Dr. Rachel Levine’s nomination to be the assistant secretary of health for the Department of Health and Human Services looks set to glide through the U.S. Senate, which would make her the highest ranking openly transgender official ever in the federal government.

Levine, who served as Pennsylvania’s secretary of health from July of 2017 until January of this year, faced occasional tough questioning from Republicans. However, she generally entertained welcoming questions from Democrats on the Senate Committee on Health, Education, Labor & Pensions. She was endorsed by fellow Pennsylvanian Sen. Bob Casey (D).

In the two-and-a-half hour hearing that also included President Biden’s nominee for surgeon general, Levine’s toughest questions on her leadership during the COVID-19 crisis came from the ranking Republican on the committee, Sen. Richard Burr of North Carolina.

In his opening remarks, Burr said Levine “hid behind federal guidance” when responding to the nursing home crisis.

“The tragic high mortality rate in your state shows that more was needed to be done, but wasn’t,” Burr said, noting that 52 percent of the fatalities in the state were in long-term care facilities. That number is backed up by the most current data collected by the COVID tracking project.

“In my state of North Carolina, our health Secretary also relied on federal guidance for nursing homes and long-term care settings,” Burr continued. “In North Carolina, our nursing home mortality rates, while still too high, account for 36 percent of deaths in the state. This discrepancy clearly shows that hiding behind federal guidance is no excuse for taking action to protect our most vulnerable.”

After noting the state had difficulties in other areas related to COVID-19, Burr asked, “How can you assure that the same challenges that Pennsylvania experienced in testing nursing home care and now vaccinations will not occur when — when given the opportunity to serve in the public health policy area?”

Levine acknowledged prior challenges, but in terms of her future role only said, “I look forward, as I mentioned, to collaborating with local, state, as well as federal officials and working on that coordination and communication.”

Burr moved on to another topic without follow-up.

As previously reported, the state’s response to the nursing home crisis was considered unsatisfactory to many, including local government officials. Counties like Montgomery County took matters into their own hands.

“We conveyed our concerns to the Department of Health in a couple of phone calls,” Montgomery County Chairwoman Dr. Valerie Arkoosh told a state senate policy committee last May. “DOH responded — I’m sure you’ve heard — they engaged a group called ECRI to help with some of the outreach to these facilities. We again mistakenly assumed that there would be some on-site assistance [from DOH] to some of these most highly impacted facilities.”

Once it became clear to Montgomery County officials that the state’s help on the nursing home issue was not what they expected, “as a county we decided that it was the right thing to do to try to take this on ourselves.”

Maine Republican Susan Collins asked Levine about a September report from SpotlightPA, which said, “more than six months after COVID-19 arrived in Pennsylvania, the public still doesn’t have a complete picture of how many people have died or been sickened by the virus” in long term care facilities, or LTCFs.

Collins said she wanted assurances Pennsylvania had not done “what New York did,” referring to an ongoing scandal in New York. Gov. Andrew Cuomo’s administration is accused of underreporting deaths at LTCFs.

“Pennsylvania was always completely transparent in terms of our data in terms of COVID-19 deaths in nursing homes, as we were in other data that we reported,” Levine began. 

“What you do have to understand is that there is a lag time from the time that a tragic death would occur to the time that it hits our electronic death reporting system, and then we would report that death. And that lag time can sometimes be days, but sometimes weeks. And so, a nursing home might have had a death, but it wouldn’t have hit our system for several weeks later,” she concluded.

“Many facility managers contacted by Spotlight PA said they are meeting reporting requirements, but could not explain why their data is not showing up in state reports,” the news organization reported in September.

“There’s just not a lot of transparency here,” Diane Menio, executive director at the Philadelphia-based advocacy group CARIE, told SpotlightPA at the time.

The most contentious moments of the hearing came when Kentucky Republican Senator Rand Paul said Levine supported allowing minors who think they might be transgender to engage in transformative hormone therapy or to take drastic measures such as genital surgery. He did not cite a source for his claim.

Later, when asked if she was happy with the vaccine rollout in her state, Levine lumped Pennsylvania in with the rest of the nation.

“Pennsylvania, like many states, had significant challenges in terms of the rollout of the vaccine over the holidays and then into January, et cetera. Of course, I left the Pennsylvania Department of Health in January, so I’ve had no contact with the Pennsylvania Department of Health and don’t really know exactly what differently they’re doing now.”

She later added she thought “things were continuing to improve” on the vaccine rollout.

Sen. Casey asked Levine if she would make children’s health and mental health issues a top priority if her appointment is approved, to which Levine said she would “do everything possible” in those areas.

The senator’s office did not respond to previous questions from Broad + Liberty as to whether he harbored any concerns about Levine’s leadership regarding COVID-19 testing, the DOH response to nursing homes, and the vaccine rollout.

Todd Shepherd is Broad + Liberty’s chief investigative reporter. Send him tips at tshepherd at broadandliberty.com, or use his encrypted email at shepherdreports at protonmail.com.