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Shortly after Medicaid expansion was finally enacted in North Carolina, Kody Kinsley stood in front of business and community leaders in Boone to explain why health insurance is personal for him.
“I think about the 600,000 people in our state who will have the peace of mind of knowing that if they get into a bicycle accident, if they hurt themselves, that they’re not going to be stuck with medical debt or worse. Talk about the weight that that lifts on our communities,” said Kinsley, secretary of the state Department of Health and Human Services. “It’s an experience I know well.”
Kinsley, who grew up in Wilmington without health coverage, was one of the key people who made Medicaid expansion happen. The law became effective December 1.
Many doubted that North Carolina would ever make the jump as 39 other states had. For more than a decade, the state’s Republican-led legislature opposed expanding Medicaid, the government health-insurance program for lower-income people, primarily fearing it would be too expensive.
But in May 2022, Republican senators reversed themselves after the federal government sweetened the pot, just six months after Democratic Gov. Roy Cooper appointed Kinsley to lead the North Carolina Department of Health and Human Services.
It was the first time expansion proponents began to believe that their goal could be within reach. But Kinsley, the Cooper administration’s point person on the issue, and supporters faced a long uphill battle.
Kinsley made inroads with the Republican-controlled legislature and won the trust of its leaders. In turn, they’ve worked to pass his key legislative priorities, including Medicaid expansion and what one senator called a “once in a lifetime” investment in behavioral health.
In an era of politics often defined by an us-versus-them mentality, Kinsley, 38, is soft-spoken and known for being a straight shooter and a bridge builder. He’s also the state’s first openly gay cabinet member.
For more than a year and a half, he spent many of his waking hours in talks with health-care industry leaders, Republican legislators, and fellow Democrats about how to make expansion happen.
He answered late-night and early-morning questions from lawmakers, and listened to opponents’ concerns. He met with top health-care lawmakers and hospital executives, encouraging them to find common ground. And when an expansion deal looked like it might fall apart, Kinsley took calls while sightseeing and sipping beer in Germany on a trip with his partner.
His efforts—and those of dozens of advocates, lawmakers, lobbyists and other stakeholders—finally paid off this fall, when the legislature passed a budget enacting expansion.
Medicaid expansion would have happened eventually, said Republican state Rep. Donny Lambeth, a former hospital administrator and longtime supporter of expansion. But it may not have gotten done in 2023 without Kinsley, he said.
“The role he played,” Lambeth said, “helped push it across the finish line this year.”
This is more than just a big political win for Kinsley. It brought him full circle: The kid who grew up without health insurance became the man who helped make Medicaid expansion a reality. And that same man is now tasked with rolling out health-care coverage to families just like his.
Balancing the Checkbook
Kinsley grew up the oldest son of two working-class parents. For most of elementary school, his mother, a waitress, was out the door by 4 a.m. and his father, who worked in construction, by 6 a.m. Kinsley was left to get himself up, ready, and on the bus in time for school.
Even as a young boy, Kinsley was keenly aware of his family’s financial situation. He remembers helping his mother, who later became a house cleaner, balance her checkbook.
Without insurance, finding ways to afford health care required creativity. His mother found a provider who let them pay on a sliding scale and dug through the office supply closet for prescription drug samples. At other times, they went to community health centers.
“The role he played … helped push it across the finish line this year.”
State Rep. Donny Lambeth
But the fear of what could happen if someone became severely sick or injured hung over them.
When Kinsley was in middle school, he was playing at a friend’s house when he fell out of a tree and sliced his leg open on a jagged limb. His friend’s dad took him to the doctor, and on the way, stopped to pick up Kinsley’s mother.
The first thing she said when she got in the car, Kinsley remembered, was that they didn’t have insurance. His friend’s home insurance policy ended up covering the bill.
Kinsley was in college when his father, then in his late 40s, had a stroke. “I don’t know what we’re going to do with the bill,” Kinsley recalled his mother saying.
“To have this major medical event happen to my dad and that be your first thought, you know, it’s hard. People don’t get to focus on what really matters,” Kinsley said. “It was a huge source of stress for my mother.” The hospital ultimately covered his father’s stay as charity care.
His family’s financial situation, coupled with his sexual orientation, left Kinsley feeling different from other people for much of his life. But it taught him resilience and empathy, he said, and gave him the ability to relate to North Carolinians trying to make ends meet.
“It is one of my primary drivers for what fuels me in the work that I do every day,” Kinsley said. “People who are historically marginalized in any other way, I have a sense of connection of what that feels like.”
Kept By Trump
Kinsley graduated from Brevard College in 2007 with a degree in health sciences, and spent time during and after college working in behavioral health. He originally thought he might pursue a career as a doctor but, after an internship with a physician, found he was more drawn to the operational side of healthcare.
He studied public policy in graduate school at the University of California, Berkeley, and eventually landed a job in the Obama White House as a member of the domestic policy council staff.
That’s where he was working during the implementation of the Affordable Care Act, which allowed his parents to finally get health insurance.
Kinsley recalls the “particularly momentous experience” of walking into a staff meeting and saying: “I just want to share that today, my parents signed up for health insurance. The only reason that it happened is because of this.”
Kinsley later climbed the ranks at the U.S. Department of the Treasury, where he was working as the assistant secretary for management when Trump won the 2016 election.
He was packing up his desk when former White House Press Secretary Sean Spicer publicly announced that Trump, whose staff liked Kinsley’s work, would keep him on board—the only Obama-era political appointee selected to stay in his department.
That transition proved to be an especially challenging moment in Kinsley’s career. The colleagues he had worked with and trusted departed, and they were replaced with new faces with far different ideologies.
“Without a doubt, staying on to work for the Trump administration was absolutely a proving ground for me to test every skill I’d ever had in trying to build relationships from scratch,” Kinsley said.
He stayed until 2018, when he decided it was time to head back to his home state, where he had been hired as a deputy secretary at the state Department of Health and Human Services.
Fighting COVID-19
Kinsley had been on the job for two years when the pandemic hit and COVID-19 consumed the department. Like many working in health care at the time, Kinsley grinded through long hours, and the work permeated every area of his life.
His partner, Angelo Mathay, recalled waking up to and ending his day with the sound of former state emergency management director Mike Sprayberry’s voice as he gave COVID updates in conference calls with state leaders.
Kinsley managed operations for the state’s COVID response. He developed relationships with hospital leaders and met weekly with them throughout the pandemic, his chief of staff Jonathan Kappler said.
Those relationships proved to be vital in Medicaid expansion negotiations a few years later, when Kinsley was constantly in talks with hospitals and other health-care industry leaders. They were hesitant to support a Medicaid expansion package that also made changes to regulations for medical facilities and equipment.
Kinsley’s shining moment came in 2021, when then-DHHS Secretary Mandy Cohen tapped him to right the ship after a rocky start to the state’s COVID vaccine rollout.
Working with providers across the state, Kinsley cleared the vaccination backlog “in less than half the time we thought was possible,” recalled Matt Gross, who leads government affairs for DHHS.
Kinsley’s handling of the rollout earned him accolades both inside and outside of the department, including with Republican legislative leaders.
“It was a fiasco, and we were ranked in the bottom of the country as far as getting vaccines in arms. Well, they put Kody in charge of it. And within two weeks, we went from the bottom all the way up to the top,” Republican state Sen. Jim Burgin said. “Kody needs the credit for that.”
Cohen, who was widely known across the state as the face of North Carolina’s COVID response, announced she was leaving the department at the end of 2021, after nearly five years. She now leads the U.S. Centers for Disease Control and Prevention.
“It was his ability to speed up vaccine uptake while maintaining our commitment to historically marginalized populations which established him as a frontrunner to become the next secretary,” Gross said.
Calling the Jim
Cooper quickly named Kinsley as Cohen’s replacement, but Kinsley’s challenges went far beyond filling the void created by her departure.
He inherited a 25 percent vacancy rate and a staff burnt out from two years of an all-hands-on-deck response to the pandemic. At the time, it had looked like COVID rates were slowing down. Then came the Omicron variant, and positive COVID rates soared to record highs.
Kinsley had already laid the groundwork with some key Republican lawmakers, including Burgin, who he’s talked on the phone with almost every day for four years.
The pair bonded over their passion for bettering mental-health care when Kinsley first started at DHHS, and their relationship blossomed into a friendship. They talk after Kinsley finishes up his workout around 6:30 a.m. (“I leave the gym and call the Jim,” Kinsley likes to say.)
Burgin said politics could use more relationships like those Kinsley has built. Even though the two are from different parties, Burgin said, they trust each other and understand they both want to improve health care in the state. “When somebody’s kid’s sick, and they need to get them in the hospital, and they don’t have insurance, they don’t care about Democrat or Republican, they just care about their kid,” he said.
Kinsley also won over other Republicans, who say he’s open and honest. Shortly after assuming the role of secretary, Kinsley invited lawmakers to his office as a way to get to know them better, Rep. Lambeth recalled.
“That kind of highlights who he is and what he means to us,” Lambeth said. “He early on wanted to build the bridges, build the relationships, because, we all knew, there would be tough times, there would be times that things weren’t going as well.”
“People who are historically marginalized in any other way, I have a sense of connection of what that feels like.”
Kody Kinsley, health secretary
Kinsley was only a few months into his tenure when conversations about Medicaid expansion, long one of Democrats’ and DHHS’ biggest priorities, began bubbling up behind the scenes in the legislature.
Senate Republicans pivoted and introduced legislation in May 2022 to expand Medicaid alongside major health-care regulatory reforms. Republicans said the policy change was worth making because the federal government would cover nearly all of the cost and had added additional incentives.
“It finally felt real,” Kappler said. For the first time in the state’s history, “it felt like there was a path forward” on expansion.
So Kinsley and his staff got to work.
A month after lawmakers rolled out their expansion proposal, Kinsley was confirmed unanimously by the Republican-majority state Senate, a notable stamp of approval for the appointee of a Democratic governor.
Kinsley’s partner sat with Burgin’s wife, Ann, who had attended the hearing to accompany Mathay and support Kinsley.
Around that same time, a fight between the House and Senate had been brewing over expansion, and House Speaker Tim Moore summoned Kinsley to his office after his confirmation hearing to discuss how the House could move an expansion bill, too.
The session ended that summer with no deal between the chambers on expansion. But Kinsley, the Cooper administration, and other stakeholders kept working long after the session ended.
“When we [ran] into roadblocks, I’m sure it was frustrating for him. But he kept the process on track,” said Republican state Rep. Larry Potts, who serves as senior chairman on the state House health committee. “He didn’t push, but he certainly guided the process along in a firm manner, and when we ran into a roadblock, he was willing to help us to find a detour around it.”
And he was always on the phone, Kappler said. For many of those conversations, though, Kinsley was just listening.
“He always has the best barometer of where the risks are and the sensitive issues are because he has spent so much time listening to the concerns of other people,” Kappler said.
The legislature passed an expansion bill and Cooper signed it into law in March. Still, Kinsley’s work wasn’t done. For six more months, Republicans fought internally over what to include in the state budget, which had to become law to trigger Medicaid expansion.
Kinsley remained in the mix, working to understand the sticking points holding up a budget deal and helping to find a solution. The budget became law in October, making Medicaid expansion a reality.
Focused On the Work
Kinsley hasn’t shied away from his identity as a gay man at the helm of the state’s health department, even as Republicans introduced bills aimed at limiting LGBTQ rights.
When hundreds of cases of mpox, formerly known as monkeypox, sprung up in the state in the summer of 2022, Kinsley addressed it head on. He worked to make the public aware of who was being affected (men who have sex with men) and how it was being spread (prolonged skin-to-skin contact). News outlets snapped photos when Kinsley got the vaccine.
Earlier this year, Kinsley also successfully pushed the U.S. Food and Drug Administration to relax its ban on blood donations from gay and bisexual men. When the FDA agreed, Kinsley was among the first to donate blood in early August under the new rules—the first time he had given blood since he came out after college.
None of those efforts, or any others Kinsley has made related to LGBTQ rights, seem to have impacted his relationships with Republican lawmakers. “He’s about doing the job, and people recognize that and don’t make it political with him,” said Burgin, one of the most socially conservative members of the state Senate. “I wish all of us would do that.”
As part of the state budget, Republican lawmakers made a large investment in behavioral health, granting millions to Kinsley’s department as part of a $1.6 billion “signing bonus” the state received from the federal government when it expanded Medicaid.
The funding will go toward a slew of major projects that will bolster mental-health care and the state’s health-care system more broadly, including a new UNC children’s hospital.
“He’s about doing the job, and people recognize that and don’t make it political with him.”
State Sen. Jim Burgin
“The General Assembly could have spent the Medicaid expansion signing bonus money on anything—it didn’t even need to be related to health care,” said Gross, the DHHS lobbyist.
That the legislature chose to invest $835 million in mental-health services is a testament to lawmakers’ trust in Kinsley’s leadership and vision for the department, Gross said.
It’s a particularly exciting time for DHHS staff, who have worked for months to roll out expansion. Letters informing eligible North Carolinians went out a few weeks ago, and as many as 300,000 people were automatically enrolled on December 1.
Kinsley wants his team to take time to celebrate the moment and their accomplishments, but he’s already looking to the next projects on the horizon: the childcare crisis, antiquated behavioral health laws, and doing more for people with disabilities.
All the while, those early days in Wilmington are never forgotten.
Dressed in a suit from Costco—his go-to place for clothes—Kinsley wrapped up his Boone speech with a reminder that channeled his upbringing.
The well-being of our neighbors will, in some way, have a negative or positive impact on our own welfare, he said, and that’s why it’s worth spending time, money and resources to help make people healthier.
Disclosure: The partner of The Assembly’s editor-in-chief, Kyle Villemain, works for Kody Kinsley in the N.C. Department of Health and Human Services. Villemain was not involved in the reporting or editing of this article.
Lucille Sherman is a reporter for Axios Raleigh, where she primarily covers state politics.