Senate confirms Mark Cruz to lead Indian Health Service
Mark Cruz confirmed as IHS director by 51-47 Senate vote, taking over an agency with aging facilities and high provider vacancies.
The U.S. Senate has confirmed Mark Cruz, a citizen of the Klamath Tribes, as director of the Indian Health Service (IHS), the federal agency responsible for healthcare delivery to roughly 2.8 million American Indian and Alaska Native patients. The 51-47 vote on Friday filled a position that had been vacant since late 2025.
Cruz, who will serve a four-year term, appeared before the Senate Indian Affairs Committee in July, where he pledged to advocate "ferociously" for better health outcomes in Indian Country. He emphasized that his personal connection to the communities he will serve shapes his approach: "My family, my friends and my tribal community will live with the consequences of the work I do for decades to come," he told lawmakers.
He arrives at a moment of significant strain for the agency. IHS operates 21 hospitals and 78 smaller health centers, with facilities averaging around 40 years in age. A 2023 Government Accountability Office report found that one-third of these buildings are in "poor" physical condition. The agency also faces persistently high provider vacancy rates and a 30-year backlog of facilities needing replacement.
Cruz has said he will prioritise addressing these infrastructure deficits, work to shield tribal health programmes from federal budget impasses, and cover the overhead costs tribes incur when they manage their own healthcare systems. He will retain his newly created role as senior advisor on tribal health to Health Secretary Robert F. Kennedy Jr. while leading IHS. During the first Trump administration, he directed the Office of Indian Energy and Economic Development under the Bureau of Indian Affairs.
His confirmation drew praise from tribal advocacy groups. The National Congress of American Indians called it a "critical time" for the agency, with executive director Larry Wright Jr. expressing hope for collaboration to ensure the federal government fully meets its trust and treaty obligations. The National Indian Health Board also welcomed the appointment, noting that its latest estimate puts the funding needed for IHS to fully meet tribal healthcare needs at around $73 billion — against a fiscal year 2026 appropriation of just over $8 billion.