First Transgender Presidential Appointee: HHS Assistant Secretary Dr. Rachel Levine on Biden Administration’s Commitment to Health Equity

Dr. Rachel Levine

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M oderator : Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter, a show where we speak to the top thought leaders
in health innovation, health policy, care delivery, and the great minds
who are shaping the hea lthcare of t he future.

This week hosts Mark and Margaret speak with Dr. Rachel Levine,
Assistant Secretary for Health at the U . S . Department of Health and
Human Services, the first transgender presidential appointee
alleviated to a high level post in U.S. government . Dr. Levine discusses
the Biden administration ’s emphasis on health equity for the LGBT
community and vulnerable populations, and is a Pediatrician with an
emphasis on mental health for kids. She examines the impact of the
pandemic on child health and the n eed to advance Telehealth to
reach more people.

FactCheck.org ’s Lori Robertson checks in the Managing Editor looking
at misstatements about health policy in the public domain , separating
the fake from the facts . And w e end with a bright idea that's
improvi ng health and well being in everyday lives.

If you have comments, please e - mail us at [email protected] or find
us on Facebook , Twitter , or wherever you listen to podcast s . Now stay
tune for our interview with Dr. Rachel Levine here on Conversations
on Health Care.

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Mark Masselli: We’re speaking today with Dr. Rachel Levine , Assistant Secretary for
Health at the U.S. Department of Health and Human Services ; t he first
openly transgender person to be confirmed by the Senate . Dr. Levine
previously served as the State of Pennsylvania’s, Secretary of Health
and before that physician general.

Margaret Flinter: Dr. Levine was Professor of Pediatrics and Psychiatry at Penn State
College of Medicine, Chief of the Divis ion of Adolescent Medicine and
Eating Disorders at Penn State Hershey Medical Center. Dr. Levine we
welcome you today to Conversations on Health Care.

Dr. Rachel Levine: Thank you so much. It’s a pleasure to be here.

Mark Masselli: Oh i t’s great to have yo u and you know your personal story really
informs your mission at HHS . A nd you've joined the agency, what I
would say is really concerning time as there is a record number of
anti - trans bills that have been making their way through state houses,
although t here is some good news that the Supreme Court just
decided, not to take up challenging one case involving trans youth
choice of school bathrooms. And I'm wondering if you could talk
about the dangerous level, I think you've called this some draconian

Dr. Rachel Levine

measu res that are happening in number of state houses a nd how they
could impact health equity, health outcomes for the LGBTQ
community, especially for youth populations.

Dr. Rachel Levine: Well, I do feel that these bills are draconian. I think that the genesis of
a lot of this legislation unfortunately is political. And th at it’s being
used as a potential wedge issue in the next election. But what you
have to remember is that this is directly impacting the health and
well - being of transgender youth. Transgender youth are very
vulnerable and are at - risk of harassments and bullying. And so it is
really particularly important for us to advocate for transgender youth.
And these laws prohibiting their participation in activities and sports
and the most egregious in t erms of preventing their access to gender
affirming medical care, really are going to harm transgender youth.

Margaret Flinter: Well, Dr. Levine, you've advocated for a long time for more integrated
approach to child and adolescent health. And that we've c ertainly
seen . W hat a terrible toll , it’s taken on the mental health of children
and adolescents in the community health center world that we're part
of . T his integration, has always been kind of a norm not the exception,
but not so much around the country or a s a standard of practice. How
is HHS going to address the crisis of child and adolescent behavioral
health needs in the country going forward ? A nd what models do you
think are going to be most effective?

Dr. Rachel Levine: Now we're very concerned abo ut the mental health challenges that
we were going to see during the COVID - 19 pandemic, and as we
eventually come out of the pandemic. Adolescent mental health
concerns have been really part of my career through Academic
Medicine and into public health. So what we're going to be doing is
actually through the secretar y’s Behavioral Health Coordinating
Council, so Secretary Becerra , is very concerned about these issues.
And he has brought back a crosscutting council which will work with
collaboration with all of our different offices throughout HHS.

One of the specific subcommittees in priorities at this council is child
and adolescent mental health. You know COVID - 19 has been such a
challenge for young people and you can think of it as almost being a
generati onal trauma for young people with the challenges that they
have faced. And so we're going to be working with experts across the
country on how we get like data, about that issue , a nd then how we
intervene and help young people struggling with their mental health
concerns.

Mark Masselli: Well the pandemic has really la id bare the flaws within our American
Health System and how they disproportionately impacted, not just
the LGBT community but vulnerable populations across the b oard.
And I know you're going to be participating in a panel this week on
how community health centers can help develop protocols that are

Dr. Rachel Levine

vital to serving these populations. I wonder if you could talk about
some of the more important initiatives under the Biden
administration, aimed at addressing health inequalities and the role
that community health centers can play in this work all across the
country.

Dr. Rachel Levine: Health equity is an absolute priority of President Biden and the
administration as well as a priority of Secretary Be cerra . We also have
another coordinating council t he Health D isparities C oun cil which I'm
very pleased to be one of the co - chairs. And we're going to be looking
at the impact of COVID - 19 as well as many different other health
equity issues for vulnerable p opulations, I mean that includes the
African American community, that includes the Latinx community, the
American Indian Native Alaskan community. I mean the pandemic has
impacted these vulnerable communities more than others. And this
really underscores t he profound disparities in health that we see in
our nation.

So we're going to be looking to make health equity a cross cutting
issue in everything that we're doing. And of course HRSA will be right
at the table, and we would be looking at the way that com munity
health centers can serve to promote health equity itself, and the way
that they really do serve all communities particularly vulnerable
communit ies . HRSA really is the agency that outside of public health
people don’t know much about , b ut it is a ve ry, very powerful agency
in terms of its impact on many of these issues . And our community
health centers are really a gem of our healthcare system.

Margaret Flinter: Well, thank you for that . A nd I want to say, we really appreciate the
work of HRSA. We're all worried obviously about the rise of the Delta
variant. We're so proud of the great work that’s been done around
vaccines. We're so worried about that last big group of people that
haven't gotten vaccinated yet. And now we've the FDA with, yeah
they ar e warning about possible cardiac side effects among people
though I understand from what I read anyway, more transient than
anything permanent. But one of the big concerns at HHS a s you all
come together every day, to talk about latest vaccine developments ,
the rise of the Delta variants spread, what are you saying to people
about what needs to happen next?

Dr. Rachel Levine: Well, you know under the President ’ s leadership we've made so much
progress in terms of our vaccination effort. 8 7% of all seniors ha ve
received, getting at least one shot, and 75% of individuals over 40 and
70% of individuals over 30. But we're having challenges with younger
people. We're having challenges with teens and particular challenges
with young people, 18 to 26, and who might be somewhat
complacent that they will not suffer the negative effects of COVID - 19,
especially in light of the Delta variant that is incorrect , t he Delta

Dr. Rachel Levine

variant is increasing in the United States . The Delta variant has been
shown to be more contagious, mor e transmissible than the previous
variants and there is evidence that it can be more virulent, meaning
need to more severe disease, more hospitalizations and possibly more
deaths. And it will really impact any unvaccinated community whether
that’s a geogra phic community or an age group . A nd so we're seeing
more younger people who have gotten ill and have gotten
hospitalize d . S o you know the message is that these vaccines are safe.
These vaccines are effective and they are more important than ever
right now, because of this Delta variant.

Now the issue in terms of the heart impacts, really is very limited. The
data from the CDC and that was reviewed by the Advisory Committee
and Immunization Practice, shows that if you look at you know a
million doses of the vaccine, there are you know maybe 20, 30, 50
young people who might get a very, very mild and transient
inflammation of the heart on a myocarditis, that will go away either
with no treatment or limited treatment within a short period of time.
That’s compar ed to hundreds and hundreds of young people out of a
million that might contract COVID - 19 , s everal hundred that might be
hospitalized and a few that could even pass away.

So the data is very clear that the benefits of the COVID - 19 vaccine, the
benefit of o ur safe and effective vaccines significantly outweigh any
potential side effects, outweigh the risk s . So the bottom - line is that
our vaccines are safe and in the face of the Delta variant they are
more important than ever. So really this is a call to actio n for people
to get their vaccination so we can stop the spread of this dangerous
variant of COVID - 19.

Mark Masselli: We're speaking today with Dr. Rachel Levine, Assistant Secretary for
Health at the Department of Health and Human Services ; t he first
open ly transgender person to be confirmed by the United State
Senate. You know I want to go back to the pandemic I think there is
probably the only silver lining for some of us, was the promotion of
Telehealth across the pandemic. Many of us ha d been waiting f or a
long time and it really allowed many of us to build very robust
systems, and reaching to vulnerable populations who hadn’t been
reach ed before . I saw that the Secretary Becerra was advocating and
supporting the work that’s going on in Telehealth . And I'm wondering
if you could share with us, how HHS is going to provide ongoing
support for the expansion of Telehealth . I know you're very concerned
about rural populations , t he ability to do this by audio as well as audio
and video. So tell us about the ty pes of investments that might be
needed ? A nd how do you see that potential payoff for the expansion
of Telehealth ?

Dr. Rachel Levine: Well, COVID - 19 has really helped usher in a new era, in terms of

Dr. Rachel Levine

Telehealth and telemedicine. And this is a priority of th e Secretary
and the priority of my office. And we'll work really across HHS on
continuing these advances in Telehealth and system. And so the
federal government did put in many measures in place during COVID -
19 to make Telehealth easier. This does include HIPAA flexibility for
Telehealth technology. Medicare and Medicaid policy, so we're
working with CMS on that in terms of waivers and regulatory changes,
making it easier for providers to deliver Telehealth services to
Medicare and Medicaid patients and to get reimburse d for that.
Providers can deliver Telehealth services across state lines. So there
were Telehealth licensing requirement in interstate context that were
waived. Prescribing control led substances including medication for
opioid use disorder suc h as Suboxone. So there are a lot of these
measures . W e're going to have a department wide group looking at
which are the priority measures, which absolutely have to remain in
place.

Another model that I wanted to kind of emphasize is a model that we
used in Pennsylvania. It was first developed in New Mexico. Project
ECHO was developed by the University of New Mexico. And it’s a
guided practice model which really helps rural areas that are serving
underserved communities, remote areas of Pennsylvania or rem ote
areas of New Mexico and other states. It’s a hub - and - spokes
knowledge sharing approach where content experts, expert teams,
for example the University of New Mexico w here it w as first
develop ed , but in Pennsylvania at Penn State Health, led virtual
cli nics. They would talk to rural providers about delivering best in
practice care. W e use d this in Pennsylvania first in terms of opioid
treatment. And I know Penn State now is using it for COVID - 19
evaluation and treatment, and many, many other conditions. So it
really is such an innovative way to use Telehealth .

But I do want to emphasize something that you mentioned, is that
you know we've to be careful of the healthcare disparities in terms of
Telehealth . Not everyone in our country especially in rural ar eas have
access to broadband, not everybody has great computers like we're
using right now to be able to do these type of visits. So auditory only
Telehealth , is a very important aspect which is a priority as well.

Mark Masselli: You know, Margaret, doctor just mention ed our good friend Sanjeev
Arora, who we worship here.

Margaret Flinter: Absolutely and we couldn’t agree more when people think about
Telehealth , thinking about that component of Telehealth , about how
we move d the needle forward for everybody . You know and in this
period of time I would have noted so many milestones, one of the
th
milestones that we noted recently here was the 40 anniversary of
the AIDS e pidemic and we were honor ed to have Dr. Fauci, back on

Dr. Rachel Levine

the show with us. And it was very ho peful when he suggested as
we're talking about COVID and the vaccine that’s a remarkable
science and the years that went into developing that vaccine, might
also pave the way for a potential vaccine for HIV. And I think he said
within a decade which kind o f took my breath away after 40 years.

Can you talk about our efforts here in the United States, and globally
to address the ongoing epidemic of AIDS and perhaps to look forward
to a day when we might end this epidemic?

Dr. Robert Levine: Well, thank you fo r that question. So I mean I started my residency
program, my internship in New York City in 1983 at Mount Sinai
Hospital. And I was in pediatrics, so I saw a different side of the
HIV/AIDS epidemic. And what I saw primarily we're in fants that we're
impact ed because they get HIV from their mother who might have
had HIV from the number of different causes. And those infants
passed away and then frequently their mother and potentially their
father passed away. And the HIV epidemic was devastating.

And so we'v e made so much progress on so many fronts. HIV testing
now is easy, it’s fast, it’s safe, and it’s confidential. And there are 1.2
million people approximately living with HIV, and take their HIV
medication, maybe one pill a day that where it’s a chronic i llness. But
they are living long healthy lives and U=U, undetectable means
untransmissible, and they have essentially no risk of transmitting HIV
to others. B ut we've a long way to go because you know one in eight
still don’t know they had HIV. So they are not able to access th ese
lifesaving medications and these needed services.

So to really end the HIV epidemic, we really have to support not only
those living with HIV that we know of and who we' re supporting with
medication, but support the people who hav e undiagnosed HIV.
We've to support them in terms of access to testing and to treatment
services. This is a strong health equity issue. But we also have to
continue to expand pre - exposure prophylaxis, correct. I mean we've a
once a day medicine that can pr event someone from getting HIV.
When I w as an intern , in 1983 , that would have seem ed like a miracle.
And we've to continue to expand access to PrEP and to PEP post -
exposure prophylaxis , syring e service programs. And so you know
ending the HIV epidemic is a core strategy for the Office of the
Assistant Secretary of Health. We seek to reduce new HIV infections
by 90% by 2030.

We talked about community health centers, they are a key
component to this effort. And th e s e health centers have prescribe d
PrEP to 63 ,000 patients . J ust this past March, HRSA announced nearly
$99 million in funding, through HRSA’s Ryan White HIV/AIDS program
to ex tent access to HIV care, treatment, medication and essential
support services. So you know the Biden - Harris administration is

Dr. Rachel Levine

committed to this funding as well as for example the Ready, Set, PrEP
program so these are priorities for the Secretary , for myself and
across the administration.

Mark Masselli: Well that’s great, important goals, but good news in terms of the
work that’s being done all across the country. You know we witnessed
some disturbing trends in the wake of recent events. And we've seen
some true assaults on science and scientist s like Dr. Fauci and
yourself . A nd thank you for being a clarion voice and standing tal l and
speaking truth in science to power.

And yet we see over the last number of years that trust is eroded in
some of our really revered organizations like the CDC and HHS. How
do we address this misi nformation, campaigns that are really
undermining the c redible work that’s being done by these agencies, in
advancing public health and trying to save lives, especially during this?

Dr. Rachel Levine: I mean COVID - 19 has been much more challenging in the United
States than it was in Pennsylvania, where I was t he Secretary of
Health, because it has been politicized. And many aspects of our
response to COVID - 19 such as mask wearing, such as the vaccination
has been politicized. And that makes it much more difficult. These are
public health issues, they are not po litical issues. And so we need to
keep politics out of public health and we need to continue to
emphasize, proven scientific methods both for medicine and for
public health . Y ou know as develop , the scientific methods that have
develop ed th ese amazingly ef fective vaccines that we're working to
distribute.

So you know NHHS, Dr. Fauci, myself, Dr. Walensky , Dr. Murthy, our
great Surgeon General , you know we're going to work to get the best
information out there to as many people as we possibly can and stick
t o the science , to educate people about COVID - 19 and other medical
and public health issues. T his is a particular priority of the Surgeon
General to counter misinformation that the public gets through social
media and other ways. So I think that we can and I firmly believe that
we'll learn the lessons from COVID - 19 and we'll build back a healthy
future for all of us, and to heal as a nation.

Mark Masselli: For all those parents out there who have two to 12 year old s , when do
you think w e’l l hear the results of the clinical trials that are going out
and that those of vaccines might be available for that age group?

Dr. Rachel Levine: Well, first it’s important to emphasize that we've a safe and effective
vaccine for 12 through 17 years old. So right now the Pfi zer vaccine
has the authorization from the FDA for teenagers 12 through 17. So I
would certainly encourage all parents to have their teens vaccinated ,
especially in the phase of the new Delta variant. So those clinical trials
for younger children are going on right now for the Pfizer vaccines and

Dr. Rachel Levine

the Moderna vaccine. I can’t put a date on science so I can’t tell you
when those clinical trials will be completed and they will be able to
present their data, to the FDA for consideration a nd then to the CDC
advi sory committee for their consideration . Hopefully by the end of
2021, but those studies are going on right now and we’ ll remain
positive [inaudible 00:21:36] that they will show the safety and the
effectiveness even for younger children. And we can start t hat
vaccination program as well. But we'll wait for science and the results
of the clinical trial.

Margaret Flinter: We've been speaking today with Dr. Rachel Levine, Assistant
Secretary for Health at the U.S. Department of Health and Human
Services, learn more about her work by going to www.hhs.gov/ash or
follow her on Twitter @HHS_ASH. Dr. Levine we want to thank you for
your innovations, for your efforts advancing child and adolescent’s
health and mental health a nd for trailblazing a way for ward for equity
and inclusion for the LGBTQ community. And thank you so much for
joining us today on Conversations on Health Care.

Dr. Rachel Levine: Thank you, it’s a pleasure to be here.

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Mark Masselli: At Conversations o n Health Care we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for vot ers that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got for us this week?

Lori Robertson: Thousands of pages of redacted emails to and from Dr. Anthony Fauci
are now publicly available. Some of those messages have been
disto rted in viral post including emails about the effectiveness of
hydroxychloroquine. Viral claims baselessly suggest that the emails
prove Fauci lied to the public about hydroxychloroquine. An
antimalarial drug touted by former President Donald Trump in 2020 .
th
One story shared on Facebook points to a February 29 , 2020 email
sent to former Vice President Mike Pence and copied to Fauci . I n the
email two doctor suggest the drug could be effective against COVID -
19 and suggest the U.S. government conduct or fund studies. Fauci
forwarded the email to a Deputy Director who works in Microbiology
and Infectious Diseases writing “please take a look and respond to
them. Thanks. ”

In another February 2020 email, a pharmacologist at the FDA inquired
with Fauci on whether t here was any data to substantiate a
publication from China that hydroxychloroquine or chloroquine could
decrease COVID - 19 infections and lung disease. Fauci wrote back,

Dr. Rachel Levine

“there are no data in this brief report, and so I've no way of evaluating
their claim”.

It’s worth noting that the government did fund a study evaluating t he
drug’s efficacy for patients hospitalized with the disease. That and a
string of other studies did not find it helped hospitalized COVID - 19
patients. That includes other Randomized Cont rolled Trials, the gold
standard in science. The FDA issued an emergency use authorization
for hydroxychloroquine and chloroquine in March 2020, allowing
adult and some adolescent patients hospitalized with COVID - 19 to
obtain the drugs from the Strategic N ational Stockpile, if a clinical trial
wasn’t available. But the FDA revoked that authorization in June 2020,
finding that the drug was “unlikely” to be effective in treating COVID -
19 for the authorized usage. It also said that the known and potential
bene fits of the drugs no longer outweigh the risks.

In short the email cited as a supposed smoking gun ab out
hydroxychloroquine simply show that some people wrote to Fauci,
expressing the possibility that the drug could be effective against
COVID - 19. His respo nses show he engaged with the emails, they don’t
prove that hydroxychloroquine was a n effective treatment against
COVID - 19 or that Fauci hi d it from the public . A nd that’s my fact check
for this week; I'm Lori Robertson, Managing Editor of FactCheck.org.

M argaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked e - mail us at www.chcradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

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Mar k Masselli : Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives. Pregnancy is
normally an exciting time for most women, but according to the
research an estimated 10% of prenatal women experience some kind
of depression during their pregnancy. And many are reluctant to treat
their depression with medication for fear of harming the fetus.

Cynthia Battle : In fact a higher percentage are experiencing lower grade depressive
symptoms so they might not meet full criteria for major depressive
episode, but they are having significant symptoms that are getting in
the way of feeling good . A nd left untreated those mild to moderate
symptoms can progress in some cases lead to a more serious post -
partum depression.

Mark Masselli: Dr. Cynthia Battle is a psychologist at Brown University with the
practice at Women’s and Infants Hospital in Providence. She and her

Dr. Rachel Levine

colleague decided to test a cohort of pregnant women to see if a
targeted prenatal yoga class which combines exercise with
mindfulness techniques, might have a positive impact on wome n
dealing with prenatal depression.

Cynthia Battle: That was a typical kind of hatha yoga that would include physical
postures, breathing exercises, meditation exercises, and we enrolled
34 women who were pregnant, who had clinical levels of depression,
th ey all had medical clearance from their prenatal care providers and
they would come to classes and we measured their change in
depressive symptoms over that period of time.

Mark Masselli: Not only were women able to manage their depressive incidents, they
also bonded with other pregnant women during the program, and
found additional support from their group.

Cynthia Battle: And the initial s igns in this research are really encouraging. So we
found that women on average were report ed that they were
reporting much less.

Mark Masselli: A larger study with controlled groups is being planned with the
assistance of the National Institute of Mental Health.

Cynthia Battle: Women who are depressed during pregnancy unfortunately do often
have less ideal birth outcomes . So one thing we're interested in seeing
is when we provide prenatal yoga program, can it improve mood and
then can we even see some positive effects in terms of the birth
outcome.

Mark Masselli: A guided , non - medical yoga exercise program design ed to ass ist
pregnant women through depression symptoms, helping them
successfully navigate those symptoms without medication, ensuring a
safer pregnancy and a healthier outcome for mother and baby, now
that’s a bright idea.

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Mark Masselli: You've been liste ning to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health

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Marianne O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
[email protected] or find us on Facebook or Twitter. We love
hearing from you. This show is brought to you by the Community

Dr. Rachel Levine
Health Center .
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