IHS Director Nominee Mark Cruz Defends Dual Role as HHS Tribal Affairs Advisor During Senate Confirmation Hearing

Mark Cruz, a citizen of the Klamath Tribes, appeared before the U.S. Senate Committee on Indian Affairs on Wednesday for his confirmation hearing to become the 12th director of the Indian Health Service (IHS).

Rep. Tom Cole (R-Okla.), a citizen of the Chickasaw Nation and chair of the House Appropriations Committee, introduced Cruz to the committee. Cole recalled meeting Cruz while he was teaching at a high school on the Rosebud Indian Reservation in South Dakota. Impressed by his work, Cole later brought Cruz on as a legislative fellow in his congressional office, where they worked together on a number of Native American issues.

“Mark immediately stood out to me, not just for his knowledge and work ethic, but also for genuine care for tribal communities,” Cole said. “I’ve watched him continue to grow as a public servant, and throughout all that growth, he’s maintained respect for tribal sovereignty and a clear understanding of the federal trust responsibility.”

In June 2025, Cruz was named senior advisor to Secretary of Health and Human Services Robert F. Kennedy Jr., becoming one of the highest-ranking Native officials within HHS.

If confirmed, Cruz would serve in dual roles as both IHS director and senior advisor to the HHS secretary.

Senators on the Committee on Indian Affairs questioned Cruz about serving in both positions. Cruz said the dual role would strengthen advocacy for tribal nations rather than create conflicts. He noted that the senior advisor position was only recently created and has improved coordination among the secretary’s office, IHS, and other HHS divisions. If confirmed, he said he would maintain a close working relationship with the HHS secretary while assuming additional management responsibilities at IHS.

He argued that the arrangement would help break down bureaucratic silos within HHS, allowing him to address tribal health issues across multiple operating divisions and participate in budget discussions affecting Indian Country.

“I look at this as a positive and a win for Indian Country,” Cruz said, adding that he would continue to advocate “even more ferociously” for tribal and urban Indian communities.

Cruz said that, if confirmed, he would maintain offices at both the U.S. Department of Health and Human Services in Washington, D.C., and the Indian Health Service headquarters in Rockville, Maryland. He also said his salary would come from the IHS budget.

In his testimony, Cruz told senators that his life story reflects both the challenges and resilience found in many Native communities. A citizen of the Klamath Tribes, a first-generation college graduate, and a former foster child, he described overcoming a difficult childhood marked by family instability, including a father who was deported and a mother who struggled with addiction.

He credited his late grandmother, Barbara “Bunny” Unive, who returned to Klamath after surviving colon cancer to raise him and his siblings, with shaping his future. Raised in the rural community of Klamath Falls, Oregon, Cruz said the values of hard work, honesty, accountability, and family support continue to guide his leadership and vision for the Indian Health Service.

“Life in Indian Country can be extraordinarily difficult. As a former high school teacher on the Rosebud Indian Reservation in South Dakota, I saw firsthand the devastating effects of suicide, substance use, missing and murdered Indigenous people, gangs, economic hardship, and chronic disease,” Cruz testified.

Cruz emphasized that tribes have a seat at the table, political power, and resources, and said tribal nations must be meaningfully consulted on policies that affect them.

“I firmly believe that tribal consultation is a process, not an event. Tribal leaders and Congress can count on me to engage early, listen carefully, and be transparent. I am realistic about the challenges but optimistic about what we can achieve together. With strong federal, tribal, and urban Indian health partners, outcomes will continue to improve,” Cruz testified.

Cruz said that, if confirmed as IHS director, he would focus on strengthening resources and infrastructure to improve healthcare delivery in Native communities.

His priorities include securing advance appropriations and full funding for contract support costs and 105(l) lease agreements, completing the agency’s long-standing facility construction backlog dating to 1993, reducing the roughly 30% workforce vacancy rate, improving the Purchased/Referred Care program, and modernizing the Indian Health Service’s electronic health record systems. He said these investments are essential to expanding access to quality healthcare for Tribal Nations and urban Indian communities.

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