Dr. Rachel Levine: Transgender Health Care Is An Equity Issue, Not A Political One

Apr 1, 2021
Originally published on April 1, 2021 5:24 pm

Updated April 1, 2021 at 6:30 PM ET

Dozens of states are considering Republican-led bills that advocates say are harmful to transgender people. The recent spate of bills are "really challenging to see," says Dr. Rachel Levine, the nation's newly confirmed assistant secretary for health.

"I really think that the decisions about health care for LGBTQ youth are really between the family, the child, the young person, their doctor, maybe their therapist," said Levine, the first openly transgender official to serve in any Senate-confirmed position, in an NPR interview.

Though more Americans than ever oppose discrimination against transgender people, Levine is taking office at a time when trans rights have once again become a controversial political issue.

Governors in Tennessee, Arkansas and South Dakota have recently signed legislation or executive orders aimed at banning transgender women and girls from participating in women's sports.

A measure passed Monday in Arkansas is now awaiting the governor's signature and would ban transgender minors from accessing gender-affirming medical care like hormone blockers and would allow insurance companies to refuse such care for people of all ages. The ACLU of Arkansas called the bill "cruel and discriminatory."

In her first interview since being confirmed, Levine questioned those efforts.

Asked whether her comments risked drawing accusations of politicizing the department's work, Levine said no, casting her involvement as appropriate given her new stead as a top public health official.

"I don't see it as a political issue at all. I view this as a health equity issue," she said. "This is about fairness and equality and about specifically health equity, which is part of my portfolio. So I don't see any risk in terms of politicization of this issue."

As the first openly transgender person to serve in such a high-ranking role — and for that role to be one of the nation's foremost public health posts — Levine said part of her responsibility is to educate Americans through her public appearances.

"I like to quote that sage Yoda from Star Wars. You know, 'Fear is the path that leads to the dark side. Fear leads to anger. Anger leads to hate. Hate leads to suffering.' I think that people fear what they don't understand," she said.

Before her nomination, Levine most recently served as Pennsylvania's top public health officer and the president of an association of state health officials. But her appointment was widely opposed by religious groups and conservatives. Some right-leaning news coverage of her appointment misgendered her in their stories.

During her confirmation hearing in February, Republican Sen. Rand Paul of Kentucky criticized Levine's support of hormone blockers for minors and compared gender-affirming surgery to genital mutilation and amputation. Ultimately, only two Republican senators voted to confirm her.

In a statement after her confirmation, Levine spoke directly to young transgender people, saying, "Sadly, some of the challenges you face are from people who would seek to use your identity and circumstances as a weapon. It hurts. I know."

Levine joins the Biden administration's Department of Health and Human Services at a moment the agency confronts a slew of challenges: an unabating opioid crisis, considerably more unaccompanied minors crossing the border than previous years, and a rising number of uninsured Americans.

The administration's first swing at a COVID-19-related relief package, the $1.9 trillion American Rescue Plan signed into law last month, included a provision that expands eligibility for health care subsidies for plans purchased through Healthcare.gov, the insurance marketplace created by the Affordable Care Act. The Biden administration now plans to spend $100 million to advertise the subsidies.

Levine called the provision "one of the most significant pieces of health care legislation since the ACA," saying that the administration hopes the subsidies will draw 15 million uninsured Americans to sign up for plans. More than 25 million people in the United States currently do not have health insurance.

And there is still the pandemic, with cases on the rise across the U.S. as some states lift restrictions.

The Biden administration's effort to scale up the nation's vaccination program has been a success: Nearly 30% of the nation has received at least one dose of the vaccine, and confidence in the vaccines among the American public has risen significantly in the last few months. But cases have begun to tick up, and hospitalizations appear to be following.

"There is a light at the end of this tunnel with the distribution and the administration of the vaccines. But we're not done yet. We have to stay the course," Levine said. "Please wear a mask, wash your hands, stay socially distant. And when the vaccine is available to you, please get vaccinated."

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When I last spoke with Dr. Rachel Levine back in December, she was Pennsylvania's secretary of health, trying to figure out how to vaccinate an entire state.


RACHEL LEVINE: This is the public health challenge of a lifetime. I don't think any of us have seen a 40-hour week.

SHAPIRO: Well, now she is newly confirmed as assistant secretary for health at the Department of Health and Human Services, and part of her job is to figure out how to vaccinate the entire country. Her appointment also makes history as the first openly transgender federal official to be confirmed by the Senate, and she is here for her first interview since that confirmation. Dr. Levine, welcome back to ALL THINGS CONSIDERED.

LEVINE: Well, thank you very much. It's a pleasure to be here.

SHAPIRO: Let's begin by talking about the pandemic. You were president of the Association of State and Territorial Health Officials, and so I'm sure you were hearing lots of complaints about the federal government. Now that you are in a senior position in the federal government, what lessons from the work that you were doing in Pennsylvania are you applying to this new job?

LEVINE: Well, I think it's very important for collaboration to exist between the federal government response to COVID-19, the states as well as local health departments. I think that we will be more successful when we're all working together.

SHAPIRO: What does that mean in practical terms, particularly when so many states are going their own way and taking very different approaches to the pandemic?

LEVINE: Well, so many governors are going their own way and developing some of their own policies, particularly in regards to mitigation. But, you know, we come back to three tools in the toolbox. The first is containment, which includes testing and contact tracing. The second is mitigation - and at its heart, that involves wearing a mask - and then the distribution of the vaccine. And I think that federal, state and local health departments are all on the same page in terms of using the tools at our disposal.

SHAPIRO: Cases and hospitalizations are starting to trend upward in many states, as you know. And CDC director Rochelle Walensky is sounding more concerned that people are giving in to pandemic fatigue. How worried are you that we are at the beginning of another spring surge right now?

LEVINE: Well, we are concerned about the increase in the number of cases as well as signs of increases in hospitalizations and deaths. You know, we are getting closer and closer, but we're not done yet. We have to stay the course, and that's why it's so necessary to take the mitigation measures very, very seriously.

SHAPIRO: Let me shift and ask you about the Affordable Care Act because as we speak today, new health care subsidies are taking effect for plans on healthcare.gov and the other insurance marketplaces created by that law. And the Biden administration has opened up enrollment on healthcare.gov until August. This is the first time Democrats have controlled the federal government after a decade of Republicans in Congress and then in the White House doing everything they could to gut the law. And so what impact do you expect these new subsidies to have on the way the Affordable Care Act marketplaces work?

LEVINE: Well, we expect a significant impact. You know, President Biden ran on the promise to bring down health care costs for families, and with the American Rescue Plan, he has delivered on that promise. This is really one of the most significant pieces of health care legislation since the ACA. Because of the American Rescue Plan, really, nearly 15 million Americans who currently lack health insurance and many current enrollees can receive additional financial support to find the coverage that meets their needs at a price that they can afford.

SHAPIRO: You say some 15 million people who don't currently have insurance can get subsidies. Is that expressing a hope that 15 million new people will get covered out of the some 26 million Americans who currently lack health care insurance?

LEVINE: No, I think that that would be our goal. And so we are having an ad campaign to make sure Americans know starting today that they can sign up for coverage until August 15. This is like a call to action. Please go to healthcare.gov and sign up.

SHAPIRO: I'd also like to ask you about the situation at the border and the flood of unaccompanied minors because your department, HHS, has announced a string of new facilities for minors, including convention centers and military bases. Homeland Security officials say their shelters are overcrowded because HHS does not have the resources to handle the number of children arriving every day. I know you've only been in the job a week, but can you tell us what the biggest sticking point right now is on getting kids out of these Homeland Security holding facilities and into HHS shelters?

LEVINE: This is really a top priority for the Biden administration and for the secretary of Health and Human Services. And as you know, I'm a former pediatrician and adolescent medicine physician, and so it's a top priority of mine as well. The Office of Refugee Resettlement in HHS is responsible for the temporary care of these unaccompanied children that are referred by the Department of Homeland Security. And it has been a challenge, but we are putting people in place to be able to accomplish that. And I think that you'll find that the situation will continue to improve.

SHAPIRO: Can you tell us whether the biggest challenge right now is a shortage of beds or a shortage of people to process the children who are moving from DHS facilities to HHS facilities or what the biggest holdup is?

LEVINE: Well, there have been a significant number of children. And so we are making sure that we have the staffing available, and we're making sure that we have, as you said, a new facility and the beds available to take care of these children. And then ORR will work to identify sponsors and places that these children can go in the United States.

SHAPIRO: You say there's this ramping up process, but it is such an urgent problem that gets bigger every day. Do you have a sense of how long it will be until there's an orderly process in place that works?

LEVINE: I think you'll find that it'll be presently. As I said, this is a priority of the Biden administration, of the president, of the vice president, as well as the secretary of health.

SHAPIRO: You have jumped on this moving train in the middle of a pandemic, and I know you've only been in the job for a week. Can you just give us a sense of what it's been like?

LEVINE: You know, it's been different because it's the federal government, but the issues are the same. You know, we're talking about COVID-19, which, of course, has dominated public health over the last year. But there are many other public health issues that we're discussing. We're discussing substance abuse and the opioid crisis. We've been talking about health equity. That was a priority in Pennsylvania. It's a priority in the federal government. And so I think that many of the issues are the same, and I feel very well-prepared for this job and excited to get going.

SHAPIRO: Dr. Rachel Levine is assistant secretary for health at the Department of Health and Human Services. We are grateful for your time today. Thank you.

LEVINE: Thank you. It was a pleasure.

SHAPIRO: And in another part of the show, Dr. Levine talks with us about her historic appointment and anti-trans legislation in the States. Transcript provided by NPR, Copyright NPR.