Why it Matters

The Indian Health Service (IHS) has operated without a Senate-confirmed director for over a year. That vacancy ends if the Senate confirms Mark Cruz, whose nomination hearing is scheduled for June 24. The timing matters because the agency serving at least 1.9 million American Indians and Alaska Natives is under fiscal and operational siege. Budget cuts have eliminated roughly $60 million in Tribal Opioid Response Grants. The Department of Government Efficiency terminated leases for at least 12 IHS facilities and issued reduction-in-force notices affecting roughly 2,200 workers, though those positions were reinstated the next day. The Indian Health Service warned that DOGE actions could cost the agency some 2,500 employees. Cruz's confirmation would give the agency leadership at a moment when its capacity and mission are under pressure.

The Nominee's Background

President Trump nominated Mark Cruz on June 1 to serve a four-year term as Director of the Indian Health Service. Cruz is a citizen of the Klamath Tribes of Oregon and was born in Salem. He holds a bachelor's degree in political science from Pepperdine University and a master's degree in urban education policy from Brown University.

Cruz has recent federal experience. He was sworn in on June 20, 2025 as Senior Advisor to Department of Health and Human Services Secretary Robert F. Kennedy Jr. His nomination comes as the agency has cycled through leadership disruptions. Former IHS Director Roselyn Tso resigned on Jan. 17, 2025, three days before President Donald Trump's inauguration. IHS Chief of Staff Clayton Fulton formally assumed acting director duties on Dec. 2, 2025.

Political Stakes

The Public

The National Congress of American Indians applauded Cruz's nomination and stated it looked forward to working with him to improve health outcomes for American Indian and Alaska Native communities, prevent chronic diseases, address infrastructure needs, and strengthen the healthcare workforce. The National Council of Urban Indian Health issued a statement supporting his nomination.

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