Gov. Roy Cooper’s choice to head the state’s Department of Health and Human Services would mark a sharp departure from recent DHHS secretaries, who entered the job having had little to no experience with the programs the agency oversees.
Dr. Mandy Cohen, a physician, is a top official in the federal agency that runs Medicare and Medicaid.
Cooper introduced her and state Rep. Larry Hall, his pick to lead the state Department of Veterans and Military Affairs, at a news conference at the Executive Mansion on Friday. Cooper said he will make the final three appointments to his 10-member Cabinet next week.
While Hall represents Durham in the General Assembly and has lived there most of his life, Cohen, who lives in Washington, has no such ties to North Carolina.
Cohen, 38, is the chief operating officer and chief of staff at the Centers for Medicare and Medicaid Services. If confirmed by the state Senate, she will lead on of North Carolina’s largest departments, with around 16,000 employees. The sprawling state agency covers public health, mental health, social services, early childhood education, and more. It runs three psychiatric hospitals, three residential centers for people with developmental disabilities, and other facilities.
The agency deals with a host of controversial issues, including Cooper’s attempt to expand Medicaid coverage under the Affordable Care Act to several hundred thousand people in North Carolina, which Republican legislative leaders said Friday they would attempt to block in a lawsuit. Republicans in Congress are moving to do away with the health law.
“Clearly, we’re going to be entering difficult times in the area of health care,” Cooper said. “We need a good manager, someone who understands health-care policy in the health-care arena. We are lucky to get Dr. Cohen to agree to come and head up our department in North Carolina.”
Cohen pledged to work with legislative leaders and other interests in the health-care debate.
“I know there is a lot of work ahead of us, but it’s work that I know well,” she said. “I’ve done it at the federal level and look forward to doing it here in North Carolina.”
On Friday evening, Senate leader Phil Berger and House Speaker Tim Moore released a joint statement saying Cohen’s selection posed a conflict of interest because her federal agency is the one evaluating Cooper’s request to expand Medicaid in North Carolina.
Earlier in the day, Rep. Nelson Dollar, a Republican from Cary involved in health-care legislation, said Cohen’s strong qualifications and experience should benefit the state, especially as North Carolina is separately asking the federal government for permission to privatize Medicaid.
But Dollar said Cohen shouldn’t be involved in Cooper’s attempt to expand Medicaid, which GOP lawmakers think would be illegal.
“I hope Dr. Cohen doesn’t participate in that process,” Dollar said. “That is a very problematic situation. I would hope that with this announcement, Dr. Cohen would immediately remove herself from that agency and anything to do with last-minute decisions that would be made.”
Cooper’s office said Cohen resigned from the Obama administration Thursday.
Cohen is the seventh Cabinet secretary Cooper has named and the first from an Obama administration that is winding down.
Gov. Pat McCrory’s two DHHS secretaries had little experience with government health agencies and none as vast as the DHHS bureaucracy.
Dr. Aldona Wos was a fundraiser for McCrory and was a former ambassador when she agreed to run the department under McCrory. Wos began her job announcing she had a lot to learn about the department and what it did. Rick Brajer, who succeeded Wos, was a former biomedical company executive.
As he left office, McCrory praised Wos and Brajer. But controversy swirled around Wos, and she was criticized for some of her decisions.
Dr. Charles van der Horst, an outspoken critic of the state’s decision to not expand Medicaid, called Cohen “a breath of fresh air.”
“Let’s look at the contrast here,” he said. “Aldona Wos had no experience. She was basically a political appointee and totally botched everything,” while Cohen has education credentials, trained at one of the country’s best hospitals, and has experience working with the private sector, said van der Horst, professor emeritus of medicine and infectious diseases at UNC-Chapel Hill.
“I can’t say enough good things,” van der Horst said. “I think she’s a brilliant choice.”
Dr. David Hill, an N.C. Pediatric Society board member, was encouraged that Cooper chose someone with deep knowledge of Medicaid. Most of the 1.9 million people enrolled in the state Medicaid program are children. Pediatricians were excited to see someone with a “wealth of experience and knowledge” chosen to run DHHS, he said.
“Anything to do with Medicaid in the state will have an inordinate impact on our children,” Hill said. “The sooner the state has a leader in place who understands the ins and outs of health care management, the better off all our children and providers will be.”
Medicaid is a focal point at DHHS because the state is constantly searching for ways to manage costs. The program costs about $14 billion a year, with the federal government picking up about two-thirds of the expenses. The state has launched what will likely be a complicated negotiation with the federal Medicare and Medicaid agency, known as CMS, over a plan to privatize the state Medicaid program.
Dr. Marvin Swartz, a professor of psychiatry at Duke University, said having a leader with Cohen’s experience will be an asset.
“She will also be an excellent liaison with CMS with whom we will negotiate the path forward with Medicaid,” he said in an email. “It is hard to imagine a more qualified applicant and one with a relatively gentle learning curve.”
An earlier version of this story misidentified North Carolina's largest state agency. It is the Department of Public Safety.
Secretary of Health and Human Services
Dr. Mandy Krauthamer Cohen
▪ Until Thursday, chief operating officer and chief of staff for the federal Centers for Medicare and Medicaid Services.
▪ Previously, executive director of Doctors for America, a policymaking and advocacy group promoting better health services. Deputy director at the U.S. Department of Veteran Affairs Women’s Health Strategic Healthcare Group.
▪ Bachelor of science degree from Cornell University, master of public health degree from the Harvard School of Public Health, and a medical degree from the Yale University School of Medicine. She is an internist.
Secretary of Military and Veterans Affairs
▪ He is a state representative in the House, although he will have to resign that position. Hall, 61, represented Durham, where he has spent most of his life, since 2006. Until recently, he was the House Democratic leader.
▪ Spent 16 years in the Marines and Marine Corps Reserves, including serving in support of operations in Lebanon and Iran.
▪ Served on the board of directors of the Democratic Legislative Campaign Committee, planning strategy and fundraising.
▪ Received a bachelor of science degree from Johnson C. Smith University, and a law degree from UNC School of Law. He is a licensed attorney.
In 2015, Gov. Pat McCrory elevated the military and veterans affairs division to a Cabinet-level department.