RFK Jr.’s pick to overhaul tribal health at HHS — Mark Cruz in Q&A| STAT
Mark Cruz’s recent appointment as a senior adviser on American Indian health to U.S. Health and Human Services Secretary Robert F. Kennedy Jr. marks a significant step forward in prioritizing Native American health within the federal government. Cruz, a member of the Klamath Tribes from Oregon, is the first person to hold this position, highlighting the administration’s commitment to considering the impacts and opportunities for Native Americans in every decision made at HHS.
In his new role, Cruz will serve as a liaison between tribes and the HHS secretary, working across different agencies within the department to develop a unified strategy on American Indian health. His extensive experience in government, including roles as chief of staff for Congressman Todd Rokita and work at the Department of the Interior on Indian affairs policy and economic development, positions him well to tackle the challenges facing American Indian health care.
One of Cruz’s key priorities is to support tribes in taking over health care services from the Indian Health Service (IHS) through a process known as 638 contracting. This approach, which allows tribes to manage their own tribal health facilities, has been shown to improve the quality and accountability of health care services within Native American communities. Cruz believes that empowering tribes through self-determination is crucial to addressing the longstanding challenges and underfunding issues that have plagued the IHS for decades.
Cruz’s commitment to promoting tribal self-determination aligns with the administration’s emphasis on local control and efficiency in government operations. By allowing tribes to manage their own health care services, Cruz believes that they can better address the unique needs of their communities and deliver more effective and culturally sensitive care. This approach has been successful in other areas, such as Indian education, feeding programs, and law enforcement, where tribal management has led to improved outcomes and accountability.
As Cruz settles into his new role, he acknowledges that there are challenges ahead, including addressing criticisms of the Trump administration’s approach to health care and navigating the complexities of the federal government’s bureaucratic processes. However, he remains optimistic about the opportunities to improve American Indian health care through collaboration, innovation, and a commitment to supporting tribal self-determination. With his expertise and dedication to advancing Native American health, Cruz is poised to make a lasting impact on the health and well-being of American Indian communities across the country. Title: The Evolution of Native Health Care in Chiloquin, Oregon
In my childhood, I used to receive dental care at the Indian Health Service (IHS) facility in Chiloquin, Oregon. Back then, the services were provided out of a double-wide trailer with only a few operating chairs. However, over the years, I have witnessed a remarkable transformation in the quality, consistency, and level of care provided at the clinic. Today, we have a beautiful state-of-the-art clinic that offers a wide range of healthcare services. This improvement is not unique to Chiloquin but has been observed in many tribal areas across the country. Despite the challenges faced by IHS in terms of funding and resources, there have been significant advancements in the delivery of healthcare to Native communities.
One of the major challenges faced by tribally run facilities like the one in Chiloquin is the limited funding provided by IHS. Many facilities rely on Medicaid reimbursements to cover their operational costs, and the recent cuts proposed in the One Big Beautiful Bill Act could further strain their financial resources. While increasing funding for 638 facilities is essential, I believe that we should work within the existing budget and authorities to maximize the impact of the resources available to us.
One area that requires attention is making Medicaid reimbursements more straightforward for 638 facilities. Allowing tribal facilities to receive reimbursements directly from CMS, rather than through states, could streamline the process and ensure timely payments. This policy discussion is worth having, and I am committed to exploring ways to simplify the reimbursement process for tribal healthcare facilities.
In addition to funding and reimbursement issues, there are other priorities in Native health that require attention. Addressing nutrition and access to healthy foods in tribal communities, combating chronic illnesses such as diabetes, heart disease, addiction, and mental health disorders are all critical areas that need to be addressed. As the first senior adviser to the secretary on Indian health, I am dedicated to working with federal agency partners to improve the overall health and well-being of Native communities.
I am honored to have the opportunity to be in this position and to advocate for the health needs of Native communities. Being able to influence budget decisions and policy discussions that impact tribal health is a responsibility that I take seriously. While there may be differing opinions on the current administration’s approach to healthcare, I am committed to providing the best advice possible to the secretary and working towards a healthier future for all Americans.
