Tapped: The Prospect Group Blog

Report: Judicial Elections Fuel Anti-LGBT Bias

The chief justice of Alabama’s highest court, who once called lesbian parents “immoral,” “detestable,” and “inherently evil,” has been suspended without pay following his February directive to the state’s probate judges to stop issuing marriage licenses to same-sex couples.

State Supreme Court Chief Justice Roy Moore’s removal from the bench last month came within a day of the release of a report by nonprofit LGBT rights group Lambda Legal that pointed to broad ideological biases by state Supreme Court judges. The report specifically singled out Moore, who had run for his seat on an anti-marriage equality platform, and whose marriage license directive violated a federal court order. Moore was suspended from the bench for the remainder of his term by a unanimous vote of the state’s nine-member judiciary court.

“When it comes to courts, win or lose, LGBT people need to know that there isn’t a thumb on the scales and that we haven’t been shut out of the process,” stated the report, dubbed Justice Out of Balance.

The report lays the blame for anti-LGBT judicial bias on the growing practice of installing state Supreme Court judges via election rather than by appointment. Today, 38 states elect their judges either via competitive or retention elections—a practice unique to America. And in recent years, the amount of spending in judicial elections has exploded; the money spent on state Supreme Court elections has more than doubled in the past decade.

“Far-right groups and powerful special interests are working to game the system by stacking state courts with judges who will rule in accordance with their agendas,” the report states. Moore himself had already been removed from the bench in 2003 for refusing to follow a federal court order to remove the display of the Ten Commandments from the state judicial building. The voters elected him again in 2012.

“The pressures of running for re-elections, courting donors, and securing endorsements often force candidates to take extreme positions,” wrote report author Eric Lesh in a blog post following the study’s release. Tellingly, appointed justices ruled in favor of the LGBT community 82 percent of the time. By contrast, elected judges ruled in favor of LGBT claims only 53 percent of the time.

In Iowa, three Supreme Court justices faced the wrath of right-wing activists when they sought re-election in 2010. Having unanimously ruled to legalize same-sex marriage in Iowa the previous year, the judges faced attacks led by Bob Vander Plaats, an influential Iowa conservative leader. All three justices lost their elections.

Judicial elections are also fueling a “stunning lack of diversity” on state Supreme Court benches, the report found. Racial minorities and women are under-represented, and only ten openly gay or lesbian justices serve on state Supreme Courts. Importantly, nine of these ten justices were appointed, and all nine appointees were installed by Democratic governors. The upshot is “a significant lack of trust in the courts among LGBT and respondents with HIV,” according to the report.

“A diverse bench increases public confidence in the court,” said Lesh in an interview. He added: “When you see the courts don’t reflect the diversity of the community that they serve, it has an impact on public confidence.”

As Hyde Amendment Turns 40, Poll Shows Support for Its Repeal

It’s been 40 years to the day since Congress first passed the so-called Hyde Amendment that bars federal funding for abortion services, and it’s also the first year that any presidential candidate—in this case, Hillary Clinton—has campaigned on a promise to repeal that amendment if elected.

It’s unclear whether Clinton’s pledge will carry much weight with voters. In an election in which women’s votes are expected to be pivotal, abortion has not surfaced as a major campaign issue. Both Clinton and GOP nominee Donald Trump have sought to appeal to female voters with proposals for paid parental leave and equal pay for women, but neither has spent much time talking about reproductive health care.

But recent polling suggests that women in key battleground states might find Clinton’s Hyde Amendment opposition compelling. Named for former Illinois Senator Henry Hyde, a Republican, the amendment prohibits abortion coverage for women enrolled in federally funded health-care plans such as Medicaid, which serves low-income families; Tri-Care, which serves military families; and the government health-care plan that covers federal employees.

The poll was conducted by Hart Research Associates for All Above All, a coalition of organizations working to end insurance coverage bans on abortion. Pollsters focused on the battleground states of Colorado, Florida, Iowa, Michigan, New Hampshire, Nevada, North Carolina, Ohio, Pennsylvania, Virginia, and Wisconsin. The poll targeted 1,155 registered voters and included larger-than-average samples of both young voters age 18 to 34, and of African Americans and Hispanics.

A full 76 percent voters agreed with the statement, “However we feel about abortion, politicians should not be allowed to deny a woman's health coverage for it just because she's poor.” The voters who agreed included 76 percent of independents, 66 percent of Republicans, and 89 percent of Democrats.

Voters also said they would support a bill that would require Medicaid to cover all pregnancy-related care, including abortion, by a margin of 53 percent to 41 percent. The support for the repeal of Hyde is even stronger with millennials, a group Clinton is making a special effort to win over. More than two-thirds of young voters said they support Medicaid coverage for all reproductive health care, including abortion.

“The battleground-state poll findings are consistent with a nationwide poll from 2015,” says Destiny Lopez, co-director of All Above All Action Fund. “Both polls found that a majority of voters support requiring that Medicaid coverage include abortion care.”

The polling data may draw notice from reproductive-rights advocacy groups that are busy registering and turning out voters in a year when Clinton, the first woman to head a major national party’s presidential ticket, has emerged as a strong women’s health advocate.

“Some of our strongest supporters are people of color and young people—a critical voting bloc,” says Lopez. “Secretary Clinton’s position on lifting Hyde [is] completely in sync with voters, and we’ll be using this to energize her base and be sure they turn out on Election Day.”

Deportations and Clinton’s Latino Outreach

Hillary Clinton has come under fire for failing to sufficiently galvanize Latinos, a bloc of voters key to Democrats in both the presidential and Senate contests. The Washington Post this week quoted critics saying Clinton had run too few Spanish-language ads, and spent too little on targeted messaging.

But there may be another reason why Clinton’s performance lags behind President Obama’s in 2012: Obama’s own deportation policies, which have drawn fire from Latinos on several fronts. These include the Obama administration’s deportations of the children who crossed the border in droves two years ago to flee violence in Central America. Overall, the administration deported 2.4 million people between fiscal 2009 and 2014. And non-criminal deportees outnumber those charged with crimes.

Deportation orders dipped when Obama signed the executive order known as Deferred Action for Parents of Americans and Lawful Permanent Residents (DAPA), which would have shielded several classes of immigrants from deportation. But a series of state lawsuits and a Supreme Court deadlock have blocked the administration from implementing that order, and Latinos remain frustrated. Some of that frustration seems to be spilling over to Clinton—despite widespread Latino antipathy to Trump.

“People are very disappointed and they don’t want to vote,” said Adriana Cazorla, a domestic worker from Washington state. “They don’t want to be guilty of putting a person in office who will do the same as [Obama].”

Cazorla made her comments Friday at a march from the Supreme Court to the White House organized by the National Alliance for Domestic Workers and several allied groups. The march brought out hundreds of immigrant women, many of them undocumented, to deliver a message to Obama: Stop the deportations.

Dubbed the Immigrant Women’s Walk Against Deportations, the event took place on the one-year anniversary of last year’s 100-mile march for immigration reform. Before the march Cazorla told The American Prospect how she had been hiding from an abusive husband when he found her and called immigration officials. She was detained for four months in a detention center.

“I was treated badly, given spoiled food, had no access to potable water or medical attention like the rest of the people did,” Cazorla says of her time in the detention center. Cazorla says she now has legal status thanks to the Violence Against Women Act—but that her children, who were without their mother for four months, suffered the most during her detention. The separation of families was a big point of contention for the marchers and their supporters.

“Many children worry about it,” Cazorla said with tears in her eyes. “They go to school with fear that they’ll go back home and their parents won’t be there.”

Marcher Patricia Rosas described how she immigrated to the United States from Mexico more than two decades ago with her children. But four years ago, her son was deported back to Mexico. “I brought him here when he was one year old,” said Rosas, “so he was basically raised here. When he got to Mexico, he didn’t know what to do or where to go.” Rosas’s son left behind a wife and a two-year-old son. “He wanted to be with his son, so he tried to come back,” explained Rosas, “but he was apprehended and was deported again.”

Rosas said she was marching in hope that DAPA would become law so, that “after 26 years, I can see my mom and my siblings again.”

Hill Hearing Spells Bad News for Veterans

Not a single veterans service organization was asked to speak last week at the House Veterans Affairs Committee’s hearing on the final recommendations of the VA Commission on Care, though such groups represent millions of former military personnel.

Also noticeably absent from the witness list was Vietnam veteran Michael Blecker, executive director of the San Francisco veterans group Swords to Plowshares, who served on the Commission on Care, and who dissented from its final report. Blecker objected that the commission’s leading recommendation—the creation of a so-called VHA Health System network of private-sector care providers—could fatally weaken veterans’ health care.

Instead, Committee Chair Jeff Miller, a Florida Republican, invited only two people to testify before the panel: Delos “Toby” Cosgrove, vice chair of the commission and CEO of the Cleveland Clinic, and Commission Chair Nancy Schlicting, who is CEO of the Henry Ford Health System. Miller happens to be a faithful supporter of Donald Trump, who has touted the VA committee’s chairman as his top pick as secretary of veterans affairs in any Trump administration.

While Schlicting has expressed support for the VHA, Cosgrove was one of the leaders of a commission faction—what some have dubbed the “Strawman” group—that favored the complete elimination of the VHA.

At the hearing, which took place on September 7, Cosgrove and Schlicting both expressed enthusiasm for creating a VHA Care System that ostensibly would create a network of private-sector providers to deliver health care to veterans while also somehow integrating them into the VHA. The report estimates that this system would eventually channel up to 60 percent of veterans into private-sector health care, and even acknowledges that the new setup would potentially weaken the VHA itself.

Alarmingly, all the Democrats on the committee—with one notable exception—voiced support for this general policy direction, albeit with less ideological fervor than Miller and his GOP colleagues. The one committee member who spoke out against the plan—fortunately for veterans—was ranking Democrat James Takano, of California, who expressed serious reservations about the proposed VHA Care System, and echoed concerns about it that have already been raised by President Barack Obama and by VA Secretary Robert MacDonald.

The other panel Democrats came across as shockingly misinformed, and offered such VHA fixes as Texas Representative Beto O’Rourke’s argument that the VHA should only concentrate on service-related mental and physical health conditions, rather than routine primary care. If treatment of veterans were limited in this fashion, many service-related conditions that experienced VHA providers now identify in primary care visits would go undetected. Such conditions would be far less likely to be diagnosed by private-sector providers, who often have little knowledge of military/veteran problems. As Blecker has pointed out, if Vietnam veterans were dependent on the private sector, PTSD and problems related to Agent Orange, which the VA itself took too long to identify, may never have been recognized and researched at all. (Having learned from its Vietnam experience, the VHA has been quick to identify and act to treat traumatic brain injuries, the signature injury of the wars in Iraq and Afghanistan.)

Also alarming was Veterans Affairs Committee members’ bipartisan embrace of the recommendations by Cosgrove and Schlicting that the VHA abandon its highly successful in-house system of electronic medical record-keeping (which it is working to improve) and replace it instead with commercial products. Lobbyists for companies that produce these systems have spent millions urging hospitals to purchase their wares—despite the fact that, as a large body of research has documented and as a recent JAMA editorial underscored, they have largely failed to fulfill their promise of creating safer and more efficient health care. 

“The systems being proposed for purchase at the VHA have been widely disparaged by medical professionals and patient safety advocates for their lack of user friendliness, failure to consider clinical workflow and [prioritization] of billing information over care,” Ross Koppel, an expert in health-care information technology at the University of Pennsylvania, told The American Prospect.

During the hearing, no member of Miller’s committee expressed concern about the estimated 300,000 veterans whose military discharges—sometimes due to service-related mental health problems—leave them barred from the VHA. The Commission on Care recommended that some veterans with other than honorable discharge receive tentative eligibility for health-care services.

All in all, it was disappointing day for vets on Capitol Hill. It was also a warning of what’s in store for veterans if Trump, who has not only floated Miller as VA secretary but has revealed his own ignorance of veterans’ health-care issues, becomes commander-in-chief on Election Day.

Studies Show Veterans Health Care Improving

When the House Veterans Affairs Committee holds a hearing on September 7 to assess the future of the Veterans Health Administration, federal lawmakers would do well to consider recent reports that challenge the continual drumbeat of negative and often unfair coverage and congressional criticism of the VHA.

One report, from the RAND Corporation, said that while there were differences in care and leadership culture across the system, researchers “did not find evidence of a system-wide crisis in access to VA care.” In fact, the report identified congressional policies as one of the main barriers to VHA improvements (despite the Veteran Affairs Committee Chairman Jeff Miller’s apparent belief that firing VHA leaders is the solution to any access problems). The report noted that “inflexibility in budgeting stem[med] from the congressional appropriation processes,” and concluded that the hastily designed and implemented Veterans Choice Program, “further complicated the situation and resulted in confusion among veterans, VA employees, and non-VA providers.”

Though it received no media attention, another positive report on the VHA came this month from the Joint Commission, the independent nonprofit that accredits U.S. hospitals and health-care organizations. After surveying the VHA between 2014 and 2015, the commission found improvements in access, timeliness, and coordination of care, as well as in leadership, safety, staffing, and competency.

Finally, the Association of VA Psychology Leaders, the Association of VA Social Workers, and unions representing VA employees issued a policy brief opposing the Commission on Care’s proposal to create a new VHA Care System, which would ultimately channel up to 60 percent of eligible veterans into private-sector health care. Two independent national groups, the American Psychological Association (APA) and the National Association of Social Workers, also signed the policy paper.

In an email, Heather O’Beirne Kelly, the APA’s lead psychologist on military and veterans policy, told The American Prospect that the APA “is opposed to the primary recommendation of the Commission on Care’s report, which we feel would in effect disassemble one of the most successful, innovative features of current VA care: the primary care/mental health integrated approach.”

Every report on the VHA over the past two years has documented that the system provides care equal to or superior to private-sector care, and have spotlighted significant improvements in problematic practices that led to two years of scandal-mongering on Capital Hill and in the national media. But instead of lauding the VHA for its progress and working to sustain the system, federal lawmakers and critics are quick to jump on any hint of a glitch and lambast the VHA for not changing more rapidly, steadfastly ignoring the fact that changing the culture of any institution, particularly that of America’s largest health-care system, must take years.

Sustained improvement will also require transformations in the congressional budgeting process and dramatic shifts in health-care policy. As The New York Times reported in 2014, shortages in the physician workforce have made lengthy waits to get an appointment “the norm in many parts of American medicine.” If Congress is serious about protecting veterans, it must immediately appropriate more money so that VHA can offer salaries competitive with those in the private sector, as even the Commission on Care recommends, and allocate more medical residency training slots to primary, geriatric, and palliative care. 

The narrative of a VHA that is broken beyond repair that the news media and some federal lawmakers insist on does not acknowledge that the VHA is a national or global leader in fields like telemedicine, mental health, primary and geriatric care, and reducing opioid use. Why would anyone want to work in a system depicted as broken beyond repair, doomed to disappear, and filled with demoralized staff? That overwrought story discourages nurse practitioners, social workers, psychologists, and other professionals from working at the VHA.

Report: Patients’ Groups With Big Pharma Ties Came Out Against Medicare Drug Plan

Earlier this year, nearly 400 patients’ groups signed onto two separate letters criticizing a recent Medicare proposal aimed at bringing down the cost of prescription drugs. Warning that there would be dire consequences for patients if the proposal moves forward, patients’ groups including the Partnership to Improve Patient Care and the Quality Cancer Care Alliance urged congressional leaders and the head of the Centers for Medicare and Medical Services to “permanently withdraw” what they viewed as “flawed policy.” In doing so, patients' groups had joined bottom-lined focused pharmaceutical companies in their opposition to the plan, a move that appeared to bolster the argument against the proposal. 

But a recent Public Citizen report “Patients’ Groups and Big Pharma” suggests that the story is more complicated. The report shows that at least three-quarters of the 147 patients’ groups who signed on to the letters received funding from the pharmaceutical industry.

Public Citizen combed through websites and documents to determine which patients’ organizations had received pharmaceutical dollars. Some groups had websites emblazoned with pharmaceutical sponsors’ logos or featured specific companies listed as benefactors in reports, while others were featured in pharmaceutical companies’ public disclosures.

“When patients’ groups side with the pharmaceutical industry against proposed policy reforms, they lend credibility and a sympathetic voice to industry lobbying efforts,” the report says, going on to note that such groups’ reliance on industry money “should complicate the view that patients’ groups’ interest in such policy battles is categorically different from the industry’s financial interest.”

The patients’ groups had warned that discouraging medical professionals from prescribing more costly drugs is a “one-size-fits-all” policy that could force them to prescribe cheaper drugs that are also less effective. Such a policy could even lead to an “abrupt halt” in treatment altogether, they argued. One group also cautioned that the measure would particularly hurt patients with disabilities, who had more diverse treatment needs.

It’s not the first time the pharmaceutical industry and patients’ groups have worked together fight this Medicare plan. Last month, USA Today reported that the Community Oncology Alliance (a patients’ group that signed onto one of the Medicare prescription drug letters) used language nearly identical to talking points disseminated by the Pharmaceutical Research and Manufacturers Association in its public comments on the proposal. The pharmaceutical association is also one of oncology alliance’s corporate members.

The Public Citizen report notes that its findings are likely understated, since they are based largely on voluntary disclosures by drug companies and the groups in question. While the Affordable Care Act mandated that drug companies disclose their payments to physicians beginning in 2013, the law did not apply to health advocacy organizations.

The ties between the pharmaceutical industry and patients’ groups are well known. After Senator Chuck Grassley, the Iowa Republican, started investigating pharmaceutical companies’ links to these organizations in 2009, The New York Times reported that the National Alliance on Mental Illness took in around 75 percent of its donations, or about $23 million, from drug manufacturers from 2006 to 2008, a sum that even the group’s executive director admitted was too much.

Patients’ groups rarely talk about high drug prices, a possible consequence of their reliance on industry money. A 2006 study of the issue noted: “Just as gifts (monetary or in kind) may induce feelings of loyalty and indebtedness in physicians which can influence medical decision-making, one may expect patient groups also to be caught between two masters.” Smaller organizations that relied heavily on industry donations to help fund their operations were particularly at risk, the study found.

Public Citizen’s report comes less than a month after the watchdog group issued a separate report on the matter, which found that members of Congress who criticized the Medicare proposal had received significant contributions from the pharmaceutical industry.   

No Running Mate, Perez Still Stumps for Clinton

When Hillary Clinton picked Virginia Senator Tim Kaine as her running mate last week, there was a predictable collective groan from progressives, particularly Latinos, who had been hoping for a selection more squarely in their camp.

Among those on the final shortlist, Tom Perez had been the clear favorite of many progressives looking for Clinton to shore up her support on the left. During President Obama’s second term, Perez has pushed through a series of labor reforms that have prompted some to hail him as the most important labor secretary since Frances Perkins served under FDR.

Perez’s prolific career in public service, his detail-oriented pragmatism, and his reputation for getting results without compromising his progressive values landed him on a list of finalists that included such white centrist contenders as Kaine and Agriculture Secretary Tom Vilsack. A son of Dominican immigrants, Perez was the only Latino candidate to receive serious consideration, and was considered a draw for Latino voters and an effective attack dog against Donald Trump.

Clinton’s failure to tap a progressive like Perez for her running mate was one of several reasons that Sanders supporters headed into the Democratic National Convention in such a disgruntled mood.

But at a speech delivered to the DNC’s Hispanic Caucus in Philadelphia Wednesday, Perez made a forceful pitch for Clinton and Kaine. His message was clear: Latinos need to mobilize now.

Perez acknowledged decreases in Latino unemployment and poverty levels and an uptick in access to health insurance, but said there’s more to be done.

“We know there is unfinished business,” Perez declared. “And who is better equipped to handle that unfinished business, starting with passage next year of comprehensive immigration reform than Hillary Clinton and Tim Kaine?”

Speaking to reporters after his speech, Perez praised Kaine.

“I know Tim Kaine well. He is a person with the same values as our values. He is a magnificent person,” Perez told a reporter in Spanish. “I’m going to travel all over this country to help the secretary and the senator. Because Donald Trump? His values are not our values.”

Another reporter asked what he would tell Latinos who think that Clinton’s decision to pass over Perez as her running mate is another signal from the Democratic Party that Latinos need to wait their turn.

Perez didn’t bite.

“We’re all working together. It’s bigger than any one person. We’re all in this together,” Perez said. “We’re at a moment in our nation’s history where we have an opportunity to send a message not only to America but to the world about the fact that we are stronger together and that e plurubis unum is who we are all about.”

Indiana Court Overturns Purvi Patel’s Feticide Conviction

The Indiana Court of Appeals last week overturned the 20-year prison sentence for Purvi Patel, the first woman in the United States to be convicted under a feticide law for having an abortion. The 3-0 decision marks a victory for reproductive rights advocates, who argued that using feticide laws to convict women who end their pregnancies sets a dangerous precedent for abortion rights and criminalizing the procedure.

Legal experts warned that if the conviction were upheld pregnant women would be prosecuted for all sorts of things—from self-inducing an abortion to smoking cigarettes, or even slipping down the stairs. Feticide laws are on the books in 38 states, and were originally passed to protect pregnant women who were victims of domestic violence.

Indiana strengthened its feticide law in 2009, after a pregnant Indianapolis bank teller was shot during a bank robbery, and lost the twin girls she was carrying. In the appeals decision, the judges wrote, “We hold that the legislature did not intend for the feticide statute to apply to illegal abortions or to be used to prosecute women for their own abortions.” They called Patel’s conviction under a feticide statute “an abrupt departure” from earlier cases.

However, while Patel’s Class A felony charge was vacated, the judges did not drop the second charge in the case. She is still left with a neglect conviction—a felony offense—though the court said it should be reduced from a Class A neglect charge to a Class D one. The minimum sentence for a Class D neglect felony is six months, and the maximum is three years. Patel has already been sitting in jail for more than a year.

Attorneys for both sides continue to review the decision; neither has indicated whether they planned to appeal to the state’s Supreme Court.

Kate Jack, an Indiana-based attorney who has provided legal advice to the National Advocates for Pregnant Women, told The Indianapolis Star that while the issue is not entirely closed, she does think the decision “will really give pause” to anyone considering bringing future feticide charges against pregnant women.

The decision comes on the heels of the Republican National Convention, where Donald Trump picked Indiana Governor Mike Pence as his running mate. Reproductive rights groups have already been organizing against Trump’s incendiary rhetoric around women and abortion rights, and the selection of Pence as his vice president has only angered advocates further.

Aside from being the chief executive of the only state to convict a woman who ended a pregnancy under a feticide statute, Pence has also achieved notoriety for supporting other reproductive health-care limitations. While serving in the U.S. House of Representatives he backed an unsuccessful 2011 federal effort to defund Planned Parenthood. When Pence became governor of Indiana in 2013, he continued to attack the organization. By 2014, state funding for Planned Parenthood had been reduced by nearly half of its 2005 funding levels: Nearly a decade of cuts forced the closure of five clinics.

In March, Pence went even further, signing an omnibus bill that included some of the strictest abortion measures in the country, including a ban on women who wish to end their pregnancy if their fetus has genetic abnormalities, such as Down syndrome. The law also called for prosecuting doctors who provided abortion services to women suspected of wanting to terminate a pregnancy based on genetic problems. A federal judge blocked this law from taking effect last month, saying it was likely unconstitutional.

While reproductive rights groups say they are heartened that the court reversed Patel’s feticide conviction, they disagree with the judges’ decision not to drop the neglect conviction. Yamani Hernandez, the executive director of the National Network of Abortion Funds, issued a statement saying that the court’s new decision does not go far enough to restore full justice. By allowing the prosecutors’ argument that Patel could have prevented the death of her child to stand, Hernandez says, the judges have rejected “both medical science and compassion for a woman who needed medical care, not to be sent to prison.” She argued that ultimately people of color will “bear the brunt of unscientific laws and misplaced moral outrage.”

Patel remains in prison for now, and advocates are continuing to call for her release. Reproaction, a group focused on abortion access and reproductive justice, released a statement calling upon Mike Pence “to be pro-life for real and release her immediately.” They add that the state of Indiana “owes Purvi Patel a profound apology.”

Congress Goes on Vacation While Zika Spreads

Florida reported the first possible case of mosquito-transmitted Zika Wednesday.  But the summer congressional recess is in full swing and Congress closed up shop without appropriating funds to combat the illness that can cause birth defects in babies born to infected mothers, leaving reproductive rights advocates and public health experts wondering what comes next.

House Speaker Paul Ryan managed to get the majority Republican House to pass a Zika funding bill as part of a larger military spending bill, but Senate Democrats voted down that version because it diverted unspent Affordable Care Act resources for health-care exchanges in U.S. territories and siphoned funds from anti-Ebola programs. The House version of the bill had included $476 million for The Centers for Disease Control for mosquito control efforts and public awareness campaigns and $230 million for the National Institutes of Health to support vaccine development.

Democrats also cried foul because the bill undercut Planned Parenthood, the family planning organization that Republicans have been trying to defund since last year. The Centers for Disease Control (CDC) says that reducing unintended pregnancies and practicing safe sex are vital to fighting Zika. However, Planned Parenthood and other women’s health organizations did not receive any funding.

Planned Parenthood officials blamed the GOP for failing to come to grips with the gravity of the crisis. “Common sense would dictate that family planning services that help prevent transmission and prevent or delay pregnancy play a central role in combating this epidemic but apparently that is not the position of congressional Republicans,” said Dana Singiser, the group’s vice president of public policy and government affairs in a statement.

Excluding the case reported on Wednesday, every person in the U.S. who has Zika contracted it by traveling to an area where the disease is prevalent. Puerto Rico (which would have received federal funding) has already declared a public health crisis: Nearly 4,000 people have contracted the disease. Mosquitos that carry the Zika virus could thrive in Texas, Florida, and other states with subtropical climates. So far, Florida has over 300 reported Zika cases—43 of the infected people are pregnant women.

But officials don’t appear to be in a panic, despite the lack of funding from Congress. Florida Governor Rick Scott recently allocated $26.2 million for CDC Zika prevention kits (which includes a mosquito net, spray, and condoms), mosquito surveillance and abatement, and training for mosquito control technicians. However, Florida has a dismal track record on women’s sexual health and lack of funding for specific programs has alarmed public health experts who are concerned that not enough is being done.

There’s still a lot that health experts don’t know about Zika, and without funding for research learning more about the disease could prove difficult. In an exclusive interview with National Geographic, CDC Director Tom Frieden lamented Congress’s inability to pass a funding bill, “This is no way to fight an epidemic,” he said.

The mosquito-borne illness produces mild to moderate symptoms including fever, rash, and joint pain in most people, but pregnant women who contract the disease may gave birth to babies with smaller than average brains, a condition known as microcephaly. Zika is transmitted through a mosquito bite or sexual contact. More than 1,300 people have contracted Zika nationwide.

How Tom Perez Embodies the Democrats’ TPP Rift

When it comes to the Trans-Pacific Partnership (TPP), Tom Perez is stuck between a rock and a hard place—or rather, between his current boss, President Barack Obama, and his potential future boss, Hillary Clinton.

In his role as the U.S. labor secretary, Perez has gone to the mat for Obama as a prominent supporter of the trade agreement. He’s quick to admit that past trade deals like NAFTA have been disasters for working people, but he’s even quicker to insist that the TPP is different—that it addresses past shortcomings with real, enforceable labor standards.

He’s long been in an awkward position on his support for the deal, given that his allies at the labor unions vehemently oppose the deal. Still, labor leaders have largely given Perez a pass on his TPP support, as they understand the position he’s in and are huge fans of everything else he’s done as labor secretary.

However, with vice-presidential speculation swirling around him; a renewed focus on the Democratic Party’s position on the TPP; and increased pressure from both progressives and Trump on Clinton’s own position, Perez is in a trickier spot than ever before.

In an interview on Meet the Press with Chuck Todd on Sunday, Perez said that his work constructing labor protections and promoting the deal was part of his job. “This is what the president tasked me with doing, Chuck, and I was proud to do it,” he said.

The rift, he says, is regarding whether the deal ensures "the strongest protections for the workers that we've ever had." 

“The president and Clinton have a disagreement on whether TPP has gone that far. This is not the first time in the history of the Democratic Party that there have been differences of opinion," Perez said.

But he evaded a direct answer on whether he, as a “political citizen” and not as a member of Obama’s cabinet, personally supported the agreement. The evasion is indicative of a future pivot that Perez would have to soon make should he be tapped for the vice presidential slot or another position in a Clinton administration. That’s a stark change from when he said just over a year ago that “[t]rade agreements like the TPP are critical to our 21st century competitiveness."

Perez’s current political quandary, however, is a product of the larger rift within the Democratic Party. The TPP remains a powder keg, just waiting to blow up the party as unity on the issue remains elusive.

Last week, when the Democratic National Committee released a draft of its party platform, it declined to explicitly condemn the TPP, citing “the diversity of views” on the matter. Given the fact that 85 percent of House Democrats voted against fast-tracking the deal last year, it was clear that the “diversity of views” was a polite way of saying that there was no way the DNC would officially snub a major hallmark of Obama’s presidency.

And that’s precisely where the dividing line is in the Democratic Party. On one side is Obama and those who support the deal as is. On the other side, the full spectrum of opposition runs from Clinton, who has sharpened her position to calling for stronger trade prosecution against China and protections for the U.S. auto industry, to Bernie Sanders, who thinks the deal should be thrown out altogether and is lobbying DNC delegates to support a platform amendment explicitly opposing the TPP.

Perez will be forced to continue the political straddling—acknowledging the disagreement between Clinton and Obama without expounding on it—throughout the campaign. That is unless the political cosmos aligns and he is tapped as vice president, or Obama tacitly agrees to back off on pushing for a lame-duck vote, or the DNC changes its platform.

In any case, Perez will be an important bellwether in monitoring how the party ultimately handles an Obama-to-Clinton TPP transition.