A day after the Department of Health and Human Services announced plans to strengthen protections against discrimination based on sexual orientation and gender identity, Adm. Rachel L. Levine, assistant secretary for health, said the move represents another important step toward securing more equitable care.
“We had been making progress under the Obama administration but had lost ground in the previous administration,” Levine, the first openly transgender person to be confirmed by the Senate for federal office, said in a STATUS List Spotlight series conversation Tuesday. “And it’s great to see us bouncing back.”
Under the Trump administration, a 2020 HHS ruling eliminated a provision that included gender identity and “termination of pregnancy” among the protected groups that health care providers cannot discriminate against. Levine referred to the previous administration’s actions as “disinterpretation” and said the Biden administration’s interpretation is that “when it says that you cannot discriminate on the basis of sex, then that means you cannot discriminate on the basis of sexual orientation and gender identity.” Levine added that the HHS Office for Civil Rights will take cases “from people who feel that they are being discriminated against because of sexual orientation or gender identity.”
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And even though she expects states to challenge this rule in courts, “it’s really critically important work.”
Levine, a physician who specialized in adolescent medicine, said the Biden administration has made it a priority to ensure the fairer care and treatment of the LGBTQIA+ community. President Biden has issued several executive orders aimed at combating discrimination and bolstering health equity.
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“Health equity is foundational. It’s fundamental to everything that we’re doing at the Department of Health and Human Services,” said Levine. “For every grant, for every funding opportunity, health equity is built into it, and it’s an absolute priority.”
She noted that the HHS proposal follows a recently proposed Title IX rule change from the Department of Education that clarifies sex-based harassment also includes discrimination based on someone’s gender identity.
Levine said discrimination in schools and communities — and more systemic bias, such as state laws to restrict gender-affirming care or ban trans youth from participating in certain sports — have taken a toll on LGBTQIA+ individuals, who are also at a higher risk of having mental health issues. “There have been very challenging politically motivated actions and laws in those states, including, specifically, actions in Texas and in Florida, and laws passed in Alabama and other states,” said Levine. “Gender-affirming treatment is medical care. It is mental health care. It is literally lifesaving care.”
“We have not made progress unless we have all made progress,” said Levine, who emphasized that youths, older adults, and immigrants are particularly vulnerable to bullying, harassment, and discrimination. “Transgender women of color,” she said, “are literally at risk of violence and murder.”
Levine also addressed other public health crises, including a shortage of vaccine doses to address the spread of monkeypox.
“Unfortunately, we are using all of the stores that we have of the Jynneos vaccine,” she said. “We’re working with the manufacturer, which is in Europe, to produce more, and then we’re going to purchase all that we can.”
She also touched on the drug overdose crisis, which led to the deaths of 107,000 people in the U.S. in 2021, according to estimates from the Centers for Disease Control and Prevention.
“We have lost ground, frankly, in many states and as a nation during the Covid-19 pandemic,” said Levine. She pointed to a need for more harm reduction efforts nationwide, including broader use of new test strips that can show fentanyl contamination, and for “states to legalize syringe service programs, so that we can work on embedding naloxone distribution.”
On climate change, Levine drew attention to HHS’s new Office of Climate Change and Health Equity, named to reflect the reality that the impacts of climate change are exacerbated in communities that are already disadvantaged, she said. “Climate change is here, now. And the health impacts of climate change are here, right now,” said Levine. “They are not an existential threat, which means maybe a threat sometime in the future. They are here right now.”
Despite so many existing and emerging issues, Levine said, she has remained hopeful in her work. “In the face of pushback, in the face of the discrimination that I see, what that does is I sublimate it,” she said, “and I’m able to turn that into further motivation to work for health equity for everyone in our nation and work for health equity for our LGBTQI+ community.”
