With a lavish salary come severe responsibilities, as Karen Bowling is about to learn. She needs to tackle them immediately and decisively.
Bowling, 55, has been appointed to head the West Virginia Department of Health and Human Services. She takes over an agency on the verge of perhaps the biggest transition in its history.
She will be paid $175,000 a year. That is nearly eight times the per capita income of Mountain State residents. It also is $80,000 a year more than her predecessor received.
State legislators agreed to the massive pay hike this year, after being told the previous $95,000 rate was not enough to attract top-quality applicants for the post.
Bowling's credentials seem solid. She has worked as a nurse practitioner, college dean and chief executive officer of a hospital in Beckley. She has served as chairwoman of the state Hospital Association.
None of that has prepared her for what she is about to encounter, we suspect: the most massive bureaucracy in state government. The DHHR budget is more than $4.3 billion and is growing by leaps and bounds. It is by far the single largest item in the state budget.
Hundreds of thousands of West Virginians rely on services provided through the DHHR. That number will grow much larger once plans are finalized to expand the state Medicaid program by about 91,500 new clients.
Medicaid provides health care services to low-income and disabled people, and is funded jointly by federal and state governments. The expansion is one of many mandates in the new national health care law.
In addition to implementing cost-cutting proposals by a consultant, it will be Bowling's task to ensure expansion of the Medicaid program is done responsibly. Regardless of what anyone in Washington says, more Medicaid means more spending by state taxpayers.
It already has been reported the state plans to curb growth in Medicaid spending by providing that clients will be responsible for modest co-payments for some services. In addition to that, Bowling should consider some sort of more sweeping personal responsibility plan - both to hold down spending and improve the health of Medicaid enrollees.
By any standard, Bowling is being paid extremely well. In exchange for that, legislators and taxpayers have a right to expect results - soon, not in years - in better DHHR services at lower cost.