Nomination Hearing for Cruz as Indian Health Service Director

Good morning. The committee will come to order. It's uh my pleasure this morning to be able to welcome to the committee, uh, Mister Mark Cruz, the nominee to be the Director for the Indian Health Service at the Department of Health and and Human Services. Um, we are we're graced this morning in our committee room to have a a leader uh and a colleague from the house join us, the chairman of the Appropriations Committee, the Honorable Tom Cole and and and uh Chairman, I know that you have a very busy morning over there. Uh ordinarily the the uh Vice Chair and I would give our opening comments, but I think I would like to defer to you this morning as a as a courtesy for time, um for your introduction for for Mister Cruz if you would like.

Well, thank you very much Madam Chair. That's incredibly gracious and I'm

We're gracious on this.

very it is very gracious of you. And uh very, very um uh pleased to accept that generous offer and I'll deliver my remarks. If it's okay with your permission, then I'll exit the room so I can get to my mark-up. But thank you again.

We respect that, yeah.

Thanks for your consideration. Mister Vice-Chair, it's good to see you again as well. Um, good morning to everyone. I'm very proud to be here to introduce my friend Mark Cruz, who's been nominated to serve as the Director of the Indian Health Service. But first, I want to extend my thanks to President Trump and Secretary Kennedy, for this nomination and for instilling such a focus on tribal health issues. Uh, Mark's nomination reflects the administration's continued commitment to strengthening the federal government's relationship with our tribal nations and ensuring that native communities have strong leadership at the helm of their primary health institution. On top of that, I want to recognize the broader work that Secretary Kennedy's department has undertaken to strengthen the IHS and improve outcomes across Indian country. Uh, HHS has made real progress on investments and expanding access to care. Not to mention just last week they convened the first White House Council on American Indian Affairs meeting. This work matters, and today's nomination of Mark Cruz continues that momentum. On a personal note, I've known Mark for many, many years, uh, and it's been amazing to watch his professional journey and his unwavering commitment to serving tribes across this nation. Mark and I first met in the summer of two thousand eleven during one of my Codells to South Dakota which focused on tribal relations. Mark was teaching at a high school on the Rosebud Indian reservation at that time. Even at our first meeting, Mark immediately stood out to me, not just for his knowledge and work ethic, but also for his genuine respect and care for tribal communities. Later that year, on December two thousand eleven, we reconnected at the White House Council on Native American Affairs Tribal Leader Summit at the Department of the Interior. Following that meeting, Mark joined my office as a legislative fellow, focusing on tribal policy and funding issues. During his time on my staff and throughout his congressional career, we had the opportunity to work closely together on a number of different Native American issues. Among them were the passing of the Tribal Labor Sovereignty Act in the House, and improvements uh to tribal educa- the tribal education system. Our advancements on these issues gave me the a front row seat to mark steadfast leadership and dedication he listens he's talented at relationship building, he asks questions, he is knowledgeable, and most important of all, he never lost sight of who the work was for, our tribal communities. Those experiences, along with many others throughout the years, gave me confidence early on that Mark was a leader. Since then, 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's responsibility. The director of Indian Health Service is an important job. It requires someone who can lead and navigate challenges, while at the same time keep Native Americans at the center of every decision. At a time when improving tribal health outcomes in Indian countries remains both an urgent challenge and a shared responsibility, I know Mark will rise to that challenge. So today, if you take uh one thing out of my remarks, let it be this. I support Mark's nomination and I can confidently say there is no one better suited for this role. He's a leader, he builds bridges, and he works across the aisle. He knows that Native American issues and are genuinely bipartisan and in most ways nonpartisan. You either believe in tribal sovereignty or you do not. And you either understand the trust responsibility of the United States or you do not. Mark understands both. As a member of the Chickasaw Nation, I know firsthand how important it is to have tribal representation here in Washington, D. C. And it's an honor and a privilege to be one of those strong voices for our tribal nations myself. I know Mark is also up to this task as a member of the uh Klamath tribes himself. His upbringing and experience will give him an insight into this role that very few have. If he is confirmed as the head of the IHS, Indian country will be in good hands. I'm so proud of Mark for how far he has come since those days when I first met and began to wor- and uh we began to work together and I'm grateful for his dedication to tribes public service. I have every confidence that Mark will be successful in this role as IHS Director, and that under his leadership, the Indian Health Service will continue advancing its missions and improving health outcomes for tribal nations and Native Americans across the country. I encourage you to move forward with this swift confirmation of Mark Cruz. He will never let you or Indian country down. Thank you, Madam Chair.

Thank you, uh, Chairman Cole. Thank you. I'm sure that, uh, uh, Mr. Cruz appreciates those words, very kind. Um, I want to show my appreciation and just extend my thanks, uh, for all of the work that you have done for Indian country. Your leadership in the house over the decades in this area has been, um, extraordinary. And as the Chairman of the Interior Appropriations Committee, where we work on these budgets, uh, I know that Indian country and, uh, Native people across America have, uh, a good strong leader and support over there. So we appreciate your words on behalf of this nominee and - and again your good work over on the House side.

That's very kind of you, Madam Chair. Thank you very much. And I won't leave till I'm excused. I know whose house I'm in.

You may be excused and, uh,

Thank you very much, Madam Chair.

any time. Thank you.

Mister Vice-Chair, thank you and thank you.

Good luck over there this morning.

Thank you.

Thank you so much.

Very much appreciated. Good luck.

Well, we shall start our our hearing then. Uh, again, we're considering the nomination of Mark Cruz to serve as the Director of Indian Health Service at the Department of Health and Human Services. President Trump nominated Mister Cruz for this position on June first of twenty twenty six. Uh, Mister Cruz, it's great to be able to welcome you to the committee and and I offer my congratulations on your nomination and my thanks for your willingness to step into this position I appreciated the opportunity that we had yesterday for the discussion um you made a couple points yesterday that I felt were um really compelling and are are worth repeating here today because I think that they demonstrate a very clear understanding of the role that you have been nominated for and and the responsibilities. First you said tribal consultation is a process, not an event. Think about that, how important it is because so much of the time around here tribal consultation is just kind of a check the box exercise. We meet for one meeting and boom, we move on to something else. But you say tribal consultation is a process and I could not agree more. Meaningful uh consultation requires ongoing engagement, trust and accountability, and you're certainly going to be doing a lot of it as director if you are confirmed. Uh, you also noted that HHS is a federal department that touches the lives of Native people from birth to death. And this observation reflects both the scope of the department's responsibilities, but also the importance of just getting it right.

Mm-hmm.

You've got a full spectrum here. The director of IHS is the most senior senate confirmed official at HHS, charged with carrying out the federal trust responsibility and advancing the agency's mission of improving health outcomes and addressing long-standing disparities that face uh American Indians and Alaska Natives and if confirmed, you will oversee health care services delivered through federal federally operated facilities, support tribal health programs operating under self-determination and self-governance authorities, and work with urban Indian organizations provide critical services to Native people living in urban communities. You'll also be called upon to understand the unique challenges facing Native communities and to help develop practical solutions that improve access to care and health outcomes. And while you do not come from the career ranks of IHS, your experience gives you a strong foundation for this position. Your lived experience in Native communities, your service as First Tribal Senior Advisor to Sen- Secretary Kennedy and your previous work at the Department of Interior as Deputy Assistant Secretary for Indian Affairs have provided you with valuable perspective and experience. I also recognize your role in advancing uh the President's FY twenty-seven budget proposal for IHS uh which includes an eleven percent increase in funding uh continued advanced appropriations and full funding for contract support costs and uh, one O five L lease obligations. You noted that the budget submission reflected partnership and consultation with tribes. I think this is really important for every agency that fulfills the Federal Trust's responsibility. The committee has received more than forty letters from tribes and tribal organizations that support your nomination and those letters will be included in the hearing record I've also heard myself from tribal leaders in Alaska, who have spoken highly of your understanding of the unique legal and policy framework that governs native health care and tribal programs. So, Mister Cruz, I - I - I don't usually say it before we've actually gone through the hearing process but I am looking forward to supporting your nomination and - and working with the Vice Chairman and our colleagues uh to move your nomination through the committee. IHS needs a confirmed director. You know there's a lot of work ahead of you. Uh, we continue to face significant challenges, including workforce shortages, behavioral needs, aging health facilities, and ensuring that tribal self-determination remains at the center of federal Indian health policy. And these are, these are issues that, that not only require, um, sustained attention, but real partnership throughout it all. So, looking forward to hearing more from you this morning about your vision for IHS and your priorities. Um, I anticipate that members will have additional questions for the record and I will look forward to your responses to those as well. So again, thank you for being here. Congratulations on the nomination. And I will now turn to the Vice Chair, uh, Senator Schatz, for his comments.

Thank you, Chair Murkowski, and thank you to the nominee and his family for being here. If confirmed as the director of IHS, Mister Cruz will manage a multi-billion dollar budget and approximately fifteen thousand federal employees. He will also be the most senior Senate confirmed executive charged with carrying out the agency's mission and will be expected by statute and tradition to fulfill the federal government's trust and treaty obligations to provide health services to American Indians and Alaska Natives and improve their health outcomes. At a time when IHS faces persistent workforce shortages, aging infrastructure and ongoing concerns about service delivery, this committee has a responsibility to carefully examine whether any nominee is prepared to meet the demands of this position from day one. This responsibility takes on added significance as tribal nations navigate proposed changes across the federal government including actions that may affect the delivery of trust and treaty obligations that are often happening without meaningful tribal consultation. So in today's hearing I look forward to hearing how Mister Cruz, if confirmed, plans to strengthen the quality and access to health care services for American Indians and Alaska Natives, improves operations and addresses challenges facing IHS, especially the workforce shortage. These duties are critical no matter which party is in the White House, and so today's hearing is an opportunity for Mr. Cruz to demonstrate his commitment to serving native communities and his readiness to provide leadership, expertise, and the advocacy necessary to uphold the federal trust responsibility. I thank the chair for convening this hearing and I look forward to hearing from Mr. Cruz.

Thank you, Vice Chair. Uh, Mister Cruz, the the rules of our committee require that, uh, all nominees be sworn in connection to their testimony, so we will now swear you in before you testify. I would ask you to to rise and raise your your right hand. Do you solemnly swear that the testimony you are about to give to the Senate Committee on Indian Affairs shall be the truth the whole truth, and nothing but the truth?

I do.

You may be seated. Now before you begin your statement, I will ask you three questions that I uh address to each nominee that comes before this committee. First, will you be available to appear before this committee and other congressional committees to represent departmental positions and respond to issues of concern to the Congress?

Yes, Chair.

Are you aware of any personal holdings, investments or interests that could constitute a conflict or create an appearance of such a conflict, should you be confirmed and assumed the office to which you have been nominated by the president.

No, chair.

Are you involved or do you have any assets held in blind trust?

No.

Very good. So, Mister Cruz, um, again, we're pleased that you are before the committee here today. Uh, I would ask you to proceed with your testimony. We do have, uh, your full written testimony, uh, that each of the members have. Um, so however you would like to, uh, uh, truncate that, uh, or expand on that, we appreciate it.

Absolutely.

And if you have any friends or family that you would like to have recognized, we also, uh, welcome that as well. So you may begin.

Great. Great. Uh, while Kleecy, Chair Murkowski, Vice Chair Schatz, and distinguished members of the Senate Committee on Indian Affairs, I'm Mark Cruz. I'm deeply honored, as are my family, the Klamath tribes and my fellow Oregonians, that President Trump has nominated me to serve as the twelfth director of the Indian Health Service. My life has been profoundly shaped by people who took a chance on me. Growing up in a rural community, I am forever grateful to the families who opened their homes, gave me rides to games, or made sure I had a meal. In that same spirit, I'd like to make a few acknowledgements. First, I want to thank Chairman Tom Cole for his generous introduction. He gave me an opportunity right out of grad school. and has been a constant source of advice, counsel, and support throughout my career. Second, I wanna thank my brother Cougar for being here today, and recognize my sister Shawnee, who couldn't join us. I also honor my late brothers Cody and Victor, um who remain in my heart. Um, I wanna give a heartfelt thank you to the many friends that I have here in the room. Many from my hometown of Klamath Falls, Oregon. Um, and my tribal delegation, Chairman Ray. Angie Wilson, who runs our health, and Councilman Jackson. And my best friends, Kyle and Blake. Also wanna recognize the BIA director who's joined us here today, a good fellow friend in Oregonian. And I wanna thank the people who have sent prayers both traditionally and by text message, they both count. I appear before you today humbled and grateful. Ready to share my story and my vision for the Indian Health Service. As a proud citizen of the Klamath tribes, a first generation college student, and a former foster child. As a, as is far too often, I come from a broken home. I'm the son of a deported drug dealer and a lifelong addict. I'm also the grandson of Barbara Unive, who after overcoming colon cancer at the Santa Fe Indian Hospital, and leaving a comfortable life in Dixon, New Mexico, she returned to Klamath to raise me and my siblings. Her love and sacrifice made everything that followed possible. In some places it takes a village to raise a child, in Indian country it often takes an auntie or a grandmother. For more than a year, I have served as senior advisor to HHS secretary Robert F. Kennedy, junior. I thank the secretary for creating position in response to tribal leaders' requests and for entrusting me with that role. I work closely with department colleagues, tribes, and advisory committees to address the variety of issues that come before the department. That also means going to your state, such as Alaska and New Mexico and Oklahoma and North and South Dakota, amongst others, where I coordinate and collaborate with other federal agency leaders to address issues brought forth by tribal communities and promote health care affordability and improve nutrition in Indian country. If confirmed, I am committed to continued rigorous engagement and follow-up. Life in Indian country can be extraordinarily difficult. As a former high school teacher on the Rosebud reservation, I saw firsthand the devastating effects of suicide, substance abuse, missing and murdered Indigenous people, gangs, economic hardship, and chronic disease. While these challenges persist, I have also witnessed the extraordinary dedication of health care providers, teachers, and law enforcement officers, both Native and non-native, who walk into our communities every day and work tirelessly to empower the next generation. Last summer, I visited the Rosebud Hospital. While I saw the real challenges with workforce, facilities, Management. My spirit was lifted when I heard someone call out, " Mister Cruz." It was one of my former students from St. Francis, who is now working the front desk, twelve years later. In that moment, I was powerfully reminded why I'm called into this work. Committee members, I firmly believe that tribal consultation is a process, not an event. Tribal leaders in 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. We see this in the work to return traditional first foods, the secretary's work to address the chronic disease epidemic, work in the special diabetes program, amongst many others. If current confirmed as director, what I will bring is direct lived experience and the communities and systems I would oversee, my family, my friends, and my tribal community will live with the consequences of that work I do for decades to come. I would welcome that challenge and I'd be honored by the opportunity. Thank you for the consideration of my nomination. Sabkatsha.

Thank you. Thank you, Mr. Cruz. Um, we will now begin a r- a round of questions. Um, I am going to ask consent to include in the hearing record the letters of support that we have received from Mister Cruz's nomination uh so they will be included um let me ask first about the dual role um that you will be um uh taking on you're gonna continue to serve as Secretary Kennedy's Senior Advisor for Indian Health while also leading IHS obviously both roles are are critically important Um, IHS is central to fulfilling the federal government's trust responsibility to provide the the health care to American Indians and Alaska Native, but many issues that impact, uh, tribal communities extend well beyond IHS and across HHS. We were talking about them just yesterday. It's everything from from Head Start, it's LIHEAP, that's some of the domestic violence, um, programs, uh, child welfare, homelessness. There's so many other areas. Um, Now, HHS is, um, um, I was gonna say undergoing, but they are, um, uh, they have announced a pretty major reorganization. Uh, we held an oversight hearing here in the committee to ensure the federal trust responsibility and the tribal programs were protected throughout any restructuring um but one of the things that we heard very clearly at that hearing was that tribes need strong advocates. within the department who understand how decisions across HHS impact our native communities. So, can you just speak to, uh, first of all, this dual-hatted, uh, responsibility that you - you have, but also, um, how you will elevate tribal issues across the entire department, and as there are discussions about organizational changes within HHH, it's HHS itself, how we ensure that not only it's meaningful tribal consultation, but protecting these programs that serve uh native communities. So often it doesn't the the programs themselves don't have uh tribal in the title, but again the impact to um to our native families is quite considerable. Can you speak to these issues? Thank you.

Yeah, thank you, chair. Uh, first to um th- your question about the dual role. Um, the secretary created this senior advisor position, and I'm the first such to do this job. And so we're still figuring out a lot. But as you mentioned, there's a lot of work in of tribal affairs in the different operating divisions. Uh, a piece of my work in that role has also been to work closely with uh the Indian Health Service. Thankfully we have a couple of political appointees there. Um you know one of my hiring philosophies is to hire people smarter than myself, so we have Doctor Hartwig, uh a experienced family provider, and Clayton Fulton, a lawyer, uh who are helping within Indian Health Service. If confirmed, I would look forward to closely working with them um and taking on some more of those management responsibilities. that the IHS director is responsible for. But what's surprising to me is that it's taken so long for that senior advisor position to be uh created. But it's also surprising to hear that the IHS director hadn't had a meaningful role with the secretary prior to this senior advisor role being created. So in a way, if confirmed, I would have I would be dual hatting, but I would essentially be uh preserving that close relationship with the secretary. And as we manage within the department, that is just a critical relationship to have because we do hear about a number of issues from tribal leaders and tribal health departments and our urban partners about issues that are occurring in different operating divisions. And in my current capacity, I get to troubleshoot that. um in a future capacity as director um again if confirmed, uh I would continue to do those things and advocate even more ferociously for the equities of our tribal partners and our urban Indian partners, so I see them as very complimentary. Um the IHS director is an important advocate for Indian country within the department, and I think that both are achievable and they're not mutually exclusive. And the final point is, I also hear all the time about the silos that HHS has artificially created. We get it in QFRs, we've seen it in GAO reports. The beauty of this role would be to be able to navigate between OpDiv and OpDiv and be a part of budget formulation conversations in ACF, in other operating divisions. And so I look at this as a a positive and a win for Indian country.

Well It is a challenge and it's one that I hope every morning you wake up and you think, how am I going to reinforce the tribal provi uh priorities at all these levels within a massive department where most of the people around you are not focused

Mm-hmm.

on the needs of Indian country.

Yep.

And so for you to be that advocate within the department and continuing this role as senior advisor, I do think is important. I think it's pretty telling, um, uh, that you note that there has been, um, somewhat of a disconnect, I'll just phrase it that way, between the IHS director and, um, and the department itself and, and the secretary's office. And maybe that's why we have, we have struggled, um, uh, sometimes over the years with a,

Mm.

um, just a lack of of connectivity there. So we're putting a lot on your shoulders here. Um, but, uh, uh, making sure that you are first and foremost thinking about, uh, tribal, um, tribal interests and, uh, the interests of Native Americans, Alaska Natives and Native Hawaiians every day is is where we want you to focus.

Absolutely. Absolutely.

Vice Chairman.

Thank you, uh, Mister Cruz, um, thank you for being willing to serve and thank you for the conversation yesterday. We we talked a little bit about the IHS uh s staffing problems and under

Mm-hmm.

the current administration, IHS's attrition rate re reached a four year high, fifteen point three percent in twenty twenty five. Um, you know what this does to service delivery. Um. We talked yesterday about housing, about pay scale, about Indian preference in hiring. Um. But in the in the written correspondence, you you tended to focus a little bit more on Indian preference in hiring than the other things. And I told you I was open to modifications if they were a real impediment. I just don't want them to be the scapegoat. It seems to me that if you're being asked to hire to to look first at a tribal member,

Yeah.

that's sort of intuitive anyway, because it's hard to keep people in these jobs in health care. And to the extent that they belong to those communities, they tend to stick around. And so it's just a smarter investment. But nobody's prohibited from hiring someone who is not a tribal member. Um. And so I I just wanted to put a fine point on what do you actually think the problem is with the IHS staffing shortfalls.

Yeah. Uh, thank you, Vice Chairman. Um, as I noted, this has been a long persistent challenge of the Indian Health Service. And in my current capacity as Senior Advisor, I've worked with the Indian Health Service team to understand why for decades we've heard of this vacancy rate fluctuate. And we can and, you know, GAOs look uh, you know, independent observers have looked at this. And as we noted, it's a number of factors, um, housing opportunities, education opportunities, a variety of factors. But when I really push back, like those are well documented again for a l for a while. But then I see my six thirty eight tribal partners who also have a duty to hire and provide direct services. Why are th th why is their vacancy not thirty percent? So that's where I wanna look to uh their expertise, their experience, and then ultimately their flexibilities that IHS i isn't subject to. So. The more we can bring authorities and flexibilities to IHS to and this long time vacancy rate, the better. And if it's a matter of our hiring managers, um, you know, being overly cautious, like, I wanna understand why and where that comes from.

Yeah, the other thing is under six thirty eight you can you can do different things, right? You the pay scale's different.

Yeah. Yep.

That's probably the main thing, like intuitively if you're trying to fill a job, the more you pay, the more applicants you're gonna get.

Absolutely.

And so the six thirty eight That authority is to me probably the dispositive one. Um, they can hire J one visas and they can provide additional benefits. And so, um, the reason I care so much about this is frankly twofold. One is like this is the problem, right? You can't run any healthcare delivery service with a fifteen percent attrition rate. And so it's extremely important that we actually identify the rate limiting factors and not the potential scapegoats.

Mm-hmm. Mm-hmm.

And one of the things this committee has been very good about doing is sort of whatever disagreements Democrats and Republicans have, or may have had in the past, or continue to have regarding DEI and all of that, we sort of hold harmless what we're up to because of trust in treaty obligations. And so I was a little worried that it was like it's preferences and hiring, and then we're down a road where there's a whole sort of swarm of internet trolls on both sides of this equation, and we're not like figuring out what's the damn problem.

Yep.

Seems to me, if you're talking about flexibilities, it's not necessarily that six thirty eight has unique flexibilities on hiring preferences, but just they can pay more, provide more benefits, and hire different people. And so I just want your commitment to attack this problem, um, as if I didn't know which political party you belonged to, cuz I, that's my expectation for you as IHS director.

Thank you, Vice Chair. Uh. you have my commitment to work with you on it, like a long-standing problem that I wanna get after, and I wanna just be honest about the situation. And at the end of the day, my priority, if confirmed as director, is patient care. I'm tired of visiting facilities where they've had double-digit vacancy rates and I really wanna work closely with my team. I've been a fierce advocate internally for hiring exemptions and put together a robust twenty twenty six hiring plan, so This is gonna take time. We didn't arrive here in eighteen months, and it's gonna take a a a concerted group collaborative effort to get out of it. So I look forward to working with you and your team.

Thank you.

One final question. Do do we have your commitment to be responsive personally if any member of the Indian Affairs Committee has any question will you call them back within a reasonable time frame?

Yes, Vice Chairman.

Thank you.

Thank you. Senator Smith.

Uh, thank you, Chair and Vice-Chair, and welcome to the committee, Mister Cruz, and thank you for our conversation last week. It was very helpful to me. Um, so here's what I'm wrestling with. You clearly have an understanding, a firm understanding of the federal government's, uh, trust and treaty obligations to tribal nations and to Native people. And you have the support of tribal leaders in Minnesota, which is, of course, very important to me. Um, yet you also have served as senior advisor to senator, to uh, secretary Kennedy during a time of great tumult in the department. Um, this administration has gutted public health, health research, mental health programs, um, which in my view has caused real harm to Native communities, um, even if IHS was spared. And as you have said, um, the Department of Health and Human Services touches all aspects of life for Native people, not just, it's not just the IHS. So I'm trying to reconcile this, and I wanna ask a couple of questions to try to get at this. Um, the first question has to do with, um, the, um, eleven fifteen Medicaid waivers, okay.

Mm-hmm.

So we know the Centers for Medicare and Medicaid Services recently published guidance implementing a provision of the one big beautiful bill that makes it harder for states to offer services like traditional healing and Medicaid programs but essentially states are now being required to resubmit existing eleven fifteen waivers. um, and prove that a service is budget neutral. And, um, you've touted the use of these waivers to expand access to traditional healing. So can you talk about this? How would this new budget neutrality requirement, you know, have an impact or how might it impede access to services like traditional healing?

Mm-hmm. Uh, thank you for that, uh, question, Senator, and I really appreciated our conversation and the heartfelt nature of it. Um, specific to your question, around the section eleven fifteens. So I am generally aware I don't work at CMS directly. Um, I wasn't involved in that role making. However, um, I have seen, uh, correspondence from tribal organizations that have, um, provided their views and feedback on, um, th these regs. Uh, some of it's been positive, some of it has asked for additional, um, work. Um, I will work closely with the DTA team, um, to understand what that budget neutrality actually does for the traditional healing, but the secretary and I have been supportive of those methods.

Okay.

You know, it's kind of a all hands on deck. Um, what we what we know is what works for one person may not work for another. So that's why we've been supportive.

Right. Well, we can follow up on that and and and further that conversation.

Um, yeah, so would love to follow up.

I think it's an example of why it's so important that these,

Mm-hmm.

you know, the these sort of broad-based changes in Medicaid that have a big impact on Native communities, that that is that is well thought through.

Mm-hmm.

Let me follow up just a just a little bit more clarity on the question that, um, Senator Murkowski was asking about dual roles. So will you which office will you work out of? Will you work out of IHS or will you stay in the secretary's office? Like, how will that work?

So, thank you, Senator. A lot of the, uh, those logistics were still working out if confirmed, right? It's predicated on a positive vote.

Uh-huh.

Um, so I, if confirmed, I will be showing up in Rockville. That's the duty station of the Indian Health Service director. Um, I've also know that I will keep an office near the secretary, where I currently uh, the one I currently occupy.

So you would imagine going back and forth a bit?

And Yeah, absolutely.

Uh-huh.

And a lot of our leaders do. Um, I see our HRSA administrator.

Uh-huh.

I see our CMS administrator and we have our all politicals meetings. Uh, oftentimes senior leadership from different op divs are staffing the secretary in meetings or briefing him.

Okay.

And so having that public board presence is important.

Well, and w- I'm sorry, uh, so you would continue. And and then will you be paid out of IHS or out of the secretary's office? Is that figured out yet?

Uh, uh, I haven't we haven't figured that out, but my understanding is if I encumber the IHS position, um,

That would be better.

I would have to be paid out of IHS,

Okay, okay.

yeah.

Um. Um, s- um, Senator Shatz was, um, getting at that a little bit, but I'm getting at this next question a little bit. It has to do with big big hullabaloo at the beginning of the Trump administration about how there was a sort of a blanket um all DEI initiatives are, are bad and need to be thrown out, this happened everywhere, and it was really, um, in my view, very unfortunate how, um, Native people got caught up in that as if providing particular attention to Native people was part of some broader DEI initiative. Can you just commit that in this role that you will um ensure that programs that are

Mm-hmm.

serving tribes in the Native Hawaiian community are not considered DEI or sort of cut because of the misconstrued connection between DEI and those tribes and those programs?

Yeah, yeah, I'm aware of the DOJ clarification last spring and I will support the trust and treaty responsibility that the federal government has for tribal partners.

Okay, and just one last quick question. Will you support advanced appropriations for IHS and strong funding in upcoming budgets?

I support the president's budget request that does include advanced appropriations.

Okay. I have a follow-up question on urban um indigenous communities, but I'll submit that to the record. Thank you very much.

That's great.

Thank you, Senator.

Thank you, Senator Smith.

Thank you.

Senator Lujan.

Good morning, sir.

Thank you for taking time to come by the office. Very much appreciated the conversation.

Yes.

Um, as as you've heard from all of my colleagues, I I share with Democrats and Republicans here how important IHS is to our constituents,

Mm-hmm.

um, to the people that have entrusted us with these responsibilities. Um, in New Mexico you're familiar. You've you've visited recently, um, to the nation, uh, to the Navajo Nation as well as a few other, um, sovereign nations as well.

Yes, Senator.

As you know, IHS serves as a backbone of healthcare for communities. And and I remain concerned any time I get a call from a constituent or see someone at their home or if they stop by and visit me cuz they see me out on the farm doing something and tell me what happened, and it's not a good story. Mm-hmm. Mm-hmm. Um. Nowhere is this more evident than at the Gallup Indian Medical Center, which we sp- spoke about in my office. Yes, sir. One of the largest Native serving medical facilities in the entire country. Now, GMI, GIMC contends with persistent drinking water issues, as you're aware. Uh, people from IHS have visited over there, um, as a matter of fact when I brought up in a hearing here that the drinking, that there were signs around the hospital that people shouldn't drink water.

Hmm.

Someone from Washington DC ordered them to take the signs down.

Hmm.

Not fix the water problem. Take the signs down.

Hmm.

That's not leadership. That probably put some of my constituents in harm's way.

Mm-hmm.

Now, I hope that the United States knows that we cannot allow a facility of this importance to keep operating under these conditions. Getting a new facility built is not optional, it's imperative. As I've shared with you, this facility was left out of the FY twenty seven budget, because it was deemed not quote " shovel ready".

Hmm.

So my question is In this new role, will you commit to working with the Navajo Nation to ensure that the project is shovel-ready so that it will be included and it is ready in time for the next budget cycle?

Senator, thank you. Um, I really enjoyed our conversation and specifically about my visits to your state. Um, when I walked in in my current capacity as senior advisor, one of the areas I wanted to look at was our construction program. because there's no more direct signal of one's commitment to health than a modern clean safe facility. And when I saw that IHS had eight projects on their nineteen ninety-three list, my jaw dropped. And unfortunately, Gallup Indian Medical Center is one of those projects on that list. And I asked the basic question, why has it taken thirty-three years to clear this list? And what is the plan of action? And so, um, what I can share is I wanna make sure that those remaining projects get on a a a a path towards completion so whether it's environmental review, permitting, I wanna understand that, if it's design, build, I wanna understand that, and then uh I'm also actively monitoring where uh projects such as the one in White Mountain Apache are So from being on the list through ribbon cutting, I wanna know where each of those are. And then I also wanna know where the resources are gonna come from to finish those projects. I have fundamental issues with the way the federal government um completes Indian schools, Indian justice centers, Indian hospitals and clinics. We pay with cash up front. It's just not a very efficient use of a big capital with big facilities. And I think that's been part of the challenge we've seen over thirty-three years and why it's taken us this long to get where we are. So yes, I am firmly committed to putting those projects on a glide path out. It's gonna require resources. There's no there's no bones about it. The latest estimate I received to get those eight projects done was eight billion dollars. My annual appropriation in that line item is just under two hundred million. Doing quick math, it's gonna take us about forty years to get those eight projects done. That's unacceptable.

So is this a flaw in the budget? Did the budget leave these projects out? And is that something you'll advocate to correct and get the a- and and ask for eight billion dollars in the president's budget cuz the president's budget, didn't ask for eight billion dollars.

So, Senator, um, what we did was within the authorities that we have at HHS, we created a one billion dollar neff commitment. So that was a strong step by the secretary to recognize and acknowledge And then I look forward to working with my colleagues at OMB too.

But, Mi- Mister Cruz, I, uh, sorry to interrupt,

Yeah.

there's my time's running out here. If the problem's eight billion dollars, if that's the need, then the request is eight billion dollars.

I look forward to w- working with you, Katie.

It's not one billion so we can say we're gonna do better. That that's failing. And I'll blame every other president, every other administration that came before the thirty-three years.

Mm.

They didn't fix it either.

Mm-hmm.

I'm here now, you're here now, President Trump is here now.

Yeah.

Pres- uh, Secretary Kennedy is here now. Are we gonna fix it or are we gonna come back in here and say, " Well, We put another hundred million dollars, we're not making anything better. And so I I hope we can get there.