Kody Kinsley, North Carolina's new secretary of health and human services, knows firsthand what it's like to be uninsured in this state and have limited access to health care.
When he was a boy growing up in Wilmington, his father was a construction worker, whose first job in the port city was building sets for a movie studio. His mother cleaned houses.
"I mean they've worked incredibly hard every day of their lives," Kinsley said in a recent interview with North Carolina Health News. "But regardless of how hard they worked, when it came to keeping food on the table and keeping a roof over our heads, having enough money for health insurance was just not an option.
“So I grew up without health insurance and coverage, and did not have health insurance until I started working after college or while I was in college from my employer."
There was no vehicle in North Carolina at the time for his parents to receive Medicaid or for Kinsley to be on the Children's Health Insurance Plan, or CHIP, which was established in 1998. CHIP is a program for families with incomes above the eligibility threshold for Medicaid but lower than what is needed to afford premiums for private market insurance.
Kinsley said he was only able to see a dentist when New Hanover County held special events at which an oral health exam was offered with a free lunch.
That experience, Kinsley said, of growing up in a family "that had to cobble together a patchwork of services and supports to try to get by," gives him an empathic understanding of what some 1 million people in this state are going through in the middle of the coronavirus pandemic.
When he was sick or hurt as a child, his mother would labor over the decision to take him to a doctor, Kinsley recalled. It never was an easy call for his parents, but sometimes a physician’s assessment was necessary. "They developed a relationship with a pediatrician in Wilmington who would see us on a sliding scale, and when antibiotics were needed because I had a strep throat or something, he'd go to his samples closet from the drug companies and that was because he knew we didn't have money to pay for the pharmacy, either," he said.
Our #COVID19 response team is made up of so many important individuals. Today, state health director, @betseytilson & I had the opportunity to visit our team at the @NCEmergency warehouse. pic.twitter.com/tAcOchIRnb
— Secretary Kody Kinsley (@KodyKinsley) January 28, 2022
‘We can do so much better’
Those experiences also led to his determination that public service would be part of his mission, an underlying theme that has brought him to where he is now — leading 18,000 employees in a diverse agencywith the charge to improve the health, well-being and safety of all North Carolinians.
"Living that life, and you know at the same time being afforded a number of opportunities — first-generation college student, Pell grants, all these other things that have helped me get to where I am — I think it engenders in me a sense of two things," Kinsley said. "One, first and foremost, a sense of what calls me to public service, a responsibility to pay it forward and to do unto others what has been benefited to me. Second, it's just the clear confidence that we can do so much better, and investment in our children, especially right now, especially as we come alongside the pandemic … is a transformative opportunity for us to improve North Carolina overall."
Kinsley, 36, was sworn in as secretary of the state Department of Health and Human Services, on Jan. 1 by Lucy Inman, a North Carolina Court of Appeals judge, in a small outdoor ceremony.
His partner Angelo Mathay was there with their dog Kopuk, a half golden retriever, half lab found on the streets of Izmir, Turkey, that they adopted from Neuse Golden Retriever Rescue.
Kinsley fist-bumped the judge after reciting the oath and then signed his first official document as secretary — on a small table placed outside DHHS headquarters, the Adams Building on Raleigh’s Dorothea Dix campus.
At the time, the Omicron variant of COVID-19 was taking the state by storm, causing record case numbers and hospitalizations and more deaths. By then, many had grown weary of the pandemic, especially health care workers.
Kinsley got right to work.
In mid-January, hospitals in the Charlotte area were struggling to keep up with the demand for COVID care, so he reached out for federal assistance and within two weeks he had arranged for a 16-person team, 11 of whom were clinicians, to help support the staff at Atrium Health Pineville.
"We anticipated that Mecklenburg County was going to be where our particular crunch point was going to be just because of the particular population," Kinsley said.
‘This is my home’
Kinsley came to DHHS in 2018 with a broad understanding of how government works. He has served as assistant secretary of management for the U.S. Treasury Department and held positions in the White House and the federal Department of Health and Human Services. He received a master's degree in public policy from the University of California at Berkeley. Though he does not have a medical degree as did Mandy Cohen, the secretary who brought him to North Carolina, he led operations for a behavioral health care service provider early in his career in the western part of the state, where he received his undergraduate degree in health sciences at Brevard College.
Kinsley’s family, he said, played a large role in why, in his words, he "said yes to the dress," when considering the enormous undertaking of being secretary of health and human services.
"Honestly, I thought really hard about that," Kinsley said. "Where I landed was, you know, I grew up in North Carolina. This is my home state. My parents live in Wilmington. My grandmother is in an adult care home. My brother is in Cedar Grove, north of Hillsborough. The choices of a leadership of this organization have direct and real daily impact on the health and well-being of people that I love. So I'm in this job, and in the middle of this pandemic, why wouldn't I. I have to be here and I feel it's a sense of duty to do this."
Kinsley, according to those who work with him, is a gregarious, energetic person who usually bellows a loud "good morning" to his team when he arrives at the office each day.
Brings Kopuk to work
Jonathan Kappler, his chief of staff, says people sometimes peek out of their doors in the office suite to see if Kopuk is tagging along with Kinsley.
Kinsley and his partner Mathay, an employment lawyer he met in Washington nearly a decade ago, have a ritual of taking Kopuk to the dog park one morning each week.
I’m prioritizing cooking more food at home & making sure to get in physical activity by taking daily walks or enjoying the park with my dog, Kopuk. Learn more about how you can help save lives: https://t.co/BPbULTVLt4 pic.twitter.com/QpCczKBbX0
— Secretary Kody Kinsley (@KodyKinsley) February 4, 2022
Kinsley tries not to schedule any meetings in earnest before 10 a.m. on those days, in part, to model behavior he wants for his team. It's important, he says, that they take care of their own mental health and have quality time with their loved ones, especially in the long-running pandemic. He’s a dog person.
Kopuk usually comes to the office once or twice a week, typically settling in near Kinsley's desk, but occasionally wandering out into the hallway to greet others on the team.
"We all bring our whole self to the job," Kappler said.
Kinsley is a list-maker, laying out tasks in several columns on a small piece of paper. He is process-oriented and thrives on a structure that allows him to bring the most diverse voices around the table to discuss policies and projects, then figure out how best to implement them.
"The most finite thing is his time," Kappler said, describing himself as a chief of staff who helps make sure Kinsley can accomplish what he needs to by structuring meetings and communication channels that flow smoothly.
Kinsley brings great passion to his work, Kappler said, as well as compassion, often asking those on his team about their families and events, big and small, in their lives.
"He's extremely engaging," Kappler said. "He's got a lot of energy, which sometimes can be a challenge for me. He moves quickly, but also wants us to move methodically."
‘He listens’
Dave Richard, the DHHS secretary in charge of Medicaid administration, spoke recently about some of the roles Kinsley has taken on at DHHS and marveled about his ability to juggle so much.
Kinsley oversaw four state-run psychiatric hospitals and 10 other state-run facilities that treat adults and children with neuro-medical disease, substance use disorders and developmental disabilities, a role somewhat akin to leading a hospital system. He led the state's response to the opioid epidemic and worked to provide more and better services for people with behavioral health needs and developmental disabilities. Then the pandemic hit, and Kinsley was tapped to help stand up COVID-19 testing across the state and get vaccines out across North Carolina.
"He really is just a very smart guy," Richard said. "Kody has run organizations. …He understands how to take a project, make sure that you focus on the things that can actually get it done, and actually execute it. His best skill-set is making sure you know how to execute on complex projects to get those done, and he does it extraordinarily well.
“Plus, he's got this engaging personality to where people want to support him and want to work for him."
Sen. Jim Burgin, a Republican from Angier, chair of the Senate Appropriations on Health and Human Services Committee, is one of the lawmakers with whom Kinsley has had many conversations.
"I call Senator Burgin every day at 6:30 in the morning,” Kinsley once said, describing Burgin as a friend. “It is really good to get his feedback. And he makes me laugh."
Kinsley calls him several times a week now, he said, and greatly respects his input.
"He listens," Burgin said. "I always say an effective leader listens with their ears, and I think he'll do that, and he's not afraid to be asked the tough questions. I've challenged him on a lot of things."
Vaccine distribution challenges
One of those challenges was fixing the bumpy rollout of the COVID vaccine in North Carolina.
"In the beginning of COVID, when we were all trying to get the vaccines and everything, we were third from the bottom, you know we just couldn't get it out," Burgin said.
Then Cohen put Kinsley in charge of the vaccine distribution plan. He and Burgin had many discussions about how to take a different approach that broadened the number of places where North Carolinians could get a shot in the early months.
"Within two weeks, it was completely different," Burgin said. "Hospitals got involved. We got the stuff distributed properly because the health departments weren't going to be able to do it by themselves. So we engaged all the hospitals and started saying, 'What do you need and how do you get it?'”
Burgin noted that North Carolina quickly went from one of the worst states for vaccine distribution to the top tiers.
"Mandy realized that Kody has the administrative abilities," Burgin added. "She put him in charge. I'm sure he worked 24 hours a day to do it because we talked all the time.
“That's a great example of somebody given a huge task, not just sitting on it, got everybody engaged, talked to all of us, and somebody like that I want to help. I love helping him because he's trying to move things along all the time, and I don't think he's going to be satisfied with the status quo."
A forward thinker
Kinsley said DHHS started behind the curve when the first lab-confirmed case was reported in North Carolina in March 2020. There have been long-standing health care access disparities for people of color and those were highlighted even more by the pandemic.
Some of the messaging didn't reflect the reality for many North Carolinians, especially those without health insurance or a doctor they routinely visited.
"I think about the most important doctor that we need in North Carolina: is ‘your doctor,’" Kinsley said. "Unfortunately what we have found, in starting this pandemic, is that we have over a million people without a primary care physician that don't have coverage. And I think we have been behind the curve in responding to this pandemic."
"Think about our message," Kinsley added. "Talk to your doctor to get guidance. 'Well, I don't have a doctor.' Or we said go and get a vaccine. It's free. 'No, my entire interaction with the health system, it's never been free.'"
Eduardo Cisneros, the White House COVID-19 Intergovernmental Affairs director, has spoken with Kinsley often during the past year of the pandemic. As they've talked about how to get vaccines and stem the current shortage of tests, Cisneros said Kinsley has not been shy about highlighting problems and offering his take on what could be done better.
"He's extremely helpful, diplomatic," Cisneros said. "My take on him is he's kind of a forward thinker, always looking ahead."
For example, Kinsley has been talking with the task force about how to get more rapid tests into North Carolina and also build supplies for the future in case there is yet another surge. He's thoughtful in his problem solving, Cisneros said.
Looking beyond the pandemic
While battling coronavirus, DHHS built engagement strategies and connections with communities of people that the department had never touched before, Kinsley said. He plans to continue with such an inclusive strategy.
Kinsley surrounds himself with physicians, epidemiologists, strategists and others who can help him develop a vision for North Carolina’s public health. He wants to tear down silos and build collaborative relationships.
"We have stood up retail infrastructure that serves people on the ground in ways that we have never done before," he said. "In the midst of COVID, we stood up data infrastructure that tells us information about who we're serving and how well we're doing with insights that we've never had, and we've done it in a way that's built public trust and confidence and transparency like we've never had before. So in my mind, how do we go forward with that and what do our priorities look like?"
Recovery from the pandemic will force a new focus on behavioral health, and Kinsley thinks there is an opportunity to build a dashboard that compiles information from emergency departments on suicidality and other indicators of substance use disorders and other psychiatric service needs.
"We always hear people talking about never being able to find a bed, but based off our annual survey data, in the given year, beds are empty 34 percent of the time for psychiatric services across the state for licensed beds," Kinsley said. "I know it blows your mind that nobody can find a bed. We don't have a data system that tracks at any given moment where beds are and why they're needed. We need that."
The same kinds of information can help the department better prepare for aging and workforce issues.
Picking up where his predecessor left off, Kinsley is focused on persuading lawmakers to expand the state’s Medicaid program to sweep in at least a half million low-income workers who are currently uninsured.
“This is to me, it is a no-brainer,” Kinsley said. “It is the right moment.”
Maintaining balance
As busy as Kinsley is leading an agency that found itself in the spotlight during the pandemic, he carves out some down time.
Kinsley and his partner are avid hikers, and on the weekends, they try to find a new place to explore. They’ve enjoyed many Triangle Land Conservancy trails. On a recent weekend, they spent a snowy day with Kopuk hiking on a Wake County trail from Reedy Creek to Loblolly Trail.
Mathay and Kinsley, the first openly gay cabinet secretary in North Carolina history, have been together for nearly a decade. They had their first date on Oct. 2, 2012, the second day of the federal government shutdown that year and one of few days they both had free time together. They went to the Smithsonian National Zoo, close to where Kinsley lived, and almost a decade later they are in North Carolina together.
"We like to be outside with the dog in the woods," Kinsley said.
Kinsley also enjoys settling in with a good book. He keeps a running list of what he wants to read, and it might include fiction, non-fiction, leadership books and more.
"I've found that to be a particularly important part of, quite frankly, just forcing myself off of the computer and off of the phone, and off of the TV to get reduced screen time," Kinsley said.
Not long ago, he finished "Isaac's Storm: A Man, a Time, and the Deadliest Hurricane in History," an Erik Larson book published in 2000 about the Great Galveston Storm that killed thousands of people in 1900.
"What I found interesting about it was, it was at the turn of the century when there was all this energy around science to the point where folks thought that they could control the weather," Kinsley said, contrasting that with the questioning of and politicizing science during the pandemic. "There was almost this hubris to science, and the juxtaposition to now, where, unfortunately, ...there's almost a displeasure toward science and discourse, which is so unfortunate."
Not one to shy away from a tough challenge, though, Kinsley plans to listen to the many voices and let science, data and input from a diversity of sources guide his vision for the health of the state.
North Carolina Health News editor Rose Hoban contributed to this report.
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.