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President-elect Joe Biden announced Tuesday that he will nominate Rachel Levine, Pennsylvania’s top health official, as his assistant secretary of health. Levine, a pediatrician, would become the first openly transgender federal official to be confirmed by the U.S. Senate.

“Dr. Rachel Levine will bring the steady leadership and essential expertise we need to get people through this pandemic — no matter their zip code, race, religion, sexual orientation, gender identity, or disability — and meet the public health needs of our country in this critical moment and beyond,” Biden said in a statement. “She is a historic and deeply qualified choice to help lead our administration’s health efforts.”

As Pennsylvania’s secretary of health, Levine has risen to national prominence for leading the state’s public health response to the <a href="https://www.washingtonpost.com/coronavirus/" target="_blank" class="contextual_link">coronavirus</a> pandemic, despite repeated and ugly <a href="https://www.washingtonpost.com/nation/2020/07/24/pa-covid-trans-secretary-health/" target=_blank>attacks on her gender identity</a>.

Biden’s transition team noted that Levine — appointed by Gov. Tom Wolf (D) in 2017 as acting health secretary — was confirmed three times by the Republican-controlled state Senate to serve as secretary of health and the state’s physician general. At the time, she was one of only a handful of transgender officials serving in elected or appointed offices nationwide.

If confirmed as assistant secretary of health, Levine would be the highest-ranking transgender official in the U.S. government.

“President-elect Biden said throughout his campaign that his administration would represent America," said Mara Keisling, the executive director of the National Center for Transgender Equality. “Today, he made clear that transgender people are an important part of our country.”

How a Biden presidency could advance transgender rights — and lead to backlash

Serving under Xavier Becerra, Biden’s nominee to head the U.S. Department of Health and Human Services, Levine would oversee key health offices and programs across the department, 10 regional health offices nationwide, the Office of the Surgeon General and the U.S. Public Health Service Commissioned Corps.

In a statement released Tuesday afternoon, Levine said she was proud of the work she has been able to accomplish at the Pennsylvania Department of Health. She highlighted her efforts to address the opioid epidemic by developing “innovative models to get people into treatment and into recovery" and the work her team has done to fight diseases such as HIV and Hepatitis C.

“I am proud of the work we have done as an administration to address health equity,<i> </i>and the work I have done personally to raise awareness about LGBTQ equity issues,” she said. "And I am extremely proud of the work we have done during the last year to save lives in the face of the COVID-19 global pandemic. I look forward to the opportunity to continue to serve Pennsylvanians, and all Americans, as part of the Biden Administration if I am fortunate enough to be confirmed to this position.”

Her nomination comes after an election season in which a <a href="https://www.thelily.com/a-record-574-lgbtq-candidates-ran-this-year-here-are-the-big-wins-so-far/">record number of LGBTQ candidates</a> ran for office but after four years of a presidential administration that repeatedly erased protections for transgender people — in health care, federal employment, federal prisons, homeless shelters and other housing services receiving federal funding.

Biden has signaled a significant shift from the Trump administration when it comes to <a href="https://www.washingtonpost.com/dc-md-va/2020/11/17/biden-transgender-rights/" target=_blank>inclusion of the transgender community</a>. He mentioned transgender people in his presidential acceptance speech, and released a lengthy platform outlining his plans to prioritize LGBTQ rights. Biden also <a href="https://www.washingtonpost.com/politics/biden-transition-team-federal-agencies/2020/11/10/6b4b6388-237f-11eb-a688-5298ad5d580a_story.html?itid=lk_inline_manual_35">named to his transition team</a> Shawn Skelly, a former special assistant to the undersecretary of defense for acquisition, technology and logistics, and coordinator of the Defense Department Warfighter Senior Integration Group. Skelly was the first transgender veteran to be appointed by a U.S. president.

Over the past two months, advocates have urged Biden to nominate LGBTQ leaders to key positions in the administration. Biden named <a href="https://www.washingtonpost.com/local/trafficandcommuting/biden-transportation-secretary/2020/12/15/cf1b7456-3a41-11eb-98c4-25dc9f4987e8_story.html?itid=hp-top-table-main" target=_blank>Pete Buttigieg</a> to lead the Transportation Department, making him the first openly LGBTQ person nominated to a permanent Cabinet position. As the highest-ranking appointed transgender official in the United States, Levine was often near the top of advocates’ lists of suggested names for top roles.

“She’s just so highly qualified, regardless of her gender identity,” said Raffi Freedman-Gurspan, who was the first openly transgender appointee in the Obama White House. Freedman-Gurspan happened to be in Pennsylvania with friends on Tuesday morning when the news of Levine’s nomination broke.

“We all screamed,” she said. “It is well deserved and I think it sends a message to the trans community about how valued we are. We have a seat at the table. There’s no doubt about that.”

Tracking the political appointees Biden is nominating to fill the top roles in his administration

A graduate of Harvard University and Tulane Medical School, Levine was the chief resident at Mount Sinai Medical Center in New York, where she also taught. In 2014, she was a top doctor at Penn State Milton S. Hershey Medical Center and served on the board of Equality Pennsylvania, a statewide gay rights group, when Wolf asked her to co-chair his transition team for health matters.

The following year, Wolf appointed her as Pennsylvania’s physician general, the state’s top doctor. Impressed with her background in behavioral and mental health, the state Senate voted unanimously to approve her, <a href="https://www.pennlive.com/midstate/2015/06/doctor_first_transgender_secon.html">paying little attention</a> to her gender identity during the confirmation process.

“With very few exceptions, my being transgender is not an issue,” she <a href="https://www.washingtonpost.com/politics/meet-rachel-levine-one-of-the-very-few-transgender-public-officials-in-america/2016/06/01/cf6e2332-2415-11e6-8690-f14ca9de2972_story.html?itid=lk_inline_manual_16">told The Washington Post</a> in 2016, declining to comment on <a href="https://twitter.com/allenwest/status/730475372827922432">an attack</a> by a former Florida congressman.

But after Levine received a promotion to become Pennsylvania’s health secretary, the coronavirus pandemic raised her profile across the state and the country. As she sought to contain the virus with aggressive social distancing rules, it also made her the target of more frequent abuse.

One attack in particular made headlines and earned a scathing rebuke from the governor: a photo of a man sitting in a carnival dunk tank wearing a floral print dress and a long blond wig. The man said he was going for a Marilyn Monroe look, but organizers of the carnival fundraiser in Bloomsburg, Pa., said he resembled Levine.

“Dr. Levine? Thank you. You were a hit and raised a lot of money for the local fire companies. Wonder why so many were trying to dunk you?” the Bloomsburg Fair Association wrote in July on Facebook, adding a smiling emoji, before deleting the post.

“The COVID-19 pandemic has brought hate and transphobia into the spotlight through relentless comments and slurs directed at Secretary of Health Dr. Rachel Levine, who is a highly skilled, valued, and capable member of my administration and Transgender,” Wolf <a href="https://www.governor.pa.gov/newsroom/gov-wolf-issues-statement-on-hate-targeting-transgender-pennsylvanians/">wrote in a statement</a> at the time. “The derogatory incident involving the Bloomsburg Fair is the latest of these vile acts, which by extension impact Transgender people across the commonwealth and nation.”

In May, a radio personality <a href="https://www.pennlive.com/news/2020/05/reporter-calls-pa-health-secretary-sir-multiple-times-in-phone-interview.html">repeatedly misgendered</a> Levine, calling the health secretary “sir” at least three times while questioning her about the state’s coronavirus response. A commissioner at a township near Pittsburgh <a href="https://pittsburgh.cbslocal.com/2020/06/17/scott-township-commissioner-paul-abel-resigns/">said</a> he was “tired of listening to a guy dressed up like a woman.” After Pennsylvania <a href="https://www.wgal.com/article/pa-health-secretary-signs-order-making-masks-mandatory-in-all-public-spaces/33125570">ordered</a> its residents to wear masks at all times in public, a Facebook page run by one town <a href="https://www.fox43.com/article/news/local/york-county/derogatory-social-media-post-toward-dr-rachel-levine-inadvertantly-shared-by-hellum-recreation-page-sparks-controversy/521-2ed3c89b-8ef4-4fb9-af21-68f1763aa3f2">shared a meme</a> referring to her as “a guy who wears a bra.”

“The entire nation got to watch her succeed in the face of really difficult attacks,” said state Rep. Brian Sims (D), an LGBTQ activist who has known Levine for years. “Republicans still deny her basic equality, and she focuses on saving their lives."

Sims has seen how Levine’s leadership has forced people in the state to better understand the transgender community, and to learn how to address transgender people like her. “Never before have I seen more people proactively, correctly using pronouns,” even some of those who oppose her, Sims said. “She’s robbed people of the false premise that they don’t know any trans people and therefore don’t need to be respectful of trans people.”

Levine rarely talks about herself publicly, Sims said. But he remembered a powerful moment in July, when Levine began her regularly scheduled pandemic briefing to <a href="https://www.youtube.com/watch?v=6fGWaUKGrog&feature=youtu.be" target=_blank>directly respond to the transphobic attacks</a> she had been subjected to for months.

“While these individuals may think that they are only expressing their displeasure with me, they are, in fact hurting the thousands of LGBTQ Pennsylvanians who suffer directly from these current demonstrations of harassment,” she said.

Despite a Supreme Court ruling just a month earlier barring employment discrimination for <a href="https://www.washingtonpost.com/politics/courts_law/supreme-court-says-gay-transgender-workers-are-protected-by-federal-law-forbidding-discrimination-on-the-basis-of-sex/2020/06/15/2211d5a4-655b-11ea-acca-80c22bbee96f_story.html?itid=lk_inline_manual_29">gay and transgender people</a>, Levine said, Pennsylvania is one of many states where LGBTQ people can still be denied housing and public accommodations in places that do not have local nondiscrimination ordinances. Transgender women of color in particular face high rates of violence and homicide, she added.

“We have not made progress unless we have all made progress,” she said. “As for me, I have no room in my heart for hatred, and frankly I do not have time for intolerance. My heart is full with a burning desire to help people and my time is full with working toward protecting the public health of everyone in Pennsylvania. I will stay laser-focused on that goal.”

<a href="https://www.washingtonpost.com/politics/meet-rachel-levine-one-of-the-very-few-transgender-public-officials-in-america/2016/06/01/cf6e2332-2415-11e6-8690-f14ca9de2972_story.html" target=_blank>Meet Rachel Levine, one of the very few transgender public officials in America</a>

<a href="https://www.washingtonpost.com/nation/2020/07/24/pa-covid-trans-secretary-health/" target=_blank>Pennsylvania governor blasts ‘vile acts’ against transgender official leading pandemic response</a>

National Headliner Award, first place for news series, 2020 

NLGJA: The Association of LGBTQ Journalists, Excellence in Long Form Journalism Award, 2020

Indiana University, BA in journalism and Arabic 

Samantha Schmidt is The Washington Post's Bogotá bureau chief, covering all of Spanish-speaking South America. 

Samantha Schmidt

Stanford University, BA in Political Science

John Wagner is The Post's national political breaking news editor. He previously was a reporter on the breaking news team. Prior to that, John covered the Trump White House. During the 2016 presidential election, he focused on the campaigns of Hillary Clinton and Bernie Sanders. John also chronicled Maryland government for more than a decade.

John Wagner

Columbia University, BA in urban studies

Teo Armus covers people, issues and local government in Northern Virginia for The Washington Post. He joined The Post as a staff writer in 2019.

Teo Armus

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Rachel Levine, transgender woman, picked by Biden as assistant HHS secretary

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