Whai Ora now had 300 employees and thought it was unlikely they would all be fired.
"That would be pretty ruthless and it wouldn't be the right thing for any government to do."
Te Punanga Ora's Ngāti Tama representative Greg White said he was not yet sure the Pae Ora reforms would be effective at fixing a "broken" health system.
"I'm not convinced we are in the position to deliver better services but we may get there the moment we start listening to the whānau voice."
White was a National Party candidate for Te Tai Hauāuru electorate in 2002, and back then criticised fellow party candidates including Don Brash for what he called racist comments.
White said he thought it would be business as usual for Te Punanga Ora, as a National-led government would have few options other than to give partnership boards a fair run.
"I think it will be difficult for another government to change the direction.
"They might be able to slow down the momentum, but I think the fact is that the government can't afford hospitals or the current health system and they've gotta look for other ways of doing things, hopefully better."
The promise of partnership never eventuated under the previous district health board iwi health forum Te Whare Punanga Kōrero so "the proof's going to be in the pudding," White said.
The head of Taranaki's largest Māori health provider said palpable change was happening under the health reforms and she expected it to continue.
Tui Ora's pou tū kūrae Alana Ruakere said the health sector was going through a sea-change.
"Engagement is far more authentic and as providers we are feeling far more empowered to guide our funders in the right things to do for whānau - that's a change of the dynamic relationship."
She said evidence of good outcomes would matter most in defending the reforms.
"People in the health sector are smart, we've been around a while. We work closely with whānau and we will continue that work no matter what happens at a national level."
Te Punanga Ora's Linda Elgar said the Treaty had previously been in health legislation but Māori had never been made real partners in setting health policy and priorities on DHBs.
"It's huge change, huge change… We now have a valid voice at the table, a true voice. Not like we're going to advise or give comment about something but then nothing happens.
"One of the things is that the region's health plan can't be signed off unless iwi sign off alongside Te Whatu Ora - that's one of our statutory duties is to sign off on plans that have been developed for our whānau."
Elgar said by Māori, for Māori success in health would be good for everybody
"It was shown during Covid. Who looked after the people, who looked after the nation? It was Māori, the marae, the kaupapa Māori services - that's just what we do."
Local Democracy Reporting is Public Interest Journalism funded through NZ On Air