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By Rose Hoban

When she talked about a woman who’d taken in dozens of foster children, Mandy Cohen began to choke up.

In her first one-on-one interview with a North Carolina media outlet after being named Secretary of the Health and Human Services by Gov. Roy Cooper, Cohen talked about how she’s spent the past four weeks getting to know her new home state. When she recalled meeting the director of social services in Burke County, her eyes got wet, her voice tight.

“The woman that runs Burke County social services is not only doing a really amazing job at work, but she really lives her values, she’s had 21 foster children in her own home, in addition to three of her own children,” Cohen said during an interview with NC Health News on March 2.

Cohen said she’s spent a lot of time meeting local health care leaders.

“I want to make sure that I’m visiting the facilities that we run and I want to understand what’s happening on the ground,” she said.

Cohen is in the process of making North Carolina her new home. She started in her new position at the head of the state’s sprawling Department of Health and Human Services about six weeks ago. For a month, she commuted between her former home in the DC-metro area and North Raleigh, where Cohen’s husband and two little girls finally moved in early March.

“I’m sorry… that’s embarrassing,” Cohen said, dabbing her eyes. “It’s probably being away from my girls that makes me cry.”

But Cohen, a veteran policy wonk in the nation’s capitol and former leader at the federal Centers for Medicare and Medicaid Services, is no wilting violet. When she was at CMS, one of her highest profile Washington moments came when she stared down an indignant North Carolina Rep. Mark Meadows who complained to her during a 2014 Congressional hearing about the Affordable Care Act’s requirement to cover maternity as part of the basic package of insurance benefits.

Cohen garnered media attention because she kept her cool – and because she was eight months pregnant at the time.

Pedigree

In 2015, Cohen told POLITICO that she was inspired to study medicine by her mother, who has worked as a nurse practitioner for more than three decades, most of it in emergency medicine.

“She was a role model. I saw the amazing work that she did,” Cohen said during the 2015 Emerging Health Care Leaders forum. “It wasn’t just the clinical aspect… but [she talked about] the issues with the system. In the emergency room often is where you see the broken parts of the health care system.”

Cohen studied medicine at Yale, and got a Master’s in Public Health at Harvard while she was training in internal medicine at Massachusetts General Hospital in Boston.

It was her interest in making the health system function better that Cohen said drove her to get involved in policy. She joined CMS in 2010, working in the agency’s “Innovation Center” before rising to become director of a department at CMS that oversaw support for millions of insurance consumers. By the time she left for North Carolina’s DHHS, Cohen was CMS’ chief of staff.

“I’m a pragmatic leader, I always have been and I’m here to focus on the work,” she said when asked about her transition to North Carolina. “I’ve been listening and learning and just showing folks that I’m here to solve problems.”

Difficult trust

When asked how well the skills of running parts of a federal agency translate to working at the state level, former CMS administrator Mark McClellan said that the common element is that they’re both  big, complex, unique agencies.

McClellan, who ran CMS under George W. Bush and who led the launch of the Medicare drug benefit in 2005, said there’s no perfect preparation for running a multi-billion dollar government agency, but he said Cohen has the skills.

“She’s physician, knows health care and public health well, and she’s also done a lot of studying in public health areas,”McClellan said. “Much of what is needed in health care is a shift from just paying the bills when people get sick to encouraging healthier individuals, including creating healthier communities to keep North Carolinians healthier.

“She’s got that background.”

Cohen has been traveling around the state since arriving, but closer to her office on the Dorothea Dix Hospital campus, she’s been meeting with legislative leaders.

“I’ve met with Sens. Berger, Hise, Tucker, Pate,” she said, ticking off the names of Republican leadership in health and human services. She also said she’s met with multiple members of the House Republican caucus who are involved with HHS issues.

“I think there’s been a lack of communication and trust,” between DHHS and the General Assembly, Cohen said. “I want to show everyone that we can work together, we can work on a hard project together, we can solve problems together and if we solve one, we can solve another.”

But before Cohen can build trust, she’ll need to be confirmed by the Senate in a process created in December by Republican leaders in the legislature. It’s the first time in generations that gubernatorial appointments will require approval by a senate committee, and the process has been the subject of a court case.

So, it could be difficult to build trust when Cohen may report to the legislature only because she’s been subpoenaed.

Connecting

Cohen said she loves being involved in government and that it’s exciting to be affecting the lives of so many. That’s what lead her to North Carolina.

“I loved what I was doing at CMS and the work that I was doing on Medicare and Medicaid… and it touched millions of lives, but it also felt pretty distant from the folks that we were serving every day,” she said. “What I decided to do was to get a little closer to the work.”

Cohen said she knows that she faces the significant hurdle of being a stranger in a state where, at least in policy circles, people tend to have connections going back decades.

But she believes connection is possible; the first issue on her list is addressing the opioid and overdose crisis that’s been gripping the state for several years.

“It is one of the things that I have geared up our team to work on in an intensive way first,” she said. “It is an issue I have heard no matter what side of the aisle you sit on, no matter what part of the health care industry you come from.”

Cooper’s budget for DHHS, released last week, tags $10 million in funding for substance abuse treatment, along with legislative initiatives to address the crisis.

Cohen could also face resistance coming from a high-profile job in the Obama administration to a state that voted comfortably for Pres. Donald Trump. But she believes that by traveling and listening, she can connect.

“I may not have grown up here, [that] doesn’t mean I don’t share an understanding of wanting our families to be healthy and successful and safe,” Cohen said. She also said she’s met less polarization in her face-to-face meetings than the headlines suggest..

“I want… to work efficiently. I want us to meet budget, I want us to have predictability in our budget, I want to serve North Carolina and the folks who rely on these programs well, I want to be getting as much value out of every dollar that we spend,” she said.

“There’s a lot of work there and we all want a lot of the same things,” Cohen said. “And… so,” she paused, ”that’s where we’ll start from.”

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Rose Hoban

Rose Hoban is the founder and editor of NC Health News, as well as being the state government reporter. Hoban has been a registered nurse since 1992, but transitioned to journalism after earning degrees...