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Yahoo Finance Presents: Dr. Rachel Levine

HHS Assistant Secretary for Health Dr. Rachel Levine sat down with Yahoo Finance’s Anjalee Khemlani to discuss the growing gaps in the healthcare system, and specific steps that the United States Department of Health and Human Services is taking to shrink those health inequities.

Video Transcript


ANJALEE KHEMLANI: A lot's going on with health equity these days and what to do about it to help the US further its goals. Joining me now to discuss all of that and more, Dr. Rachel Levine, Assistant Secretary for Health at the US Department for Health and Human Services. Dr. Levine, thank you so much for joining me today.

RACHEL LEVINE: I'm very pleased to be here. Thank you.

ANJALEE KHEMLANI: Well, let's start off with just the idea of health equity. And starting from the policy perspective, we know that historically, systemic issues have been sort of credited for where we are right now. And it will take some government input to resolve some of this.

I know that specifically, mental health is a big issue. And there is funding going to it right now, as well as it is a priority for you, including also the opioid crisis, and also a specific focus on LGBTQ health. So how exactly do you see policy affecting some of these changes?

RACHEL LEVINE: Well, you are correct. Health equity really has to crosscut everything that we do in this arena. COVID-19 has shown us the depth of the health care disparities that we have in this country. and so we have to address this in regards to COVID-19 and the pandemic, but then also work to address this systemic issue throughout our health care system.

ANJALEE KHEMLANI: Well, and what can you actually do to effect that? Because right now, there's been a lot. If I look over the last decade or so, there have been enough studies to help inform some of these decisions. There have been pilot programs upon pilot programs that have just fizzled out.

The phrase in the industry now is just "death by pilot." Nothing gets scaled up, in large part because of the way that the health care system is set up. And it's complex. It's siloed. And so that has really caused even more problems when you try to fix one part of it. So knowing all of that, how do we avoid repeating history and actually getting into real change?

RACHEL LEVINE: Well, I really think that COVID-19 has changed everything. And so as we have in the Biden-Harris administration a whole-of-government response towards COVID-19, we have now a COVID-19 Health Equity Task Force that is led by Dr. Marcella Nunez-Smith. And I'm very pleased to have a seat at that task force.

And so we are coming up with a set of specific recommendations that go directly to the president about how to address health equity and COVID-19. We're working on that in terms of testing. We're working on that in terms of access to health care, working on that in terms of the vaccinations-- reaching out to specific vulnerable communities in terms of vaccinations to make sure that health equity informs our vaccination effort. We're going to take those lessons, and then we're going to apply them to, really, the whole health care system.

The Department of Health and Human Services has a Health Care Disparities Council. I am the co-chair of that. And we met yesterday, for example. And so we're going to take those lessons that we've learned from COVID-19, and we're going to apply that across the department in terms of everything we do, whether it's the Office of the Assistant Secretary for Health or HRSA. Or you mentioned behavioral health. And that includes, of course, SAMHSA, the Substance Abuse Mental Health Services Administration.

ANJALEE KHEMLANI: So looking at that, obviously the pandemic has put a lot of it in focus, to your point. And the idea, really, that we now know so much more. It's in the spotlight and can't really be ignored anymore. Or it can't be sort of a one hit wonder, if you will. I know that starting with the prior administration, they did in fact start talking more publicly-- I think the idea of saying, or addressing tribal nations at a podium was done more times in the past year than really has ever been before, and on such a public stage.

So looking at it from that perspective, do you see how-- you said that you can take some of these lessons and apply them. But it's also a market that exists, an industry that exists that it's finding very hard not to be changed as quickly. How do you-- how do you get to impact that with the policy that you're looking to do beyond just where the government controls the money, beyond Medicare and beyond Medicaid?

RACHEL LEVINE: Well, you're exactly right. We have to embed this into the health care system. One of the advantages is the funding that the Biden-Harris administration has worked with in terms of the Recovery Act for public health. What COVID-19 has certainly shown us is, one, that we're all interconnected. And the second is the critical importance of public health.

We need to work on coordinating federal public health, state and local public health authorities to make sure that we address these issues. And you're right, the time for talk is over. We need specific programs that address health equity at all levels of public health. And now, with the Recovery Act and then other legislation that the Biden-Harris administration is asking for in Congress with further funding, we will have the funding to take those actions.

ANJALEE KHEMLANI: So definitely some funding behind it, and some oomph. Right now on that point of funding, a lot of money is pouring into the health care market, into the health care industry, whether you're talking about startups that deal with remote monitoring or digital health, telehealth, as well as a lot of biotech. There's a lot of money, a lot of capital flowing into these areas.

Meanwhile, there is this call and this public pressure for some sort of reckoning and some sort of awareness of how to make sure that it actually reaches everyone and it's not just a service that is being provided to the very wealthy. And so that's-- that's still a struggle. And the digital divide has been something that has increasingly come to light as part of that problem.

How do you overcome that, or can you, from your perspective? I know you were talking-- you've talked about environmental health as well being a part of what you need to focus on. Is this also something that, from the health side, from the health care department, that you can actually impact?

RACHEL LEVINE: We can. And we're going to. So in terms of telehealth, we are going to be looking departmental-wide at many of the changes in telehealth that occurred in COVID-19, and then looking at the best ones and the ones that have the most outcome studies to support them, and then work to inculcate them into the health care system with funding.

We do have to work on the digital divide. Not everyone has access to Wi-Fi and broadband, and we have to take that into consideration. In terms of environmental health, that is going to be one of the priorities of my office, of the Office of the Assistant Secretary for Health. We are forming a new office under my jurisdiction on climate change in health equity specifically.

We're going to be hiring experts on that, and we're going to be looking at climate change and other severe environmental health issues, and we're going to be looking at them at the community level with a health equity lens. And so it's very important. And this is a priority, again, coming from the White House and the secretary.

ANJALEE KHEMLANI: It's a very complex task and a very complex goal you have going on. We know that with the buildup over time of all the reasons why we've reached here-- I know that I've talked to many experts who point to some of the political things that have been done over time. Redlining has had enormous implications for the African-American community.

And so now that we have that also, where communities have lived together, there are certain environments that they're exposed to, it seems like there is a lot that needs to be done to address that without really uplifting or uprooting families. There has to be a way to address it in the local community. How does environmental health play into that? Have you thought of maybe a specific program or specific way to improve the life of a family that lives in, say, a poor air quality area?

RACHEL LEVINE: So this is a new office that we're forming now. But you're exactly right. I mean, I think that the impacts of climate change-- and these environmental health challenges impact vulnerable communities, communities of color and other vulnerable communities much, much more. And so we need to look at those. That could include air quality. It could include water quality. It could include rising sea levels.

There are so many different issues. Increase in heat, particularly in the Southwest. Access to water in the Southwest. There are so many issues. So we're going to come up with some specific actions and some specific improvements. And that is what is being demanded by the White House and by the secretary.

ANJALEE KHEMLANI: And the last one I have for you is on LGBTQ health. I know that there are a lot of policies popping up in states, laws that are being enacted that are really making it harder for, especially transgender individuals, to access care or even have affordable care.

So how does this-- I know you've said it's politics right now. This is sort of a new skin for the health department to engage very actively in these political fights. How do you think about that and what you have to do in order to overcome this?

RACHEL LEVINE: Well, thank you for that question. The laws that are being considered, and in some cases being passed, that target transgender youth are just so challenging and unfortunate. And you are correct. I think that the impetus for those laws is politics. I think that some think that this is a wedge issue for the next election.

But they are directly impacting vulnerable LGBTQ, and particularly trans, youth who are already facing bullying and harassment. Particularly egregious is the law-- are the laws that are limiting access to gender-affirming medical care. That can cost lives. And so we need to address this throughout the administration, but in our case at the Department of Health and Human Services.

We have already taken action. The Office of Civil Rights has already stated a couple weeks ago that section 1557 of the Affordable Care Act is being interpreted to include sexual orientation and gender identity. And so that will have a significant impact in terms of access to health care, really throughout the entire United States.

But we have to do even more than that. So we are, again, going to look department-wide at each of our offices about how we can have an impact to protect LGBTQ issues. Because as you said, this is a health equity issue. This shouldn't be politics. This should be a health equity issue for everyone.

ANJALEE KHEMLANI: We'll certainly be watching to see what you do in the next couple of years. Dr. Rachel Levine, thank you so much for joining me today.

RACHEL LEVINE: Thank you very much.