Maternal Health is an Everybody Issue with Rep. Lauren Underwood

TOPICS DISCUSSED

  • “Trust the Science”

  • Rep. Lauren Underwood on the Momnibus

  • Outside of Politics: AKA Sorority Sisters

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TRANSCRIPT

Sarah [00:00:07] This is Sarah Stewart Holland.  

Beth [00:00:09] This is Beth Silvers.  

Sarah [00:00:10] You're listening to Pantsuit Politics.  

Beth [00:00:12] Where we take a different approach to the news.  

[00:00:14] Music Interlude.  

Sarah [00:00:29] Thank you for joining us. We have a very special guest today. Representative Lauren Underwood, who represents Illinois's 14th Congressional district, is here with us. Representative Underwood generously spoke with us about parenting policy and health care policy and joined us for Outside of Politics, which you guys are going to love. We can't wait for you to listen to that conversation. But before we get to that, we're going to talk about the phrase trust the science and where people are with that. Where we are with that around trust and the institution and the next evolution may be in that conversation?  

Beth [00:01:05] Before we get into all of that, just a little housekeeping. Normally, we release new episodes of Pantsuit Politics on Tuesdays and Fridays, but unfortunately, no one consults with us when scheduling major political events.  

Sarah [00:01:16] Rude.  

Beth [00:01:18] The first presidential debate, perhaps the only presidential debate between Vice President Kamala Harris and former President Donald Trump is next Tuesday night, and we want to get you our reactions to that debate quickly. So we are going to hold off on our normal Tuesday episode, and we are going to record Wednesday morning and get the files out in the world as fast as we possibly can. So hopefully, we'll have that episode in your feeds by early Wednesday evening. If you don't want to wait that long for our debate takes, you can join us on either our Patreon or Substack for a live chat. The chats are only available to paid subscribers on those platforms, so this is for our premium audience. I'll be over on Patreon, Sarah will be on Substack.  

Sarah [00:02:00] Finally, if you're in the Nashville area, we'd love to have you join us at Edgehill United Methodist Church this Sunday. You can find all the details about our time there in the show notes or on our website. Next up, let's talk about trusting the science.  

[00:02:14] Music Interlude.  

[00:02:26] Beth, I emailed you because I feel like I've been seeing all kinds of places where the scientists are saying we don't know. I don't think this is an organized effort to build trust in science, but I find it helpful. I find it helpful when they say, we don't know how this works. Lots of we don't know how this works around semaglutides and artificial intelligence. Semaglutides, in case you don't recognize that word or I'm mispronouncing it because I've heard it pronounced lots of different ways, is known as Wegovy, Ozempic- that brand of drugs. Read an article about how they don't really understand how women's periods work, and I appreciate that shocking confession. I even saw stupid Twisters and they talk about we don't really know how a tornado works. I don't even know if that's true. I'm just saying, I feel like there's a lot of that energy in the scientific community, and I wanted to call it out because I appreciated it.  

Beth [00:03:23] What is it that makes you appreciate that? You linked that to the phrase trust the science. So I would love for you to kind of flesh out why those two things go together in your mind.  

Sarah [00:03:31] Well, because I think the reason people really struggle with trust the science is then in my conversations with family members, for example, there was a lot of, "How can you say that? They told us to eat all the stuff that was bad for us. Or they told us to take these drugs that were bad for us, and then they changed their minds." Or even, I think, around the pandemic, the pivot on mask, that in the beginning it was don't worry about masks, don't make your own mask. And then all of a sudden it was everybody wear a mask all the time. And I think the sense of, like, they don't tell us when they get it wrong, how can I trust an institution that doesn't tell us when they get it wrong? Because I do think in public health and lots of places, there was this sense of, like, we can't trust people with conflicting information.  

[00:04:14] We can't trust people to say we don't really know. When really that builds trust, when you say, I don't know, we're figuring it out. Because I think science became answers when really it's a process. Science is a process of exploration and testing theories and peer reviews and all these places that it's still a human process. It's still humans running the process. And so the more we can say, hey, we're just building on this information, that makes me feel a lot more trustworthy. I mean, that's definitely an issue I've had with health care. Hello, I had my first two children at home because I was very skeptical and didn't feel like I could trust the science-- maybe not the science. The processes in place at that time.  

Beth [00:05:01] I think this is one of the key challenges here because the phrase 'trust the science' gets batted around politically when what people are reacting to is a combination of science and policy choices and communication skills, even around health care and the experiences that shape our tendency to trust or not trust. Yes, there is medical education, but education is different from the science that you're learning in the process of being educated. And service delivery is different no matter how much education and science is backing the service, and communication is always a challenge and fee structures and billing and insurance. The science is way more than just the science by the time we're yelling at each other to trust it or not trust it.  

Sarah [00:05:58] Yeah, that's what's so hard, I think, when you say trust the science, especially around a public health episode like the pandemic. We got to break off health care. I think its own thing. I think we need a new phrase because health care is so complicated. I was even getting in my head about the vaccines, and I was thinking-- we'll talk about this. You'll hear us talk about this with Representative Underwood, that even Trump's own loyalists would not stand by him on the vaccine. And I thought, well, maybe there's just something really visceral with the injection, with the injecting something into your body that really triggers something in people. But then I thought, well, shit, Semaglutides are injections and people are lining up for that. How come that's not triggering the same sort of visceral you want me to inject something into my body that vaccines do? Cause I do think there's something there with the injection part. And that's the thing. I think you say trust the science. But people have a very emotional, unscientific reaction. And there's no way to navigate that or speak to that in a way that makes sense to people.  

Beth [00:07:11] I think a lot about the beginnings of the opioid epidemic and about the physician who wrote a letter to the editor about his observations in giving people that pain medication. And then that observation was quoted over and over and it becomes the science, even though he was not intending to conduct a mass scale peer reviewed study that's used in congressional hearings and it's used by pharmaceutical companies in their marketing. And so I just really feel for the people in this community doing this work who study something in a certain container and then it quickly takes on its own life.  

Sarah [00:08:00] Well, it's in a container and you're like it doesn't belong in that container. It was really not done well or we missed some parts. Like with the autism and the vaccine study. And you're like, but that container was bad. It was a bad container. And people just want to keep it and then they trust the science too much. You know what I mean? That's why that phrase is just so quippy and it just doesn't get to, I think, a lack of understanding around the scientific method. I think there's this really weird paradox where people want to trust the professional and they'll just say, well, the doctor said it was okay. Well, the doctor told me to. But then also, when something goes wrong or just human errors that are inherent in the institution, then all of a sudden it's like, well, I hate that institution. Health care is corrupt, but I love my doctor. I mean, it's like same thing with Congress, right? People hate Congress but love their congressmen. I don't know what that paradox of human psychology is, but I think that's at play, especially because the scientific method component of it is so hidden from people. It's not like you can name your researcher. You know what I mean? You can't name a data analysis who's going through all this and concluding and making-- that part is so hidden from people. Maybe that's where the distrust comes from.  

Beth [00:09:21] Well, and I wouldn't have the skills to make meaning of that even if we could.  

Sarah [00:09:25] Right.  

Beth [00:09:25] I'm a good researcher, but in a container. I don't have the skills to know. It might be helpful to me something that I appreciate that my doctor will do when we're talking about options is say, "Here's what we have good information about. Here's what we don't really know." Now, on balance, what's the risk that you're willing to absorb around what we don't really know. And we talk through that. And I think that's really helpful. And I hope that that's some of what you're seeing that gives you confidence through these articles where people are just being honest. Like we observe this result, but we don't know why. Or we observe this result, but we don't know over the long term what the effect of that is going to be. I think that stuff is important. And putting it in questions that a layperson can follow helps us make a better calculus. But the core of all of this that is so disorienting to accept, if you think about it too hard, is that very few things are certain always in every set of circumstances, and will continue to be certain forever.  

Sarah [00:10:32] And I think that's what people want when you say trust it.  

Beth [00:10:34] Yeah.  

Sarah [00:10:36] Trust. Well, trust means I know exactly what I'm getting and I know what I'm going to continue to get. So I don't think that works either. Doesn't work is the word for that.  

Beth [00:10:45] We definitely want advice that we can rely on. And it's hard to come by, especially around our bodies. I think the best you can do is say in most people, this is the result that we have seen over a period of years, but it could be different for you. You could be allergic to some strange ingredient in here that we don't know that about you, and we didn't know that it could happen under these circumstances. There's just so much. When I hear someone like Representative Underwood making the case, as you'll hear in a few minutes, that we need to put more funding into the National Institutes of Health, the CDC, etc., I think a better word than trust is value. Value the science. Value the scientific process. Value the mechanisms under which people try to learn from the past and prepare for the future.  

Sarah [00:11:32] Yeah. Because I think with so much of this-- listen, I just finished reading Frankenstein or The Modern Prometheus. The danger of technology. The danger of a road we start down and don't understand what it's going to mean. And I feel a lot of that modern Prometheus energy around artificial intelligence and semaglutides. They feel like massive experiments happening right in front of our eyes where everybody's like, that's weird it does that. We don't know why, huh! And I'm like, wait. Because I don't think it's a nefarious-- the distrust that bothers me is there's this undercurrent of they, this nefariousness, that I'm like, I don't feel there's a villain here. I think there are outcomes that I don't like. I think that there are mistakes being made. I think that there are people operating-- I guess there are villains in the opioid epidemic, for sure. But most part with our health care, it just gets away from people. And the problem is there's no one to go hold up because I don't believe in a conspiracy, because I don't believe in these nefarious actors. I also know that there's no one that can go, "Hold up."  

[00:12:52] There's nobody in charge that will just go, "We've gone too far modern Prometheus, pump the brakes." There is no Zeus to go, "You shouldn't have done that. Brakes are on." That's not the reality. Even with opioids to a certain extent, it's not that people didn't see it. But those people couldn't stop it. There's no one foot on the brake. And so, even when we can see things going, whoa, whoa, whoa, personally I'm not a biologist, but I don't think rising rates of colorectal cancers and medicine that slows gastric emptying, those don't sound like good combos to me. Not my area of expertise, but I just I'm like, urgh. But even if somebody who had all that expertise, what are they going to do? Like they can't just again ring a bell and make it stop. I think that's the tension we all feel. If there is a distrust, that's where it comes from. It's this sense of like, well, we can see some bad outcomes. What the hell are we going to do about it?  

Beth [00:13:53] I'm trying to decide what I think about villains. I think villains are most easily understood in retrospect, which is why it's easier to sit here today and say that there are villains in the opioid crisis. I think with all of this, there's a blend. I think the people who put a lot of money and time-- and I mean big money capital-- in pharmaceuticals, both believe that they are genuinely helping some people and that they can get rich doing it.  

Sarah [00:14:23] Yeah.  

Beth [00:14:23] And I think the same thing about artificial intelligence. I think the people who are all in on AI right now both think that it will have some good outcomes for humanity and think that they can make an awful lot of money in the process. And in retrospect, I think a lot of those folks are going to look like villains to us. I think that with semaglutides, there is unquestionably an exploitation of societal standards about how we look at work as people make a lot of money and some people are helped by them. So all those things are true at the same time. And maybe villain connotes like a pure evil, but I don't think so. I think villains’ motives are always mixed, and I think some of that is going on here. And the bigger problem with all of this is that the unknown of it, to me at least, feels farther and farther away from my ability to grasp it, to get to some kind of known about it, to integrate the lessons of the opioid epidemic because it's moving so rapidly. It feels hard to figure out where those brakes are going to come from and how the brakes could even be effective if we all decided that we wanted them and we understood how to deploy them.  

Sarah [00:15:42] I mean, just think about what we've already unpacked from what could be contained across the science. Your own personal experience with the medical industry. I mean, some people are like a novel, a whole long epic novel. Just one person's experience inside the health care industry. Any profit motive. I mean, money. So let's talk about life and death and also money.  

Beth [00:16:08] And suffering.  

Sarah [00:16:10] And suffering and pain. And our fear about not just our bodies, but the bodies of our loved ones and their health. I mean, that's why when I hear it used as like a bludgeon, they don't trust us, I just think-- and look, maybe it's because of my own history as a home birther. I did vaccine all my children. Please hear me say that. And I love a vaccine. But I did it on an alternate schedule. I definitely read Dr Sears. So maybe it's just my own experience with how easy it is to get in a space where you're doing something sort of alternative that I think-- I don't know, man, there's so much involved in that. I don't think it's as easy as, like, they hate science. I just don't think it's that simple.  

Beth [00:17:01] I don't either. I think it's all just a lot about risk calculus, which we've talked about many times. So many shows during the pandemic we talked about we're not good at risk assessment. We're not good at making decisions that involve risk. And we tell ourselves a lot of stories about our capacity for risk and about other people's motives. So I feel comfortable saying I trust the science that backs up the safety and efficacy of vaccines. I trust the science that tells me that it is an unnecessary risk to drink unpasteurized milk.  

Sarah [00:17:39] Me and Matt Walsh did not think I would come down on the same side as Matt Walsh as firmly as I did on unpasteurized milk, but here we are. That's what happened.  

Beth [00:17:47] Yeah, I think drinking raw milk involves a level of risk that I am uncomfortable with and that I find unnecessary.  

Sarah [00:17:53] It's a very easy call for me because I don't even drink milk.  

Beth [00:17:57] But maybe that little difference is that it's like I trust the science that backs up this action step or this behavior, but I accept that science has its limitations and that few things in life are absolutely certain, and that there will always be a vast unknown out there.  

Sarah [00:18:21] And I think this will help. I think the more doctors and scientists and data analysis and everybody can go, "We don't know; we're just figuring it out," that builds trust. I think for a long time we thought it was the opposite. And it's just very encouraging to me for them to say, we don't know. I want to see more conversation about the unknown risk individually. This is a hot take I have. I don't really think you can have informed consent around most medical procedures. This is a radical idea. Because how are you going to inform? You don't know. You're not living it. You don't know. You can read all manner of things on paper and go, "Yeah, sure, I can handle that." But they can't list everything on the paper and you can't really understand it just reading the paper.  

[00:19:06] That's my take on informed consent around medical procedures. And so, I don't think you can take that in and express it. So it's not even just risk, but it's consequences that are just hard to understand until you're in the midst of them. And just holding all of that around the delicacy of suffering and death and health and what it means to live a good, active life all of that, we're asking a lot of people. And that's why you have some like RFK with his stupid 'Why is there so much chronic disease' ad on Twitter that I'm still seeing that can touch something for people and really hit something and really hook them?  

Beth [00:19:50] Because why is there so much chronic disease is not a bad question.  

Sarah [00:19:53] It's not a bad question.  

Beth [00:19:55] It's a question that we all have. It is a reasonable question. And some of what RFK has done in his life to try to answer that question has been valuable. When he talks about clean drinking water and clean air, I'm with him on some of those things. Where he loses me is in writing off vaccines as a tool in trying to live a healthier life and taking the resistance to that, and then making it his whole personality that he's against, against, against everything that they tell you. I think that's the summary for me. Even when we're talking about science, there is no they. There are the scientist, and that is a vast group of people who do wildly different things. And then there are the policy people, and then there are the communicators and the service providers. It's just too much to lump it all in one thing.  

Sarah [00:20:46] Listen, it's a bummer because our brains like conspiracy theories better than they like critical thinking. It sucks. I don't love it, but it does seem to be our reality; that we are just more prone to a conspiracy theory than walking through this prevented something we never experience. We're so bad at recognizing the bad things that didn't happen, but we are so, so, so good at making up stories about the bad things that did happen.  

Beth [00:21:13] I think that part of this is because-- and I want to say the graceful side of we're so bad at it, is that often we are making these assessments about a current or past personal experience that is so difficult that we want to assign blame.  

Sarah [00:21:37] Yeah.  

Beth [00:21:38] My mother's father just passed away, and he suffered in the last days of his life. And there are a million places where the system-- even though it's not one system, but it feels like one system when you're the individual on the other side of it. Where the system let him down and let our family down. And I understand why people experience things like this. His experience was not uncommon. I understand why you experience things like this. And for one family member maybe it's I lash out at the doctor who probably doesn't like this set of circumstances either, but is the person in front of me who represents all the systems that work here.  

Sarah [00:22:31] Or who might have legitimately screwed up.  

Beth [00:22:36] Right, or even might have. And another family member is angry about insurance and another... You know what I mean? We all process the grief and the disbelief and the outrage of that and let all of it coalesce around something. And whether that is rational or complete doesn't matter because our capacity is exhausted by all of the other pressures. And that's what I see going on here. It is not just that we struggle with critical thinking or the scientific method or even blame, it's just that our resources are depleted in the very instances that form our views about these things.  

Sarah [00:23:20] Well, I totally agree. We're sitting around the table last night and I said, "You know what, Felix? You are a gift to this family because you understand something that some people fight their whole life, which is bad shit just happens. It doesn't have anything to do with what you deserve or that somebody screwed up or that there's this big evil system trying to get you. Bad shit just happens to our bodies. We don't deserve anything. We are not owed a single day or a single pain free breath. We're just not. And I think the people who rage against that reality are the people who lash out in those ways, and who want to blame and want to make a story because they just believed or were told or were convinced that this is what you deserve. If you do this, if you are xyz person, then you deserve this type of life. And I have a real problem with the word deserve. I think we should probably strip it from the human language, particularly when it's surrounding our health and life and death and tragedy or chronic illness or chronic pain or whatever. Because that to me is where you get that fight, that conflict, that push, that blame, the conspiracy theories, is I deserve this. The most valuable thing my husband ever said to me is, "This is not happening to you. It's just happening." And I think that that's where a lot of this distrust of science and blame and anger and conspiracy theories is like, no, no, I didn't deserve this. I didn't deserve this, and it's your fault.  

Beth [00:25:08] What I think I know, as we turn to the policy of all of this, is that those issues don't get better by starving out the systems responsible for them. I don't think many things improve by saying keep doing what you're doing, but do it with way less than you say you need to do it. And so I really value the experience that Representative Underwood brings professionally to Congress to inform her appropriations work around health policy in our country.  

Sarah [00:25:48] Yeah, that's why a nurse who sat in a room and felt that situation, the reality of it happened and you didn't deserve it, that's why we need those kinds of perspectives in policymaking. Not just around health care or child care, but pandemic planning. So we can't wait for you to listen to Representative Underwood up next.  

[00:26:07] Music Interlude.  

[00:26:18] Representative Underwood, welcome to Pantsuit Politics.  

Rep. Laureen Underwood [00:26:20] Thank you for having me. I'm so delighted to be here.  

Sarah [00:26:23] We ran into you in Chicago at an Emerge event. We all had a great time at the DNC. How do you feel like your town performed? I mean, I have a take, but I want to hear yours.  

Rep. Laureen Underwood [00:26:34] Chicago was showing off just for you. Yeah, it was a special time.  

Sarah [00:26:40] It was beautiful. I already like Chicago, but I really felt like the red carpet was rolled out for us.  

Rep. Laureen Underwood [00:26:47] You need to come on back. We'd love to have you.  

Sarah [00:26:50] We will. Especially in August, where else are you going to go that's halfway pleasant except for the great city of Chicago?  

Rep. Laureen Underwood [00:26:57] You can eat. You can shop. It's beautiful people. We share values. You're paid a living wage. You have reproductive freedom here in our city.  

Sarah [00:27:07] See, you don't even have to visit. You can move.  

Rep. Laureen Underwood [00:27:09] Win, win, win.  

Sarah [00:27:11] That's right.  

Beth [00:27:13] Well, we have been so excited to talk with you. Really since you introduced the Momnibus, we've wanted to have you here. So will you tell us a little bit about your background? I know you're a registered nurse and you have really prioritized health issues. I saw you tweeting today about clean drinking water from replacing lead pipes. So tell us about your journey to Congress and your focus on health care.  

Rep. Laureen Underwood [00:27:34] Well, as you mentioned, I'm a registered nurse. I spent my career working to expand health care coverage in communities across our country. I work to implement the Affordable Care Act at the federal level, worked on private insurance reform, health care quality and Medicare and preventive services, those free screenings and vaccines and contraceptive coverage. Basically, anything the Obama administration was getting sued on related to the ACA was in my portfolio, and I loved it. I had such a good time working on those health care issues. And then I joined the Obama administration and worked on public health emergencies and disasters. We did Ebola, the Flint water crisis, and I stayed until the very last day of his administration. Because I had begun my career working as like a regular federal worker, I had the opportunity to convert back. But I didn't want to help the Trump team take away health care coverage from people. So I decided to leave federal service. I returned home to Illinois. I was working for a Medicaid managed care plan in Chicago and happened to go to a town hall meeting. And so this was like the first couple months of the Trump administration. They were talking about repealing the ACA. You might remember that time,  

Sarah [00:28:46] John McCain and the vote.  

Rep. Laureen Underwood [00:28:47] Exactly. The big vote from John McCain. But before that, it was being considered in the House. And so, our congressman had a town hall meeting and he stood in front of our community and said he was only going to support a version of repeal that let people with preexisting conditions keep their health care coverage. So here I am, this nurse who had worked on the ACA. I have preexisting conditions myself. I have a heart condition. I have a rapid heart rate. And so when he made that promise, I believed him because it was personal to me. And then literally two weeks later, he broke his word and he voted for the American Health Care Act, which was the version of repeal that did the opposite. It made it cost prohibitive for people like me to get health care coverage. I got really upset. I felt betrayed, and I said, you know what? It's on. I'm running. Now, having that kind of conviction and actually launching a campaign on different things, but I couldn't let it go. And so I decided to run for Congress.  

Sarah [00:29:42] Well, and that passion for health care is still present in so much of what you do. I saw that you recently filed a new bill on maternal health, which is something people are paying more and more attention to. And what policies are you feeling like really address this problem that's been in existence for a long time, but is not getting the attention it deserves?  

Rep. Laureen Underwood [00:30:01] So let's just spend a second on the problem. It's been around for decades, right? Where the United States has led the industrialized world, and preventable maternal deaths are very high. Death rates are driven by disparities seen between black moms and Native American moms who are between two and four times more likely to die of pregnancy related complications than their white counterparts. Eighty percent of the deaths that we see are preventable in this country- 80%. And so while this has been a long standing disparity certainly my entire lifetime-- I'm 37 years old. Since the pandemic, it's gotten worse. Maternal deaths have increased 89% since Covid. So we have this phenomenon that is touching every mom in this country where we're seeing every zip code-- and when I say every mom, people are getting substandard care. That's what I'm saying. And folks know it. There's sort of a heaviness when they find out sometimes that they're expecting during what should be a time of joy, so many people feel anxiety or dread or just latent concern that is not really feeling like they are empowered to have choices that allow them to have an optimal, healthy pregnancy and birth experience.  

Sarah [00:31:11] You feel like you're suited for battle. That's how you feel when you get pregnant thinking about, like, what you want to do. You're like, it's all on me to get the experience I want and I have to battle for. I have to fight for it.  

Rep. Laureen Underwood [00:31:21] Exactly. And then in this country, for every death, we have 77 zero near misses. So it's a dual crisis of maternal death and severe complications. And the way that our health care system has approached this is saying to a family you did something wrong. It's an individualized thing versus saying there's something deeply wrong with our healthcare system, and therefore we need to have a system intervention, a system wide solution. And so what I did when I got to Congress, was working with Congresswoman Alma Adams. We co-founded the Black Maternal Health Caucus to put a bright spotlight on this problem, to talk about ending preventable maternal death in this country, ending the disparities that we see, and lifting up the experiences of those most harmed, which are black women, but also really embracing solutions that improve the quality of care for all moms in America. And in March of 2020, we introduced a bill called The Momnibus. It combines a legislative word, omnibus, which means big bill, for moms. Okay, so we call it The Momnibus. And we introduced it at the time with then Senator Kamala Harris. And it's 13 evidence- based bills to address every clinical and non-clinical factor contributing to our nation's maternal health crisis. And we've been working so hard to get the full package signed into law.  

Beth [00:32:54] And how is that going? What are the obstacles? Have you found any surprising pockets of support for this effort?  

Rep. Laureen Underwood [00:33:01] The bill has a lot of bipartisan support. So 13 bills and one. So we have about four or five bills within the omnibus that are bipartisan. We've had one signed into law already. It's the protecting moms who served a bill to help our veteran moms who see the same type of disparities in maternal death, even within a single payer VA health care system. And so, we were so proud to travel to the white House in November of '21 to see President Biden sign that legislation, to help these heroes get the health care that they earned and deserved. We are now working to advance the other bills in the omnibus. We've had a lot of progress this year. The House Veterans Affairs Committee had a hearing that I spoke at in support of the Maternal Health for Veterans Act, which is the follow up bill to the one that we had signed into law to re-authorize this effective program. The Senate Health Committee under Chairman Bernie Sanders had their first ever maternal health hearing, where he called for the Congress to pass the Momnibus, which represents tremendous progress. And we're working hard to get Republicans on the bill, particularly in the Senate.  

[00:34:17] In the last Congress, in the 117th Congress-- so from '21 to '22-- we made a lot of progress. We got 80% of the Momnibus passed out the House, and it was getting attached to must pass bills. But at the end of the day, we ran into some barriers with Republican senators who have been kind of in a neutral posture. And we learned that neutrality is not necessarily enough to get that bill across the finish line and signed into law. We need a Republican champion. Now, post Dobbs, everything has changed. This landscape has changed. So two years post Dobbs, now one in three American women is living in a state with a partial or total abortion ban. In fact, for black women, we're talking about over half of black women are living in these states. And so in these states, early data has shown us from places like Texas, the maternal mortality rate has increased as a result of these abortion bans. And so, within the what they call pro-life community, there is what I would call a significant range of opinion. And there's a lot of people who are uncomfortable with the idea of moms bleeding out, hemorrhaging while miscarrying and dying.  

Sarah [00:35:36] I should hope so.  

Beth [00:35:36] Yeah, I'm glad to hear that.  

Rep. Laureen Underwood [00:35:38] They're very, very uncomfortable, and so they're looking for a solution. And so what we have done is we have approached colleagues to offer the Momnibus as the solution. Do I believe in reproductive freedom? Absolutely. Do I believe in safe legal abortion care? Absolutely. But is that in the Momnibus? No. The Momnibus is talking about ending preventable maternal death. The Momnibus is written so that we can have more doulas and more midwives. It's written to address the leading cause of maternal death in this country, which is suicide and overdose. When you combine those mental health and behavioral health challenges, those are killing more moms than anything else. The Momnibus is designed to address things like housing and nutrition and transportation and environmental conditions that are contributing to maternal death.  

[00:36:27] We're not fighting some other necessary battles within the Momnibus. It's very laser focused on this problem. And so the area of opportunity is in talking with our Republican Senate colleagues to explain the work that we're doing, the flexibilities within the Momnibus and how that helps those states. So let's just look at the map in our minds. And if you look across the American South, those are often the states that have advanced a partial total abortion ban. Those are often the states that have not expanded Medicaid postpartum to the full year postpartum. And those are also the states with the highest maternal mortality rates. That Venn diagram is just overlapping big time.  

Sarah [00:37:09] It's a circle.  

Rep. Laureen Underwood [00:37:10] Yes. And it is not exclusively those places, but in those places they often are more likely to have Republican senators who are hearing from their constituents, who are saying we can't go on in this way. Moms cannot continue to die. And so we're extending that offer in partnership for them to work with us and to support the Momnibus. And so our advocacy has switched up. We have some great faith-based partners, the Mormon Church, the Catholic bishops, the United Methodist Church-- which is not the black A.M.E. church, it's the United Methodist Church. The white Methodist are supporting the Momnibus We've been in Bible studies, for example, and Mother's Day sermons. We are really trying to engage with CEOs, for example, to encourage those industry leaders who often have an audience with a senator to embrace the solution and talk about the business case for keeping employees alive during and after pregnancy, things like that. And so I think we've been making good progress. We're looking for the first legislative opportunity to get this bill signed, and hopefully we can get it done this year.  

Beth [00:38:23] It's got to be so frustrating to have to explain that maternal health is an everybody issue. It's the Momnibus for all of us. Everybody needs women to survive their reproductive years. It touches every aspect of the economy. And I can imagine that in those discussions you're just like, see how obvious this is going? This is really important for everybody.  

Rep. Laureen Underwood [00:38:47] Well, what's been interesting is that so many people see the title of our caucus, Black Maternal Health Caucus, or see the title of the bill, Black Maternal Health Management Act, and they think that it's just for black people. And so they think it's not for them. And then when we start having the conversation, they understand the rural health component. They understand how we have these deserts. Like in my congressional district, my district is suburban and rural, okay? A suburban county doesn't have a hospital. And when you don't have a hospital, you don't have providers and specialists in many cases that can offer this lifesaving care. And it gets really personal very quickly when people pause to have the conversation. I also just think we have to just say it, it is not our responsibility to keep ourselves alive during childbirth and that postpartum period. This shifting of responsibility to that mom and to that family, I believe, is unfair.  

Sarah [00:39:53] But it's also pretty unique in the world. It's not a lot of places where like, have a baby. Good luck to you. Hope it turns out well. That's just the thing we do here. That's weird.  

Rep. Laureen Underwood [00:40:04] I do think we can continue to use our voices collectively to not just talk about the problem, but also the solution. So I am happy to explain the crisis, to explain what I mean when we say we have a crisis in our country, it touches every zip code. I'm happy to do that work, but I do think we can't leave out the discussion of the solution. This is not a cancer moonshot where we are searching for a cure, where we are counting on our scientists to innovate and discover that lifesaving cure. We know how to solve this problem. What we are lacking are elected leaders who are willing to step up and say we are no longer going to find it acceptable for moms to die of preventable deaths, and therefore we will take action in the way that the science tells us works to save their lives. That's where we are. And so I do think that there's space for moms and families as advocates to lift up that solution. Now, I'm not going to put the responsibility there. It's a responsibility of leaders to lead, to tackle big issues and to solve hard problems. But I do think-- and I'm trying to make sure that people understand that their voices are needed-- if we're going to get this solution across the finish line, if we're going to get the Momnibus signed into law, we're going to all have to reach out and demand, really, that our elected officials support these policies.  

Sarah [00:41:41] Well, this seems like an important point to say to our audience, many, many, many of whom live in red states to call up their senators and please ask them to support the Momnibus in the Senate. Seems like a good moment to just ask everybody to do that.  

Rep. Laureen Underwood [00:41:53] To co-sponsor.  

Sarah [00:41:54] Co-Sponsor. Yes, co-sponsor. I think during my time on Capitol Hill, the advocacy and the passion from the lived experience was something to behold. But I think it's also so fascinating to watch people come to Congress and learn from their constituents and their fellow Congress people about experiences they didn't understand and policy issues that were outside of their lived experience. And I'm wondering, you clearly have this passion for health care, but is there another area you got to Congress and thought, oh my gosh, I didn't understand this until I got here. I didn't understand this problem. I didn't understand that there was a solution available to us. Have you had that experience in your time in Congress?  

Rep. Laureen Underwood [00:42:35] I've had it over and over again. I represent about 75 towns and cities here in northern Illinois, and every community has a water issue. Every single one. And it's not always the same. Folks, water sources are drying up by the end of this decade, so we're looking for new water sources. Illinois has the most lead pipes of any state in the country. We got to replace those lead pipes. We have aging infrastructure and small communities that are looking for economic opportunities and so they need to extend, let's say, a water main from the downtown, the teeny tiny downtown, to the highway. So they can get-- guess what-- a truck stop and make some money in their town through tax revenue. We have places that need new water towers or new water treatment plants, but everybody has a water issue. But when you talk about small rural communities, they don't have a tax base to replace their water infrastructure. If even large, vibrant cities can't afford a 100% loan to replace their water source. And so, this idea of water insecurity, water affordability and just basic water infrastructure is something that I never knew that I would be spending so much time on as an elected official.  

Sarah [00:44:01] Wow. Yeah, that makes so much sense. We read a great book about water and they just talked about you just turn on the tap. If that's your only experience and interaction with the water system, is you turn on the tap and the water comes out, you don't realize how much is going on behind the scenes. That was one of my favorite parts when I was the city commissioner, was Joint Sewer Board. Boy, were there things I did not understand.  

Rep. Laureen Underwood [00:44:25] Oh, yeah.  

Sarah [00:44:25] Rain water. I could talk about rainwater more than I thought you could talk about rainwater, but yeah, it's huge. I love that. I think that that's not surprising, but delightful.  

Rep. Laureen Underwood [00:44:36] And then that's before we get to the great Lakes and something called invasive species. Have you heard of these things called Asian carp?  

Sarah [00:44:43] Yeah. We have those in Paducah and the Kentucky. We also have Asian carp. We have a famous chef who started serving them in one of our restaurants. She was like, well, she calls them Kentucky carp. People eat them right up. How about that?  

Rep. Laureen Underwood [00:44:56] Is it good?  

Sarah [00:44:57] Yeah, it actually is really good. And we have a processor who takes the Asian carp that's invaded our lake and ships it back to Asia as a product because it's very popular inside their food system. I mean, wild. They're scary though if they get in your boat. They're crazy. They're huge.  

Rep. Laureen Underwood [00:45:14] Listen, we do not want them in our Great Lakes. And my district is the Bay area, and so we have hundreds of millions of dollars invested in preventing these little guys from getting into Lake Michigan. And so, just all kind of water challenges.  

Beth [00:45:33] I want to stick with this kind of public health theme, because in your convention speech you talked about the Trump response to Covid.  

Rep. Laureen Underwood [00:45:38] Yes.  

Beth [00:45:39] And you are professionally positioned to have a lot of thoughts about what we should have done through. We read and really enjoyed Lessons From the Covid War, the after action report that a group of experts assembled. I wonder for you, what are the congressional lessons from the Covid war? What should we have taken from this? What should Congress be doing to think about the next public health crisis?  

Rep. Laureen Underwood [00:46:04] Well, unfortunately, we are seeing-- and my vantage point is serving on the Appropriations Committee, which is the committee that funds all federal agencies every year. It's must pass bills in order to keep our federal government functioning. And what I've seen, since the pandemic is an unwillingness to have a conversation about just vaccines. You see the word vaccine, people shut down completely. That's tough.  

Sarah [00:46:30] It's showing up in our vaccination rates, for sure.  

Rep. Laureen Underwood [00:46:34] Yes, it is. We're seeing at the congressional level this attack on science and on truth and on facts that has unfortunately characterized so much of MAGA extremist ideology. It's inserting itself not just in governing, but in literally our effort to fund federal programs. And so, unfortunately, the legacy of the pandemic is that we are now decades behind in having legislators, in my opinion, who are prepared to fund essential programs to keep Americans healthy and safe. No one's talking about infringing on anything, but I think we should all be able to agree that we need a fully funded centers for Disease Control and Prevention. We need to have an agency at the federal level that's doing public health surveillance and response. We need to be able to identify emerging infectious diseases and resource those experts to keep us safe and healthy. And unfortunately, it has been politicized such that that bill cannot come to the floor of the House of Representatives for a vote. And it hasn't been able to since the Republicans had been in charge of the House of Representatives as Congress. And so that used to be an area where we could all agree.  

Beth [00:47:58] If I'm hearing you correctly, it's not about the money either. Like, the reason that it's being held up is not about the money.  

Rep. Laureen Underwood [00:48:05] Well, I mean, it's about the money in the sense that there's a basic amount of money that needs to be allocated in order to do this essential work. And so you have extremists that want to get that down to zero. They want to fire the director. They literally offer amendment saying let's pay the director $1. They are just firing that person. It sounds so petty, but that is why you see these fights in the news about government shutdowns. That is why we have Americans that are dying of preventable causes because of this deeply rooted dysfunction. And folks who think that they singularly know best and they want to make decisions and control. This is about control. We have MAGA extremists who want to control every aspect of our lives, every aspect of our society. And it manifests through the fight for reproductive freedom, but also manifests through the fights to fund these critical public health agencies.  

Sarah [00:49:08] Well, and it's deep-seated. Donald Trump couldn't even argue with them. He got vaccinated. That vaccine program is a success of his administration. He could brag about if he wanted to, if he found any traction with that group. But, man, even him pushing them on vaccines got him nowhere until he stopped talking about it. He's even scared of their extreme positions on vaccine. They've even backed him off of it.  

Rep. Laureen Underwood [00:49:30] I don't have anything nice to say, so I'm just not going to say it other than to say we have a choice in this election. And it's extremely important for those who believe in facts and truth and science, those who believe that we can trust the experts to do their jobs and do their jobs well, make sure that we go vote on or before November 5th and vote for Democrats.  

[00:49:56] Music Interlude.  

Sarah [00:50:06] On Pantsuit Politics we always do a little Outside of Politics. This is only adjacent.  

Rep. Laureen Underwood [00:50:11] Great.  

Sarah [00:50:11] We are sorority sisters and we hear that you have a famous sorority sister yourself. That was one of my favorite parts of the sorority [Inaudible]. You're going to be able to talk to them. It's over. So tell us what your show already means to you and tell us about your famous sister.  

Rep. Laureen Underwood [00:50:34] Okay. I'm a member of Alpha Kappa Alpha Sorority Incorporated, founded in 1908 on the campus of Howard University. It's the first Black Greek-letter sorority in the United States. So really rich, incredible history. And Vice President Kamala Harris is my sorority sister. And there are eight of us in the Congress.  

Sarah [00:50:57] Do you have a group text? You a group text [crosstalk].  

Rep. Laureen Underwood [00:51:00] We have a very robust group text. 

Sarah [00:51:04] I bet it is. I'm jealous.  

Rep. Laureen Underwood [00:51:05] And it's just a really special moment. Our sorority says part of our motto is that we're supreme and service to all mankind. And so to now have our vice president in office leading us so capably forward, expressing our shared values and commitment is something that I am enormously proud of. And I think that the membership is certainly very animated around what it means to vote, what it means to show up and to galvanize our communities to make sure that when we have this choice in an election season like this, that we are not missing the opportunity to make our voices heard.  

Sarah [00:51:52] I love that. And just even as a sorority member, I feel that much less as a member of the sorority. You know what I mean? I just think that's so beautiful. And I know we're all going to fight hard and we're going to vote and we're going to knock on doors. And also, I did panic book and Airbnb when I saw that tweet about all the AKAs have already booked all the hotels for inauguration. I was like, oh my God. Literally ran [inaudible]. They're probably all booked. I better go right now. And I did. I panic booked.  

Rep. Laureen Underwood [00:52:19] I don't know if it was all us, because I've been hearing from a lot of ladies across the country who are very upset thinking that we had some more time. All I'll say is January 2025 is about to be very special. And I hope that we all do our work over these next 60 odd days to make sure that we can share this special moment with our daughters and our nieces and our sisters and our besties and our coworkers.  

Sarah [00:52:52] And our group chat.  

Rep. Laureen Underwood [00:52:53] And our group chats and all the special friends in our lives because this is, I think, a moment for all of us.  

Beth [00:53:05] I love every story about how Kamala Harris called me or sent me a note. It sounds like a sorority woman to me. All of the ways in which she has come in at important and pivotal moments and celebratory moments and moments of grief in people's lives. And the more those stories are told, the more I feel like I think I recognize something in this person that I really value in other people, and it has to be so special to share that specific connection with her.  

Rep. Laureen Underwood [00:53:36] Well, I look forward to the American people getting to know the Kamala Harris that I've come to know. A woman who is smart and kind and funny and warm and who cares deeply about the lives of her fellow Americans. Deeply. And there is a really urgent effort to turn her into a caricature, to cast her as untrustworthy and unserious. And I think that she has done a tremendous job in a very short number of weeks to introduce herself as a dynamic leader, proud American, an extraordinarily capable person to lead us forward in an important time. But I want people to also get to know her as I have.  

Sarah [00:54:27] And a hell of a cook! That's what I'm picking up on. That's what I'm picking up. You know a lot of selfish people who love cooking that much?  

Rep. Laureen Underwood [00:54:33] No.  

Sarah [00:54:34] I don't. You know what I mean? I don't cook because it's too much work for other people. But she clearly loves it. I love that. I could watch that turkey video a million times. That's how many times I could watch it. Never cooking a turkey. I never plan on cooking a turkey and I still watch it on repeat.  

Rep. Laureen Underwood [00:54:49] That's so funny.  

Beth [00:54:51] Well, Representative Underwood, you've given us lots of good calls to action. We're getting excited for January to share with our people. We are voting up and down the ballot with health care in mind. We are asking our senators, especially in red states, to co-sponsor the Momnibus. Anything else that you need from our audience today?  

Rep. Laureen Underwood [00:55:10] I think that that's a good list.  

Sarah [00:55:12] It's a good start.  

Rep. Laureen Underwood [00:55:13] We have power and our votes and our voices are so powerful in this moment. So this is what I want to tell you. When this happens, sometimes things get weird. They get a little weird when we start winning. So let's not be distracted because our freedom, our victory, all those things are within reach. We have the power to chart our destiny. I believe this to be true, especially in this moment. And so, push through the weirdness, the noise, the distractions. People who try to criticize and cause us to doubt, push through. We have some work to do, and we can win if we work together and stay disciplined.  

Sarah [00:56:04] Someone told me when we fight, we win. I don't remember when I first heard it, but I heard it quite a bit.  

Rep. Laureen Underwood [00:56:09] And you know what? It's thunderous. And she's right when she said that.  

Sarah [00:56:16] That's right.  

Beth [00:56:17] That clear priority, clarity of purpose, I really admire right now in her leadership and in yours. Thank you so much for spending time with us today.  

Rep. Laureen Underwood [00:56:26] Thanks for having me. Take good care, everybody.  

[00:56:28] Music Interlude.  

Sarah [00:56:31] Thank you so much to all of you for joining us, and of course to Representative Underwood. We will be back in your ears next Wednesday. Remember, Wednesday, after the presidential debate. And until then, keep it nuanced y'all.  

[00:56:56] Music Interlude.  

Sarah: Pantsuit Politics is produced by Studio D Podcast Production.  

Beth: Alise Napp is our Managing Director. Maggie Penton is our Director of Community Engagement.   Sarah: Xander Singh is the composer of our theme music with inspiration from original work by Dante Lima.  

Beth: Our show is listener-supported. Special thanks to our executive producers.   Executive Producers: Martha Bronitsky. Ali Edwards. Janice Elliott. Sarah Greenup. Julie Haller. Tiffany Hasler. Emily Holladay. Katie Johnson. Emily Helen Olson. Barry Kaufman. Katherine Vollmer. Laurie LaDow. Lily McClure. Linda Daniel. The Pentons. Tracey Puthoff. Sarah Ralph. Jeremy Sequoia. Katie Stigers. Karin True. Onica Ulveling. Nick and Alysa Villeli. Amy Whited. Lee Chaix McDonough. Morgan McHugh. Jen Ross. Sabrina Drago. Becca Dorval. Christina Quartararo. Shannon Frawley. Jessica Whitehead. Samantha Chalmers. Crystal Kemp. Megan Hart. The Lebo Family. The Adair Family. Genny Francis. Leighanna Pillgram-Larsen. The Munene Family. Ashley Rene. Michelle Palacios. 

Sarah: Jeff Davis. Melinda Johnston. Michelle Wood. Nichole Berklas. Paula Bremer and Tim Miller. 

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