Mark Cruz to Lead Indian Health Service Amid Staffing and Infrastructure Challenges

The U.S. Senate voted Friday to confirm Mark Cruz as the new director of the Indian Health Service (IHS). Cruz is a citizen of the Klamath Tribes and will lead the federal agency that provides healthcare for about 2.8 million American Indian and Alaska Native patients. The Senate approved him by a vote of 51 to 47. The IHS director position had been empty since late 2025, so this was an important step for Native American communities across the country.

Cruz will serve a four-year term leading the IHS. Before this new role, he worked as a senior advisor on tribal health for Health Secretary Robert F. Kennedy Jr., and he will continue that job at the same time. During President Trump's first administration, Cruz also managed the Office of Indian Energy and Economic Development under the Bureau of Indian Affairs. He brings real-life experience with tribal communities to his new position.

At his confirmation hearing in July, Cruz promised to fight hard for better healthcare in Native American communities. He told the Senate Indian Affairs Committee, 'My family, my friends and my tribal community will live with the consequences of the work I do for decades to come.' He said he would advocate 'ferociously' to improve health outcomes for Native Americans. His personal connection to tribal life is a big part of why supporters believe he is the right person for the job.

The Indian Health Service runs 21 hospitals and 78 smaller health centers across the United States. The federal government is legally required to provide healthcare to Native Americans, which is why the IHS exists. However, many of its buildings are very old — the average facility is about 40 years old. A 2023 government report found that one-third of those buildings are in 'poor' physical condition.

Cruz takes over an agency that faces serious problems. There are not enough doctors and nurses to fill open positions, and there is a 30-year backlog of facilities that need to be replaced. Cruz has promised to fix these issues, protect tribal health programs from government budget problems, and help pay the costs that tribes take on when they manage their own healthcare. These are big goals that will require a lot of work and funding.

Native American organizations welcomed the news of Cruz's confirmation. The National Congress of American Indians said his confirmation comes at a 'critical time' and called on the federal government to honor its promises to tribal nations. The National Indian Health Board also praised the decision. That group estimates it would cost about $73 billion for the IHS to fully meet the healthcare needs of all tribal nations — but for the year 2026, Congress only approved a little over $8 billion for the agency.