She Starred in Trump’s Anti-Trans Campaign Ads, Yet Remains Hopeful About What's Ahead.
In an exit interview, Rachel Levine emphasizes that she continues to observe progress, even in the face of political backlash against trans rights.
TroibNews 
In her final days as assistant secretary for health at the Department of Health and Human Services, Rachel Levine reflects positively on her experience attending a 2022 Pride Month reception at the White House.
As the highest-ranking openly transgender individual in the U.S. government, Levine was recognized by a speaker for her contributions to the LGBTQ+ community in the Biden administration. She recalls President Joe Biden gesturing for her to stand up.
“And so I stood up, and I got applause,” she said. “For the president to notice me and gesture at me to stand up, that really stuck in my memory.”
Conversely, she faced less favorable moments, particularly when her image was utilized in anti-trans advertisements by Republican campaigns during the presidential race. The Trump campaign allocated significant resources to criticize Vice President Kamala Harris for her support of transgender rights, placing Levine in a troublesome position.
“I found it very challenging,” she said. “But you know what? I’m a strong and resilient person, I’ll be fine. What I worry about are other members of our community.”
As a uniformed admiral in the U.S. Public Health Service Commissioned Corps, Levine joined Washington after her tenure as Pennsylvania’s health secretary, where she was trained in psychiatry and pediatrics.
In an exit interview with PMG Magazine, Levine discussed her health policy initiatives, including her focus on long Covid research and the health impacts of climate change. She also addressed the ongoing political debates surrounding youth access to gender-affirming care and expressed optimism about the future of trans rights despite current challenges.
This interview has been edited for length and clarity.
Looking back nearly four years after becoming the highest-ranking openly transgender official in the U.S. government, what is something you wish you had known when you started?
It has been a tremendous honor to assume my commission and the uniform of the United States Public Health Service Commissioned Corps.
I had very good experience in public health when I was the secretary of health of Pennsylvania, as well as the president of the Association of State and Territorial Health Officials. It’s a really good training ground to take this position.
When I started, we were in the midst of the acute phase of the Covid-19 pandemic. But the topics were very familiar to me.
This [she gestured to her uniform, which she was commissioned to take in 2021] was completely new, and it's a choice for the assistant secretary for health. I absolutely wanted to assume my commission and take the uniform.
Republicans have been making their anti-trans stance a bigger focus lately. What do you think of that? And were you surprised to find yourself targeted in anti-trans ads during the presidential campaign?
I found it very challenging. But you know what? I'm a strong and resilient person, I'll be fine. What I worry about are other members of our community. I worry about those young people. I worry about their families, and I worry about the doctors that treat them. I worry about adults as well in the LGBTQI+ community, broadly, as well as specifically in the transgender and non-binary community.
They might have had my visage up there, but they're the ones that are going to be targeted.
With a growing number of states implementing restrictions on gender-affirming care for minors, how concerned are you about the potential for further action from the new administration to limit or ban this care?
I can't really comment on the incoming administration. I don't know what they'll decide to do, but I'm very proud of the work that we have done in support of health equity. In terms of transgender medicine for youth, it is performed primarily at our nation's fantastic children's hospitals.
The way I think of it is: If you have a child who has diabetes, then you would see a pediatric endocrinologist, probably at the local children's hospital. If you have a child with depression or anxiety, you might see a child psychiatrist or a child psychologist at the local children's hospital. If you have a child with an eating disorder or perhaps a gynecological issue, you might see the adolescent medicine specialist — like me — at a local children's hospital.
So if you have a young person with gender issues, you would see the gender specialists at the children's hospital who might be exactly the same people I just discussed — the pediatric endocrinologist, the child psychologist, the child psychiatrist or the adolescent medicine physician. It is extremely, completely appropriate to see these specialists for the other conditions, but the legislatures in those states are prohibiting it for this issue.
To be frank, it has really been a strategy of think tanks from Washington based on ideological and political purposes with a well-developed playbook that has gone through many of the states of our country with draft legislation.
Now we'll see what happens when it happens nationally.
I think it is really challenging and potentially harmful to young people and their families and their medical providers. Yet, I remain a positive and optimistic person. I remain positive enough to continue my work and I think that eventually things will change. I don't know when that will be, and I think I’ve got to be very realistic of the challenges that exist now in half the country, and could exist in other parts of the country in the future, but I think that the wheel will eventually turn. Although it's going to be a while.
Do you think HHS did enough to uphold the policies you’ve advocated for regarding transgender youth, including strengthening anti-discrimination regulations in healthcare?
I think that we are leaving it in the strongest place possible with a transition of administrations.
You have focused extensively on how climate change impacts healthcare, as well as the federal response to long Covid. Both initiatives face uncertainty with the new Congress and administration. Where do you see this work headed?
All these [natural disasters, like ongoing wildfires in Los Angeles] are exacerbated by and stoked by climate change, and all of these have impacts on health. It is really going to be extremely important now, and in the future, to be addressing these health impacts. However a new administration wants to describe it, I still think these health issues will need to be worked on and addressed. Extreme heat is extreme heat, however you want to talk about it, and so we're going to need to address the health impacts [of climate change.]
One of the things that we have said is that we know long Covid is real. Long Covid might not be one thing. It would be easier if it was, but it might actually not be one thing. It might be a constellation with different causes. We have a clinical definition of long Covid that was published by the National Academy of Sciences, Engineering and Medicine. And so I think that we have made progress. I think one of the biggest things that we've worked on is long Covid centers that I think are really important, multidisciplinary centers throughout the country that serve as referral centers, as well as hub and spoke centers, to the community.
How concerned are you about the future of public health in the U.S., especially with rising vaccine skepticism and someone like Robert F. Kennedy Jr. potentially leading HHS?
I can't comment on the next administration overall. I remain a positive and optimistic person, but I choose to do that because I think that that's how the work gets done. Public health is public health and is not political.
I know that there are differences as we change administrations in terms of certain policy — and that's how our system works — but the basic public health work will need to continue, and we have fantastic civil servants and full-time public health employees that will continue that work, as well as the Public Health Service Commissioned Corps.
Vaccinations are one of the victories of public health in the 20th and 21st century. All those immunizations for youth and adolescents and adults are absolutely critically important to public health. Smallpox has been eradicated from the world. And so I have complete faith in our fantastic vaccine programs.
Has anyone from the incoming administration reached out to discuss your work?
No. This happens with our full-time leadership staff. And so I have nothing to do with that as a political appointee.
Do you have any regrets from your time in office?
I'm not a person who has regrets about anything. I don't think it's very useful to have regrets. None of us are perfect, and we all do the very best we can. I have done the very best I can for the common good and for the health and welfare and public health of our nation. I am very proud of my service in Pennsylvania and here. What could be a more rewarding job, right?
What’s next for you?
I’m going to go home to Central Pennsylvania. I'm going to take a long nap, rest and center myself, and then I'm going to consider what my next steps are.
Ian Smith contributed to this report for TROIB News
As the highest-ranking openly transgender individual in the U.S. government, Levine was recognized by a speaker for her contributions to the LGBTQ+ community in the Biden administration. She recalls President Joe Biden gesturing for her to stand up.
“And so I stood up, and I got applause,” she said. “For the president to notice me and gesture at me to stand up, that really stuck in my memory.”
Conversely, she faced less favorable moments, particularly when her image was utilized in anti-trans advertisements by Republican campaigns during the presidential race. The Trump campaign allocated significant resources to criticize Vice President Kamala Harris for her support of transgender rights, placing Levine in a troublesome position.
“I found it very challenging,” she said. “But you know what? I’m a strong and resilient person, I’ll be fine. What I worry about are other members of our community.”
As a uniformed admiral in the U.S. Public Health Service Commissioned Corps, Levine joined Washington after her tenure as Pennsylvania’s health secretary, where she was trained in psychiatry and pediatrics.
In an exit interview with PMG Magazine, Levine discussed her health policy initiatives, including her focus on long Covid research and the health impacts of climate change. She also addressed the ongoing political debates surrounding youth access to gender-affirming care and expressed optimism about the future of trans rights despite current challenges.
This interview has been edited for length and clarity.
Looking back nearly four years after becoming the highest-ranking openly transgender official in the U.S. government, what is something you wish you had known when you started?
It has been a tremendous honor to assume my commission and the uniform of the United States Public Health Service Commissioned Corps.
I had very good experience in public health when I was the secretary of health of Pennsylvania, as well as the president of the Association of State and Territorial Health Officials. It’s a really good training ground to take this position.
When I started, we were in the midst of the acute phase of the Covid-19 pandemic. But the topics were very familiar to me.
This [she gestured to her uniform, which she was commissioned to take in 2021] was completely new, and it's a choice for the assistant secretary for health. I absolutely wanted to assume my commission and take the uniform.
Republicans have been making their anti-trans stance a bigger focus lately. What do you think of that? And were you surprised to find yourself targeted in anti-trans ads during the presidential campaign?
I found it very challenging. But you know what? I'm a strong and resilient person, I'll be fine. What I worry about are other members of our community. I worry about those young people. I worry about their families, and I worry about the doctors that treat them. I worry about adults as well in the LGBTQI+ community, broadly, as well as specifically in the transgender and non-binary community.
They might have had my visage up there, but they're the ones that are going to be targeted.
With a growing number of states implementing restrictions on gender-affirming care for minors, how concerned are you about the potential for further action from the new administration to limit or ban this care?
I can't really comment on the incoming administration. I don't know what they'll decide to do, but I'm very proud of the work that we have done in support of health equity. In terms of transgender medicine for youth, it is performed primarily at our nation's fantastic children's hospitals.
The way I think of it is: If you have a child who has diabetes, then you would see a pediatric endocrinologist, probably at the local children's hospital. If you have a child with depression or anxiety, you might see a child psychiatrist or a child psychologist at the local children's hospital. If you have a child with an eating disorder or perhaps a gynecological issue, you might see the adolescent medicine specialist — like me — at a local children's hospital.
So if you have a young person with gender issues, you would see the gender specialists at the children's hospital who might be exactly the same people I just discussed — the pediatric endocrinologist, the child psychologist, the child psychiatrist or the adolescent medicine physician. It is extremely, completely appropriate to see these specialists for the other conditions, but the legislatures in those states are prohibiting it for this issue.
To be frank, it has really been a strategy of think tanks from Washington based on ideological and political purposes with a well-developed playbook that has gone through many of the states of our country with draft legislation.
Now we'll see what happens when it happens nationally.
I think it is really challenging and potentially harmful to young people and their families and their medical providers. Yet, I remain a positive and optimistic person. I remain positive enough to continue my work and I think that eventually things will change. I don't know when that will be, and I think I’ve got to be very realistic of the challenges that exist now in half the country, and could exist in other parts of the country in the future, but I think that the wheel will eventually turn. Although it's going to be a while.
Do you think HHS did enough to uphold the policies you’ve advocated for regarding transgender youth, including strengthening anti-discrimination regulations in healthcare?
I think that we are leaving it in the strongest place possible with a transition of administrations.
You have focused extensively on how climate change impacts healthcare, as well as the federal response to long Covid. Both initiatives face uncertainty with the new Congress and administration. Where do you see this work headed?
All these [natural disasters, like ongoing wildfires in Los Angeles] are exacerbated by and stoked by climate change, and all of these have impacts on health. It is really going to be extremely important now, and in the future, to be addressing these health impacts. However a new administration wants to describe it, I still think these health issues will need to be worked on and addressed. Extreme heat is extreme heat, however you want to talk about it, and so we're going to need to address the health impacts [of climate change.]
One of the things that we have said is that we know long Covid is real. Long Covid might not be one thing. It would be easier if it was, but it might actually not be one thing. It might be a constellation with different causes. We have a clinical definition of long Covid that was published by the National Academy of Sciences, Engineering and Medicine. And so I think that we have made progress. I think one of the biggest things that we've worked on is long Covid centers that I think are really important, multidisciplinary centers throughout the country that serve as referral centers, as well as hub and spoke centers, to the community.
How concerned are you about the future of public health in the U.S., especially with rising vaccine skepticism and someone like Robert F. Kennedy Jr. potentially leading HHS?
I can't comment on the next administration overall. I remain a positive and optimistic person, but I choose to do that because I think that that's how the work gets done. Public health is public health and is not political.
I know that there are differences as we change administrations in terms of certain policy — and that's how our system works — but the basic public health work will need to continue, and we have fantastic civil servants and full-time public health employees that will continue that work, as well as the Public Health Service Commissioned Corps.
Vaccinations are one of the victories of public health in the 20th and 21st century. All those immunizations for youth and adolescents and adults are absolutely critically important to public health. Smallpox has been eradicated from the world. And so I have complete faith in our fantastic vaccine programs.
Has anyone from the incoming administration reached out to discuss your work?
No. This happens with our full-time leadership staff. And so I have nothing to do with that as a political appointee.
Do you have any regrets from your time in office?
I'm not a person who has regrets about anything. I don't think it's very useful to have regrets. None of us are perfect, and we all do the very best we can. I have done the very best I can for the common good and for the health and welfare and public health of our nation. I am very proud of my service in Pennsylvania and here. What could be a more rewarding job, right?
What’s next for you?
I’m going to go home to Central Pennsylvania. I'm going to take a long nap, rest and center myself, and then I'm going to consider what my next steps are.
Ian Smith contributed to this report for TROIB News
