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- The Indian Health Service clinics average 40 years old; about one-third are rated in poor physical condition.
- The agency faces provider vacancy rates and a 30-year backlog of facilities needing replacement, straining care delivery.
- Advocates warn of a major funding gap: the National Indian Health Board estimates $73 billion needed; FY2026 funding just over $8 billion.
ALBUQUERQUE, N.M. — The U.S. Senate voted Friday to confirm Mark Cruz, a citizen of the Klamath Tribes, to lead the federal agency that provides healthcare for some 2.8 million Native American and Alaska Native patients.
Cruz was confirmed to serve a four-year term as director of the Indian Health Service, a position that has sat vacant since late 2025.
At his July confirmation hearing, Cruz said he would advocate “ferociously” to improve health outcomes in Indian Country and bring lived experience to the role.
“My family, my friends and my tribal community will live with the consequences of the work I do for decades to come,” Cruz told the Senate Indian Affairs Committee.
Cruz was confirmed by a 51-47 vote along with more than 70 other nominees of President Donald Trump — one of the Senate’s last actions before taking an August recess.
Cruz is a senior adviser on tribal health to Health Secretary Robert F. Kennedy Jr. and will retain that newly created role while leading the IHS. In Trump’s first administration, Cruz oversaw the Office of Indian Energy and Economic Development under the U.S. Bureau of Indian Affairs.
The IHS operates 21 hospitals and 78 smaller health centers nationwide as part of the federal government’s legal responsibility to provide healthcare for Native Americans. The average age of those facilities is around 40 years old and one-third are in “poor” physical condition, according to a 2023 U.S. Government Accountability Office report.
Cruz assumes leadership of an agency grappling with stubbornly high provider vacancy rates and a 30-year backlog of facilities in need of replacement. He has pledged to address those challenges, better insulate tribal health programs from federal budget impasses and fund overhead costs tribes take on when they manage their own healthcare systems.
In a statement Friday, the National Congress of American Indians said Cruz’s confirmation comes at a “critical time.”
“We congratulate him on his confirmation and look forward to working together to ensure the federal government fully upholds its trust and treaty obligations,” NCAI executive director Larry Wright Jr. said.
The National Indian Health Board also applauded Cruz’s confirmation. By that nonprofit’s most recent estimate, it would take some $73 billion for the IHS to fully meet the healthcare needs of tribal nations. For fiscal year 2026, Congress appropriated just over $8 billion to fund the IHS. ___
This story is published through the Global Indigenous Reporting Network at The Associated Press.
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