By Rose Hoban
As Kody Kinsley, secretary of the state Department of Health and Human Services, answered a lawmaker’s question about how to get more nurses trained in North Carolina’s community college system, he noticed a group of school children walking by the floor-to-ceiling windows of the North Carolina Legislative Building.
He didn’t miss a beat.
“Oh, there’s me in fourth grade,” Kinsley dropped in mid-sentence, before continuing his answer to lawmakers at the first part of his official confirmation hearing.
The comment was indicative of one of Kinsley’s frequent talking points. He’s a North Carolina native who grew up in a low-income, working-class family in Wilmington. As a child, Kinsley lacked health insurance, ate free school lunches and got dental care courtesy of the local health department. He has argued that these experiences make him uniquely experienced to lead the 18,000 employees of the North Carolina Department of Health and Human Services who often serve people like the child he was.
“I’ve told a few of you and some folks, the sergeant at arms, that the last time I was on the third floor of this building was in fourth grade when I came here for my public school trip,” Kinsley said. “I’m so humbled to have had the opportunity to serve in so many roles of significant responsibility and public trust.”
This week, Kinsley is hoping that his appointment as DHHS secretary becomes official some five months after he started the job. Since January, when his predecessor Mandy Cohen stepped away from the job and shifted to work in the private sector, Kinsley has been in an acting position.
Formal confirmation hearings started in the state senate on Wednesday.
As a physician and public health expert, Cohen was well-suited to lead during a coronavirus pandemic that drew on multiple aspects of her training.
Now, Kinsley argues that his vastly different biography — as a North Carolina native, as a first-generation college student who attended Brevard College before heading for training at Harvard and a master’s degree at the University of California at Berkeley, as a veteran of first the Obama, then the Trump administrations and as an undersecretary at DHHS before being tapped to lead the department — also give him strong qualifications to lead the department as it moves beyond the pandemic.
“I still know that my life is better because of the investments the state and the General Assembly made in programs that created economic opportunities, public health services, a strong public education and more,” Kinsley told the Senate Health Care Committee. “These early experiences foster in me a passion to serve others to pay it forward, and they shape how I view my role as secretary if confirmed.”
Sen. Jim Burgin (R-Angier) started the confirmation hearing asking about when the COVID-19 state of emergency would end, something that’s been an issue for Republican lawmakers.
Kinsley explained that one of the most important powers the state of emergency gives his department is to allow for movement of patients between health care facilities more easily. For instance, Kinsley told lawmakers that during the recent fire at a Winston-Salem fertilizer plant, those powers made it easier to move nearby nursing home residents further away.
“The second tool that’s particularly important for us is the ability to have standing orders in place that allow for a no-red-tape, no-bureaucracy quick approach for folks to be able to get vaccinated, to get tested and to get treatment,” Kinsley said.
Kinsley told lawmakers that one of his priorities as secretary would be to improve the mental health system. He spoke about how the problem of people in mental health crisis, sitting in emergency departments waiting on a psychiatric bed to open up, is as much a problem of data management as it is of bed supply.
“While individuals are waiting in emergency departments, what is often referred to as behavioral health boarding, we’ll have upwards of 100 people waiting at any given moment to get a psychiatric bed, we have 36 percent of those beds that are empty,” Kinsley told lawmakers.
While the solution isn’t exciting, Kinsley said that creating a better data management system will keep track of open beds, in particular those in facilities that will take people who lack insurance.
“I just don’t have good data,” Kinsley said. “We don’t have the technology and the infrastructure and the reporting necessary for us to really understand the contours of this problem to solve it.”
Another priority for Kinsley is to provide more mental health support to children.
“Unfortunately, our children and the behavioral health needs of our kids have languished in our state for far too long,” he told lawmakers. “There’s been a lot of focus on kids that get in-patient care, specifically around kids that are engaged in the foster care system.”
But he also told the confirmation committee that the state needs to invest in prevention programs to help keep kids from descending into crisis.
A final behavioral health issue Kinsley identified is that of getting enough resources to people with substance use issues. More than 3,595 North Carolinians died from opioid overdose in 2021, and more than 8,800 people ended up in emergency departments with overdoses, both numbers surpassing the record high number seen during the height of the COVID-19 pandemic in 2020.
Kinsley said he was excited about the influx of $750 million in opioid settlement money that will flow to North Carolina over the coming two decades. But he also called those dollars a drop in the bucket compared to what could flow to the state if North Carolina were to expand the Medicaid program, something that’s been on the table since 2012.
Medicaid expansion front and center
One of the strongest messages Kinsley gave to the senators questioning him at Wednesday’s confirmation hearing was that it’s time for North Carolina to embrace an expanded Medicaid. The state is only one of 12 in the country that has not taken advantage of the policy, something that was originally offered as part of the Affordable Care Act.
If North Carolina expanded, it would add some 600,000 low-income workers to the program and go a long way to reducing the burden of uninsured people unable to access mental health and substance use treatment, Kinsley stressed to lawmakers.
For years, members of the Republican-controlled North Carolina senate staunchly refused to consider the policy, effectively killing it. But in recent weeks, the leadership in the senate has changed direction. A bill is moving through the legislature this week to add those people to the program.
There’s also a lot of money at stake, about $4.8 billion in annual funds with an additional one-time bonus of $1.5 billion.
“I believe that this is a transformational opportunity for North Carolina, perhaps once in a generation or even once in 100 years investment,” he said, pointing out that the high number of uninsured in the state put North Carolina on the back foot as COVID-19 started making inroads in the state. And it was difficult to get people who were uninsured into care during the ever-evolving pandemic.
“When you tell individuals that don’t have health insurance, ‘if you have a question about your vaccine, call your doctor.’ It’s kind of hard,” he said.
Senators did not vote on the confirmation on Wednesday but will come back on Thursday to potentially move Kinsley’s nomination forward. Given the congenial atmosphere of the hearing, Kinsley said he thought the years he’d spent building relationships with lawmakers would yield a positive result.
“It’s my experience working in government now for over the past decade, that in the end, relationships are what matter” Kinsley said after the confirmation hearing. “There’s going to be problems, and you have to have the necessary capital with people around getting to know folks so that way, when problems arise, you can go through them.”