Cruz’s appointment as senior adviser on American Indian health is a significant step towards ensuring that Native American voices are heard in decision-making processes at the U.S. Health and Human Services (HHS). By having a member of the Klamath Tribes from Oregon in his inner circle, Health Secretary Robert F. Kennedy Jr. is signaling a 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 to create a unified strategy on American Indian health across different HHS agencies. With a background in government at the federal and state levels, including experience in policy and economic development on Indian affairs during the Trump administration, Cruz brings a wealth of knowledge and expertise to the position.
One of Cruz’s key priorities is to advocate for tribes to take over health care services from the Indian Health Service (IHS) and run their own tribal health facilities through a process known as 638 contracting. This approach, which aligns with Kennedy’s Make America Healthy Again initiative, aims to empower tribes to provide more efficient and effective health care services to their communities.
Despite the challenges facing the IHS, Cruz remains optimistic about finding solutions to improve the delivery of health care services to tribes and tribal communities. He is committed to identifying inefficiencies in government processes that may be hindering the effectiveness of the IHS and exploring best practices from tribal health facilities to modernize and improve operations.
Cruz also emphasizes the importance of supporting tribes in taking control of their own health care facilities, citing examples of tribes successfully managing other programs and services more effectively than the federal government. By promoting Indian self-determination and local control, Cruz believes that tribes can provide better health care services tailored to the needs of their communities.
As he embarks on his new role as senior adviser on American Indian health, Cruz’s commitment to addressing longstanding challenges in Indian health care and promoting tribal self-determination will be closely watched by clinicians and stakeholders in American Indian communities. With his experience and dedication to improving health outcomes for Native Americans, Cruz has the potential to make a significant impact on the future of American Indian health. The transformation of dental health services in tribal areas, such as Chiloquin, Oregon, has been remarkable over the years. From operating out of a double-wide trailer to now having a beautiful clinic, the improvements in quality and consistency of care have been significant. This positive change is not unique to Chiloquin but is also seen in other tribal communities. It is essential to acknowledge the progress and not always focus on the challenges.
While Indian Health Service (IHS) provides funding to tribally run facilities, it is often not enough to cover all their operating expenses. Many facilities rely on Medicaid reimbursements, which are now facing potential cuts. The recent One Big Beautiful Bill Act has raised concerns about the impact on tribal health services. However, increasing funding for 638s may not be the immediate solution, as IHS operates within its allocated budget.
One suggestion to streamline the process for tribal facilities is to allow them to receive Medicaid reimbursements directly from the Centers for Medicare and Medicaid Services (CMS) rather than through states. This could simplify the reimbursement process and ensure that facilities receive the funding they need to operate effectively.
In addition to funding challenges, there are other priority areas in Native health that need attention. These include improving access to healthy foods, addressing chronic illnesses like diabetes and heart disease, and tackling issues related to addiction and mental health. These are complex issues that require a comprehensive approach involving federal agency partners.
As the first senior adviser to the secretary on Indian health, the focus is on advocating for the needs of tribal communities in budget discussions and policy decisions. The goal is to ensure that the unique health challenges faced by Native populations are considered and addressed effectively. Working towards a healthier future for Native communities is a rewarding and inspiring mission.
Despite concerns raised by some clinicians, tribal leaders, and community members about changes in health policy under Secretary Kennedy’s administration, the priority remains on providing the best possible advice and support to improve healthcare outcomes for Native populations. Engaging with stakeholders, asking tough questions, and advocating for the needs of tribal communities are key aspects of the role.
In conclusion, the journey towards better health outcomes for Native communities is ongoing, with both challenges and opportunities. By working collaboratively with federal agencies, tribal leaders, and community members, it is possible to overcome obstacles and create a healthier future for all.
