Molly Magarik was unanimously confirmed June 23 by the Delaware State Senate to be the state’s new secretary of the Department of Health and Social Services (DHSS). She’ll take over at the end of July for Dr. Kara Odom Walker, who resigned to take a leadership position at the Nemours Children’s Health System.
Magarik, who turned 40 in April in the midst of the pandemic, has been the deputy secretary of DHSS since January 2017. In her new role, she will lead the state’s largest agency with 11 divisions and more than 4,000 employees. With a $2 billion annual budget, DHSS is the second largest state agency by allocation, behind only the Department of Education.
Prior to being appointed to the second-in-command position at DHSS, Magarik had no public health experience. She had served as Gov. John Carney’s state office director when he served in Congress, and prior to that had served as executive director of the Delaware Democratic Party and campaign manager for the late Beau Biden.
Magarik is married with twins and the oldest of seven children. During her opening statement at her confirmation hearings, she talked about her high-risk pregnancy – her twins were ultimately born at 29 weeks – and how it impacts the way she approaches serving DHSS’s clients.
“I’m a white female with great health insurance and I know how differently this could have ended,” she told Editor Peter Osborne during a June 25 interview, where she talked about the challenges ahead. This interview has been edited for length and clarity.
How will your job change in leading a division of this size versus being the deputy secretary?
I’ll have more forward-facing opportunities, sitting on task forces versus being in audience as the deputy. As the head of the organization, there’s a lot more responsibility and the buck stops here. Many of my jobs have been behind the scenes, doing the work but not being the person who’s front and center. I won’t be able to take deep dives on issues. I’ll be placing more emphasis on delegating and relying on the tremendous leadership team we have here. You just have to be prepared to have an idea and then rely on other people getting it done.
Did you expect more pushback during your Senate confirmation hearing? When will you earn your Masters of Science and Health Care Delivery?
I’ve had many opportunities to work with the legislature, helping them get answers and understanding how to navigate the system but I didn’t take anything for granted [regarding the hearing]. I’m humbled and grateful to have them trust me in my role as Cabinet secretary. As for my degree, I’ll be finishing that up by the end of January 2021. It’s a joint program with the Tuck School of Business at Dartmouth that is almost like a health care MBA, with an emphasis on health policy.
How are you balancing COVID-19 data versus anecdotes in making tough decisions? Are you concerned about the fluctuating data and what you’re seeing in other states? There’s still a lot we don’t know. I worry every day. As we see data from other states that have reopened, we see the percentage of positive tests and cases on a steady uptick. The question is when that starts to raise alarm bells. We talk to the CDC and see what other states are doing. We are seeing that the states having the most dramatic upticks are the ones without face coverings.
Senate Minority Leader Gerald Hocker asked for your thoughts on a shutdown in the event of a second wave and you talked about being more surgical than using the broad brush. What specifically would that look like?
We are in a different place on June 25 than we were on March 25. The issues then were would hospitals run out of personal protective equipment (PPE) and questions about testing; supply chains being out; and orders being cancelled unless you paid more. Testing supplies were in short supply. Today, you can very quickly go in and get a test. We can quickly direct people to get tested and we can now do confidential tracing. We understand risk and exposure and can now be more targeted.
But we still need more staff to do the contact tracing. Like the census, we need to involve people who are trusted in that community. We’re hiring 42 people at DPH to be field investigators, preferably from the community and who speak the language. Mitigating the issue – testing and isolating – can be scary. We’re learning that parts of the populations don’t always have stable phone numbers so using local groups to help with the outreach is important.
The governor spoke at his June 23 press conference about being more aggressive with businesses that are flaunting the rules. How far do you see the department handling restaurant inspections moving from education to enforcement?
We’re still trying to get those pieces together. We may need to hire additional staff. These businesses want to do the right thing and our decisions about enforcement may help them have difficult conversations with customers about masks and social distancing. If the public knows that the state is serious, it’s easier to get them to comply. Face coverings really matter. We know this is a difficult time, but 6 feet of physical distancing at a minimum is a key tool to keep people safe from spread, especially with a face covering.
The first time around, the big box stores were allowed to stay open, but smaller businesses were shut down or limited. Would that change in a second wave?
Closings in the future will definitely be different. We’re going to learn from what we saw and the impact that it had. Between the lessons from the past and the resources we have today, it’s incumbent to evolve and [avoid] shutting down the economy.
How do you balance the question of what comes first – public health or the economy?
One doesn’t trump the other. The good news is that the private sector is incredibly creative. We provide the public-health guidance and what matters and the private sector and others have come up with really cool ideas that I would not have thought of. It’s all about building relationships and maintaining a spirit of collaboration.
Can you elaborate on the timing of going into Phase 3, or at least the metrics that the governor is looking at to make that decision?
Delaware has done a great job of not focusing on just one metric. We are reopening and people expected the numbers to go up. But we have seen a bit of gyration in the data. Some are lagging indicators, and some are more real time [like hospitalizations]. Anecdotes about what people are doing is not on the same level as data [in making decisions] but it gives us some perspective on whether people are being compliant.
We’re very fortunate that COVID didn’t hit us as hard as other places. We were never a New York City. But we need to make sure that the tremendous sacrifices Delawareans have made were not for naught. We’re way ahead of New York, [which as of today] is not allowing in-person dining. We didn’t shut down some of the things that they did, and that New Jersey and Pennsylvania did. Our phased reopenings were more robust and helped us avoid rampant spread.
How will you define success at the end of 2020?
It will continue to revolve around our response to the pandemic – testing, contact tracing – and that we haven’t gone back. We see indicators that we’ve lost ground. I think success will also be about the extent to which we’re able to bring individuals safely back to work and expand the services that we offer – helping providers, partnering with clients to be in the new normal, and [reducing or eliminating] gaps in our services. We’ve seen troubling numbers with the opioid epidemic in terms of substance abuse and overdose deaths. We were starting to get to a better place before this and I think we’ve lost ground.
Were you surprised by Secretary Walker’s departure?
I love her. I truly do. She’s an exceptional human being and a tremendous Cabinet secretary. I was never going to be ready for her to leave. These jobs are so demanding. There’s a lot of sacrifice. Many of us aren’t seeing family. It’s a real gut check around what matters. And you want to spend more time with your family. I know it was hard for her to leave us too.
By Peter Osborne
