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

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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