1. Collins, Amy M. Managing Editor


Freshman congresswoman Lauren Underwood brings nursing and health care policy experience to the table.


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The 2018 midterm elections saw an unprecedented number of women winning seats in Congress-among them, Lauren Underwood, representative from Illinois, who beat a four-term Republican incumbent in the state's heavily red 14th congressional district. At 32, Underwood is the youngest black woman ever to be elected to Congress. She's also an RN. She joins nurses Karen Bass (D-CA) and Eddie Bernice Johnson (D-TX), the first nurse elected to Congress.

Figure. Lauren Under... - Click to enlarge in new window Lauren Underwood (D-IL) with volunteers at her campaign headquarters in Illinois. Photo courtesy of Lauren Underwood for Congress.


Underwood credits her desire to become a nurse to the nurses and health care providers who cared for her after she was diagnosed with supraventricular tachycardia in elementary school. "I wanted to go into pediatric cardiology as soon as I learned how to spell it," she said. In high school, however, she shifted her focus to public health and nursing. In her freshman year at the University of Michigan School of Nursing, she took a course called Policy and Politics in Nursing and Health Care, which introduced her to health policy. "I just knew that's what I wanted to do," she says, "and I've been on that path ever since."


After graduating with a bachelor of science in nursing degree, Underwood worked as a research nurse. She was awarded a fellowship at the National Institutes of Health and ran a study at Johns Hopkins University, where she pursued two master's degrees (a master of science in nursing and a master of public health). Later, she joined the U.S. Department of Health and Human Services where she worked on implementing the Affordable Care Act (ACA), with a focus on private insurance reform, health care quality in the Medicare program, and preventative services. "It was my dream job," she said. "I was 23 and I got to go to work every day to change the health care system in our country." She admits that immediately after its passage, the ACA wasn't the most popular piece of legislation, but she knew it had the potential to help so many people. "I believe health care is a right-evidence tells us that when people don't have health care coverage they die. This was the one chance we had to get it right, to save lives, and I brought that deep sense of commitment and purpose to the job every day."



It was this commitment to providing health care to the American people that motivated Underwood to run for Congress. She served in the Obama administration until its last day but knew she couldn't stay on to help the new administration try to repeal the ACA. She left Washington and returned to Illinois, where she worked for a Medicaid managed care company in Chicago. In 2017, she attended a question-and-answer session hosted by the League of Women Voters, where Underwood's then district representative, Randy Hultgren, made a promise to support a version of Obamacare repeal that would allow people with preexisting conditions to keep their health care coverage.


"That promise was really important to me-as a nurse taking care of patients but also as someone who had worked on the ACA and who had a preexisting condition myself. It was really personal for me. So, when he made that promise, I believed him." But Hultgren voted for the American Health Care Act, a version of repeal that made it cost prohibitive for people with preexisting conditions to get insurance coverage. "I got really upset and said, 'You know what? It's on. I'm running.'"


A winning campaign. Underwood ran in a primary against six men and received 57% of the vote, beating Hultgren. She attributes her win to getting out and having a presence in all seven counties in her district, some of which were very rural and Republican, and spending time in areas where it was thought no democrat could win. She also believes her campaign was successful because she addressed the issues that were most important to her constituents. The number one, front-and-center issue, says Underwood, was health care-especially affordability of insurance coverage and premiums, and prescription drugs.



Underwood is already demonstrating that, as a member of Congress, she will keep health care issues at the forefront. She recently introduced the Health Care Affordability Act (HR 1868) to help make health care more affordable by reducing premiums for insurance purchased through the marketplace, as well as legislation to protect Americans with preexisting conditions by overturning a Trump administration rule that expands limited-duration insurance, commonly known as "junk plans."


She also made headlines recently for her March 6 questioning of Department of Homeland Security (DHS) secretary Kirstjen Nielsen about the current administration's policy of separating children from their families at the border and the psychological and physical trauma children experience as a result. She specifically asked Nielsen about toxic stress, which results from a prolonged stress response to the absence of a supportive adult relationship (for more on this, see AJN Reports, January). "From what I've heard today," Underwood said at the hearing, "I'm not sure if DHS was so negligent they didn't know how traumatic family separation was for children, or if they knew and did it anyway. In my opinion, both are unacceptable."


When asked by AJN what her focus will be in Congress, Underwood had a clear list of priorities. One, she said, is to stabilize the ACA. "It is bruised and battered, but it is still standing." She pointed out that millions of people rely on the law to provide affordable care. Implementing fixes to the law will be a top priority. She also wants to focus on ACA expansion to allow more people around the country to gain coverage. And she wants to address prescription drug prices. "We need a Congress that will negotiate with drug companies-bring them to the table. It's critical."


Another area Underwood says needs significant attention is mental health care reform. "I would love to see the day when there are mental health clinics in every strip mall just like there are Massage Envys," she said, then added, "but the absence of a reimbursement, claims, and workforce development infrastructure does not allow for mental health care to be as accessible around the country. It takes intentional action."


She also wants to focus on the health care workforce. "I was in graduate school when the nursing shortage hit its peak," she said. "We got some additional funding through the stimulus bill and the ACA for workforce development, but now we need to begin that conversation anew. There are shortage areas and a need for more providers in certain specialty areas, so I'm looking forward to leading on these and other nursing issues in Congress."-Amy M. Collins, managing editor