Dr. Rachel Levine’s historic appointment to the Biden administration, explained

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Rachel Levine, physician general for the state of Pennsylvania, dines with her mother Lillian Levine on May 16, 2016, in Harrisburg, Pennsylvania. | Bonnie Jo Mount/The Washington Post via Getty Images

In a pivotal moment for trans health care, Levine has been tapped to lead US health policy.

On Tuesday, Joe Biden, then president-elect, nominated Pennsylvania Secretary of Health Dr. Rachel Levine to serve as the new assistant secretary of health at the Department of Health and Human Services (HHS). Levine’s nomination is historic: If confirmed by the Senate, she would become the highest-ranking openly transgender government official in US history.

In her new role, Levine would 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 400,000 Americans. But she will also play an important role in rolling back a host of Trump-era policies in 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 appointment marks a sea change from the right-wing political activists appointed to OASH under 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 about 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 Biden’s appointment, 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 appointment 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 would step 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. “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.

It was widely reported Thursday morning that Biden officials were shocked to learn there was no vaccine distribution plan developed under the Trump administration — and Levine, as one of the nation’s top health officials, will have a role in developing that plan.

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 be tasked with restoring that office at the federal level if she’s confirmed.

“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 has been scheduled, the Biden administration has taken some initial steps to overturn Trump policy at OASH. According to the Hill, the White House plans to launch a review of the Title X domestic gag rule — which banned federal funding to health clinics that perform or refer patients for abortions in an executive order on January 28.

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.

Earlier this week, newspapers and websites 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. Even the LGBTQ Nation’s headline — “Joe Biden picks transgender woman for assistant health secretary” — did not mention Levine by name.

If confirmed, Levine will be the highest-ranking transgender official in the federal government, a welcome step forward for a community that has historically had very little institutional power. But she will not be the first openly trans government official appointed by a president — 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 in 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, said in a statement Tuesday.

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 the 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.

With the far right showing no signs of slowing down their all-out assault against trans people, it remains to be seen whether opposition to her appointment will build among Republicans in the Senate.

She’ll likely be asked about her role in handling the Covid-19 pandemic in Pennsylvania nursing homes, where she ordered Covid-positive patients to stay in facilities even while pulling her own mother out of a nursing home at the time. It’s the kind of situation that has popped up all over the country over the course of the pandemic, but her status as a trans public figure puts her under a particularly hot spotlight, especially among conservatives who oppose some state restrictions that seek to mitigate the effects of the pandemic.

If confirmed, though, Levine would make 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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