Manuel Balce Ceneta/AP Photo
Rep. Lauren Underwood (D-IL) speaks during a news conference unveiling of the Affordable Care Enhancement Act, which she co-sponsored, June 24, 2020, on Capitol Hill in Washington.
The 2018 midterms saw 41 Democrats flip Republican House seats, including Illinois-14, picked up by Rep. Lauren Underwood. Roughly half of those districts mirrored Underwood’s: They were more than two-thirds white; a mixture of urban, suburban, and rural middle-income residents who historically supported Republicans. In her district, health care was the number one issue. “As we would travel from place to place to place, everybody was talking about health care,” Underwood recalls.
An incumbent seeking her second term in the middle of a global pandemic, Underwood faces stark challenges. In the final days of the 2020 campaign, she sees the same level of anxiety among her constituents that she saw during the Trump administration’s failed attempts to repeal the Affordable Care Act two years ago. The current health care crisis may serve to strengthen Underwood’s standing among Democrats—and Republicans frustrated with the status quo may cross over to vote for her, just as some did two years ago.
Kim Hacker, a lifelong Republican, broke ranks to vote for Underwood. Her father and his family voted Republican. Her former husband volunteered for local GOP campaigns. Growing up in the northwest suburbs of Chicago, most of her neighbors supported Republicans. She firmly believed in the party’s tenets of fiscal conservatism, limited government, and family values. Though she knew politicians “spun the truth,” she never considered them to be liars and thought that they dedicated themselves to making the country better for people like her—until her father’s health began to fail in 2008.
He suffered from heart disease, and near the end of his life he was hospitalized and needed around-the-clock care that cost the family thousands of dollars. The Hackers were lucky. Her father saved diligently and had high-quality insurance during his years as a corporate vice president, so her mother would still be comfortable in retirement. For the first time, however, Hacker understood how health care costs could wipe away family savings. She also gained a new appreciation for the difficult work providers do. She rejected Donald Trump in 2016 and supports Joe Biden this year, and she plans to vote for Underwood again.
In 2018, Underwood, a registered nurse, defeated four-term incumbent Republican Randy Hultgren by 52.5 percent to 47.5 percent to become the youngest Black woman in Congress. She is the first woman and African American to represent IL-14, a district that sent Dennis Hastert, a former House Speaker, to Washington for 20 years, and she is only the second Democrat to win in IL-14 in the past 80 years. During her first congressional campaign in the seven Northern Illinois counties comprising her district, Underwood, who worked on the implementation of the Affordable Care Act during her time as a Department of Health and Human Services senior adviser on emergency preparedness and response, got an earful about the affordability of prescription drugs and medical procedures from voters.
Two health care bills that she worked on were signed into law. Last December, President Trump signed the Lower Insulin Costs Now Act, a bill she co-sponsored, which allows the FDA to review generic-brand insulin applications beyond the previous March 2020 due date. On October 20, her Veterans’ Care Quality Transparency Act was also signed into law. The bill ensures that both Veterans Affairs and outside providers offer mental-health and suicide prevention services.
But with the ACA in jeopardy of being struck down by the Supreme Court, voters also fear losing the health insurance they gained under the measure. Trump has repeatedly promised an alternative (“I have it all ready,” he said in September) but has failed to deliver and, instead, has devoted his energies to trying to eliminate existing ACA protections.
Americans worried about health care long before COVID-19 infected over eight million people. Nearly one in four Americans skip doctor visits to avoid the cost, and over 27 million Americans lack access to health insurance. In a 2019 Gallup poll, voters ranked the “availability and affordability” of health care as their top concern, above crime, the economy, and immigration. If anything, the pandemic has amplified many people’s financial nightmares: One COVID-19 “miracle” survivor received a $1.1 million bill following a 42-day hospital stay.
“For a lot of people, that’s more than the value of their home,” says Robin Wilson, director of the Institute of Government and Public Affairs at the University of Illinois at Urbana-Champaign. “COVID could strike you, and it would be nothing within your control.”
Underwood is the first woman and African American to represent IL-14, a district that sent Dennis Hastert, a former House Speaker, to Washington for 20 years.
Many of the people facing health care struggles live in the rural areas of Underwood’s district, places where the health care system’s flaws have become readily apparent since the outbreak of COVID-19. Families who run local, family-owned farms recognize that the Affordable Care Enhancement Act, a bill co-sponsored by Underwood which provides funding to reduce the cost of premiums for individually purchased health insurance plans, offers them a means to afford health care while being self-employed. “So many people had neglected to talk with the farmers about their number one issue because they only speak with the trade associations,” says Underwood.
Hana Hinkle, associate director of the National Center for Rural Health Professions at the University of Illinois College of Medicine Rockford, says COVID-19 could shift how rural voters view the government’s role in health care investment. “There’s already a rural health workforce shortage,” she says. “But since the pandemic, hospitals that serve more vulnerable, rural, and underserved communities have closed.”
Kim Hacker knew she needed to do more to get involved in Underwood’s campaign after Underwood debated her opponent, businessman Jim Oberweis, and the Republican dismissed her experiences and training as a nurse. “He was everything that I had come to find so frustrating about politics,” says Hacker, who donated to Underwood’s 2020 campaign and now volunteers for a number of Democratic efforts. “I’m still working on saying, ‘I’m a Democrat,’” she says. “But health care has become such an important issue for me and has been a major reason why I am no longer a Republican.”
The chance of an IL-14 Republican victory appears slim, with Underwood heavily favored to win. However, Oberweis, owner of a restaurant and dairy product corporation, has spent $1 million of his own money on his campaign and has received funding from the House Freedom Caucus.
If she returns to Washington, Underwood plans to focus on expanding the ACA and improving access to coronavirus relief and mental-health services. She recently demanded that Education Secretary Betsy DeVos expand mental-health services in public schools to address the feelings of “stress, trauma, and isolation” exacerbated by the pandemic. “There shouldn’t be these barriers in place keeping people from getting the health care that they need,” Underwood says. “Certainly not in 2020, and certainly not during a once-in-a-century pandemic.”
