Senate panel weighs Mark Cruz nomination to lead Indian Health Service

The Senate Committee on Indian Affairs held a confirmation hearing Wednesday for Mark Cruz, nominated to lead the Indian Health Service, with Chair Lisa Murkowski declaring early support before the session concluded.

Cruz, a citizen of the Klamath Tribes of Oregon, currently serves as the first Tribal Senior Advisor to HHS Secretary Robert F. Kennedy Jr. If confirmed, he would oversee health care delivery to approximately 2.8 million American Indians and Alaska Natives.

"I don't usually say it before we've actually gone through the hearing process, but I am looking forward to supporting your nomination," Murkowski said.

Cruz told the committee: "Committee members, I firmly believe that tribal consultation is a process, not an event."

Vice Chair Brian Schatz pressed Cruz on IHS workforce shortages, noting the agency's attrition rate reached a four-year high of 15.3% in 2025, and sought his commitment to addressing root causes including pay scale and housing. Cruz pledged to prioritize patient care if confirmed.

Senators also raised a construction backlog dating to a 1993 facilities list that Cruz said would cost an estimated $8 billion to clear against an annual appropriation of just under $200 million. Electronic health record modernization and sanitation funding were also discussed.

Murkowski pressed Cruz on tribal self-governance and noted plans to introduce the Native Children's Commission Implementation Act with a self-governance pilot focused on SAMHSA programs. Cruz said expanding self-governance beyond IHS would require a congressional fix to existing authority.

The FY 2027 budget proposal for IHS includes an 11% funding increase, continued advanced appropriations, and full funding for contract support costs and 105L lease obligations.

US House Appropriations Committee Chair Tom Cole introduced Cruz at the outset, saying he "builds bridges" and that his commitment to tribal sovereignty is unambiguous. The committee received more than 40 letters from tribes and tribal organizations supporting the nomination. Murkowski said she hopes to move Cruz to a markup as the next step.