Former HHS Adviser Lauren Underwood Running for House Seat

With years of experience as a registered nurse and federal healthcare policy adviser, Underwood is seeking to unseat Rep. Randy Hultgren in Illinois' 14th congressional district.

As a former senior adviser to the U.S. Department of Health and Human Services under President Barack Obama, Lauren Underwood, RN, is no stranger to the effects that federal healthcare policy, such as the Affordable Care Act, can have on assisting vulnerable populations.

That is one of the driving forces behind her decision to challenge Republican Rep. Randy Hultgren, who voted to repeal the ACA last year, in Illinois' 14th congressional district.

In addition to her training and career as a nurse, Underwood assisted the Obama administration on public health emergencies such as dealing with the Ebola epidemic in 2014 and the Flint water crisis in 2016. While she had hoped to hand off her work to the next administration, she has been disappointed by the Trump administration's approach to federal health policy and chose to run for public office.

After being named one of the three healthcare leaders included in former President Obama's midterm election endorsement waves, Underwood discussed her candidacy with HealthLeaders, how the government should strengthen the Affordable Care Act, and promote the push toward value-based care.

The following transcript has been lightly edited.

HL: How has your work as a nurse shaped your view of healthcare, and how would that carry over if you were elected to Congress?

Underwood: At the most foundational level, I believe that healthcare is a human right. That's how I approached my career in nursing, in public health, and that's how I hope to approach my time as a representative. Through the opportunities that I had as a nurse, I've been there for people during life-changing events; birth, death, and devastating diagnosis. [Being around] civilian's life moments and the vulnerability associated with providing this type of care to individuals, [I noticed] there have been a lot of parallels in running for office.

I spent my career as a public health servant, and I think that I'm particularly well-suited for this type of public service because of my time working to improve the lives of communities and populations. The opportunity to work on H1N1, the Flint water crisis, and Ebola, were major disasters in history that [showed] that special intersection between clinical care, local public health, and the impact of policies at the federal level.

HL: Are there changes or fixes you would support to strengthen the ACA?

Underwood: The Affordable Care Act is still the law. We have 37,000 people in [the Illinois 14th congressional district] that still have coverage. I see the ACA as black and blue: it got in a terrible street fight—black eye, broken nose, cracked rib, might have some splotchy parts around the kidneys, and may be limping down the street, crying out for help. But it's still standing, still moving, and still living. That street fight is an intentional sabotage on the part of congressional Republicans to weaken the program, and any program that is starved of resources will fail.

It's no surprise that we've seen some of the symptoms of what's been going on [with the weakening of the ACA]. Incredibly high premiums, [instability] in the marketplace, that's been manifested in our community as well as real and deep anxiety: will we continue to have this as a coverage option? If the ACA goes away, what will [people] do?

HL: Do you have thoughts on potential Medicare for All legislation and whether it is a practical goal for federal healthcare policy?

Underwood: Again, I think healthcare is a human right, and universal coverage is a great goal. I think that there are certainly political challenges towards [passing Medicare for All] in the immediate next session. But I think it's something I support [regarding] the underlying value statement, which is folks need healthcare to live their healthiest lives.

HL: What do you think the government's role should be in pushing toward value-based care?

Underwood: I think it's really interesting. I worked on those different [value-based care] programs improving quality and Medicare. I did the value-based purchasing program and implementations in skilled nursing facilities and those different program areas under the ACA. I also did National Quality Strategy and what we saw for the first time under the ACA was a coordinated effort to measure and improve the quality of care provided across settings. It was not just hospitals; it was across settings in our healthcare system, because for so long that had been opaque. There was not a coordinated federal strategy for tracking, monitoring, and improvement.

I think that as we work to refine the existing quality programs and move to more closely align the federal payers, like Medicare, Medicaid, VA, to high-quality care and reimbursement for those outcomes, we're going to continue to see a move in the larger marketplace to rewarding excellence.

HL: What should hospital executives and health system leaders take away from your candidacy?

Underwood: I'm a registered nurse, and my career is at the intersection of clinical and policymaking, working to help transform our healthcare system. We know there are real challenges, the ACA created some and helped some, but we will need to have another serious effort around health reform. It is critical to have the voice of patients and providers at this table. And I am excited to partner [with] providers, plans, patients, and even hospital CFOs in order to get this done.

I think that we need to have these critical voices at the table because healthcare is not theoretical. So many people who have had the pen for too long see healthcare through a theoretical lens, and as a result, we have a system that is broken and fragmented and inefficient, and it's time we fix that.

Jack O'Brien is the Content Team Lead and Finance Editor at HealthLeaders, an HCPro brand.