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By Rose Hoban and Anne Blythe
Mandy Cohen, the physician who has led North Carolina through the ongoing coronavirus pandemic and a massive transformation of how Medicaid is administered, told her staff at the state Department of Health and Human Services on Tuesday that she would try not to cry while letting them know she was stepping down as the state’s top public health official.
They shed virtual tears for her, instead, during the all staff Webex meeting.
Cohen, who became widely known as the “three Ws lady” — which stands for wear a mask, wash hands and wait six feet apart — during the first year of the pandemic, informed those she works closely with of her decision to resign on Monday.
Hundreds of “crying face” emojis appeared in the chat of the virtual meeting on Tuesday as nearly 2,200 DHHS workers responded to the news of Cohen’s departure.
“I have some personal news to share and it’s with mixed emotion,” Cohen told the staff. “I’m going to try hard not to tear up while I talk about this, but I wanted to share that I will be stepping down as secretary at the Department of Health and Human Services. It’s been an incredible five years, I can’t believe it’s been five years. Two of those have been pandemic years. And I’ve been joking that in pandemic years, it means that, you know, I think I’ve been secretary at least 12, at this point, for normal years.
“It really is hard to step away from this team and this work,” Cohen added, while also stressing that it was the “right time.”
Cohen, who plans to stay in her position through December, informed the rest of the state on Tuesday during a briefing with reporters broadcast on PBS North Carolina.
“It has been the honor of a lifetime to serve this state at such an important moment in history,” Cohen said in a statement. “I am grateful for Governor Cooper’s leadership, and I am so proud of what we have accomplished to improve the health and well-being of the state over the last five years. There is much work still to do, and I am so pleased the Governor selected Kody Kinsley to take the baton to run the next leg of this race.”
Kinsley, chief deputy secretary for health at DHHS, has been nominated by Gov. Roy Cooper to be the next secretary subject to approval by the General Assembly.
Kinsley, a Wilmington native who received a bachelor’s degree from Brevard College before heading to the University of California at Berkeley for a master’s degree in public policy, has held jobs in the public and private sectors.
He has been with DHHS for nearly four years after stints with the federal Department of Health and Human Services and the U.S. Treasury Department.
In his role as deputy secretary, Kinsley has overseen the Division of Mental Health, Developmental Disabilities, and Substance Abuse Services, the Division of State Operated Healthcare Facilities, the Division of Public Health, the Division of Health Service Regulation and the recently created Office of Emergency Preparedness, Response, and Recovery within DHHS.
Kinsley would also be the first openly gay cabinet secretary in North Carolina history. After Cooper appoints him, he will have to be confirmed by the Senate, led by Lieutenant Governor Mark Robinson, who has recently come under fire for anti-LGBTQ comments.
He has been instrumental in the state’s response to the opioid epidemic.
“Mandy Cohen has shown extraordinary leadership during her tenure and she has worked every day during this pandemic to help keep North Carolinians healthy and safe,” Cooper said in a statement. “We are stronger because of her efforts and I am enormously grateful for her service. She has built a remarkable team of talented people including Kody Kinsley, and I know he will continue the strong legacy of competence, effectiveness and efficiency as he takes over as Secretary.”
Though Kinsley is not a physician, Cooper said he has the right skill set to lead a department with such a keen focus on health.
“I’m appointing Kody Kinsley because he is the most qualified and experienced person for the job,” Cooper said. “He has been a part of this team for the past number of years, and we’ve seen him in action and Dr. Cohen has put a lot of trust in him. Dr. Cohen and I, and Kody when he becomes secretary, have been supported by a team of doctors and medical advisers, and health experts who have collectively helped to advise us.”
Arrived in NC with a mission
An internal medicine physician who graduated from Yale Medical School and completed a master’s degree in public health at Harvard, Cohen was a high-profile catch for the Cooper administration in 2017, coming to North Carolina after being in leadership at the federal Centers for Medicare and Medicaid Services during the implementation of the Affordable Care Act.
For the first couple of months, she was often in Raleigh away from her daughters, commuting between the North Carolina capital and the country’s capital, where her husband Sam tended to the parenting until they all could be together again in a new state.
The governor brought Cohen in to help him expand Medicaid, a goal he has been unable to attain as Republicans in the state legislature continue to block the mission.
Cohen has a reputation for being able to listen to and talk with people on both sides of the political aisle, gaining respect from Republicans such as Senate leader Phil Berger (R-Eden) who said her “leadership throughout her tenure at the DHHS has helped our state navigate turbulent times. She made herself available to legislators to answer questions and kept us informed about issues facing the department.”
Former Republican state Sen. Tommy Tucker was on the Senate Health Care Committee through five HHS secretaries, including two chosen by a governor from his own party, but he said that he had his best relationship with Cohen over any of the others.
“I was candid and honest with her. And she, in return, understood that and she was candid with me,” Tucker told NC Health News.
He also spoke to her competence and her ability to remain unflappable under pressure.
“You remember when she testified, before Congress, and they tried to do all their end runs on her, and she was eight months pregnant,” he said.
“Secretary Cohen and I had major policy differences. But it was always a civil debate,” Tucker continued. “However, managing a $15 billion budget and 17,000 people is no easy job for her or anybody else.”
Cohen made it her mission early in her time at DHHS to be responsive to questions and to have conversations with people who might not support the programs and directions she wanted to move the state toward.
“I have tried over the five years of my tenure here as secretary to work with everyone across North Carolina, different stakeholders from all walks of life, all sides of aisles,” Cohen said. “The way I do that is approach it as a problem solver. I want to make our state healthier. I want to improve the well-being of our state, and there’s a lot of common ground that I have found there, when we can exchange ideas. So that is how I have approached things.
“I also have been as transparent as I can, both as you see with a lot of data, try to help explain why we are making these decisions we are making, and I also want to make sure that folks can reach me, that we can be in dialogue, that I can hear their concerns and that we can find a place where we can move forward together,” Cohen added.
Cooper praised Cohen for how she tried to build trust among those who might not be as enthusiastic as she is about proposals.
“Not only is Dr. Cohen brilliant and hard-working, she has the ability to communicate with almost anybody,” Cooper said. “That has been a source of her strength and effectiveness in the state.”
Handing off the baton
The change comes just as the Omicron variant adds another twist to the pandemic, leaving many to wonder what might come with a fifth wave of cases some 19 months after COVID-19 was first detected in North Carolina.
Cohen told the governor of her plans about two weeks ago, she said, giving him time to figure out who he wanted the next DHHS leader to be and to have a smooth transition.
“The last two years have been quite a marathon,” Cohen said in response to a question about when she decided it was time to do something else. “As we came through coming down off the Delta surge, I saw things getting more stable, I watched my team with a lot of pride, being able to react to any new thing that was being thrown at them, whether it was new boosters or this new variant. They were jumping into action in ways that were fantastic and I felt like now I was able to take this step back and pass the baton to the next folks.”
Cohen has not revealed what she plans to do next, but she quashed any speculation that she intended to run for U.S. Senate.
“I am not planning to run for office,” Cohen said. “I am looking at opportunities that will allow me to continue to impact the health and well-being of communities. I don’t know what that will look like.”
Cohen said she has been looking at a range of opportunities, but did not elaborate on what they were or where they might take her family.
“She said to a small group of folks about two weeks ago that she was thinking of this,” said Dave Richard who has worked closely with Cohen for five years, as her Medicaid director.
When Cohen arrived at DHHS in early 2017, outside observers noted morale problems in the department. But Cohen had come from a massive federal agency where her last position was as Chief Operatingl Officer and she had organizational experience.
“On the first day, when she came in to talk to the team, there were several things that were really clear. One is that she would have a vision, and two, that she was going to evaluate everyone,” Richard said.
“She required us to up our game,” he continued, noting her emphasis on values which won over many. “I would follow her anywhere because of her leadership. Sometimes it wasn’t easy, because she demanded of us things that I think sometimes we didn’t believe we could achieve, but she supported our efforts to get there.”
Cohen’s legacy extends beyond NC
“She was a transformative leader and a pioneer in driving change around whole-person care and addressing the social drivers of health,” wrote Matt Salo, head of the DC-based National Association of Medicaid Directors. “She was the face of NC’s response to the pandemic and followed the science while leading the state through recovery.”
The Medicaid transition is one being observed across the country, as one of the most innovative and possibly significant changeovers, if it’s ultimately successful in meeting its goals.
Berger also praised Cohen for implementing the state’s Medicaid transformation from a state-run fee-for-service program to one run by managed care companies.
Not all of Cohen’s orders and advice during the pandemic were roundly accepted, though.
She found herself in a southern state, where some defied mask orders, social distancing measures and COVID-19 vaccines, features of the pandemic that became politicized.
North Carolina, nonetheless, fared better in keeping case numbers, hospitalizations and deaths at a lower number than many other southern states.
Cohen acknowledged that the state was not prepared to battle COVID-19 at the start of the pandemic.
“Were there things we should have done in preparation to be better ready to respond? Absolutely,” Cohen said reflecting on the early days of the pandemic. “We all remember back to the fact that we had a shortage of protective equipment. We had supply chain issues. We weren’t sure if we would have enough ventilators. So certainly there were a lot of lessons learned there. Our data infrastructure, as well, was something we needed to build.”
With hindsight, Cohen said she would have done more preparation.
“I think as we come out of this pandemic, there are a lot of lessons learned about how we can stay prepared for something in the future and then make sure that we are putting the resources into public health,” Cohen said. “I think we’ve learned a lot. We’ve built a lot and we need to make sure we maintain that posture into the future.”