The Senate confirmed Mark Cruz (Klamath Tribes) to serve as Director of the Indian Health Service on August 7 by a 51-47 vote. His confirmation ended more than 18 months without a Senate-confirmed IHS Director following the departure of former Director Roselyn Tso in January 2025.

At his June 24 confirmation hearing before the Senate Committee on Indian Affairs, Cruz stated that he intends to advocate “ferociously” for improved health outcomes in Indian Country. The Committee’s hearing page, including Cruz’s testimony, is available here.

Cruz takes over an agency facing enormous unmet needs. Congress appropriated just over $8 billion for IHS for FY2026. By contrast, the National Indian Health Board has estimated that IHS needs approximately $76 billion to fully fund the agency and meet current needs.

Cruz will also retain his position as Senior Advisor on Tribal Health to HHS Secretary RFK, Jr. while serving as IHS Director. Holding both positions simultaneously is unusual given the size and operational responsibilities of IHS, which provides health services to about 2.8 million American Indians and Alaska Natives.

Cruz’ dual role may be particularly important to watch in light of recent changes in IHS public health communications under Secretary Kennedy. ProPublica reported last fall that IHS officials had begun flagging terms including “vaccines” and “immunizations” as risky “buzzwords” requiring additional review by agency public information officers before their use in social media updates, pamphlets, and presentations. Current and former IHS clinicians told ProPublica that the restrictions interfered with their ability to communicate effectively with patients, and one IHS doctor said that the restrictions led to her decision to leave the agency.

The ProPublica report takes on added significance in light of internal CDC emails recently made public by Sen. Bernie Sanders. The emails released in late June of this year don’t concern IHS or Cruz directly, but they document centralized HHS oversight of the CDC’s vaccine communications, including HHS direction about vaccine-related material that had been removed from CDC websites and what content would be put back online. The emails don’t establish that HHS directed the IHS restrictions reported by ProPublica, but they provide important context for Cruz’s unusual dual role, since he was already serving as Secretary Kennedy’s Senior Advisor on Tribal Health before becoming IHS Director and will now serve simultaneously in the Secretary’s office and at the head of IHS. Whether Cruz uses his new position to protect IHS clinicians’ ability to communicate evidence-based public health information is worth watching.