The U.S. Senate confirmed Mark Cruz as director of the Indian Health Service in a 51-47 vote on Friday, ending a vacancy in the position that has existed since late 2025. Cruz, a citizen of the Klamath Tribes, will serve a four-year term leading the federal agency responsible for healthcare delivery to approximately 2.8 million Native American and Alaska Native patients.
Cruz’s confirmation occurred as part of a broader set of actions involving more than 70 other nominees of President Donald Trump, with the vote taking place before the Senate’s August recess. In his July confirmation hearing before the Senate Indian Affairs Committee, Cruz stated he would work to improve health outcomes in what he described as Indian Country and bring firsthand experience to the leadership role. He emphasized the personal stakes involved, noting that his family, friends, and tribal community would experience the long-term effects of his work.
Prior to his confirmation, Cruz served as a senior adviser on tribal health to Health Secretary Robert F. Kennedy Jr., a position he will retain while leading the IHS. During Trump’s earlier administration, he held the position of overseeing the Office of Indian Energy and Economic Development within the U.S. Bureau of Indian Affairs. The IHS operates 21 hospitals and 78 health centers across the nation as part of the federal government’s legal obligation to provide healthcare services to Native Americans.
The agency Cruz now leads faces significant operational challenges. According to a 2023 Government Accountability Office report, the average age of IHS facilities stands at approximately 40 years, with roughly one-third in poor physical condition. The agency contends with sustained provider vacancies and a 30-year backlog of facilities requiring replacement. Cruz has pledged to address these infrastructure and staffing issues while working to shield tribal health programs from federal budget disruptions and provide funding for administrative costs that tribes assume when operating their own healthcare systems.
Native American advocacy organizations responded positively to the confirmation. The National Congress of American Indians characterized the timing as critical and expressed commitment to working with Cruz to ensure the federal government meets its trust and treaty responsibilities. The National Indian Health Board similarly welcomed his confirmation, noting that its estimates indicate approximately $73 billion would be required for the IHS to fully address tribal healthcare needs, though Congress appropriated just over $8 billion for the agency in fiscal year 2026.
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