ScienceInsider’s coverage of the 2018 U.S. elections has featured profiles of several candidates with scientific backgrounds running for the U.S. House of Representatives, as well as stories about the challenges those candidates have faced on the campaign trail. Today’s story looks at Lauren Underwood, the Democratic nominee in the 14th congressional district in Illinois.
Democrat Lauren Underwood decided to run for the House after she says her Illinois congressman—and now political opponent—“broke his promise” to oppose any bill that would make it harder for people with preexisting conditions to get health insurance.
“As a clinician, I take care of patients who rely on that coverage to afford their meds and procedures,” says Underwood, a registered nurse with a master’s degree in public health policy. “Also, as a child I was diagnosed with a heart condition [supraventricular tachycardia] that required me to go regularly to a pediatric cardiologist. So it’s personal, too.”
Underwood faces off on 6 November against Republican Randy Hultgren in Illinois’s 14th congressional district west of Chicago. But before jumping into politics, the 32-year-old spent 6 years in the U.S. Department of Health and Human Services (HHS) in Washington, D.C. She began as a career employee, working to implement the Affordable Care Act (ACA), and then converted to a political appointee dealing with biopreparedness.
What inflamed her was Hultgren’s support for the American Health Care Act, the Republican vehicle for repealing the ACA that was narrowly defeated last year in the Senate after passing the House. She decided his vote contradicted what he had said during a town hall meeting in his district. “So I got mad,” she says. “And then I decided, you know what, it’s on.”
Early dreams of political career
Her decision to run may have been personal. But it was not impulsive. Underwood has been thinking about a career in politics for a long time, says Nicole Lurie, director of HHS’s Office of Preparedness and Response during former President Barak Obama’s administration.
“I asked about her long-term goals,” recalls Lurie, a physician-scientist and health policy expert, before hiring her as a special assistant. “And she gave me a two-part answer: ‘I want to use what I know about nursing and public health to do good,’ she told me. ‘And ultimately I want to be a U.S. senator.’”
Lurie says she has no trouble imagining Underwood holding that position someday. In the meantime, Lurie has donated to her campaign, hosted fundraisers, and recruited a small army of volunteers to work for Underwood. It stems from her admiration for Underwood’s work at HHS, which dealt with such public health crises as the Ebola and Zika viruses; lead poisoning in Flint, Michigan; and hurricanes and other natural disasters.
“Any task I asked Lauren to do, it didn’t matter how outlandish it was, she just got it done,” Lurie says. “At times, like in Flint, we’d be working with a community that was terrified and angry. So it was important to talk to the person in the street, explain what was going on and understand their concerns. Then we could develop a strategy to meet their needs. And those are the same skills that a candidate needs to serve their district.”
A taste for policy
Underwood got her first taste of public service in high school, as a student member of the fair housing commission in her home town of Naperville, Illinois. One of the small number of black people in the well-to-do suburban community, Underwood said she “loved” reviewing allegations of discrimination against landlords and “making recommendations to city council to allow our community to be more welcoming and inviting and live up to its ideals.”
She won a scholarship to attend the University of Michigan in Ann Arbor, where she took a course on the politics and policy of nursing. “It opened up a new world for me,” she says. “While my nursing school colleagues were spending summers working in an [intensive care unit], I went to Capitol Hill in 2006 and interned for [then-]Senator Obama.”
Although still an undergraduate, her aptitude for policy was obvious, recalls Dora Hughes, a research professor of health policy at The George Washington University in Washington, D.C., and then a senior health adviser to Obama. “She was poised and mature, and very interested in what people had to say,” Hughes says. “She was functioning more at the level of a junior staffer than an intern.”
Four years later, Hughes had joined the Obama administration as counselor for science and public health to HHS Secretary Kathleen Sebelius. Then, someone told Hughes Sebelius had hired Underwood to be her executive assistant, a career position. “Everyone thought I had pulled some strings,” Hughes says. “But Lauren had won the job totally on merit.”
Underwood had just finished a joint master’s program in nursing and public health from Johns Hopkins University in Baltimore, Maryland, and her role was to manage the flow of paper across the secretary’s desk.
“It was my dream job,” she says. “I was 23, and I got to play a critical role in transforming the country’s health care system and providing 23 million Americans with health insurance for the first time. It was incredible.”
Even so, Underwood was already thinking about her next career move. She felt that professional development within the federal government focused too much on “depth, not breadth.” And she craved the latter.
“I was interested in growing,” she says. “So I started enrolling in these women’s leadership development programs. And some of them began to include an aspect relating to running for office.”
Lurie remembers Underwood “going off to boot camp on the weekends to learn how to become a candidate.” It was part of a staggering list of community activities that included being an adjunct nursing instructor and starting a foundation that could offer college scholarships to needy students in the inner-city Girl Scout troop she led.
A turning point
The November 2016 presidential election marked another turning point for Underwood. “I could have gone back into government,” she says. “But when the [Donald] Trump administration came in, it was clear that they wanted to take away health care for the American people. And that’s not why I became a nurse. I knew I couldn’t stay in government while they tried to do that.”
She returned to Naperville and joined a company that provided managed care to Medicaid beneficiaries in Cook County. Before deciding to run, she spent her weekends huddling with friends and “figuring out what we needed to do and who could help us.” She declared in August 2017, and over the next 6 months she put together a grassroots campaign that helped her win 57% of the vote against six other Democrats in the state’s March primary.
Running in a district adjacent to two U.S. Department of Energy labs—Fermi National Accelerator Laboratory and Argonne National Laboratory—Underwood says she wasn’t surprised that her opponents included two engineers. That abundance of technically trained candidates caused 314 Action, a Philadelphia, Pennsylvania–based organization created in 2016 to help scientists and science, technology, engineering, and math professionals run for office, to stay neutral in the primary, although it later endorsed Underwood.
“It’s great that [314 Action is] now on board,” she says. “But they were not a ground-level, validating organization for us. It’s the early money that is most helpful in a campaign. And I had already won my primary by the time [314 Action] got involved.”
Although voters will be asked to choose between Underwood and Hultgren, the candidates’ starkly differing political philosophies have led some analysts to see this race as a test of the national mood as well.
“I’m progressive because I support the idea that all Americans should have affordable health care services,” Underwood told the Chicago Tribune, which interviewed both candidates. “I’m progressive because I recognize that climate change is real and that we need to have solutions that would stem the impact of climate change. And I’m progressive because I believe that all Americans should be paid a fair wage for their work.”
In contrast, Hultgren, who the Tribune labeled “a solid conservative” when it endorsed him, regularly touts his agreement with Trump on tax cuts, repealing the ACA, and pulling out of the Paris climate agreement. He holds a classic small-government philosophy: “The most important thing is providing opportunities,” he told the paper. “It’s not government leveling everybody else off [and saying] that no matter how hard you work, everybody gets a C in the class.”
Despite his fiscal conservatism, Hultgren has been named “a champion of science” by research advocacy groups because of his vocal support for increased federal funding of basic energy research. And although both candidates support greater investments in clean energy technologies, they disagree sharply on the government’s role in regulating the environmental impact of those technologies.
To take just one example, Hultgren says the Clean Power Plan proposed by the Obama administration is unconstitutional and he backs Trump’s attempt to repeal it. Underwood calls the plan, now in limbo, an essential step in reducing the country’s greenhouse gas emissions.
Underwood has raised enough money—including more than $2 million in the latest quarter—to blunt the financial advantage normally enjoyed by an incumbent. But she also knows the money simply affords her a chance to reach voters. Convincing them to support her will require making a connection. That’s a skill she’s already learned, she asserts.
“In nursing you have maybe 5 minutes to establish trust so that the patient and their family can understand the recommendations and will trust the advice and the treatment plan,” she explains. “It’s the same thing on the campaign trail. I’m meeting people every day who are vulnerable, and they tell me some of their most personal experiences. And when they say they need help, you need to be able to fill that need.”
Political analysts think her approach is working. Underwood has raised more than $3 million, nearly double Hultgren’s total, and one tip sheet recently moved her race from “leans Republican” to “toss-up.” If Underwood helps Democrats recapture the House, her victory will be hailed as evidence that young, progressive, female candidates played a key role in that blue wave.