State Health and Human Services Secretary nominee Dr. Mandy Cohen has a sterling pedigree with Ivy League credentials and a previous job at the highest level of federal health care.
She also has past links to a checkered VA Administration, the disastrous Obamacare website rollout, and a potential conflict of interest with a husband who is a health-care lawyer. Members of the Senate Health Care Committee wanted to know more about those issues during her confirmation hearing Wednesday.
Cohen, who worked as chief operating officer and chief of staff at the Centers for Medicare and Medicaid Services in the Obama administration, addressed those and other pointed questions in winning unanimous committee approval. That recommendation was sent to the Senate Nominations Committee.
“I’ve dedicated my life to medicine, and to public service,” Cohen said in her opening remarks.
Cohen did undergraduate work at Cornell University, got her medical degree at Yale, and a master’s of public health at Harvard. She credited her success to her mother, one of the first nurse practitioners to work in New York who still goes to work nightly in an emergency room.
“It was through my mom’s eyes when I first saw the power of medicine to touch people’s lives, but it was also where I learned about the broken parts of the health-care system,” she said.
She spent six years at CMS.
“I learned to lead by cultivating issue-based teamwork, proactive communication, transparency, clear accountability, and excellence in operational execution,” Cohen said.
“I worked closely and constructively with a diverse array of stakeholders, members of Congress on both sides of the aisle, and I’m excited to bring those leadership lessons, as well as my policy and clinical knowledge to bear here in North Carolina,” she said.
“You speak a lot, and use a lot of great buzzwords of transparency, and accountability,” said Sen. Deanna Ballard, R-Watauga. Yet there were assertions that she had not aggressively pursued fraud along with troubling internal audit reports during her time at a Veterans Administration Hospital working on women veterans’ health care issues.
Cohen said she worked closely with the Office of the Inspector General and the Government Accountability Office.
“I think they make us stronger. They can see things that sometimes we can’t see, and are asking important questions,” Cohen said. She already has met with State Auditor Beth Wood, reviewing problems state audits have revealed for possible action.
Ballard asked Cohen about conflicts of interest.
Cohen said her husband, Sam, is a health care lawyer but has no clients in North Carolina that would pose a conflict of interest. Should that change, she said, they would seek guidance from the State Ethics Commission.
Sen. Tommy Tucker, R-Union, asked whether she was in charge of the team that rolled out the initial healthcare.gov website, which was fraught with problems. The epic failure included massive overspending, enormously long delays in accessing the portal, and inability to select the plans desired.
“I was not part of the first iteration of the rollout of that website,” Cohen said. “But it was quite a career-defining moment for me, and certainly defining for the agency as well. It was a big public failure, there’s no way around it.”
Echoing President Obama, she characterized the debacle as a learning moment.
“It’s about accountability. It’s about communication. It’s about transparency.”
Sen. Ralph Hise, R-Mitchell, zeroed in on Cohen’s position at CMS at a time Gov. Roy Cooper “chose to ignore the law, and work with the Obama administration in its final weeks to rush a massive expansion of Medicaid. Do you agree that attempting to expand Medicaid without the approval of the legislature is a violation of North Carolina law?”
“I’m not a lawyer,” Cohen said. But her understanding is that DHHS must get Washington to approve a Medicaid waiver, or a state plan amendment, and North Carolina could not have received permission to change eligibility requirements to expand Medicaid without getting approval from the General Assembly.
Hise asked whether she was ever contacted by anyone in North Carolina regarding the Medicaid expansion plan or the particular waiver sought by Cooper before accepting the DHHS position or being sworn in.
“CMS actually has some very strict recusal rules, so even when you’re entertaining a job outside of CMS that may still be in the health-care space, you are required to recuse yourself,” Cohen said.
She “was in the interview process, so I was recused from all things North Carolina,” she said. “I was reading about it in the newspaper just like everybody else.”
Hise asked Cohen what she thought about DHHS seeking Graduate Medical Education payments that were not allowed by law. Those payments are made to hospitals on top of their base rate for hospital-based or hospital-sponsored medical education.
“What I would say is our team on the Medicaid side has moved forward with complying with the law,” Cohen said, noting that administrators need to find ways to ensure adequate funding for rural hospitals and access to doctors in rural areas.
Sen. Mike Woodard, D-Durham, mentioned a series of problems DHHS has had with data breaches. He asked Cohen about her experience protecting medical records.
Cohen said that was a major priority for her at CMS. In addition to ensuring they had the best cybersecurity tools, they conducted test drills on staff by sending out emails containing mock phishing scams to see who would click on them. Phishing scams induce people to open a website that unleashes an attack on their computer system, allowing access to personal data.
Sen. Don Davis, D-Greene, asked Cohen how she would address rural health-care issues.
“When I think about access to care in rural areas I think this is where technology is going to be critical,” Cohen said. “Telehealth can play an important role,” especially with psychiatric care.