In the latest Policy Talk hosted by the Ford School of Public Policy, U.S. Rep. Lauren Underwood, D-Ill., spoke Monday about health policy and the Affordable Care Act. James Hudak, professor of health policy, and Paula Lantz, associate dean of the Public Policy School, also spoke at the event.

Underwood is the youngest Black woman to serve in the House of Representatives and is a University of Michigan alum and registered nurse. She has served Illinois’s 14th Congressional District since 2019 and serves on the House Committees on Education and Labor, Veterans’ Affairs and Homeland Security. She is also a member of the Future Forum, the Congressional Black Caucus, the Congressional LGBTQ+ Equality Caucus and the Congressional Gun Violence Prevention Task Force. 

In addition to enacting legislation to ensure universal coverage for all Americans such as Medicare for all, Underwood said further action would be required to give everyone access to quality healthcare and services.

“We need to be taking these actions to make sure that people actually have places to go, providers to see,” Underwood said. “This means making robust investments in our health care workforce, including mental and behavioral health rights.” 

Underwood said she began advocating for an Illinois Medicaid plan after the 2016 election when former President Donald Trump began his repeated attempts to repeal the ACA. Medicaid is a state-run health coverage program for low income individuals who meet federal requirements. The ACA is a federal law that provides subsidies, or premium tax credits, that lower the cost of health insurance for low income individuals. It also expands Medicaid and supports innovative medical care methods. 

Underwood also discussed some of the strengths and weaknesses she saw with Medicaid legislation. She said despite evidence showing that expanding Medicaid can reduce mortality rates, Congress still had to incentivize doing so in the American Rescue Plan Act, which was passed earlier this month to provide COVID-19 relief to the economy, individuals and small businesses.

“There have been so many articles showing the consequences being deaths, excess deaths, because they will not expand Medicaid — we’re talking about 15,000 deaths in one study,” Underwood said. “So the American Rescue Plan did have provisions to incentivize states, these holdout states, to expand Medicaid.” 

Underwood said many families in the country are burdened by out-of-pocket costs for health care. The Health Care Affordability Act, which Underwood introduced in January, extends eligibility for premium tax credits and expands the size of premium tax credits. By doing this, the act aims to lower out-of-pocket costs for health insurance premiums. The legislation states that no American would pay more than 8.5% of their income on premiums for a silver-level plan on the marketplace. A two year version of this bill was included in the American Rescue Plan Act that waves all premiums and provides a healthcare coverage option for uninsured individuals in 2021. 

Underwood said she shifted careers from nursing to public service when she ran for Congress at the age of 30. 

But her former career has continued to influence her current one, as Underwood discussed how nurses could contribute to policymaking, arguing that advocacy and engagement should be a professional responsibility. She acknowledged that the country’s shortage of nurses, the aging population and increasing frequency of chronic conditions across different groups will put a strain on nurses nationwide.

In February, the Future Advancement of Academic Nursing Act was reintroduced to Congress, which would invest $1 billion in schools of nursing for recruiting and retaining students and faculty in hopes of enhancing nursing education. Underwood was one of three representatives who reintroduced the bill.  

“Nurses should be able to practice to the full extent of their education and training, and my work in Congress is firmly rooted in that framework,” Underwood said. 

Underwood also co-founded and co-chairs the Black Maternal Health Caucus, a group of representatives who are working to end the nation’s maternal mortality crisis. She said in the United States, Black women are three to four times more likely to die from complications during pregnancy and she was inspired to take action.

“This disparity has been around my entire lifetime,” Underwood said. “I’m 34 years old. We have not seen any national initiatives to solve this problem — the Surgeon General’s report, nothing. And so when I got to Congress, I knew we wanted to work on it.”

Underwood encouraged audience members to contact their representatives about health care issues and said she hopes Congress can make progress. 

“I hope that on these health care issues, particularly in the pandemic, particularly with the level of inequity that we have seen on display, that it is so clear that we need to take decisive bold action right now,” Underwood said. 

Social Work student Robin Mae Berk asked in the chat how the Black Maternal Momnibus Act, which Underwood introduced along with two other members of Congress and the Black Maternal Health Caucus, will proceed to create change in the future. Underwood said Congressional representatives are currently working with Sen. Cory Booker, D-N.J., to pass this legislation which has over 120 House and Senate co-sponsors.

The Black Maternal Health Momnibus Act is a package of 12 bills and aims to address various health disparities and maternal mortality. Underwood said one of the bills is called the Social Determinants of Moms Act, which includes funding for safe, quality housing for pregnant people and provides resources for the creation of a task force to study the impact of social determinants on maternal health. The Centers for Disease Control and Prevention defines social determinants as “conditions in the places where people live, learn, work and play that affect a wide range of health and quality-of life-risks and outcomes.” 

Lantz discussed the difference between health and health care and asked Underwood what governments could be doing to address social determinants of health.

“Health and healthcare are not the same thing, and so health and health care policy are not the same thing,” Lantz said. “We’re talking about education and income security and housing affordability and neighborhood investment and food security and structural racism and all the upstream things that matter for health.”

Underwood said she aims to introduce legislation that protects mothers and children from the adverse effects of climate change.

“(We need to) move the needle more and more away from this … conflation of health and health care with the thought that every health problem we have in the U.S. has only a health care solution,” Underwood said. “Obviously health care is important, but how can we focus more policy attention to the social determinants of health, is such a great question.”  

Underwood then pivoted to discussing the importance of leadership skills in public service and recalled her own anxiety about being successful in her career during her undergraduate and graduate years. 

“I think about leadership so often in terms of find(ing) work that you care about, you’re passionate about doing, and the recognition will come, the acknowledgment will come, the titles will come, the pay will come,” Underwood said. 

Lantz reiterated this point, said the Ford School of Public Policy often sees leadership as influencing others rather than having power over them.

“We really simply defined leadership as having a positive impact on others, organizations and communities,” Lantz said. “It’s not about power, it’s not about control, it’s about impact and influence.” 

Toward the end of the webinar, Underwood reflected on some of the challenges she has experienced as a Congresswoman and the role of activism in policymaking, citing the late U.S. Rep. John Lewis, D-Ga., as a personal inspiration. 

“John Lewis spent his whole lifetime, his whole lifetime, fighting for the cause of voting rights and equality in this country.” Underwood said. “And he did it as an activist. He did it in the church, he did it in the Congress, he did it leading organizations. And he did it until he died … My only point is sometimes it takes that amount of time. But it doesn’t mean that it’s not worthwhile. You have to do it.” 

Underwood addressed aspiring policymakers in the audience, advising them to focus on what kind of impact they desire to make.

“The University of Michigan has a legacy of activism of engagement and that has been so critical to my ability to step forward and lead and dream and run and win and serve,” Underwood said. “We can dream and step forward and take risks, and have a tremendous impact and change the world. And we should just do it fearlessly.”

Daily News Staff Reporter Nirali Patel can be reached at nirpat@umich.edu

 

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