Raleigh, N.C. — Despite her links to the Affordable Care Act and Gov. Roy Cooper's push to expand the state's Medicaid program, Dr. Mandy Cohen was unanimously recommended Wednesday for confirmation as secretary of the North Carolina Department of Health and Human Services.
Political observers expected a bruising battle for Cohen in the Senate confirmation process, but her credentials and extensive knowledge of an array of issues that confront DHHS apparently dispelled any qualms Republican lawmakers may have about her leading the state's largest cabinet-level agency.
Before Cooper picked Cohen to head DHHS, she served as chief operating officer of the federal Centers for Medicare and Medicaid Services. Her previous work at CMS included overhauling the operation of the HealthCare.gov health insurance marketplace after its troubled launch and improving the efficiency and effectiveness of Medicare delivery.
A graduate of the Yale School of Medicine and the Harvard School of Public Health, she also has worked as a primary care physician and was on staff at a Department of Veterans Affairs hospital in Washington, D.C., where she focused on care for women veterans.
Sen. Tommy Tucker, R-Union, quizzed Cohen about HealthCare.gov, which repeatedly crashed in late 2013 when people tried to sign up for health coverage under the Affordable Care Act.
"It was a big public failure. There's no way around it," she said, noting she wasn't involved in the initial rollout. "What I learned about any 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 she hopes to bring some of those lessons to DHHS, which has had its own technology challenges in recent years with its Medicaid claims and benefits enrollment systems.
Tucker also asked about the ACA's overall operations, noting that it has failed to live up to former President Barack Obama's promise that people could keep the doctors and the coverage they had.
"Not to quote our current president, but health care's complicated," Cohen replied. "It is hard, when you're making changes in the health care system, I think this committee knows better than most, when you make one change, there is an unintended consequence somewhere else. It's a matter of playing through those consequences of changes and making sure that we are understanding them and prioritizing."
Other senators questioned Cohen about battling the opioid epidemic, rural health care delivery, data security and changes to the mental health system, where she has already dressed down contractors for delays in the construction of a new psychiatric hospital in Morganton.
"I want to make sure that those with mental illness aren't left to the side," she said, noting her work with mental health specialists while at the VA helped shape her views. "I am thinking about how we can best serve that population, and so I hope we can drive forward with innovation and integrated care in that population."
The harshest questioning cam from Sen. Ralph Hise, R-Mitchell, who asked about Cooper's attempts to expand Medicaid as allowed under the ACA, despite state laws that require legislative approval for such a move.
"Gov. Cooper chose to ignore the law and worked with the Obama administration in its final weeks to rush a massive expansion of Medicaid," Hise said, asking Cohen whether she thinks that violates the law.
Cohen sidestepped the question by saying any changes to Medicaid would require several steps, including getting legislative approval to increase funding to the program.
"There wouldn't have been a way to move forward on changing any of the eligibility requirements without coming back here to the General Assembly," she said, adding that she wasn't involved in any Medicaid discussions with the Cooper administration while she was still at CMS.
When Hise persisted, she said she wanted to work with lawmakers to address any concerns about DHHS programs.
"I want to make sure that we are having an open dialogue," she said, "and making sure that we can work together on the things where there is common ground."