Global Health Institute

On March 11, 2025, the Conversations in Global Health: Global to Local class welcomed Katie Keith (L’12) for a conversation on health policy litigation, challenges to gender-affirming care, and carving out a non-traditional path in the health care space.

Previously, Keith served as the director of the Health Policy and the Law Initiative at Georgetown University O’Neill Institute for National and Global Health Law. She also served under the Biden administration as the deputy assistant to the president and deputy director of the White House Gender Policy Council.

With a joint J.D. and MPH, Keith centered her career on tracking the growing intersection between public health and the courts. Following the signing of the Affordable Care Act (ACA) in 2010, Keith anticipated a marked shift in the health policy life cycle—namely, that passing legislation no longer guarantees implementation.

As a contributor to Health Affairs’ “Following the ACA” column, Keith analyzed what became the most litigated statute in American history. Over the course of five years, she tracked an evolving docket of over 50 lawsuits against the ACA.

This playbook has since been applied to a range of health issues. One example, Keith noted, is the negotiation of Medicare drug prices. Introduced in 2022 under the Inflation Reduction Act, the program faces various legal challenges from the pharmaceutical industry, including charges that it levies excessive fines and violates property rights. This has elevated the need to have a prepared legal strategy to secure health outcomes.

Keith stated that this trend has accelerated under the Trump administration, particularly as it relates to LGBTQ+ care. In his first 50 days in office, President Donald Trump issued executive orders disputing the concept of gender identity and blocking minors’ access to gender-affirming care. Keith also said she was closely watching United States v. Skrmetti, a pending Supreme Court case on whether providing transgender care to minors violates the Equal Protection Clause. The arguments, Keith believes, highlight a perceived tension in scope: Is this a case about sex discrimination or states’ rights to regulate health care?

Much of Keith’s career has centered on gender issues. This peaked during the Biden administration, where she supported women’s economic security initiatives, including work on paid leave and childcare and gender-related grievance procedures. 

Despite this, Keith notes that she never expected to work at the White House. “I’m a big advocate of non-traditional careers,” she said. “I [only] wanted to be in the room where decisions are made.” She emphasized: “I like to work on the headlines — the Affordable Care Act, LGBTQ+ care, [or] abortion access. I want to be in the fight.”

This continues to guide Keith’s work today. Currently, she writes for Health Affairs’ “Health Policy at a Crossroads” series. In this position, she sheds light on underreported executive orders, such as Trump’s expansion of in vitro fertilization and his pardons for health care executives convicted of Medicare fraud. 

Given the pace of recent policy changes, Keith’s clarifying authority is essential. Perhaps more than ever before.

Ula Ekmecic (SFS’26) is an undergraduate at Georgetown University majoring international politics. She is a student in the Conversations in Health: Global to Local class.

As part of the Conversations in Global Health: Global to Local class, Katie Keith (L’12) delivered an insightful reflection on her career. She traced her journey from an accelerated high school education program to her role as a science education volunteer in Ghana with the Peace Corps, and ultimately to her involvement with the Affordable Care Act.

One of the topics discussed was about diversity, equity, and inclusion (DEI) initiatives in health research. This discussion was in part a response to the U.S. government sunsetting DEI initiatives. Keith explained that without disaggregation in research, problems within the health care system will not be identified. For example, Keith explained, mortality rates have been decreasing over the years, but black women’s rate is decreasing much more slowly. Keith illustrated that to ensure the health care system in the United States is working properly for everyone, data must be disaggregated, and these DEI initiatives should not be removed from research. 

Another topic was about education on health care policies. Once the Affordable Care Act (ACA) was implemented, historically marginalized groups, such as trans and queer people, assumed due to systemic obstacles in care, they would not be covered by ACA. However, ACA prohibited discrimination in health care based on gender identity through Section 1557 and ensured access to insurance and care, in addition to stopping the denials of coverage for transition-related services. Keith, through the nonprofit Out2Enroll, was able to communicate with these groups about their insurance coverage.

Lastly, Keith identified U.S. Supreme Court cases and other policy changes that will affect how minorities will interact with health care. Keith highlighted the United States v. Skrmetti case that challenges Tennessee’s ban on gender-affirming care for minors. This case is on the forefront of trans care policy and, depending on the outcome, has the potential to attack the human rights of trans individuals. 

Keith was a fantastic lecturer and a great resource to the future health care workers in the class. Not only did she provide outlets for future health care workers to advocate for their patients outside of the clinic, she instilled a commitment to bettering the health care system to a diverse audience of passionate students. 

Maeve McGuire (C’25) is an undergraduate at Georgetown University majoring biology. She is a student in the Conversations in Health: Global to Local class.