During a Senate confirmation hearing on Thursday, Dr. Rachel Levine expressed her support for telemedicine, emphasized the importance of addressing young people's mental health needs and described her strategy for combating the ongoing opioid crisis amidst the COVID-19 pandemic.  

President Joe Biden nominated Levine for the position of assistant secretary of the U.S. Department of Health and Human Services this past month. She would be the first openly trans federal official to be confirmed by the U.S. Senate.  

"My career has been about helping people live healthy lives," Levine told members of the Senate Health, Education, Labor and Pensions Committee. "As the assistant secretary for health, I would be committed each day to helping the people of our nation and improving our public health."   

WHY IT MATTERS  

Levine faced questioning Thursday alongside fellow HHS nominee for Surgeon General Dr. Vivek Murthy. Murthy, who served as the Surgeon General from 2014 to 2017 prior to being ousted by former President Donald Trump, acknowledged the continuing devastation COVID-19 has had on millions of people, including members of his own family.  

"If confirmed as Surgeon General my highest priority will be to help end this pandemic," said Murthy.   

Several members of the committee asked Levine and Murthy about the opioid epidemic, with Sen. Maggie Hassan, D-N.H., noting the importance of continued federal funding for states as they work to turn the tide.  

"I'm encouraged that you both have knowledge and experience in combating the opioid crisis through expanding access to substance misuse treatment and services," said Hassan.  

"The opioid crisis and overdoses continue," said Levine. "[The crisis] has been exacerbated during the COVID-19 crisis, and we have to continue to address this robustly." Levine, who is currently Pennsylvania's top health official, pointed to the state's programs expanding access to medication-assisted treatment.   

Murthy emphasized the importance of continuing to focus on public education around opioids and implementing core recommendations around treatment in future policy. He also pointed to a 2016 report issued by the Surgeon General's office addressing addiction, which included a number of cost-effective prevention programs. 

"Those are still not well-known, and they don't often receive the investment they need," he said.  

Levine also signaled her support of telehealth programs, particularly regarding mental health care.  

"This is a particularly difficult issue in rural areas, where there is lack of access to mental health services. And so I think telehealth is going to be very, very important," she said. "And that includes telepsychiatry and telepsychology.

"Of course … access to broadband is critical to that success," she added.  

Murthy echoed the role telemedicine plays in enabling access to care in rural areas, adding that strengthening rural health workforce will also be important.  

"We see often clinicians get trained and then they relocate [to], or stay in, urban areas," he said. "We don't have enough nurses and doctors in rural areas, but we can address that."  

The nominees cited the power of a data-driven approach to public health needs, especially disparities in health outcomes.   

"The origins of the disparities that we see in health are complicated," said Murthy in response to questioning from Sen. Bill Cassidy, R-La. "With [COVID-19] in particular, why some communities are experiencing worse outcomes than others – some of that we understand, but we're still learning about that."  

Although the senators on the committee largely focused on the coronavirus and mental health, a few did raise the issue of LGBTQ health – seemingly acknowledging Levine's trans identity.  

Sen. Tammy Baldwin, D-Wisconsin, noted that data is often lacking when it comes to the health disparities faced by the LGBTQ community.  

"Based on your experience as a state health official, what should the federal government do to support state and other efforts to better prioritize and address the health needs of people in the LGBTQ community?" asked Baldwin, who herself was the first openly gay member of the U.S. Senate.

"Health equity is a critical aspect of our approach to COVID-19, and really to all issues," said Levine. "COVID-19 has certainly shown us the challenge in healthcare disparities that we see in our nation, and that would include the LGBTQ community." 

Levine said that Pennsylvania is the only state collecting sexual orientation and gender identity data in terms of COVID-19 testing.  

"I think this brings up the point of the importance of data. It is critically important that we include questions about sexual orientation and gender identity in our data collection. That would include many studies done by Health and Human Services and the CDC. I think that as we get more data, then we understand more about these health disparities, and we can develop the appropriate policies in order to address them."   

Sen. Rand Paul, R-Ky., pressed Levine about the issue of people under 18 making medical decisions regarding gender identity. Studies have shown that transgender children have equally strong gender identity as cisgender children, and many medical professionals have expressed their support for allowing minors to access gender-affirming care.  

"Transgender medicine is a very complex and nuanced field, with robust research and standards of care that have been developed," said Levine. "If I'm fortunate enough to be confirmed as the assistant secretary of health, I will look forward to working with you and your office … to discuss the particulars of the standards of care for transgender medicine."

THE LARGER TREND  

Murthy and Levine's hearing followed those for HHS Secretary nominee Xavier Becerra, who signaled his support for telehealth in front of the HELP committee earlier this week.  

"If we don't learn from COVID how telehealth can help save lives, then we're in trouble," said Becerra.  

The three are among a slew of appointees Biden has made to the agency since his inauguration, including Rear Admiral Susan Orsega as acting surgeon general.  

ON THE RECORD  

"In addition to centering equity in our COVID-19 response, we have to commit ourselves to the hard work of building a more equitable healthcare system," said HELP Committee Chair Sen. Patty Murray, D-Wash."

All people, including families of color, people from low-income backgrounds, underserved areas, LGBTQ people, people with disabilities and others need to be able to get high-quality, affordable care. … Dr. Murthy and Dr. Levine, I know that is a priority we share," said Murray.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: kjercich@himss.org
Healthcare IT News is a HIMSS Media publication.