Today Rachel Levine, M.D., FAAP, became the country’s first Senate-confirmed openly transgender federal government official by a 52-48 vote. Dr. Levine will be the assistant secretary for health in the U.S. Department of Health and Human Services (HHS), handling many of the same urgent issues she worked on as a pediatrician, professor, and top state health official—Pennsylvania’s physician general from 2015 to 2017 and secretary of health from 2018 to 2021. Here are a few of the key issues she’ll be addressing in her new role.
On the coronavirus:
Much of Dr. Levine’s Senate confirmation hearing focused on the ongoing COVID-19 pandemic and what she did to address it in Pennsylvania. “When COVID-19 came to our state, Dr. Levine’s leadership was marked by clear, science-based communication at her daily briefings,” Democratic senator Bob Casey said at the hearing.
Dr. Levine demonstrated that she is equipped to respond to a pandemic that disproportionately hospitalizes and kills communities of color. As demonstrators masked up to march for Black lives amid COVID-19, Dr. Levine unequivocally stated that racism is a health issue. Health policy advocates consistently praise Dr. Levine’s understanding of the “social determinants of health,” including socioeconomic status and discrimination based on race, sexual orientation, and gender identity.
“As an advocate, it’s nice to not have to take that first step of explaining, ‘Hi, we exist. This is a problem, and why.’ She’s already there,” Sharita Gruberg, senior director of the LGBTQ Research and Communications Project at the Center for American Progress, tells SELF.
On reproductive health:
Some of the same HHS offices that undermined reproductive health under the Trump administration will now report to Dr. Levine. With her job comes the enormous task of undoing the web of Trump-era health regulations that disproportionately prevent people with low incomes and people of color from accessing abortion care and affordable contraception, breast and cervical cancer screening, and STI and HIV testing.
For Dr. Levine, fixing the damage will be the floor rather than the ceiling, according to Rachel Fey, senior director of public policy at contraceptive-access advocacy group Power to Decide. “To have somebody who understands the needs of the people who depend on those programs and the particular barriers they’re facing is critical,” Fey tells SELF.
While members of the Senate Health, Education, Labor, and Pensions Committee didn’t question Dr. Levine about reproductive health, her record is promising. In 2016, Dr. Levine denounced Pennsylvania Republicans’ proposed dual ban on abortion care after 20 weeks gestation and on a safe method of abortion care commonly used in the second trimester of pregnancy.
“We don’t always see folks in that position weighing in on those types of bills, so I think that speaks to her understanding of how medically inappropriate that sort of legislation is,” Heather Shumaker, director of state abortion access at the National Women’s Law Center, tells SELF. Many Pennsylvania officials have a history of opposing abortion, but Dr. Levine and the commonwealth’s Democratic governor, Tom Wolf, didn’t attempt to cut off abortion access during the pandemic as some Republican state officials did.
On HIV/AIDS:
Dr. Levine will no doubt pursue former President Trump’s pledge to end HIV transmission in the United States by 2030, yet without simultaneously engaging in discrimination. “A lot of what the previous administration said about what was needed to really end the HIV epidemic was accurate, quite accurate,” Dan Bruner, senior director of policy for the Whitman-Walker Institute, tells SELF. But Trump’s federal agencies routinely discriminated against trans people and other populations hardest hit by HIV—as Bruner describes, “pulling the rug out from under [those] efforts.”
On the contrary, “Dr. Levine has proven to be a strong supporter of a more equitable health care system,” Breanna Diaz, policy director for the Positive Women’s Network–USA, tells SELF. “For example, in Pennsylvania, Dr. Levine has led efforts to count LGBT people in public health data, prioritized people living with HIV in the vaccine distribution plan, and developed a robust response to the opioid epidemic.”
On drug policy:
Pennsylvania is no exception to the U.S. overdose crisis. As physician general, Dr. Levine signed statewide orders for first responders to carry naloxone, the potentially life-saving opioid overdose reversal drug, and for pharmacies to dispense naloxone to anyone who wants it. Amid the pandemic, community-based organizations can now mail naloxone under the order Dr. Levine updated after she became secretary of health.
Dr. Levine collaborated with the HHS on the overdose crisis in both of her previous roles. “We focused on opioid stewardship, meaning the safe, appropriate, and responsible prescribing of opioids,” she testified in the Senate. Now she’d welcome working with Congress and the Substance Abuse and Mental Health Services Administration, an HHS agency, “on continuing the absolutely essential sustainable funding for the opioid crisis.”
On mental health:
The coronavirus pandemic has only worsened preexisting health care disparities and crises, including those around mental health. For instance, the Centers for Disease Control and Prevention reported an increase in the proportion of mental-health-related emergency department visits among children and adolescents between April and October 2020 compared with 2019 rates. Child psychiatrists recently raised concerns about increases in suicide and suicidal ideation among young people. LGBTQ youth remain at an elevated risk for suicide, and trans and nonbinary youth disproportionately report feeling unsafe at home during the pandemic, according to data from the Trevor Project.
Dr. Levine is perhaps uniquely qualified to address issues in mental health care. At Penn State Hershey Medical Center, she started programs to treat adolescents with mental health issues and children, adolescents, and adults with eating disorders. Her Senate testimony highlighted the importance of telehealth services like psychiatry and psychology—and dedicated internet access to allow patients to benefit from those services.
On LGBTQ-inclusive health care:
Reports from outlets including Politico describe the previous administration’s HHS as being so overrun with anti-LGBTQ political appointees that some LGBTQ staffers removed photos of partners or spouses from their office desks. The Trump administration’s health policies provided cover to doctors, receptionists, and ambulance drivers, among others, who refused to treat queer and trans patients with respect—or refused to treat them at all. Such policies can have a chilling effect on patients seeking routine, emergency, and gender-affirming care.
Advocates expect the opposite from Dr. Levine. “Her life experience and her life’s work lend themselves to the very areas where people are most likely to face barriers in access to their care and to their reproductive well-being,” says Power to Decide’s Fey.
Under the Trump administration, HHS, the U.S. Census Bureau, and other federal agencies scrubbed questions related to sexual orientation and gender identity from key surveys and scrapped plans to add them to others. Collecting this demographic data is “critically important” to address LGBTQ health care disparities, Dr. Levine testified in the Senate.
At the same time, Dr. Levine refused to engage with Republican senator Rand Paul’s wildly transphobic questions and dangerous misinformation about trans health during her hearing. “I would certainly be pleased to come to your office and talk with you and your staff about the standards of care and the complexity of this field,” she said.
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