By Rose Hoban

When Mandy Cohen stood, with her hand upraised, to swear an oath of truth before her Senate confirmation committee hearing on Wednesday, she stood alone before the panel of senators, appearing almost vulnerable.

But during almost an hour of questioning by senators from the Health Care Committee, Cohen proved herself tough and sharp-witted. Gov. Roy Cooper’s pick for Health and Human Services secretary, who’s only been in North Carolina for two months, showed that she is a quick learner and a skillful negotiator.

Mandy Cohen (right) and her husband Sam (second right) talk with Sens. Chuck Edwards and Paul Newton before her confirmation hearing. Photo credit: Rose Hoban

As she answered questions, Cohen showed a grasp of some of North Carolina’s most complicated and intractable problems, from the opioid overdose crisis and to construction delays at a new state psychiatric hospital, to the needs of her 16,000-employee  department.

“In her 8 weeks here, she’s begun to get a good handle on what’s going on in North Carolina,” said Lynette Tolson, head of the North Carolina Public Health Association, after the meeting.

Big failures, big fixes

Cohen comes to North Carolina fresh from her role as the chief operating officer at the federal Centers for Medicare and Medicaid Services.

In 2013, Cohen was advising on policy for the Medicare program, which serves mostly seniors and people with disabilities. But in late 2013, the web portal for health insurance under the Affordable Care Act,, had a botched rollout.

That’s when Cohen had a “career defining moment.” She was asked to take on the role of interim director of the division managing the rollout and get it fixed.

“It was a big public failure, there’s no way around it. We had multiple case studies written about it and…in the space of crisis, I try to find all the things you can learn from it.

“What I learned from any big big technology failure is it’s not about technology. It’s about people, it’s about accountability, it’s about communication, it’s about transparency,” she said. “Those are some of the lessons I learned.”

Building trust

Another lesson Cohen brings with her from Washington is an imperative to build relationships. Throughout her hearing, Cohen referred to meetings she had with all of the members of the panel in prior weeks. Her testimony was peppered with phrases like, “I know you and I had a good discussion about…”

older man demonstrating use of the microphone to a younger woman.
Sen. Louis Pate (R-Mt. Olive) shows Dr. Mandy Cohen how to use the microphone in the committee room where she testified as part of her confirmation process. Photo credit: Rose Hoban

In turn, senators thanked her for taking the time to talk with them about their concerns.

Cohen also showed mastery in the art of subtly sidestepping some of the more pointed questions raised by senators.

When committee co-chair Ralph Hise (R-Spruce Pine) asked whether Cohen believed Gov. Roy Cooper violated a 2013 law when he made moves to expand the Medicaid program, Cohen made a deft deflection.

“I’m not a lawyer,” she began, then talked about the complicated process of gaining federal approval for Medicaid plan changes.

“You need to have [all] steps in order to move forward, so my understanding is that there wouldn’t have been a way to move forward on changing any of the eligibility requirements without coming back to the General Assembly,” she responded.

But Cohen never stated whether she believed Cooper had broken the law.

Cohen also kept her cool when freshman Sen. Deanna Ballard pursued a line of questioning informed by a series of attacks made on Cohen by right-wing blogger Robert Harris.

New commitment

When asked before the committee started how this hearing compared to testifying before Congress, Cohen quipped that “every situation is unique.”

“But this time, I’m testifying for my job,” she added.

From all appearances, the Northeasterner has made a commitment to North Carolina. Cohen noted she and her husband have bought a house in North Raleigh and moved their two-and-a-half and five-year-old daughters here, so she could “devote myself to this endeavor.”

“I take my commitment to the people of North Carolina and this role very seriously,” Cohen said. She also noted she plans to serve out her full four-year term.

She did note, though, that her medical license is in suspension because she is not currently practicing. Cohen also said her board certification expires in 2018. For someone who is not currently practicing medicine, the process of studying for board exams could take weeks.

Cohen said the question of whether to allow her board certification to lapse is something she is trying to resolve for herself.

Observers who were curious to see what Cohen was made of had good reviews.

“I thought it  was a very respectful hearing, with good questions by members of the Senate and very good answers by Dr. Cohen,” said Greg Griggs, head of the North Carolina Academy of Family Physicians, after the hearing. “She is extraordinarily well qualified, not only as a physician, but the roles she’s had previously.”

The members of the committee voted unanimously to move Cohen’s nomination forward. Next, her approval goes to the nominations committee.


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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...

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