In March, Rachel Levine, MD made history as the first openly transgender federal official confirmed by the Senate.
Levine, the Assistant Secretary for Health in the Department of Health and Human Services, is part of a larger effort in the Biden administration to make even more history in addressing health equity at the federal level. Most recently, HHS established the Office of Climate Change and Health Equity to use the lessons learned from COVID-19 to address climate change-infused health disparities. The administration also created the COVID-19 Health Equity Task Force, which Levine has taken part in and the HHS Health Disparities Council, of which she is a co-chair. There’s also a specific council that focuses on LGBTQ+ health equity issues.
“Health equity is a significant part of my portfolio as the assistant secretary of health,” Levine recently told Health Evolution in an interview. “I am really excited about all the areas I can work in to affect meaningful change…both internally and externally. Already, the HHS Office of Civil Rights has interpreted Section 15.57 of the Affordable Care Act that one cannot discriminate on the basis of sex to include sexual orientation and gender identity. In all aspects of the ACA, we’re working on that interpretation.”
Levine spoke with us about how COVID has exposed the vulnerabilities of underserved patient populations, the need for public-private partnerships to enact change in this area and more.
What kinds of work is the Biden administration undertaking to address health equity, particularly as it relates to LGBTQ+ patients?
The impact of the global pandemic has certainly shown the depth and breadth of health disparities in our nation and, of course, globally. At HHS, each operating and staff division is looking at health equity issues internally, within our divisions and our offices, and then we’re going to be coordinating that throughout the department. This includes the assistant secretary for health, CMS, HRSA, CDC, FDA, NIH, etc. We’re all looking at our own offices and then going to coordinate those efforts across the department.
This of course includes the LGBTQ+ community. It’s coming directly from the White House—the President and the Vice President. LGBTQ+ Americans faced a lot of challenges from the previous administration and President Biden made it clear on day one that he was going to be the strongest ally and advocate that we could have for LGBTQ+ civil rights. He has issued executive orders strengthening civil rights for LGBTQ+ Americans. He repealed the Trump transgender ban [on serving in the military]. He’s pushed the Senate to pass the Equality Act, which is really important. He spoke out in Congress in specific support of LGBTQ+ individuals in general and LGBTQ+ youth, who are very vulnerable in particular.
Already we’re seeing progress. For example, the interpretation of Section 15.57 of the ACA. But there’s more work to do at HHS. One example would be in terms of data. The previous administration stopped all data measurement of SOGI (sexual orientation and gender identity) questions. That impacts so many things. It’s an attempt to make us invisible. Under President Biden and Vice President Harris, we’re not invisible. We’re going to be working to include SOGI questions in the appropriate way with many data collection efforts. We’ll work to collect data and then to use that data to inform our policies with that health equity lens.
When different states might be looking to enact regressive bills, such as those that have targeted transgender individuals and youth, it’s important for companies who employ people in that state to advocate to the governors and the legislature about the importance of diversity.
Rachel Levine, MD, HHS
How can the public and private sector work together – not unlike what we’ve seen throughout the pandemic – to improve health equity for LGBTQ+ people and other underserved populations?
The best way to create change are these public-private partnership. From a public point of view, we need legislation nationally, but also, we need legislation in the States about LGBTQ+ equality. In Pennsylvania, it is the only state in the Northeast that does not have a comprehensive nondiscrimination act. Governor Wolf, my previous boss, has strongly advocated for that. In those settings, it’s up to the private sector to act. I know that there have been many companies in Pennsylvania and nationally that have stepped up to create nondiscrimination rules and regulations within their company.
For example, I transitioned at the Penn State College of Medicine and Penn State University. They worked to develop a nondiscrimination policy that included not only sexual orientation but also gender identity. So It’s really important for companies to have those types of policies in their human resources department and it’s important for companies to advocate.
When different states might be looking to enact regressive bills, such as those that have targeted transgender individuals and youth, it’s important for companies who employ people in that state to advocate to the governors and the legislature about the importance of diversity. This includes the importance of diversity in their companies and the importance of diversity in those states. I’m the biggest proponent, as is President Biden and Secretary Becerra, of diversity and the wonderful tapestry of people we have in our country. We need to support diversity, which of course includes LGBTQ+ people.
You touched on this earlier, but perhaps go a little deeper into what you’ve seen with COVID and how it’s exposed so many vulnerabilities?
COVID has exposed the vulnerabilities in a lot of ways. One is in terms of data collection. In Pennsylvania, when I was there, was the first state to add SOGI questions in terms of laboratory, data results, etc. But just by saying that, it doesn’t mean it’s done. They have to implement it and get people to do that. We’ve had challenges with data collection in terms of health equity for many groups, including making sure that we have race and ethnicity data coming from the state and local health departments. That’s something that we still need to work on.
COVID has affected all of us, but it’s affected certain communities far more than others. It has impacted the African American, LatinX, Native American and Native Alaskan communities more than other communities. We see more illnesses and deaths in those communities. And we have seen challenges for the LGBTQ+ community. When a community feels marginalized and has difficulty accessing medical care and then you have a public health challenge like COVID-19, it makes it much worse.
We’re continuing to see health equity challenges in terms of the distribution and administration of our safe and effective vaccine. That is something that we’re working on, again with African American, LatinX, Native American and Native Alaskan communities, along with LGBTQ+, with specific outreach to all of those communities. I want to take this opportunity to highlight the importance of our safe and effective vaccines for everyone, but specifically members of those vulnerable communities that with the delta variant, which is so contagious and transmissible, it’s more important than ever to pull up their sleeves and get a vaccine. It’s so important in light of the health equity challenges that we’re facing.
