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Rachel Levine’s historic confirmation to the Biden administration, explained

In a pivotal moment for trans health care, Levine has been confirmed as assistant secretary of health.

Rachel Levine, then physician general for the state of Pennsylvania, dines with her mother Lillian Levine in 2016, in Harrisburg, Pennsylvania.
Bonnie Jo Mount/The Washington Post/Getty Images

On Wednesday, the Senate voted to confirm former Pennsylvania Secretary of Health Rachel Levine as the new assistant secretary of health at the Department of Health and Human Services (HHS). Levine’s confirmation is historic: She is now the highest-ranking openly transgender government official in US history.

In her new role, Levine will run the Office of the Assistant Secretary of Health (OASH), which oversees the nation’s public health policy. She will be a key administration figure as the White House tackles the deepening Covid-19 pandemic that has claimed the lives of more than 500,000 Americans. But she will also play an important role in rolling back a host of Trump-era policies on reproductive, adolescent, and LGBTQ health. As a trained pediatrician with a history of supporting evidence-based adolescent health, and who has spoken about her own closeted trans youth, her confirmation marks a sea change from the right-wing political activists appointed to OASH under former President Donald Trump.

Because of the historic nature of Levine’s appointment, there has been much talk about her trans identity. Meanwhile, her qualifications, which should not be overshadowed, have taken a back seat. For the last three years, she’s been the secretary of health for Pennsylvania, where she has taken the lead on the state’s handling of the Covid-19 pandemic. Her clear-eyed press conferences instructing Pennsylvanians on how to survive the pandemic have earned praise from Democrats inside the state. Before she became the secretary of health, she was the state’s physician general.

Levine frequently takes a holistic approach to policy, telling Philadelphia magazine last July how she conceptualizes public health. “Economic opportunity is health. A living wage with an increase in the minimum wage is actually health,” she said. “Improving educational opportunities, improving nutrition, improving the environment, improving transportation for people is health. Getting rid of racism is health.”

Following President Joe Biden’s nomination, Pennsylvania Gov. Tom Wolf called Levine “a highly skilled and valued member of my administration.”

“She has been a wise and dedicated partner during this pandemic and throughout her career with the commonwealth,” Wolf said in a statement. “I couldn’t be prouder of the tireless work she’s done to serve Pennsylvanians and protect the public health.”

Levine’s confirmation would be important, if only because she would instantly become a recognizable and authoritative trans voice on public health at a moment when access to trans health care is increasingly threatened worldwide. With Biden taking an explicitly pro-trans stance, Levine steps into a visible role in charge of federal youth health policy.

“This marks a real turning point that honors and includes trans people,” Molly Bangs, director of Equity Forward, an HHS watchdog group, told Vox about Levine’s nomination in January. “She’s given every indication that she will continue to center equity from all perspectives when ascending to federal office. Transgender youth need real quality health care and access to information more so than ever. She’s demonstrated that that is very much a cornerstone of really what drives her career.”

Levine takes over a key federal public health office in a pivotal moment

Her most immediate demand as assistant secretary of health is likely to be helping manage the federal government’s handling of the pandemic.

But beyond the pandemic, she will take over a department that underwent some radical changes under Trump. The Office for Women’s Health and the Office of Population Affairs oversee most of the government’s reproductive health initiatives. The transition from Obama to Trump saw progressive initiatives tossed out in favor of anti-reproductive health policies, including rolling back the Obamacare birth control mandate.

Meanwhile, the Office of Adolescent Health, which administered the Teen Pregnancy Prevention Program, was shunted to a different office’s oversight and essentially shuttered under Trump. One of Levine’s first accomplishments in Pennsylvania was establishing the state’s Office of Adolescent Health, and she’ll now be tasked with restoring that office at the federal level

“This position of assistant secretary of health has a massive portfolio of issues,” said Bangs. “Dr. Levine and her colleagues will have their work cut out for them, and they will need a really proactive agenda in order to not just reverse the damage that’s been done but also protect and expand LGBTQ rights [and] sexual and reproductive health [access].”

That work will get underway almost immediately. Even before Levine’s confirmation hearing was scheduled, the Biden administration took initial steps to overturn Trump policy at OASH. The White House has already launched a review of the Title X domestic gag rule — which banned federal funding to health clinics that perform or refer patients for abortions.

Levine’s office will oversee the review, putting her at the center of US reproductive health policy for the next several years.

Levine will not be the first openly trans government official

Though she is deeply qualified for the position, Levine’s trans identity has grabbed the lion’s share of media attention.

Newspapers and websites have trumpeted her identity, almost to the exclusion of any other facts about her. “Biden picks 1st transgender person for Senate-confirmed post,” read an Associated Press headline in January. Even the LGBTQ Nation’s headline — “Joe Biden picks transgender woman for assistant health secretary” — did not mention Levine by name.

While Levine is now the highest-ranking transgender official in the federal government, a welcome step forward for a community that has historically had very little institutional power, she is not the first openly trans government official appointed by a president; she is just the first to be confirmed by the Senate. President Barack Obama named trans woman Amanda Simpson senior technical adviser in the Commerce Department’s Bureau of Industry and Security in 2010, though it was not a Senate-confirmed appointment.

Levine’s trans identity will inform her new role as one of the nation’s top public health officials. “At a time when access to health care is a growing crisis for transgender people made worse by anti-LGBTQ legislation and legislators across the nation, Dr. Levine has the empathy to understand the health needs of our diverse country and the skillset to improve them,” Alphonso David, president of the Human Rights Campaign, has said in a statement.

Levine has spoken previously about her experiences as a closeted trans child. At a conference in 2015, just after she’d been appointed Pennsylvania’s acting physician general, she described growing up playing football and hockey near Boston in the ’60s, but also carrying with her a deep secret. ”All I knew is I wanted to be a girl, or I was a girl, or female,” she told a crowd in Swatara Township, Pennsylvania.

During that conference, Levine spoke directly to the state’s trans youth. “What I want to tell those kids is I am there for you. We are here for you,” she said. “Please don’t harm yourself and please don’t despair, because we are there for you.”

It’s a message she’s continued to stand by throughout her public health career, even as critics and random internet trolls relentlessly attacked her gender identity and appearance. And she’s making history in a time and place when trans “firsts” are becoming rarer — an appointment that is as much a win for trans people as it is for a well-qualified doctor with a lifetime of public health experience.

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