Madame Speaker, Make a Difference for Women on HIV

Scott Swenson

When it comes to PEPFAR, is Speaker Nancy Pelosi better for women and girls, or is President Bush's Global AIDS Coordinator, Dr. Mark Dybul? The Democratic Majority seems to be ignoring the pleas of public health experts.

This presidential primary season is serving as a national teach-in on race and gender issues as America confronts, once again, its history of struggling with the notion that all of us are created equal. The hope of many progressives is that by electing more women and people of color to higher offices, our government will better reflect the sensibilities of the diverse nation we are.

So it is disappointing when a staff member of Speaker Nancy Pelosi, discussing the President's Emergency Plan for AIDS Relief (PEPFAR), compares the bill now before Congress to the recently passed economic stimulus package. PEPFAR has the potential to save millions of lives, the economic stimulus package is intended for American consumers to go buy new gadgets. Public health experts and economists have their doubts about both efforts, due to politics as usual.

The comparison intended by the Pelosi staffer is that PEPFAR, like the stimulus package, will be marked-up, compromised, voted on and passed before any real debate occurs. According to sexual and reproductive health advocates who heard the comment, the comparison indicated that while their concerns about the bill had been noted, nothing would change.

Assuming the staff member reflects the Speaker's views on PEPFAR, it appears she is more interested in passing a bill quickly than making sure PEPFAR achieves its goals. Recent action in the House Foreign Affairs Committee, which compromised vital aspects of the bill before mark-up, is more evidence of the Speaker's plan to rush PEPFAR. This is particularly upsetting given changes to early drafts of PEPFAR that have been compromised by the Democrats, jeopardizing the lives of millions of women and girls.

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Compare the attitude of the Speaker's office to that of Ambassador Mark Dybul, M.D., U.S. Global AIDS Coordinator, as expressed in a letter to the International Planned Parenthood Federation in 2006. The letter clarified PEPFAR's complex ideological restrictions (three years after it first passed):

President Bush has stated that the conditions of the Mexico City Policy "shall not apply to foreign assistance furnished pursuant to [PEPFAR]." Accordingly, all U.S. Government funding solely for HIV/AIDS activities is exempt from the Mexico City Policy.

But the new Democratic Majority's compromise plan, implemented by the staff of the House Foreign Affairs Committee, applies the Mexico City Policy, also known as the Global Gag Rule, to PEPFAR. PEPFAR has nothing to do with abortion, which is what the Global Gag Rule deals with. Democrats did not remove onerous ideological restrictions, they added another one, and on abstinence-only shifted one set of confusing rules to another, just to placate social conservatives.

Amb. Dybul's 2006 letter continues,

… there are numerous reasons why the linkages between voluntary family-planning and HIV prevention and care are important, particularly as we reach out to women who are vulnerable and can face tremendous stigma and barriers in accessing care. Programs supported by the U.S. Government to prevent mother-to-child transmission include linkages with voluntary family planning to ensure quality care, with goals that include prevention of unintended pregnancy among HIV-positive women, in keeping with the World Health Organization guidelines. Evidence also shows that, particularly in high-HIV prevalence settings, voluntary family planning and antenatal care clinics can be important venues for reaching women with HIV prevention, treatment, counseling and testing, and other interventions or referrals. We have made our staff aware that voluntary family-planning clinics and programs are an important HIV/AIDS care delivery point, and play a key role in reducing morbidity and mortality from HIV/AIDS.

But the Democratic Majority's plan, being marked up in the Senate next week and scheduled for a House vote soon, missed the opportunity to apply World Health Organization guidelines with respect to women and girls. Their plan to pass the bill quickly, just like the economic stimulus package, ignored the advice of the Institute of Medicine, Government Accounting Office and Center for Public Integrity that suggested PEPFAR should be streamlined, its ideological restrictions removed, to help more people.

Letters now in circulation from researchers, sexual and reproductive health advocates, public health experts and people who have been on the ground working to implement PEPFAR with its existing ideological restrictions, urge Congress to take a different path. From one letter,

… 75 percent of persons living with HIV still lack access to anti-retroviral therapies (ARVs) needed to ensure they can live long and productive lives. However, there are also seven new infections for every person accessing treatment. Today, we have the benefit of five years of lessons learned and of a strong and growing body of evidence that underscores an immutable fact: We cannot end the global AIDS epidemic without concurrent and dramatically increased support for robust, evidence-based prevention strategies. To achieve our goals, the US must put evidence ahead of ideology in its effort to reauthorize PEPFAR, ensuring the maximum benefit from the resources invested.

Political expediency — avoiding a fight with a dwindling minority of social conservatives — seems more important to Democrats than making sure PEPFAR works. Political expediency seems more important than efficiently distributing the generous $50 billion to NGO's working in Africa, with less bureaucracy so they can focus on their life-saving work.

From another letter signed by experts and advocates urging the Democratic Majority to change course,

… mis-characterizations and untruths were used to remove from the draft, language supporting expanded access to contraceptives for HIV positive women receiving prevention of maternal-to-child transmission (PMTCT) services. We are simply mystified at the failure to support the World Health Organization’s (WHO) standards for these programs. WHO recommends that family planning services be provided to women in PMTCT services should they choose to prevent another pregnancy. Sound health practice appears to have fallen prey to those program implementers who simply do not believe in contraception – putting their own wishes above the health and well being of those they are charged with serving.

The 2003 legislation created barriers to sound health programming and HIV prevention work with sex workers. These men and women are often disenfranchised and without social and health support systems – and US law has put additional barriers in place, rather than paving the way for undertaking more health care interventions with them. Because this community is deeply affected by HIV/AIDS, now is the time to remove these barriers and promote best practices in working with these communities

To President Bush's credit, PEPFAR has helped prevent mother-to-child transmission in Africa in more than three million cases. PEPFAR provided counseling and testing to more than nine million people, 69 percent of whom were women. Sixty percent of the people getting treatment for AIDS from PEPFAR are women. But the reality is that this year, 2.5 million more men, women and children will become infected with HIV. Some of those women and girls will be infected by husbands who have visited sex workers. Sex workers forced into this work because of poverty, many trying to support children of their own. Sex workers made more vulnerable by President Bush's requirement effectively restricting public health outreach to them. The Democratic Majority is now complicit in this failure of leadership, by compromising the Global Gag Rule and the Anti-Prostitution Pledge, thus making this program more complex.

We cannot hope to catch up to, let alone get ahead of, infection rates, if we continue to compromise sound public health strategies for the sake of political expedience. Do people supporting the compromised bill really think we'll have a different conversation five years from now without more courageous leadership?

Senator Barbara Boxer (D-CA) has a chance to help improve the bill, as do other concerned Representatives and Senators. But it appears they will have to do it over the objection of Speaker Pelosi. The question is, will they, or will Congress once again prove how tone deaf it can be to voters demanding more accountability, more solutions, more reality and less ideology.

If ever there was a moment for women and men to demonstrate leadership in Congress and stand up for women and girls in Africa, this is that moment.

If ever there was a moment to ignore the far-right ideologues and make a principled stand for sound public health strategies, literally the difference between life and death for many women and girls, this is that moment.

If ever there was a moment to prove that electing and elevating more women and people of color really can change our politics, and not just on the surface, this, Madame Speaker, is that moment.

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Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.

News Politics

Democrats in Utah, Colorado Make History as First Openly Transgender Women to Win Congressional Primaries

Ally Boguhn

Though Misty Snow's win may be historic for LGBTQ equality, she has previously noted that it was not the reason she is running for office."I'm not running because I'm transgender. I just happen to be transgender," the Utah candidate said.

Voters in Utah and Colorado made history Tuesday after nominating Democrats Misty Snow and Misty Plowright to run for Congress in their respective states—making them the first openly transgender women to win a major party’s congressional primary nomination.

Misty Snow, according to the bio listed on her campaign’s website, is a 30-year-old grocery store cashier from Salt Lake County, Utah, “concerned by the degree of income inequality in this country: particularly how it disproportionately impacts women, people of color, and the LGBT community.” Among the many issues prioritized on her website are paid maternity leave, a $15 minimum wage, and anti-choice regulations that “restrict a woman’s right to having a safe and legal abortion as well as any attempts to undermine a woman’s access to important health services.”

Though her win may be historic for LGBTQ equality, she has previously noted that it was not the reason she is running for office. “I’m not running because I’m transgender. I just happen to be transgender,” she told the Salt Lake Tribune in May. In later statement to the publication, however, Snow acknowledged that “a lot of people have told me whether I win or lose, I’m already making a difference just by running.”

Snow ran opposite Democrat Jonathan Swinton in Utah, having filed to run for office just before the March 17 deadline. Snow decided to run after Swinton, who was running for the Democratic ticket unopposed, penned an op-ed in September arguing that Planned Parenthood should be investigated—though the government should not be shut down over it. After reading the op-ed and thinking it over for several months, Snow told the Tribune she began to think the people of Colorado deserved a more liberal option and thought, “Why not me?”

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Snow’s win means she will move on to run against incumbent conservative Sen. Mike Lee. As previously reported by Rewire, Lee is stringently anti-abortion and has consistently pushed measures “attempting to limit access to or outright ban abortion.”

Misty Plowright, who is running to represent Colorado’s 5th congressional district, describes herself as an “Army veteran, a self-educated woman, a member of the LGBTQ+ community, and a passionate social democrat,” according to her campaign’s website. An IT worker from Colorado Springs, Plowright billed herself as the “anti-politician” during an interview with the Colorado Springs Gazette, and is running on a platform that includes campaign finance reform and defending voting rights.

Plowright will now challenge incumbent Rep. Doug Lamborn (R) for his seat in the House.

Plowright congratulated Snow in her win in a Wednesday post to her campaign’s Facebook page. “Congratulations from ‪#‎TeamMisty‬ to another progressive candidate in Utah, Misty K Snow,” wrote Plowright’s campaign. “Both women made history last night by winning their Democratic Primary.”

As Slate reported, though the candidates may have both won their primary races, “Snow and Plowright face uphill battles in the coming months”:

Despite a Gallup survey from March 2015 that calculated Salt Lake City’s LGBTQ population as the seventh-highest in the nation, Lee leads Snow 51 percent to 37 percent among likely general election voters according to a poll commissioned by the Salt Lake Tribune and the Hinckley Institute of Politics in early June. And Lamborn, who has represented Colorado’s heavily conservative fifth district since 2007, took nearly 60 percent of the vote in his most recent reelection fight.