A National-led government would demote the Māori partnership boards which currently have a deciding say over regional health plans.
Iwi-Māori partnership boards were set up under last year's health reforms and Te Whatu Ora (Health NZ) cannot sign off local health plans without their agreement.
National health spokesperson Dr Shane Reti said the partnership boards would lose that veto power and be relegated to the same level as any other health group, if his party won the election.
"An iwi-Māori partnership board will be collaborative at the provider level along with every other major stakeholder.
"That includes hospitals, that includes all of the NGOs, every major provider of community care - iwi-Māori partnership boards will be right at that level."
Last month some members of Taranaki's partnership board Te Punanga Ora were optimistic they would retain their new powers under National.
Te Punanga Ora's Ngāruahine representative and acting chair Linda Earl expected partnership boards would be protected by their legal status under the Pae Ora (Healthy Futures) Act.
"That on its own is a very good defence... 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."
Ngāti Tama's representative on Te Punanga Ora Greg White thought it would be business as usual as a National-led government would have to give partnership boards a fair run.
"I think it will be difficult for another government to change the direction."
But Labour's Māori health spokesperson Peeni Henare warned that the newly-enhanced say for Māori "is seriously at risk".
"We knew that the Pae Ora legislation would be the strongest way to protect the kaupapa but that doesn't mean it can't be changed at the whim of a National-led government.
"All it takes is a majority in Parliament - and Act and National have both said this kaupapa our people have fought so hard for [would be] gone."
On its website the Māori health authority Te Aka Whai Ora says iwi-Māori partnership boards have "decision making roles at a local level, and jointly agree local priorities and delivery with Te Whatu Ora."
Their role was set in law "to ensure Māori governance in the determination of health priorities for iwi and Māori locally."
Reti claimed National would offer the partnership boards "more autonomy and decision-making [power]" but that would not include a governance role.
"Primary health organisations, iwi-Māori partnership boards, pharmacy, allied health, NGOs, laboratory, radiology, the social determinants of health (so education employment and housing) they would all be side-by-side in provision of community health care."
Iwi partnership boards might get a single seat at the table at a regional level, he said, but National hadn't yet decided on its preferred regional structure.
Last year's Pae Ora Act set up the independent Te Aka Whai Ora to work in parallel with the Ministry of Health and Te Whatu Ora to improve outcomes for Māori.
This year's budget included $168m for Te Aka Whai Ora to spend directly on health services.
Marked disparities in Māori health have persisted for over 100 years under the previous single health authority system.
A Māori pēpi born today is expected to die 7.5 years earlier than a non-Māori with the same birthday.
National says it will scrap Te Aka Whai Ora and replace it with a Māori health directorate within the health ministry.
Potential coalition partner and ACT leader David Seymour has also promised to abolish Te Aka Whai Ora, calling it an example of racial discrimination.
Local Democracy Reporting is Public Interest Journalism funded through NZ On Air