Monthly Archives: September 2019

With the Affordable Care Act’s future in doubt, evidence grows that it has saved lives

 Add to list

Bonnie Sparks, 47, walks on the treadmill at Planet Fitness in Wayne, Mich., on Sept. 4, 2019. (Brittany Greeson/for The Washington Post)By Amy GoldsteinSeptember 30 at 7:00 AM

DETROIT — Poor people in Michigan with asthma and diabetes were admitted to the hospital less often after they joined Medicaid under the Affordable Care Act. More than 25,000 Ohio smokers got help through the state’s Medicaid expansion that led them to quit. And around the country, patients with advanced kidney disease who went on dialysis were more likely to be alive a year later if they lived in a Medicaid-expansion state.

Such findings are part of an emerging mosaic of evidence that, nearly a decade after it became one of the most polarizing health-care laws in U.S. history, the ACA is making some Americans healthier — and less likely to die.

The evidence is accumulating just as the ACA’s future is, once again, being cast into doubt. The most immediate threat arises from a federal lawsuit, brought by a group of Republican state attorneys general, that challenges the law’s constitutionality. A trial court judge in Texas ruled late last year that the entire law is invalid, and an opinion on the case is expected at any time from the U.S. Court of Appeals for the Fifth Circuit. The case could well put the ACA before the Supreme Court for a third time.

President Trump has dismantled as much of the law as his administration can,by expanding the availability of skimpy, inexpensive health plans that skirt ACA rules, for example, and slashing federal aid to help people sign up for coverage through ACA insurance marketplaces.

And some 2020 Democratic presidential candidates contend the country needsfurther-reaching health reforms than the ACA, calling for a government-financed system they call Medicare-for-all.

The law’s supporters have not taken political advantage of the signs that the ACA is translating into better health — at least, not yet.

When the sprawling 2010 statute was new, a central question was whether it would help more people gain affordable health coverage, as intended.

With about 20 million Americans now covered through private health plans under the ACA’s insurance marketplaces or Medicaid expansions, researchers have been focusing on a question that was not an explicit goal of the law: whether anyone is healthier as a result.

It is difficult to prove conclusively that the law has made a difference in people’s health, but some strong evidencehas emerged in the past few years. Compared with similar people who have stable coverage through their jobs, previously uninsured people who bought ACA health plans with federal subsidies had a big jump in detection of high blood pressure and in the number of prescriptions they had filled, according to a 2018 study in the journal Health Affairs.

And after the law allowed young adults to stay longer on their parents’ insurance policies, fewer 19- to 25-year-olds with asthma failed to see a doctor because it cost too much, according to an analysis of survey results published earlier this year by researchers at the U.S. Centers for Disease Control and Prevention.

Sparks exercises her hips on a weight machine at Planet Fitness. (Brittany Greeson/for The Washington Post)

Most of the emerging evidence concentrates on the health effects of joining Medicaid under the law’s expansion of the safety-net program. Medicaid is an appealing research focus because a 2012 Supreme Court decision gave each state the option to widen eligibility to people who are somewhat less poor, allowing comparisons between the three dozen states that have expanded and the rest that have not. In addition, low-income people without insurance are most likely to have built-up medical problems that get treated once they get covered.

Michigan has emerged as a hub for understanding the ACA’s effects on health because University of Michigan researchers have been rigorously evaluating the Healthy Michigan Plan, as the state calls its Medicaid expansion covering about 650,000 people.How Trump is weakening ObamacarePresident Trump’s health-care actions could have ripple effects throughout the Affordable Care Act’s marketplaces. (Video: Jenny Starrs/Photo: Jabin Botsford/The Washington Post)

One 2017 study compared heart surgery patients in Michigan and Virginia, which had not yet expanded Medicaid at the time. It found that those who had cardiac bypasses or valve operations in Michigan had fewer complications afterward than similar people in Virginia, where more were uninsured.

One in three Michigan women said that, after joining Medicaid, they could more easily get birth control. And four in 10 people in Healthy Michigan with a chronic health condition — such as high blood pressure, a mood disorder or chronic lung disease — learned of it only after getting the coverage, according to survey results published this month.

In a few neighborhoods here in Detroit, the consequences for patients and their doctors are clear.


Bonnie Sparks, dripping sweat in a mint green T-shirt, reached the finish line of the CHASS community health center’s 5K run/walk. As she trudged the final steps, the center’s chief medical officer Richard Bryce urged workers and some medical students to walk alongside her in the 97-degree heat, chanting her name. Then, Bryce wrapped Sparks in a hug.

Sparks and Richard Bryce, the chief medical officer from the CHASS community health center in Detroit, pose for a photo after the center’s 5K run/walk in July. (Mary Rosencrans)

Sparks came in last of the event’s 270 runners and walkers in late July in a southwest Detroit neighborhood pocked with vacant lots. She was halfway to Clark Park when the center’s executive director found her at the back of the pack and offered a ride. “No way,” Sparks said, insisting on continuing under her own power.

The miracle was that, at 47, she walked the course at all.

CHASS has been a medical haven in Detroit’s Mexicantown for a half-century, since the city’s riots prompted hospitals to close and physicians to move to the suburbs. Five years ago, when Bryce, a family physician, arrived and took over Sparks’ care, she weighed more than 300 pounds and could not get from the clinic parking lot to the front door without help. She’d had her first heart attack at 34. Her anxiety was so sharp she often could not leave her apartment. On a rare family road trip — to Daytona Beach — she waded into the Florida waters where flesh-eating bacteria infected an open sore on her right leg. Back home, she landed in the hospital for 3 1/2 weeks.

For 13 years, Sparks had worked for a defense contractor, NCI Information Systems, overseeing two computer help desks. But when the company lost a contract, her job ended in late 2010, and her good HMO insurance disappeared.

Living on unemployment, she kept taking pills for her diabetes and high blood pressure, because she could get the prescriptions for $4 a month through a Walmart discount. But she did not have the $300 a month to pay for Plavix — a blood thinner she needed because of a stent put in her heart — so she stopped.

“I talked to my doctor at the time. I said, ‘I can’t afford this,’ ” recalls Sparks. “He said, ‘You could have another heart attack.’

“And I did.”

The second heart attack, in early 2012, was serious. Afterward, her doctors told her she should not work. She applied for Medicaid twice and received form letters telling her she was denied because she was not under 21, pregnant, blind or taking care of a child.

The following year, she appealed in writing, then asked for a hearing, but a state administrative law judge concluded that, though Sparks had a solid job history and significant medical problems that made it difficult for her to work, she was not technically disabled so did not qualify for insurance.

“I felt abandoned,” Sparks recalls. “I nearly died. I kept thinking, ‘I am just sick right now.’ ”

So Sparks was uninsured when her boyfriend rushed her to an emergency room for a second time within days after the Florida trip. This time, she was diagnosed with the flesh-eating necrotizing fasciitis. She was in breathing distress and kidney failure because of the infection and was placed in a medically induced coma for most of her time in the Henry Ford Hospital.

But the day she was admitted, April 3, 2014, was the third day that the state had begun accepting applications for the Healthy Michigan Plan. On April 29, Sparks got a letter. She was insured.

Medicaid paid her $132,000 hospital bill.

Since then, social workers and a psychologist have helped ease her out of her smoking habit and her anxiety. She met with a bariatric surgeon to consider a gastric bypass, but, by that point, had started to lose so much weight by improving her diet and walking that she decided she did not need the surgery. Last month, she was down to 234 pounds.

Sparks shops for healthier grocery options at a Kroger in Westland, Mich. (Brittany Greeson/for The Washington Post)

Sparks has an endocrinologist for her diabetes. A cardiologist approved a catheterization when she had more chest pains — and inserted additional stents. And she has an OB/GYN who treated her worsening fibroids and, when they got too severe, made sure she got a hysterectomy.

Bryce, who arrived at CHASS at about the time of Sparks’ infection, says she was like many sick and uninsured patients who can get primary care through the health center but have trouble finding medical specialists willing to treat them.

If not for the health plan she has through Healthy Michigan and Medicare, which she has had since the state eventually classified her as disabled, Sparks said, “I would be dead, or I would be financially ruined.”

On the east side of Detroit, the part of town where poverty and illness are most common and life expectancy is shortest, Healthy Michigan has transformed the lives of patients at the Mercy Primary Care Clinic. Like Sparks, David Brown says that, without it, “I probably would not be here. I would have had a heart attack and died.”

David Brown, 55, following a routine checkup at the Mercy Primary Care Center in Detroit on Sept. 4, 2019. (Brittany Greeson/for The Washington Post)

Before Medicaid expanded, all of Mercy’s patients were uninsured. Now, at 55, Brown is among the half at the clinic covered by Healthy Michigan.

Right after he got laid off in 2007 from a job with Wayne County, driving trucks and front-end loaders at the airport, he began having spells in which his chest was tight, his head spinning. Finally, a friend took him to an emergency room. He was prescribed rest and ordered to follow up with his primary care doctor. Except he did not have one.

Over the next few years, the spells came more often, and he was going to emergency rooms around town, dizzy and with headaches, two or three times a month. When the bills showed up, he stored them, unpaid, in the brown plastic crates where he keeps files.

He does not remember anyone checking his blood sugar, even though his favorite foods were fried chicken, Burger King, cinnamon doughnuts, chocolate milk and — especially — Snickers bars.

Finally, during an emergency room visit, someone mentioned he might be borderline diabetic.

When he finally heard about Mercy and was diagnosed with diabetes by Pamela Williams, a staff physician, Brown recalls, “she started telling me what could happen — amputation, kidney failure, heart failure. I was like, ‘I could lose my foot, my hand?’ I had never heard of anything like that.”

Dr. Pamela Williams goes through routine questions during an appointment for Brown at the Mercy Primary Care Center. (Brittany Greeson/for The Washington Post)

On a Mediterranean diet, Brown, also a licensed pastor who does online counseling, has gone from 340 pounds to 215. His blood sugar has been under control the past few years.

“But unfortunately, the damage was done when he didn’t have insurance,” Williams says.

With coverage from Healthy Michigan, Brown sees a nephrologist for his chronic kidney disease, a cardiologist for his congestive heart failure, an ophthalmologist for eye damage — all downstream effects of the years he did not know he had out-of-control diabetes.

Brown now has three stents in his heart, including a new one this summer after he had balloon angioplasty to open a clogged artery. He takes medicines that, if he had to pay retail, would cost about $2,400 a month.

“This stuff was not available to me without insurance,” Brown says. “I am grateful for it.”


Understanding the ways the ACA has affected Americans’ health is a work in progress. In the law’s first years, results were mixed, but signs of improvements have accelerated lately, as people uninsured before now have more years of coverage, giving researchers better data to study.

It is too soon to know whether the patterns might reverse with new U.S. Census Bureau data showing that the uninsured rate rose significantly last year for the first time since the ACA has existed.

The findings that exist are not perfect. One National Bureau of Economic Research paper in July, looking at deaths from all causes among adults from their mid-50s to mid-60s, found that dying in a given year has been significantly less common in the states that expanded Medicaid. The paper said that perhaps 15,600 deaths could have been avoided if the expansion had been nationwide, but cautioned that is a rough estimate in part because the study was unable to look specifically at the people who signed up for Medicaid.

Similarly, a study last year found that infant deaths — especially among black babies — were dropping more rapidly in parts of the county that had expanded Medicaid. But the study does not distinguish families who got coverage through the ACA expansions.

The University of Michigan work, including on trends in hospital stays for four main chronic diseases, was able to focus specifically on people who had joined Healthy Michigan. It found that from the first year in the program to the second, hospital stays for asthma plummeted by half and also fell for diabetes complications. But hospital stays for heart failure became more common. The researchers have not yet looked at the patterns for additional years.

Still, John Ayanian, director of the University of Michigan’s Institute for Healthcare Policy and Innovation, said, “the weight of evidence is on the positive side.”

Brown has his vitals checked by Williams during a routine checkup at the Mercy Primary Care Center. (Brittany Greeson/for The Washington Post)

Why Trump gets away with everything


President Trump talks to members of the media on the South Lawn of the White House on Sept 12. (Jabin Botsford/The Washington Post)

Written by E.J. Dionne Jr.Columnist – Washington Post September 22

A depressing mystery hangs over our politics: Why is it that when we have a president whose behavior puts our security interests in peril, our political parties can’t confront the threat together?

Here we have a whistleblower from the intelligence community who, as The Post reported, found a “promise” that President Trump made to a foreign leader “so alarming” that the “official who had worked at the White House went to the inspector general of the intelligence community.”

If what Trump did is entirely innocent, you’d assume the White House would want everything to become public so the president could be cleared of suspicion. After all, Trump tweeted on Friday that he had had a “perfectly fine and respectful conversation” and that “there was nothing said wrong, it was pitch perfect!” Further, he accused the whistleblower of being “highly partisan.”ADVERTISING

So why not share all the information available with the House Intelligence Committee? If Trump’s accuser is some kind of “partisan,” why wouldn’t the president want the world — or at least Congress — to know his basis for saying so?

Instead, the White House and Justice Department are stonewalling, thus ripping apart systems of accountability that were put in place to prevent the abuse of the substantial powers we have given our intelligence services. This is part of a larger undertaking by Trump and his minions to block Congress from receiving information or hearing from witnesses, which is part of Congress’s normal and constitutionally sanctioned work of keeping an eye on the executive branch.

When Republicans held Congress during President Barack Obama’s administration, it seemed that a missing box of staples might have been enough to launch 100 subpoenas and months of hearings. Now, the GOP is going along with a president whose lawyers — in a court filing trying to block the Manhattan district attorney from getting Trump’s tax returns — are asserting that “a sitting President of the United States is not ‘subject to the criminal process’ while he is in office.” It is a sweeping and astonishing assertion that a president is above the law as long as he sits in the White House, no matter which level of government might be investigating him.Trump calls whistleblower a ‘partisan person’President Trump insisted a whistleblower who filed a complaint about Trump’s communications with a foreign leader is a “partisan” on Sept. 20. (Reuters)

There’s also this: On Sunday, without admitting that he tried to encourage Ukraine to dig up dirt on Joe Biden, Trump acknowledged discussing the former vice president and his son Hunter during a phone call with Ukrainian President Volodymyr Zelensky in the context of “the corruption already in the Ukraine.” It was classic Trump. Admit to a small piece of a dangerous story floating around about him, and then turn it into a smear of his opposition.

We have become so accustomed to what is blandly called “political polarization” that we don’t think there is any mystery about why the Republicans rally around Trump no matter what he does or what dangers our republic might face. It’s just what they do now.

And so far, this extreme partisanship has worked for Trump and his party. Attorney General William P. Barr’s false account of what special counsel Robert S. Mueller III concluded in his probe of Russian interference in the 2016 election poisoned the public debate because it sat there for weeks before the report itself was released.

The lie that Mueller had cleared Trump took hold just enough that it turned the discussion of “partisanship” on its head. If Democrats pursued impeachment, the Trumpists argued, they would be the partisans. Fear that this ploy would work has made Democrats in swing districts wary of impeachment.

Thus did Trump pick up an additional benefit from Barr’s initial falsehood, backed up by his own party: While Democrats are united in condemning Trump’s behavior, they have been divided on the impeachment question. A split opposition is exactly what Trump wants and needs — although there were signs Sunday that the latest story may be the last straw for many of the more cautious Democrats. Rep. Adam B. Schiff (Calif.), chairman of the House Intelligence Committee, said on CNN’s “State of the Union” that while he had been “very reluctant to go down the path of impeachment,” the latest allegations could make it “the only remedy that is coequal to the evil” involved.

Still, the lesson to Trump so far: If lying and stonewalling work, and your own party is too afraid to challenge you, stick with the program.

You might think that Republicans who have made national security their calling card since the Reagan era might finally hit the limits of their cravenness in the face of a whistleblower’s bravery. But the party, our politics and our media system are too broken for the old norms to apply.

Even Republican politicians who know how dangerous this situation is thus prefer to stay in their bunkers and hope to survive. The GOP’s electorate is dominated by Trump’s supporters. Staying mum provides protection from opponents inside their own party — and from their own voters. And if they broke ranks, Trump’s media allies would attack them viciously.

By playing for time, these taciturn Republicans will be able to tell us once Trump is gone how they knew all along just how bad he was.

But when the greatest threat to our country is the corruption of our constitutional system, might at least some of the GOP’s leading politicians decide that there are worse things than losing a primary, or being upbraided by Fox News?

Read more from E.J. Dionne’s archivefollow him on Twitter or subscribe to his updates on Facebook.

Read more:

George T. Conway III and Neal Katyal: Trump has done plenty to warrant impeachment. But the Ukraine allegations are over the top.

The Post’s View: What did Trump tell Ukraine’s president?

Jennifer Rubin: Americans have a right to know if the GOP actually thinks Trump’s conduct is acceptable

Henry Olsen: Giuliani has got to go

Anne Applebaum: Welcome, Americans, to the Ukrainian swamp

The Power of Greta Thunberg’s Stare Down

The 16-year-old climate activist is not alone in waging a generational fight. It’s going to get ugly — just as it should.

Written by Colin HorganFollowSep 24 · 5 min read

A photo of Greta Thunberg at the Climate Action Summit.
Youth activist Greta Thunberg speaks at the Climate Action Summit at the United Nations on September 23, 2019 in New York City. Photo: Stephanie Keith/Getty Images

Greta Thunberg “sells fear.” This, according to climate change skeptic Marc Morano, the so-called “[Matt] Drudge of Denial,” is the real issue that should concern most adults. In an appearance on Fox & Friends on Monday, Morano accused Thunberg of “causing and instilling fear in millions of kids.”

He’s right — at least, in part. Thunberg, the 16-year-old climate activist, whose solo protest outside Swedish parliament last year has helped spark a global movement, does sound a bit scared herself. Her presence on the national stage highlights a gaping divide between generations old and new: On one side, kids are endlessly propped up as totems of a brighter future; on the other is everyone else, who has done little to secure it for them.

It might be Thunberg’s obvious fear that makes her so captivating. After all, fear about climate change is not a difficult idea to sell, if that is all she’s doing (it’s not). By most accounts, it’s likely that things on Earth are going to tip into chaos pretty soon, and before reaching that point, they will continue to get deeply weird: more once-in-a-lifetime storms blowing through every year; more killer heat waves; more glaciers melting into the ocean. We’ve only recently come to terms with just how terrifying that progression will be, not to mention what comes next. Maybe someone should have been selling fear to young people for decades.

As Thunberg noted later Monday in front of an audience at the United Nations, kids themselves are being packaged and sold as tokens. “This is all wrong,” Thunberg told a gathering of world leaders. “I shouldn’t be up here. I should be back at school on the other side of the ocean. Yet, you come to us young people for hope. How dare you?”

Apparently, President Donald Trump wasn’t in the room to hear Thunberg’s remarks in person. He stopped by the UN earlier in the day to listen to Indian Prime Minister Narendra Modi talk about things like clean cooking gas and water conservation, then left. But Trump and Thunberg did cross paths briefly — and a GIF was born.

Thunberg’s probing question of the day — “How dare you?” — doesn’t quite capture the intensity of her piercing stare aimed at the U.S. president. Her glare cuts through a crowded room of reporters and security guards, dressing down Trump from several feet away. But in that split second, the silent, one-sided exchange doesn’t project a sense of anger. What we, as viewers, feel is time; the immense generational gap and all the grandiose expectations, the false hope, and unfairness that it has brought. The difference between them is an entire understanding of the world, of what it means to live today, and of what tomorrow looks like.

Generational fights are nothing new, but in this moment, the stakes feel higher than usual. Climate change is the most pressing matter at hand, but it’s hardly the only issue that inspires existential dread, if not outright fear, in young hearts these days. Beyond the threat of a climate crisis, young people must also wrestle with widening economic inequality and the institutional acquiescence to increasingly racist and exclusionary policies and ideas. There’s plenty in their futures for young generations to worry about.

The climate crisis stands to exacerbate bleak economic trends and introduce new, more complex factors into the mix for millennials and Gen Z. Not being able to afford a house might soon be the least of their worries — the question may be more about how to best move further inland for survival. Rising sea levels could upend real estate as we know it, not to mention the potential mass migration it may cause. Climate change will increase the risk and frequency of extreme weather, and the economic destruction and shock that come with it. As far as jobs — let alone careers — go, it’s anyone’s guess. Even as it stands, young people struggle to achieve upward mobility, often having to opt for tasking work in the gig economy over total unemployment. What of manufacturing? Or global supply chains? Food? Water? It’s going to be chaos.

Unless things change — immediately.

Anyone who sees Thunberg’s stare down and thinks her message is just about the weather is being willfully delusional. She — and the millions who’ve joined her protest in the last year — is asking for something more than action on climate change. She’s asking for quality of life. It’s an entirely reasonable request.

As Thunberg showed Monday, the kids are getting very pissed off.

But she has reason to fear, and to be angry, that it won’t be granted. Kids and young adults — and even those who still remember the 1980s, the oldest millennials — have been raised to believe that the democratic capitalist system we are inheriting has been designed for generational success. What we’re realizing is that promise might have been a half-truth. As it turns out, the system we’re inheriting might have only been designed for one generation’s success — that of our parents and grandparents, not ours. And all you have to do is look around to see that this unfairness is not sitting well. As Thunberg showed Monday, the kids are getting very pissed off.

Over the summer, as Thunberg’s long campaign finally began garnering attention in the United States, Christopher Caldwell took to the pages of the New York Times to outline what he saw as a problem: Thunberg’s age. “Since a 16-year-old is not a legally responsible adult, she cannot be robustly criticized and, even leaving aside her self-description as autistic, Ms. Thunberg is a complicated adolescent. Intellectually, she is precocious and subtle,” Caldwell wrote. “She reasons like a well-read but dogmatic student radical in her 20s.”

It’s a revealing couple of sentences, in that it exposes a special kind of fear. With youth, Caldwell suggests, comes extremism. Caldwell’s column was mostly an unfair and silly dismissal, but he might have been onto something. And he may be right to be scared, because a reckoning is coming. In Thunberg’s stare Monday was the distance between generations, yes, but equally the anger that the separation was allowed to grow so vast. The adults of the world have been so negligent in leaving their kids alone that they’ve (quite literally) exposed them to the elements. How much longer will they stand for it?

Thunberg seems intent on closing that gap. And it isn’t about hoping the adults like Trump, or his generation, come back to the rescue. It’s about making sure their actions catch up with them. If you think you have seen youthful radicalism, just hang on. You ain’t seen nothing yet.

The Relentless Bias Against Donald Trump

Dave Pell, Media

Even after the performance of the last week; the avoidable gaffes, self-inflicted wounds, bad decisions, poor judgment, and utter incompetence, there are still some who argue that there is a vast bias against Donald Trump. Well I’ve got news for them.

They’re right.

Many people and organizations are biased against the president. Understanding that bias gets one a long way towards understanding the massive failure of this presidency.

The media is biased against Donald Trump. He’s earned that bias time and again. He has maligned the media, invented stories, lied during interviews, repeatedly made false claims of false news. He has damaged the reputations of journalists in America and put those abroad at risk with the foolish and reckless decision to label journalists as the enemy of the American people. Every politician knows the first rule of governing is not to make an enemy of the media. It was a stupid move by Trump. The first of many.

Rule two of governing is not to make enemies among the intel community. The intelligence community is biased against Trump. And he’s earned that bias over and over. He has publicly questioned the patriotism of various agencies, and he even compared them to their counterparts in Nazi Germany. These are serious people with serious jobs, who risk their lives to defend the country and maintain the rule of law. Trump is not a serious person. He has treated US intel officials with less respect than he gave to Gary Busey and Dennis Rodman on The Apprentice. Trump stood in front of the CIA wall of honor and bragged about his election win and the size of his inaugural crowd. Add that to that his unwillingness to learn, his wild lack of curiosity and his inability to keep a secret — is it really any wonder that he is hated in this community?

While there is a general bias against Trump among intel agencies, the contempt is especially strong among those in the FBI. Think about it. Trump fired the well-liked head of the agency without even having the guts to tell him to his face. Comey found out about his firing on the TV. These folks always saw Trump as a loose cannon without the chops to run the country, but they may have held out hope that at least some of his supposed chief executive skills would translate to his new gig. They now know that hope was misplaced.

The people in the White House are biased against Trump. While we should give the media some credit for stepping up to history’s challenge, this is not exactly a meeting with Deep Throat in the lower floor of a parking garage situation.The leaks are shooting out of the White House like an Icelandic geyser. They never stop. During Watergate, reporters were told to follow the money. These days, they just have to sit by the phone and wait for White House staffers to call. There are a few key reasons for this. The first is that people in the administration are rightly concerned for the security of the country. The second is that Trump habitually throws his staff under the bus and undermines their credibility by going off script and distracting them from their work with nonsensical digressions and distractions. Trump came into office pretending to be a great job creator. Instead, he will be remembered as a masterful career and reputation killer.

His own people are also biased against him because the buck never stops with him. He never admits being wrong. He throws tantrums and lashes out at staff when there is zero doubt that he is the weak link in his own administration. We’ve never had this kind of a minute by minute view into the workings of a White House. It’s there because Trump is a terrible leader and for the reasons above, no one can stop talking about it.

People in cabinet departments are biased against Trump because he has shown disdain for their work by denying the value of science, research, and knowledge, and repeatedly appointed people who are either unqualified or who have utter contempt for the work these departments are tasked with doing.

One thing all these people have in common is that they are biased against Trump because he lies nonstop. The world doesn’t trust his word, his people don’t trust it, those who cover him don’t trust it. And this is all with good reason. He’s the most active and aggressive liar we’ve ever seen in public life (and that’s a high bar). To make matters worse, even with all the practice, he is really bad at lying.

Finally, Trump himself is biased against his own presidency. He knows he can’t do the job. That is clear because he oozes insecurity, he constantly needs praise, and no one can effectively reassure him that he really deserves the job.

So to those who argue there is a bias against Donald Trump, I say you’re right. It exists because it has been wholly earned. The bias against Trump is ultimately a bias in favor of America. At this point, one can’t be loyal to the president and the country at the same time.

Americans of both parties overwhelmingly support ‘red flag’ laws, expanded background checks for gun buyers, Washington Post-ABC News poll finds

Sarah Parnass, Monica Akhtar/The Washington Post)By Mike DeBonis and Emily Guskin September 9. Rachael Bade, Scott Clement and Beth Reinhard contributed to this report.


 How do Americans feel about guns? Inside the latest Washington Post-ABC News poll a Washington Post-ABC News poll conducted in early September explored Americans’ opinions on gun issues in the wake of several mass shootings. (

Americans across party and demographic lines overwhelmingly support expanded background checks for gun buyers and allowing law enforcement to temporarily seize weapons from troubled individuals, according to a Washington Post-ABC News poll, as President Trump and Republicans face fresh pressure to act.

Although the poll finds a continued partisan divide on more far-reaching gun-control proposals, public opinion is firmly behind Democrats’ push for action as Congress returned to Washington on Monday. More Americans say they trust congressional Democrats over Trump to handle the nation’s gun laws, 51 percent to 36 percent, with independents siding with Democrats by a 17-point margin — a divide that could have political ramifications for the 2020 presidential and congressional elections.

Democrats and allied activists have been trying to kick-start a national push for new federal gun restrictions for weeks, since mass shootings last month in El Paso and Dayton, Ohio. Urgency dissipated as a six-week congressional recess wore on, but a deadly rampage in West Texas on Aug. 31 has reignited the issue.

The Post-ABC poll finds 86 percent of Americans support implementing “red flag” provisions allowing guns to be taken from people judged to be a danger to themselves or others. And 89 percent support expanding federal background checks to cover private sales and gun-show transactions. Both measures are supported by at least 8 in 10 Republicans, white evangelical Christians, members of gun-owning households and other traditionally conservative groups.

More far-reaching restrictions also have majority support, the survey finds, albeit by more-modest margins. Six in 10 support a nationwide ban on gun magazines holding more than 10 rounds of ammunition.

A 56 percent majority supports a nationwide ban on sales of assault weapons, and nearly all who support such a ban also back a mandatory federal buyback program for those weapons — a notion that gun rights advocates have decried as government confiscation and that has been at the fringes of the national gun debate until recently.

Trump has wavered on the issue throughout his presidency, endorsing tough measures after a mass shooting at a Florida high school in February 2018 and then abandoning expanded background checks and other proposals as the powerful National Rifle Association expressed its strong opposition. Late last month, Trump backed away from tougher restrictions, telling NRA chief executive Wayne LaPierre that universal background checks were off the table.

[Trump tells NRA chief that universal background checks are off the table ]

Trump said last week that he expected to present a “package” of proposals, but he suggested that those proposals would be aimed at the mentally ill.

“I support keeping guns out of the hands of sick people,” he said Wednesday, adding that background checks “wouldn’t have stopped any of the last few years’ worth of these mass shootings, which is a problem.”

The House passed two bills expanding federal background checks in February — both face a veto threat from Trump — and party leaders are pushing Senate Majority Leader Mitch McConnell (R-Ky.) to act on them. This week, the House Judiciary Committee is expected to advance a bill encouraging states to create “red flag” laws as well as other gun-control measures.

Although McConnell declined to heed calls from Democrats last month to bring his chamber back from the recess to act on guns, Democrats insist they can persuade Republican leaders to break the cycle of tragedy and inaction.

House Speaker Nancy Pelosi (D-Calif.) and Senate Minority Leader Charles E. Schumer (D-N.Y.) pushed Trump and McConnell at a news conference Monday to bring one of the House-passed background-check bills up for a quick vote, calling it a necessary precursor to any further gun legislation.

“Two people in Washington can make sure the background-checks bill passes: Donald Trump and Mitch McConnell,” Schumer said. “It is on their shoulders. They can’t escape that responsibility.”

McConnell said in a Wednesday interview with radio host Hugh Hewitt that he is looking to Trump to take the lead on any legislation responding to the violence. “If the president is in favor . . . and I know that if we pass it, it’ll become law,” McConnell said, “I’ll put it on the floor.”

He did not address gun legislation Monday in his first remarks on the Senate floor, instead discussing government funding and presidential nominations.

A stark gender divide

The poll finds a stark gender divide on the gun issue. More than two-thirds of women say they are worried about a mass shooting in their communities, compared with just more than half of men. Women are also 20 points more likely than men to be confident that passing stricter gun-control laws would reduce mass shootings.

Women are more than twice as likely to trust Democrats in Congress over Trump to handle gun laws, 59 percent to 28 percent. Men are split more evenly on this question, with 44 percent trusting Trump and 41 percent trusting Democrats.

There are some cautionary signals for gun-control supporters: More than 7 in 10 Americans across party lines are confident that improving mental-health monitoring and treatment would reduce mass shootings, but there is less agreement that passing stricter gun-control laws would do the same. Majorities of Democrats (87 percent) and independents (55 percent) are confident new gun restrictions would have that effect, while a minority of Republicans agree (34 percent).

Support for expanded background checks and a ban on assault-style weapons remains largely at the same level as in early 2013 — during the last major push for congressional action, following a mass shooting at Sandy Hook Elementary School in Newtown, Conn. That push, focused on closing background-check loopholes, failed.

Since then, however, Americans’ anxiety about a mass shooting happening in their communities has ticked up, with 6 in 10 saying they are greatly or somewhat worried about that possibility. A partisan divide on that question has widened: Democrats and independents are more worried now than they were in 2013, while Republicans are less worried.

The Post-ABC News poll was conducted by telephone from Sept. 2 to 5 among a random national sample of 1,003 adults, with 65 percent reached on cellphones and 35 percent on landlines. The margin of sampling error is plus or minus 3.5 percentage points overall and is larger among subgroups.

Since the Sandy Hook tragedy, Democrats have focused on background checks as the most urgent and appropriate response to mass shootings, even though the perpetrators in many incidents purchased their weapons from licensed gun dealers and passed background checks. But House Democrats decided more needed to be done after shootings in Gilroy, Calif., on July 28, El Paso on Aug. 3 and Dayton on Aug. 4.

Besides the red-flag bill, the House Judiciary Committee is expected to advance a proposed federal ban on high-capacity magazines and a third bill that would bar people convicted of misdemeanor hate crimes from being eligible to purchase firearms — measures that go beyond the party’s previous comfort zone.

[House panel’s plans to advance gun-control bills delayed by Hurricane Dorian]

“Democrats understand that gun safety is America’s new kitchen-table political issue, and this is something that you would not have seen just a few years ago,” said Peter Ambler, executive ­director of Giffords, an ­anti-gun-violence group founded by former congresswoman Gabrielle Giffords after she was badly wounded in a 2011 attack that left six others dead.

A growing number of Democrats — and a few Republicans — have signed on to a bill authored by Rep. David N. Cicilline (D-R.I.) reimposing a version of the Federal Assault Weapons Ban that was in place from 1994 to 2004. The House Judiciary Committee will hold a hearing Sept. 25 on the bill — a significant step for Democratic leaders who have long treated an assault-weapons ban as too politically risky. 

In a sign of the changing politics, several of those joining the assault-weapons bill are freshman Democrats who won suburban districts previously represented by Republicans. “I don’t really see any reason for ordinary citizens to own weapons of war,” said Rep. Susan Wild (D-Pa.), who represents a moderate Lehigh Valley district.

Republican reservations

The obstacles continue to be Republicans who argue that the Democratic bills would infringe on law-abiding gun owners’ rights while doing little to prevent the actual causes of mass shootings. That is a perspective shared with a highly motivated slice of the party’s conservative base and promoted by its most aggressive advocacy group, the NRA. 

“My concern is that what’s being proposed is not going to solve the root-cause problem,” Sen. Steve Daines (R-Mont.) told reporters in mid-August when asked about red-flag laws.

But there is a rising concern in the GOP that the party is putting itself at risk if it does not take action to address the bloodshed.

“If we’re not willing to do the common-sense stuff, probably legislation will occur that we’ll regret, that will actually, I think, infringe upon Second Amendment rights down the road, so I’m going to be one that’s going to look to try to do something,” Sen. Mike Braun (R-Ind.) said Friday.

Several Republicans have expressed openness to federal action on red-flag laws, which are also known as “extreme-risk protection orders,” including influential lawmakers such as Senate Judiciary Committee Chairman Lindsey O. Graham (R-S.C.) and Sen. Marco Rubio (R-Fla.).

Daines suggested instead that juveniles who commit serious crimes or make felonious threats be prevented from purchasing weapons as adults — a proposal that is getting serious consideration for inclusion in the White House package.

How should we talk about what’s happening to our planet?

(Barry Falls for The Washington Post)By Dan ZakAugust 27

In the middle of a winter’s night in 2017, Frank Luntz’s cellphone alerted him to a nearby wildfire. The longtime analyst of public opinion opened his bedroom curtains and saw, less than a mile away, flames chewing the dark sky over Los Angeles. Luntz — who specializes in how the public reacts to words — saw scary evidence of a threat that he once tried to neutralize with language. In 2001, he’d written a memo of environmental talking points for Republican politicians and instructed them to scrub their vocabulary of “global warming,” because it had “catastrophic connotations,” and rely on another term: “climate change,” which suggested “a more controllable and less emotional challenge.”

Last month, with a revised script, Luntz appeared before the Senate Democrats’ Special Committee on the Climate Crisis.

“I’m here before you to say that I was wrong in 2001,” Luntz said. Nearby was a colorful chart of vocabulary, developed since his polling in 2009 showed bipartisan support for climate legislation. He went on: “I’ve changed. And I will help you with messaging, if you wish to have it.”

Don’t talk about threats, he told the senators. Talk about consequences.

Don’t talk about new jobs created by green energy. Talk about new careers.

And sustainability?

“Stop,” Luntz said. “Sustainability is about the status quo.”

Even the committee’s name had a troublesome word in it: “crisis.” It’s flabby from overuse, Luntz thought. If everything is a crisis, then nothing is.

From a word standpoint, that’s true. And sometimes it feels true in the real world. The phone in your hand has become a police scanner of unfolding crises. The Kashmir crisis, the Hong Kong crisis, the border crisis, the trade crisis, the measles crisis. The crisis of mass shootings, of the national debt, of Puerto Rico, Brexit, the Amazon. And, yes, the climate crisis, formerly climate change — somehow the least tangible but most alarming of the crises, which makes it trickier to talk about.

Those who are talking about it have ratcheted up their rhetoric. In May, the Swedish activist Greta Thunberg ditched “climate change” for “climate breakdown” or “climate emergency.” The Guardian now uses “climate catastrophe” in its articles. A resistance movement born in Europe last year named itself Extinction Rebellion, partly to normalize the notion of aggressive action in a life-or-death situation.

Luntz wants defter language. “The strongest advocates for a particular issue are often the worst communicators,” he says later by phone, because “they forget that the people they need to convince are not themselves or their friends.”

The climate problem is not just scientific. It’s linguistic. If we can agree how to talk and write about an issue that affects us all, maybe we can understand and fix it together.

But words can be clumsy tools. They can be too dull to puncture ignorance, or so sharp that people flinch and turn away. Is “change” appropriately neutral, or unjustlyneutered? Is an “emergency” still an “emergency” after months or years? Does “catastrophe” motivate people, or make them hide under the bed? How long before words such as “breakdown” and “extinction” lose their bite?

And if we keep returning to the dictionary for new words to replace them, will there eventually be any left?

The second volume of the fourth National Climate Assessment is 1,515 pages long. The word “likely” appears 867 times, sometimes after “very” or “extremely.” Last spring, as they distilled data into text, the scientists who wrote the report spent long hours debating the usage of “likely.”

Without significant action to curb climate change, they wrote in the final chapter, “it is very likely that some physical and ecological impacts will be irreversible for thousands of years, while others will be permanent.”

When translated to conversational English, “very likely” becomes “this is something really bad and totally crazy and wild,” says one author of the report, who spoke on the condition of anonymity to discuss internal deliberations.

“Why don’t we use plain language and say, ‘Yes, this is crazy and, yes, you should be freaking out’? Because that’s not fair. That’s not the role of the National Climate Assessment,” the author says. “But then we sort of fail as a community in actually getting people to understand the severity of it.”

The science community is supposed to interpret for the rest of us, but its dialect does not always pack rhetorical oomph. “I didn’t realize that pointing to a climate graph I think is the Rosetta stone — people don’t see it the way I see it,” says Brenda Ekwurzel, director of climate science for the Union of Concerned Scientists. “We as humans don’t experience an exponential curve viscerally, in our gut.”

In the industrial age, environmentalist writers have tried to access the brain via the gut. “Thank God men cannot fly, and lay waste the sky as well as the earth,” Henry David Thoreau wrote in the 19th century. In the 1960s, Rachel Carson envisioned an ecosystem silenced by chemicals: “Everywhere was a shadow of death.” In the 1980s, as global warming was first debated widely, Bill McKibben pondered “the end of nature” itself.

But “there’s a point at which words like ‘climate change’ become part of your mental furniture,” McKibben says in an interview. “Like ‘urban violence’ — things that are horrible problems but you just repeat the thing so often that people’s minds kind of skip over them.”

Terms lose their power as they get used over many years, says Anthony Leiserowitz, director of the Yale Program on Climate Change Communication, and “come to accrete their own set of connotations.”

Such as: elitist, liberal, socialist. When thousands of pages of analysis become a two-word slogan, it passes from science to politics. Facts become less important than feelings. For some people, “climate change” is a wedge word synonymous with “hoax” and calls to mind former vice president Al Gore. For others, it summons the specter of ExxonMobil and is a rallying cry for restructuring the global economy.

[Al Gore is near the end of his quest to save the Earth. Nina Barrett just got started.]

“The facts do not speak for themselves,” says Richard Buttny, a professor in the department of communication and rhetorical studies at Syracuse University. “People make decisions based on values.”

And therein lies an opportunity, according to Kim Cobb, professor of earth and atmospheric sciences at Georgia Tech. Scientists observe and publish findings for the public, Cobb says, but then often fail to “recognize the emotional toll this takes on the recipient and the challenge to their core values.”

Cobb refrains from using words such as “crisis” and “emergency” on Twitter, where the character limit discourages context and nuance. Instead, she elevates language about solutions, and about the emotions triggered by the science, in the hopes of widening the circle of understanding.

“We’re way behind creating these communities for shared values and shared goals,” Cobb says. “And from that comes shared language.”

We are gradually building that language to talk about where we are, where we’re going and about the emotions that accompany that knowledge.

The Germans have a word for feeling guilty about flying on airplanes: “flugscham,” or “flight shame.”

The biologist Edward O. Wilson has a word for a future epoch following a profound loss of species: “the Eremocine,” or “the Age of Loneliness.”

Karla Brollier, founder of the Climate Justice Initiative, is listening to her fellow indigenous Alaskans as their language evolves to include loss and adaptation, without relying on words such as “climate refugee” that connote victimhood.

Jennifer Atkinson’s students at the University of Washington at Bothell have used “blissonance” to describe the feeling of enjoying a record-hot day in winter — while recognizing that climate change might have something to do with it.

“Solastalgia,” coined by environmental philosopher Glenn Albrecht, means distress over change in one’s home environment. Atkinson phrases it as a homesickness without ever having left home.

Her students “describe how the sound of frogs has slowly disappeared over time — these changes that destabilize connections to personal memories,” says Atkinson, a senior lecturer at Bothell. “Unlike with personal bereavement, we don’t have a vocabulary for the grief people have for the loss of the natural world.”

Her course is called “Environmental Anxiety and Climate Grief.” One of the goals is to search for ways of communicating outside the bounds of science and its “value-neutral” vocabulary — all those likelys and somewhat likelys.

[‘Everything is not going to be okay’: How to live with constant reminders that the Earth is in trouble]

“We’re moving into an age of great earnestness, because we’re trying to figure out, ‘How do we show up for each other?’ ” says Sarah Myhre, a climate and ocean scientist who has studied social and ecological decision-making. “And the language that’s being used in my spaces is all about heart-centered work.”

Whereas Frank Luntz once tried to strip the climate problem of emotional resonance, Atkinson, Myhreand others are acknowledging and amplifying it. Whereas science has traditionally been guided by dispassionate, male-centric authority, women are rewording climate conversations to honor the collective, connective nature of the problem.

And how we talk about the environment affects how we think about it. In the colonial and industrial ages, Myhre says, our language reflected an idea of the natural world as an inventory of useful commodities — separate from, and subservient to, humanity.

Trees became timber.

Animals became livestock.

Oil and coal became fuels.

And thus a cultural problem has given birth to an environmental one, says Daniel Wildcat, a professor at Haskell Indian Nations University in Kansas.

“Think of how our worldview changes if we shift from thinking that we live in a world full of resources,” he says, “to a world where we live among relatives.”

Protesters block the street as they gather for a demonstration organized by Extinction Rebellion outside the Brazilian embassy in London on Aug. 23. (Isabel Infantes/AFP/Getty Images)

In June, the White House slashed its red pen through certain labels in written congressional testimony from a State Department analyst. When the analyst used “possibly catastrophic” to describe the future impacts of climate change, a member of the National Security Council typed a note in the margin: “not a science-based assessment but advocacy for the climate-alarm establishment.”

The analyst listed “tipping point processes” on a page that was entirely crossed out. A note in the margin: “ ‘Tipping points’ is a propaganda slogan designed to frighten the scientifically illiterate.”

Some activists believe fright is appropriate, and they’re eager to use keener language than “tipping points” to do it.

“We’ve been told for years: ‘Don’t scare people, people don’t want to know the bad news’ — and all that’s meant is nothing’s changed,” says Charlie Waterhouse, founder of the company behind Extinction Rebellion’s branding. “We know that we have to up the ante, and we have to have a more extreme position because that opens that crack that lets other people follow.”

The word “extinction” is a blunt instrument that whacks at complacency.

The word “rebellion” invites enlistees and subverts established power structures.

But this “constant inflation” in terminology hampers rational discussion, says the Danish author Bjorn Lomborg, whose skeptical writings on the economics of climate action have riled scientists and activists. Words such as “catastrophe” and “extinction” imply that we should either cower and do nothing, or overreact and do everything, says Lomborg, who is president of the Copenhagen Consensus Center.

“The conversation we should have is: How do we make smart policies that cost less than the damage they reduce?” Lomborg writes in an email. “Climate policy shouldn’t be done with labels but with careful analysis.”

We don’t need labels as much as we used to, back when the effects of climate change were forecast instead of seen and felt.

[Extreme climate change has arrived in America]

“In a certain sense, words are no longer as necessary as they once were,” says McKibben, author of “The End of Nature.” “Twenty or 30 years ago we were describing things that hadn’t happened yet, so you couldn’t take a picture of them. Now every single day you can take 1,000 pictures around the world of the trauma of climate change.”

Nearly two decades after Frank Luntz recommended it, “climate change” may still be the closest thing to a shared language that Americans have for describing what’s happening to the planet. But we diverge from there. Scientists speak about consequences. Activists speak about crises and catastrophes. Politicians speak about doubt and propaganda. And if you’re paying attention, you’ll hear nature speaking loudly for itself.

Why Trump Supporters Believe He Is Not Corrupt

What the president’s supporters fear most isn’t the corruption of American law, but the corruption of America’s traditional identity

The AtlanticFollowAug 22, 2018 · 3 min read

Photo: MANDEL NGAN/AFP/Getty Images

By Peter Beinart

On Wednesday morning, the lead story on was not Michael Cohen’s admission that Donald Trump had instructed him to violate campaign-finance laws by paying hush money to two of Trump’s mistresses. It was the alleged murder of a white Iowa woman, Mollie Tibbetts, by an undocumented Latino immigrant, Cristhian Rivera.

On their face, the two stories have little in common. Fox is simply covering the Iowa murder because it distracts attention from a revelation that makes Trump look bad. But dig deeper and the two stories are connected: They represent competing notions of what corruption is.

Cohen’s admission highlights one of the enduring riddles of the Trump era. Trump’s supporters say they care about corruption. During the campaign, they cheered his vow to “drain the swamp” in Washington, D.C. When Morning Consult asked Americans in May 2016 to explain why they disliked Hillary Clinton, the second-most-common answer was that she was “corrupt.” And yet, Trump supporters appear largely unfazed by the mounting evidence that Trump is the least ethical president in modern American history. When asked last month whether they considered Trump corrupt, only 14 percent of Republicans said yes. Even Cohen’s allegation is unlikely to change that.

The answer may lie in how Trump and his supporters define corruption. In a forthcoming book titled How Fascism Works, the Yale philosophy professor Jason Stanley makes an intriguing claim. “Corruption, to the fascist politician,” he suggests, “is really about the corruption of purity rather than of the law. Officially, the fascist politician’s denunciations of corruption sound like a denunciation of political corruption. But such talk is intended to evoke corruption in the sense of the usurpation of the traditional order.”

Fox’s decision to focus on the Iowa murder rather than Cohen’s guilty plea illustrates Stanley’s point. In the eyes of many Fox viewers, I suspect, the network isn’t ignoring corruption so much as highlighting the kind that really matters. When Trump instructed Cohen to pay off women with whom he’d had affairs, he may have been violating the law. But he was upholding traditional gender and class hierarchies. Since time immemorial, powerful men have been cheating on their wives and using their power to evade the consequences.

The Iowa murder, by contrast, signifies the inversion — the corruption — of that “traditional order.” Throughout American history, few notions have been as sacrosanct as the belief that white women must be protected from nonwhite men. By allegedly murdering Tibbetts, Rivera did not merely violate the law. He did something more subversive: He violated America’s traditional racial and sexual norms.

Once you grasp that for Trump and many of his supporters, corruption means less the violation of law than the violation of established hierarchies, their behavior makes more sense. Since 2014, Trump has employed the phrase rule of law nine times in tweets. Seven of them refer to illegal immigration.

Why were Trump’s supporters so convinced that Clinton was the more corrupt candidate even as reporters uncovered far more damning evidenceabout Trump’s foundation than they did about Clinton’s? Likely because Clinton’s candidacy threatened traditional gender roles. For many Americans, female ambition — especially in service of a feminist agenda — in and of itself represents a form of corruption. “When female politicians were described as power-seeking,” noted the Yale researchers Victoria Brescoll and Tyler Okimoto in a 2010 study, “participants experienced feelings of moral outrage (i.e., contempt, anger, and/or disgust).”

Cohen’s admission makes it harder for Republicans to claim that Trump didn’t violate the law. But it doesn’t really matter. For many Republicans, Trump remains uncorrupt — indeed, anticorrupt — because what they fear most isn’t the corruption of American law; it’s the corruption of America’s traditional identity. And in the struggle against that form of corruption — the kind embodied by Cristhian Rivera — Trump isn’t the problem. He’s the solution.

Conversion therapy center founder who sought to turn LGBTQ Christians straight says he’s gay, rejects ‘cycle of self shame’

 Add to list

Pedestrians cross an intersection near the Stonewall Inn in New York City during the LGBTQ Pride parade in June. (Frank Franklin II/AP)By Marisa IatiSeptember 3

McKrae Game wants people to know that he was wrong about all of it.

He was wrong to found Hope for Wholeness Network, a faith-based conversion therapy program that seeks to rid people of their LGBTQ identities. He was wrong to create a slogan promoting the idea of “freedom from homosexuality through Jesus Christ.” He was wrong to tell people they were doomed for all eternity if they didn’t change their ways.

After 20 years working in that field, Game said he realizes the harm he has caused and that he, himself, is gay. Conversion therapy encompasses a widely discredited range of methods that purport to change someone’s sexual orientation or gender identity. The practice is illegal in 18 states and the District.

“It’s all in my past, but many, way TOO MANY continue believing that there is something wrong with themselves and wrong with people that choose to live their lives honestly and open as gay, lesbian, trans, etc.,” Game, 51, wrote on Facebook last week. “The very harmful cycle of self shame and condemnation has to stop.”

Hope for Wholeness, based in South Carolina and known as one of the nation’s most prominent conversion therapy centers, did not respond Tuesday to requests for comment.

Game is among many founders and leaders of conversion therapy programs to disavow the practice later. In 2014, nine former “ex-gay” leaders signed an open letter denouncing conversion therapy as “ineffective and harmful” and calling for an end to it. A Latter-day Saint counselor who practiced conversion therapy said in January that he is gay and that he “unequivocally renounces” ex-gay ministry.

[To some, this queer couple look straight. For him, that’s okay. But for her, it feels ‘like a lie.’]

Game announced in June that he was gay, almost two years after Hope for Wholeness’s board of directors fired him, the Post and Courier reported. In his Facebook post, he said all conversion therapy programs should be closed, but that he would support them becoming support groups for people who believe being LGBTQ is incongruous with their faith.ADVERTISING

“I was a religious zealot that hurt people,” Game told the Post and Courier. “People said they attempted suicide over me and the things I said to them. People, I know, are in therapy because of me. Why would I want that to continue?”

In a Facebook Live video posted Tuesday, Game said he decided to tell people he was gay because he was scared that someone would “out” him — reveal his sexual orientation — and he wanted to control his own story. He said he slowly hinted on Facebook that he was attracted to men.

Game said he is currently doing yard work and that his wife has been “ridiculously understanding” of his coming out. The couple has two children. He said some people, including Christians and LGBTQ advocates, have expressed anger against him.

“I can see how my life could have been used manipulatively, and I’m very sorry for that,” Game said. “How can I count all the ways I did wrong? I don’t know that I can. But I’ve tried, and I’m trying.”

Leaders of conversion therapy programs rarely renounce the practice publicly because doing so involves turning their backs not just on the ex-gay community, but also on conservative faith as a whole, said Alan Chambers, the former president of Exodus International. Exodus was the world’s largest conversion therapy ministry until Chambers shut it down in 2013 and apologized to the LGBTQ community.

[There’s no one ‘gay gene,’ but genetics are linked to same-sex behavior, new study says]

“Oftentimes, not only do you lose the relationships of people in the community that you’ve been in, but you lose your church,” Chambers told The Washington Post. “Sometimes you lose your family. Sometimes you lose everything.”

Chambers, who said he is “a gay man married to a straight woman,” said his decision to reject conversion therapy developed slowly over decades. He said he was particularly struck by the devastated reactions he saw to California’s passage of the now-defunct Proposition 8, a constitutional amendment that in 2008 banned same-sex marriage there. Chambers now advocates for an end to conversion therapy for minors and for including LGBTQ people in faith communities.

Mel White, a former ghostwriter for high-profile evangelical Christians, describes himself as “a victim of the ex-gay movement.” White said that when he was married to a woman and believed his same-sex attractions were sinful, he tried every kind of conversion therapy in the book: He took cold showers, subjected himself to electric therapy and got an exorcism. He and his wife paid more than $1,000 for the treatment, he said, and none of it worked.

Eventually, White said he couldn’t live that way anymore. He and his wife divorced, and he has been married to a man for 37 years. He said he eventually came to believe that God loves him exactly as he was created, and he stopped ghostwriting autobiographies for the likes of Jerry Falwell and Billy Graham.

White said he believes Christianity is the greatest source of suffering for LGBTQ people, and he co-founded the organization Soulforce to combat what he sees as this oppression. The organization promotes nonviolent resistance to religious fundamentalism.

After spending years working with the conservative Christian right, White said he has “spent the rest of my life trying to redeem myself from having anything to do with that ex-gay system.”