Kate Walsh reflects on her time as Mass. health secretary

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Monday was Kate Walsh’s first day in semi-retirement. As Massachusetts secretary of health and human services, she oversaw a tumultuous period of hospital sales and closures, increasing public skepticism about vaccines, and big declines in overdose deaths. This past Friday, she announced she was stepping down.

She’ll still be an advisor to Gov. Maura Healey. But for the first time in several decades, she won’t be on the front lines of health care in Massachusetts. And she has been a force.

Walsh was president and CEO at Boston Medical Center for 13 years when she left to join the Healey administration in 2023. Before that, she held leadership positions at Brigham and Women’s Hospital, Massachusetts General Hospital and Novartis Institutes for Biomedical Research. She started her adventures in health care as a summer intern at Brookside Health Center in Jamaica Plain. There are lots of stories to tell.

But for the moment, let’s focus on the two and a half years Walsh spent leading the state’s Executive Office of Health and Human Services, with its 11 agencies plus MassHealth, a $32 billion budget and over 23,000 employees.

Much of her last year was consumed with efforts to keep Steward Health Care hospitals open after the system declared bankruptcy. (Two hospitals in the state shut down, several others were transferred to new operators). But Walsh doesn’t mention that in an emailed response to questions she sent on her last day at work.

Here’s a lightly edited version of the exchange:

Why are you retiring now, two and half years into Healey's first term? 

“When the governor and I first started talking about this role, we agreed that I would serve in this position for two years.  And I so appreciate the governor’s willingness to honor that commitment while I continue to advise her on health care issues facing our state. My work has been such a big part of who I am!  I’m most proud of the great team we assembled, and I’m certain that under Dr. [Kiame] Mahaniah’s leadership, the important work of our 11 agencies and the MassHealth program can continue and that this excellent team will guide our state through some rough waters ahead.”

Can you please share a story from one of your most difficult days and from one of your most joyful? 

“One of my most joyful days was when I attended a graduation for an internship program that our Department of Development Services (DDS) team set up as part of our efforts to connect families in Emergency Shelters with employment. This was truly one of my favorite things I’ve done so far as secretary. It was really moving — seeing all of the families dressed up like it was the Oscars. They were so proud to be moving on to meaningful jobs, building a real foundation for a future here in Massachusetts… This can be such a politically divisive issue, but the joy of the families, the enthusiasm of the patients and staff at Hogan [Regional Center in Danvers] … it will stay with me for the rest of my life.

The worst days are any time I have to look across the table at someone doing something important and tell them that we just can’t afford to continue doing this, or we have to change this program, or move it, or consolidate it, or redeploy resources to meet a greater need.  I never met a program I don’t like — that part is tough.”

What goals did you accomplish or get closer to, and where did you feel stymied?  

“As I said earlier, I’m so proud of the team I get to work with every day.  We’ve accomplished a great deal, some are very public like a reduction in [drug-related] fatalities, or the massive redetermination effort for MassHealth enrollees, when we successfully transferred 400,000 people to the Connector [state health insurance marketplace] or employer-sponsored insurance.

Some of our work is much longer term or may be less visible to the public, like our efforts on reducing and hopefully eliminating the disparities in health outcomes in maternal health and cardiometabolic disease in areas across our state. Some of our really important work isn’t very flashy, the business and management of running large, complicated agencies, making investments in process improvements, our IT systems and front door for constituents, decreasing the time it takes for providers to get licensed and license renewals, improving our compliance functions and doing strategic planning.

I never felt stymied but sometimes I did get impatient … maybe because I’m not getting any younger!”

What are the top challenges you see in the coming year for health care in Massachusetts? 

“It’s no secret that President Trump and Republicans in Congress have passed a budget [reconciliation bill] that will make it hard for every state in our country to care for older people, disabled adults, and children, to help lift families out of poverty and keep us all safe from disasters, pathogens, and an overheated planet. But at least once a day, we all say, ‘thank goodness [we] live here in Massachusetts,’ where Gov. Healey, the Legislature, the Attorney General’s Office, and the rest of government are committed to ensuring that people can access high quality health care, gender affirming care, equitable reproductive health care, inclusivity and opportunity for people with disabilities, and dignity and respect for families that need a help like food assistance  during tough times in their lives.

"It will be hard, but I am certain that here in Massachusetts we will get this as right as it can possibly be over the next few years.  There are tough times ahead but we are working from such a position of strength. Our hospitals, health centers, community behavioral health centers and human services providers are the best in the country, as you can see in any national ranking of health indicators… Sometimes Hawaii beats us… (I kept proposing a site visit there, in the dead of winter so we could learn more! But no luck). We have a great deal to be proud of and to protect!”

What's next? 

"That might be the hardest question you’ve ever asked me…  I’m going to take a bit of time over the summer to think about that, while serving as senior advisor to the governor, lieutenant governor, Kiame and the team as needed.  I’ll get back to you when I come up with an interesting answer!"