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'I can see the difference in her': Fear of Medicaid cuts looms at school that serves disabled students

By Mandy McLaren
'I can see the difference in her': Fear of Medicaid cuts looms at school that serves disabled students
Physical therapist Lauren Fery spots student Kamille Davis as she climbs up the playground ladder at St. Coletta. MUST CREDIT: Washington Post photo by Calla Kessler.

WASHINGTON - With a mailbag slung across his small frame and a wide-brim hat perched atop his head, Mason Wade stepped up to the catwalk. Clasping his aide's hand for support, he sashayed across the gym, a sprawling red carpet under his feet.

For the 6-year-old dressed as a mail carrier, his favorite community helper, the end-of-year fashion show at St. Coletta Special Education Public Charter School in Southeast Washington was a chance to strut his stuff. For the school-based therapists looking on, it was a moment years in the making.

Mason, who has a developmental delay, used a wheelchair when he started at St. Coletta in 2015. Hundreds of physical therapy sessions and oodles of enthusiasm later, Mason is walking, able to traverse the school's black-and-white-tiled hallway with the support of an adult.

At St. Coletta, where all students have special needs, tiny pieces of progress can add up to life-changing trajectories. The school relies on funding from Medicaid to employ a cadre of therapists. But with each twist in the health-care debate on Capitol Hill, staff members wonder whether their Medicaid dollars could be at risk.

Pride for student achievement is shadowed by anxiety over the unknown.

"We would not rest easy if we knew we couldn't provide the appropriate services for our kids," said Loni Licuanan, who directs the school's therapeutic services.

The federal government allows public schools to receive Medicaid reimbursement for school-based health services required through students' special education plans. Although federal law mandates that schools provide these services, Congress has never authorized the amount of funding it pledged when the law was passed decades ago. To make up that budget gap, schools have turned to Medicaid.

The District of Columbia, which expanded Medicaid coverage in 2010 under the Affordable Care Act, received more than $40 million in Medicaid reimbursements for special-education services during the last fiscal year, according to the Office of the State Superintendent.

Cuts to Medicaid would affect schools across the District, but St. Coletta would be especially hard-hit. Each of the school's 250 students is intellectually disabled, and most require multiple types of therapy.

During fiscal 2016, St. Coletta provided more than $1 million in special-education services to Medicaid-eligible students. The school was reimbursed for 70 percent of the cost through Medicaid, which helps pay the salaries and benefits of 35 service providers, including physical therapists, occupational therapists and speech-language pathologists.

Overall, Medicaid reimbursements account for only 5 percent of St. Coletta's annual budget, but the school says those funds - more than $750,000 annually - make it possible to provide services not available at other public schools in the city.

In addition to weekly one-on-one sessions, St. Coletta students have therapy as part of their daily routines. Bathroom breaks are used as skill-building opportunities, from support walking across the hall to guidance in using a toilet independently. At lunchtime, where feeding and swallowing can be arduous for some students, therapists assist.

Antoinette Davis of Southwest Washington said school-based therapy has given her daughter, Kamille, the confidence to make new friends and to climb the spiral stairs in the family's duplex.

Kamille, 6, has Smith-Magenis syndrome, a rare genetic disorder that can cause delayed speech. As a toddler, she was nonverbal. Unable to express herself, she resorted to self-harm, scratching her arms and banging her head, Davis said.

"She would get mad and frustrated because we didn't know what she wanted," she said.

Since enrolling at St. Coletta two years ago, Kamille has learned to use a specialized tablet to communicate her needs and to show what she's learned.

"She knows her colors, the alphabet, how to spell her name," Davis said. "I can see the difference in her."

Located across from the D.C. Armory, St. Coletta educates students until they turn 22. Because of the severity of students' disabilities, there are no grade levels. Students are separated by age.

Brandon Walker, 20, is a member of the school's oldest group. A student at the school for more than a decade, he is unable to walk or speak. It took a team of therapists years to find a communication system that worked for him, said Katherine Short, the school's therapy coordinator.

Walker uses eye-tracking technology to communicate. A camera inside a tablet-like device mounted to his wheelchair monitors his eye movements back and forth, as one might a cursor moving across a computer screen. When his eyes dwell on an image for one-sixth of a second, the machine says the chosen word for him.

Using the device, Walker can tell his teacher when he's hungry, tired or in the mood to listen to his favorite jazz music. And, for the first time, he can engage socially.

The technology, purchased by his family through Medicaid, "gives him access to his world, access he never had before," said Short, a speech language pathologist.

According to a report from the Office of the D.C. Auditor, the District would lose $563 million in federal funds for Medicaid in the first year and up to $1 billion annually by 2028 if Congress were to repeal the Affordable Care Act.

If the federal government reduces its share of Medicaid spending, schools might have to compete with other medical providers, including hospitals and nursing homes, for limited resources, said John Hill, executive director for the National Alliance for Medicaid in Education.

"There's going be losers, and it will be up to the states to decide who those losers are going to be," he said.

For Sharon Raimo, St. Coletta's chief executive, that prospect can be maddening.

Raimo, who helped found the school in 2006, said any threat to her students' safety net is worrisome. Medicaid cuts, in particular, would be shortsighted, she said.

"When these kids attain these goals, it makes them easier to take care of at home, rather than being placed outside of the home, which is much more expensive," she said.

St. Coletta already fundraises for many of its needs and would seek additional support from donors if necessary.

"These are the people who make my heart beat faster," she said. "Everybody here who does this work, we do it because we care about them and we really think they have potential."

How doctors used virtual reality to save the lives of conjoined twin sisters

By Peter Holley
How doctors used virtual reality to save the lives of conjoined twin sisters
Doctors were given a 3-D model of Paisleigh (red and blue) and Paislyn's (purple) hearts to help them prepare for surgery. MUST CREDIT: Photo courtesy of University of Minnesota

During an 18-year career in medicine, Daniel Saltzman -- the chief of pediatric surgery at University of Minnesota Masonic Children's Hospital -- has grown accustomed to looking at X-rays as if they were imperfect road maps of the human body.

He compares this exercise to looking at a one-dimensional traffic map on your smartphone and thinking about that image in three-dimensional terms in your mind.

Like any other road map, an X-ray image is an incomplete reduction of reality that can misrepresent challenges or include distortions, which explains why, even in 2017, high-stake surgeries can involve a shocking degree of guesswork and improvisation.

"That's why medicine is still an art as much as a science," Saltzman told The Washington Post.

For decades, increasingly sophisticated imaging techniques have allowed doctors to peer into the human body before they cut it open, reducing uncertainty and helping them prepare for complicated procedures. Now, advances in virtual reality may flip that dynamic on its head, allowing doctors to confront the unknown before they evenenter the body.

The latest evidence of this revolutionary shift in health care is the successful separation of two conjoined newborn sisters in Minnesota. Until their separation in May, Paisleigh and Paislyn Martinez were attached from their lower chest to their bellybuttons -- a condition known as thoraco-omphalopagus. Both babies survived the dangerous, nine-hour procedure, a development that Saltzman and other surgeons involved link directly to their use of virtual reality before surgery.

"It felt like I was working in the future," Saltzman said. "It was extraordinarily exhilarating."

Conjoined twins are extremely rare, occurring as infrequently as one of 200,000 live births to up to one in a million births, depending on how the babies are attached, according to University of Minnesota doctors.

Separating them is a risky procedure, though survival rates differ depending on how the siblings are connected and which organs they share, according to the University of Maryland Medical Center. The Medical Center notes that twins "joined at the sacrum at the base of the spine have a 68 percent chance of successful separation, whereas, in cases of twins with conjoined hearts at the ventricular (pumping chamber) level, there are no known survivors." In the latter case, the hearts are completely joined.

Experts said they were unaware of any other example of virtual reality being used to prepare for the separation of twins partially conjoined at the heart. Virtual reality has been used to assist in the separation of twins conjoined at the head on three occasions, two of which were carried out by Housing and Urban Development Secretary Ben Carson, experts said.

Anthony Azakie -- chief of pediatric cardiac surgery and co-director of the Heart Center at the University of Minnesota Masonic Children's Hospital -- called the university's procedure a "once-in-a-lifetime event."

Using goggle-like virtual reality headsets a month before surgery, Saltzman, Azakie and their team were able to explore a 3-D model of the twins' hearts, virtually embedding themselves inside the walnut-sized organs as if the infant's anatomy had been blown up to the size of a living room.

"It's completely surreal and the resolution is unbelievable," Azakie said. "T he details are absolutely superb."

The experience was not only riveting but revelatory, doctors said, so much so that the stunned surgeons decided to alter their entire operative strategy. Within minutes after strapping on the headsets, Saltzman and Azakie discovered something unexpected: new connective tissue -- a "bridge" -- linking the girls' intertwined hearts, one of which had become heavily reliant upon the other to filter impurities and remain beating because of a severe congenital heart defect.

That defect meant that the lives of both babies were in jeopardy and doctors would have to conduct the surgery several months early, before the twins were as robust and healthy as doctors had hoped they'd be.

Standing inside the 3-D rendering of the infants' hearts, the challenge before the physicians was daunting. They realized that improperly severing that connection could lead to the twins bleeding to death. Placing pressure on the hearts could cause blood loss or arrhythmia so severe that the organs could stop beating entirely. They needed to find a way to navigate around the connection that didn't damage each delicate organ.

The team members interacted with the 3-D model using a "track system" that allowed them to turn their heads without distortion. Doctors said the ease of the virtual interaction helped the team arrive at a simple yet elegant solution, which they drew on a whiteboard moments later. The surgeons decided to flip the babies around on the operating table so that the procedure occurred from the opposite angle. In the end, doctors said, the straightforward solution to a complicated quandary may have saved the twins' lives.

"In our line of work -- especially in pediatric cardiac surgery -- it's important that one is able to think on their feet and plan for the unexpected," Azakie said. "The imaging helped us prepare by developing an approach in the event that we came across something we didn't expect.

"It was like the Oculus Rift of pediatric heart surgery."

The planning effort to get to that point was methodical, with weekly meetings, endless tests and trialruns with a team of nearly 50 hospital staffers who practiced each stage of the surgery using baby dolls that had been sewn together.

To create the virtual model of the infants' hearts, Saltzman and Azakie and other team members partnered with the University of Minnesota's Earl E. Bakken Medical Devices Center, where experts used software to turn MRI's and CT scans from both infants into a detailed virtual model. The university's Visible Heart Lab also created a 3-D printed model of the hearts using a printer purchased online for $300.

Bethany Tourek, a PhD candidate in the University of Minnesota's department of mechanical engineering, said watching the medical team experience the virtual heart for the first time was a seminal moment.

"My favorite part was actually watching these four medical doctors standing inside this screen and being in complete silence at first," Tourek said. "You could just see them thinking and processing and taking it all in for the first time. It was a wonderful experience."

Two months after their separation, the twins are still recovering, but doctors say that they'll lead healthy, independent lives, with a scar on their chests the only evidence that they were ever conjoined.

Doctors said they expect the 3-D modeling and imaging used to see the twins' anatomy to appear in medical journals, setting a precedent for surgeries that ripples beyond procedures involving conjoined twins.

"Separating these infants was no small feat," he said. "The fact that we got to do it using virtual reality for direct patient care makes that feat truly incredible."

_ _ _ _

VIDEO:

Daniel Saltzman of the University of Minnesota used virtual reality to enhance the size of organs to help assist making incisions to separate conjoined twins. (Courtesy of the University of Minnesota)

URL: http://wapo.st/2tiPMyc

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Beer-swilling Vietnam plans stake sales as top brewers swoop

By Luu Van Dat, et al.
Beer-swilling Vietnam plans stake sales as top brewers swoop
Customers sit eating and drinking over crates featuring branding for Heineken and Tiger beers at an outdoor restaurant in the Old Quarter of Hanoi, Vietnam, on Feb. 22, 2016. MUST CREDIT: Bloomberg photo by Maike Elan.

Ho Chi Minh called alcohol a poison peddled by French imperialists. Half a century later in the Vietnamese city that bears the revolutionary founder's name, young women in short skirts haul cases of Tiger Beer and buckets of ice to wooden tables crowded with young men.

"Drinking beer is essential in Vietnam," shouts Nguyen Nhat Truong, a 26-year-old researcher, over techno music. He and his friends are regulars at "123-Zo" - an outdoor eatery in suburban Ho Chi Minh City named after a regional refrain for "bottoms up!" Here glass-mugs of lager cost less than 50 cents. "We have a lot of free time and there isn't a lot of other entertainment, so we drink beer."

Vietnam, where a beer-swilling culture is stoking concern about binge-drinking, will be "the next key battleground for brewers," market researcher Euromonitor International said in a report this month. The planned sale of the government's majority stakes in the nation's two largest domestic beer companies leaves "wide open" the door for foreign rivals, it said.

"There aren't many markets left that have the growth potential Vietnam has," said John Ditty, managing partner of KPMG Vietnam's deals advisory unit.

Sabeco, from Ho Chi Minh City, and Hanoi-based Habeco will submit plans to the government this month for the process, with the stakes slated to be sold later this year, an official at the Industry and Trade Ministry told local media last week. The stake-sales will create an opportunity for international companies to expand geographically, especially those still without a presence in Vietnam, Ditty said.

An expanding Vietnamese middle class and youthful population helped drive a 300 percent surge in beer demand since 2002, according to Euromonitor, which estimates the market was worth 147.2 trillion dong ($6.5 billion) in 2016. It predicts per-capita consumption will reach 40.6 liters (11 gallons) this year, making Vietnam the biggest consumer of the amber fluid in Southeast Asia.

"Vietnam will be the market to watch," Euromonitor said in a July report on the beer market in the Asia-Pacific region. "Thanks to the strong street consumption culture and rapid urbanization, Vietnam is forecast to see the largest volume growth over 2016-2021."

As competition intensifies among brewers, more aggressive promotions and new product launches will lead to even higher demand for beer, the report said. The Netherlands' Heineken NV and Denmark's Carlsberg have been fighting for share in Vietnam, driving beer sales "through the roof," it said.

Heineken, Anheuser-Busch InBev, and Japan's Asahi Group Holdings and Kirin Holdings are among about half a dozen foreign companies that registered interest in a Sabeco stake, its former chief executive officer Le Hong Xanh said Thursday.

"Asia and Oceania are the focus markets for our company, and we are interested in investing in Vietnam as we see growth in the market," said Naomi Sasaki, a spokeswoman for Kirin Holdings in Tokyo.

Asahi Group continues to be interested in acquiring shares in the Vietnamese brewer, said Takuo Soga, a spokesman for the Tokyo-based company. Heineken doesn't comment on speculation, said Michael Fuchs, a company spokesman.

"AB InBev is committed to Vietnam and to growing our business for the long-term," said Marianne Amssoms, the company's New York-based vice president of global communications, adding that it doesn't comment on "rumors or speculation."

The Ministry of Industry and Trade valued its 89.59 percent share of the nation's top beer-maker, also known as Saigon Beer Alcohol Beverage Corp., at $1.8 billion last August. The government's 82 percent holding in Habeco, or Hanoi Beer Alcohol Beverage Corp., was worth $404 million, the ministry estimated.

Sabeco shares have increased 11 percent in the past week on news of the timing of the privatization process, while Habeco has jumped 8.7 percent. Carlsberg, which owns 17.51 percent of the Hanoi-based brewer and says it has a first right of refusal for the stake, has been in tense talks with the Ministry of Industry and Trade about the sale.

"We are hunting to get it," Carlsberg President and Chief Executive Officer Cees't Hart said of the Habeco stake on a conference call with analysts and investors in May after three trips to Vietnam in the previous six weeks.

The Danish company's share of the Vietnamese beer market by volume has slipped the past four years as Heineken expanded, Euromonitor data show. The Dutch brewer's 2016 sales volumes jumped at least 10 percent, spurred by Tiger Beer, Chairman and Chief Executive Officer Jean-Francois van Boxmeer told the company's annual shareholders meeting in April. Vietnam drove an almost 27 percent surge in operating profit from the Asia region, he said.

Vietnam will represent half of Sapporo Holdings's overseas beer sales in the next decade, according to Mikio Masawaki, general director of Sapporo's Vietnamese brewing unit, which began about six years ago. Annual beer consumption will probably eclipse Japan's 6 billion liters in a few years, he said.

It wasn't always like this. Revolutionary Minh criticized French colonizers' efforts to "weaken our race" with alcohol in Vietnam's 1945 Declaration of Independence. Now, the country's communist leaders see the potential to capitalize on the popularity of booze. At the same time, officials are recognizing the trade-off with public health.

About a third of men and two-thirds of women in Vietnam are lifetime alcohol abstainers, according to the World Health Organization. The men who do drink, tend to drink a lot and 8.7 percent suffer some form of alcohol dependence or disorders, compared with 4.6 percent across the Western Pacific region.

The government is now trying to slow the liquor flow. A special consumption tax aims to increase the excise tax rate on beer annually to reach 65 percent in 2018. The National Assembly is considering proposals to turn off beer taps during lunch hours and the late evening. It's also weighing whether to prohibit the sale of alcohol to pregnant women and to ban government employees from drinking during work hours.

"There often is tremendous pressure from the financial side - both within and outside the government - to grow the market," said David Jernigan, director of the Center on Alcohol Marketing and Youth at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. The school was renamed in 2001 in honor of Bloomberg LP founder Michael Bloomberg, a major donor.

"The revenues are very visible, but the costs are much less visible: increased drinking and driving, increased alcohol-related violence, domestic violence, suicides, drownings," Jernigan said.

Even if the government does tighten alcohol regulations and curbs beer sales, foreign investors won't be deterred, KPMG's Ditty said. "Every global company involved in the alcohol industry is extremely conscious of responsible drinking," he said.

For now, the amber liquid is being poured unabated.

At 11 a.m. on a July Friday the tables were filling up at Lan Chin, a restaurant serving 5-liter chilled glass containers of bia hoi, or fresh beer. The eatery, located across the street from an office of the Hanoi People's Committee and about 3 kilometers (2 miles) from the Ho Chi Minh Mausoleum, draws government officials and workers until 2 p.m. before overflowing again in the evening.

"When we drink beer, we feel relaxed," said loan officer Nguyen Nam, 27, sitting at a long table covered with plates of chicken, pork, vegetables, and beer glasses. "I can still work in the afternoon even though I am a little bit tipsy, but some people need naps."

At night, Vietnamese flock to street-side establishments with plastic chairs and young female beer attendants in form-fitting dresses displaying the logos of local and international brewers.

Business is conducted amid clinking beer mugs, with each downed glass moving the meeting closer to a deal, said Hanoi banker Nguyen Phu Quy, 26, gulping beer and vodka chasers with colleagues.

"I learned this from my bosses and my bosses learned this from their bosses," he said.

---

Bloomberg's Nguyen Dieu, Tu Uyen Nguyen, Kieu Giang and Grace Huang contributed.

Pulitzer-winning opinion from the most respected voices in the world.

How health care controls us

By robert j. samuelson
How health care controls us

WASHINGTON -- If we learned anything from the bitter debate over the Affordable Care Act (Obamacare) -- which seems doubtful -- it is that we cannot discuss health care in a way that is at once compassionate and rational. This is a significant failure, because providing and financing health care has become, over the past half-century, the principal activity of the federal government.

If you go back to 1962, the earliest year with the data, federal health spending totaled $2.3 billion, which was 2.1 percent of the $107 billion budget. In 2016, the comparable figures were $1.2 trillion in health spending, which was 31 percent of the $3.85 trillion budget. To put this in perspective, federal health spending last year was twice defense spending ($593 billion) and exceeded Social Security outlays ($916 billion) by a comfortable margin.

The total will grow, because 76 million baby boomers are retiring, and as everyone knows, older people have much higher medical costs than younger people. In 2014, according to the Kaiser Family Foundation, people 65 and over had average annual health costs of $10,494, about three times the $3,287 of people 35 to 44. Medicare and Medicaid, nonexistent in 1962, will bear the brunt of higher spending.

At a gut level, we know why health care defies logical discussion. We personalize it. We assume that what’s good for us as individuals is also good for society. Unfortunately, this is not always true. What we want as individuals (unlimited care) may not be good for the larger society (overspending on health care).

Our goals are mutually inconsistent. We think that everyone should be covered by insurance for needed care; health care is a “right.” Doctors and patients should make medical choices, not meddlesome insurance companies or government bureaucrats; they might deny coverage as unneeded or unproven. Finally, soaring health spending should not squeeze wages or divert spending from important government programs.

The trouble is that, in practice, we can’t have all these worthy goals. If everyone is covered for everything, spending will skyrocket. Controlling costs inevitably requires someone to say “no.” The inconsistencies are obvious and would exist even if we had a single-payer system.

The ACA debate should have been about reaching a better balance among these competing goals -- and explaining the contradictions to the public. It wasn’t.

The ACA’s backers focused on how many Americans would lose coverage under various Republican proposals, more than 20 million, the Congressional Budget Office has estimated. The ACA’s entire gain in coverage would be wiped out, and then some. From 2013 to 2015, the number of insured Americans rose by 13 million, estimates Kaiser. But the ACA’s advocates don’t say much about stopping high insurance costs from eroding wage gains or strangling other government programs.

Meanwhile, congressional Republicans and the Trump White House proposed huge cuts in health spending -- $1 trillion over 10 years for the ACA’s repeal alone -- while implausibly suggesting that hardly anyone would be hurt or inconvenienced. There was no coherent strategy to reconcile better care with lower costs. Democrats kept arguing that the health cuts were intended to pay for big tax cuts that would go mainly to the rich and upper middle class. Sounds right.

Still, there’s no moral high ground. Some Democrats have wrongly accused Obamacare opponents of murder. This is over-the-top rhetoric that discourages honest debate. It’s also inconsistent with research. Kaiser reviewed 108 studies of the ACA’s impact and found that, though beneficiaries used more health care, the “effects on health outcomes” are unclear.

We are left with a system in which medical costs are highly concentrated with the sickest patients (the top 5 percent account for half of all medical spending). This creates a massive resource transfer, through insurance and taxes, from the young and middle-aged to the elderly (half of all health spending goes to those 55 and over, who represent just over one-quarter of the population).

And yet, we govern this massive health-care sector-representing roughly a third of federal spending and nearly a fifth of the entire economy-only haphazardly, because it responds to a baffling mixture of moral, economic and political imperatives. It will certainly strike future historians as curious that we tied our national fate to spending that is backward-looking, caring for people in their declining years, instead of spending that prepares us for the future.

We need a better allocation of burdens: higher eligibility ages for Social Security and Medicare; lower subsidies for affluent recipients; tougher restrictions on spending. But this future is impossible without a shift in public opinion that legitimizes imposing limits on health spending.

We didn’t get that with the eight-year Obamacare debate. The compassionate impulse overwhelmed the rational instinct. The result is that health care is controlling us more than we are controlling it.

(c) 2017, The Washington Post Writers Group

Trump’s election commission lacks integrity

By e.j. dionne jr.
Trump’s election commission lacks integrity

WASHINGTON -- President Trump had some remarkable things to say at the inaugural meeting of his Commission to Promote Voter Suppression and Justify Trump’s False Claims, which is formally known as the Presidential Advisory Commission on Election Integrity. He also asked a question that deserves an answer.

Lest anyone believe Vice President Pence’s claim that “this commission has no preconceived notions or preordained results,” Trump was on hand last week to state clearly what its agenda is.

With the resignation of Sean Spicer as White House press secretary and the rise of Anthony Scaramucci as White House communications czar (an appropriate word these days), the television cameras are riveted on the latest reality show, “Spicey and The Mooch.” But we dare not lose track of the threat the Trump Administration poses to the most basic of democratic rights.

Remember that in January, Trump told congressional leaders that between 3 million and 5 million illegal votes were cast in last year’s election and that they were the reason he lost the popular vote to Hillary Clinton by 2.9 million.

There is not a shred of evidence for this -- none, zero, zilch. Trump’s defenders could find no plausible way to support his statement, which is not unusual. But Trump never backs off from a falsehood. So instead, he did something without precedent: He appointed a presidential commission solely to justify an offhand lie.

And now that this body exists, it will almost certainly try to find ways to rationalize purging legitimate voters from the rolls and erecting yet more barriers to voting.

Trump would not let the commissioners forget their reason for being there, his belief that those phantom votes really exist, although he put his own words into the mouths of unnamed “people,” who -- surprise! -- came to the same conclusions he did.

“Throughout the campaign and even after it,” Trump said, “people would come up to me and express their concerns about voter inconsistencies and irregularities, which they saw. In some cases, having to do with very large numbers of people in certain states.”

The commission issued a sweeping request to the states for data that included everything from voters’ Social Security numbers, military status and party affiliation to information on felony convictions.

Trump purported to be pleased because “more than 30 states have already agreed to share the information with the commission.” In truth, the request has been met with widespread resistance from Republican as well as Democratic officials. As of July 8, the Associated Press reported not a single state was in full compliance. The Republican secretary of state of Mississippi, Delbert Hosemann, spoke for many of his colleagues (with a regional twist) when he told the administration to “go jump in the Gulf of Mexico.”

Trump is not happy, and he responded in the way he knows best: with innuendo questioning the motives of others. “If any state does not want to share this information, one has to wonder what they’re worried about. And I asked the vice president, I asked the commission: What are they worried about?”

Excellent question. Here’s what we should worry about.

We should worry about the security of the data. States have absolutely no confidence that the Trump administration will protect it. They also have every reason to fear Trump will misuse it.

We should worry because his commission is the furthest thing imaginable from a dispassionate investigation into voting procedures.

We should worry because Kris Kobach, Kansas’s secretary of state, is vice chairman of the commission. Kobach is a voter suppression fanatic. He is also a Trump flunkie. The Washington Post’s Philip Bump, who is doing an excellent job covering this charade, noted that when NBC’s Katy Tur asked him about the 3 million to 5 million fraudulent vote claim, Kobach replied: “We will probably never know the answer to that question.” Sorry, but we do know, and if Kobach thinks we don’t, not a single state should trust him with a single bit of information.

We should worry because, as Ari Berman noted in The Nation, a new study by MIT found that 12 percent of the electorate in 2016 encountered a problem voting, and the Brennan Center reported that more states have enacted new voting restrictions in 2017 than in 2015 and 2016 combined. This commission will push states to enact even more laws like these.

We should worry because the Supreme Court gutted the Voting Rights Act in 2013 and this Congress has shown no signs of wanting to fix it.

We should worry about the Trump administration closing civil rights offices and the Justice Department switching sides in voting rights cases. As Rep. Elijah Cummings (D-Md.) said: “I am old enough to remember when African Americans were denied access to the ballot box, and I fear that we are watching history repeat itself.”

We should worry that Elijah Cummings’ intuition is right.

E.J. Dionne’s email address is ejdionne@washpost.com. Twitter: @EJDionne.

(c) 2017, Washington Post Writers Group

Sean Spicer is the latest Trump casualty. He won’t be the last.

By dana milbank
Sean Spicer is the latest Trump casualty. He won’t be the last.

WASHINGTON -- Sean Spicer wasn’t a Trump guy.

During the primaries, when he was chief strategist to the Republican National Committee, Spicer told friends that he was confident Donald Trump wouldn’t win the nomination and that if Trump did, both Spicer and RNC chairman Reince Priebus would have to do some soul-searching about whether they could remain in their jobs.

Not only did Spicer and Priebus continue, but also they became fierce advocates for Trump during the general election and took senior roles in his White House. A cynic would say they saw Trump as their meal tickets. A more charitable interpretation is that they were hoping to tame Trump, to temper the crazy. Mike Pence, who had reservations about Trump but accepted the vice presidential nomination, made a similar calculation.

The choice wasn’t irrational. I don’t blame them for trying. But they were wrong: This beast will not be tamed.

Spicer, disgraced for the past six months because of his extravagant pugilism and lavish untruths on Trump’s behalf, finally quit Friday.

Priebus, suffering the shame of being a chief of staff with neither power nor the president’s ear, will likely follow soon, at least if he wishes to keep intact some dignity.

In business, Trump tended to destroy those around him, walking away from failure relatively unscathed while others -- lenders, partners, vendors -- paid the cost. Something similar is happening to those around Trump now, but this isn’t a casino -- it’s our country.

Nobody has been more slavishly loyal to Trump than Attorney General Jeff Sessions, one of his earliest supporters in the Senate; now Trump is publicly savaging him. Trump is likewise disparaging Rod J. Rosenstein, the man he appointed to be the No. 2 at the Justice Department, as well as the special counsel that Rosenstein appointed. Trump has publicly contradicted Secretary of State Rex Tillerson twice (on Qatar and Russia sanctions) and has denied Tillerson even the dignity of staffing his own agency. Trump accepted Chris Christie’s over-the-top support during the campaign then cast him aside.

He demands loyalty but offers little. Bodies, meritorious and otherwise, pile up: James Comey, Preet Bharara, Michael Flynn, Paul Manafort, Corey Lewandowski, Carter Page, Mike Dubke, Monica Crowley, Mark Corallo, Marc Kasowitz and, now, Spicer.

In comes Trump pal Anthony Scaramucci, financier and Fox News chatterbox, named White House communications director Friday. He appeared before the cameras to praise Trump (”he’s genuinely a wonderful human being”), to suspend disbelief (”I actually think the White House is on track and we’re actually, I think, doing a really good job”) and to say that “there is probably some level of truth” even to things Trump says that sound patently false. Asked if he’ll be truthful, he replied, “I hope you can feel that from me just from my body language.”

He’ll fit right in. This is more of the same for a president who prefers friends and kin to the threat to his ego that could come from appointing people with the experience to run the federal government and the heft to tell Trump when he is wrong. Trump’s Cabinet of billionaires has proven more adept at flattering their boss (Incredible honor! Greatest privilege of my life!) than navigating the bureaucracy. Young son-in-law Jared Kushner, out of his depth as he runs everything from Middle East peace negotiations to reforming the federal government, has, along with Donald Trump Jr., worsened the president’s Russia headaches.

Conservative foreign-policy academic Eliot Cohen in November wrote a prescient op-ed for The Post saying conservatives should not serve in the administration because Trump “is surrounding himself with mediocrities whose chief qualification seems to be unquestioning loyalty.”

Cohen argued that the president’s team would be “triumphalist rabble-rousers and demagogues, abetted by people out of their depth and unfit for the jobs they will hold, gripped by grievance, resentment and lurking insecurity. Their mistakes -- because there will be mistakes -- will be exceptional.” He predicted that until the administration can acquire humility and magnanimity, “it will smash into crises and failures.”

So it has. Luckily, the lack of expertise in the White House hasn’t been tested by a major crisis yet, such as war, a large-scale terrorist attack or economic collapse. The troubles Trump faces are of the self-inflicted variety.

Scaramucci won’t succeed any more than Spicer. The problem is more than personnel -- it’s the principal.

Follow Dana Milbank on Twitter, @Milbank.

(c) 2017, Washington Post Writers Group

Homage to a great editor

By kathleen parker
Homage to a great editor

WASHINGTON -- Behind every great column is a great editor -- a truism never more so than when Alan Shearer puts highlighter (not red pen) to copy.

Shearer, who has run the Washington Post’s syndication operation the past 26 years, has managed to ignore the wailing, weeping and lamentations of his devoted cadre of columnists and cartoonists and retires next week.

To the dustbin of history goes not Alan, as his well-spelled words, his hyphenated adjectives and hyperbole-resistant attention to perfecting prose will persist through thousands upon thousands of published columns bearing someone else’s name.

It is time you knew his.

Shearer is editor to a stable of 20 writers, many of whom are destination columnists, including George Will, Charles Krauthammer, Fareed Zakaria, Eugene Robinson, Ruth Marcus and Dana Milbank among others, as well as this humble correspondent. At a farewell party Thursday, writers took turns praising Alan, who stood stoically to the rear betraying nothing and tolerating what he termed an excess of hyperbole.

That’s Alan: deadpan, reserved, modest, generous, tough, tolerant, and thoughtful. It would never occur to him to take credit or even allow mention of his role in a writer’s success, though he deserves a great deal of it. That so many have received Pulitzer Prizes under his watch is no coincidence.

Based on Thursday’s testimonials, I think it’s safe to say that we don’t only admire Alan; we love him. Some even said so. He isn’t only a great editor but also a great leader with an eye for quality. He will leave behind another great editor, whom we also love, Richard Aldacushion, as well as editorial production manager Sophie Yarborough and operations manager Karen Greene, who keeps the ship afloat.

We have all been hand-picked by Alan. (I pause here to wonder whether hand-picked is hyphenated, knowing that Alan’s team will put it right. His epitaph, he once told me, would read: “The un-hyphenated life isn’t worth living.”)

Part of our affection for Alan stems from his dedication to our craft -- for making us the best we can be -- but also for his generosity in being invisible. The hand of a good editor should never be seen. When you, gentle reader, peruse the op-ed page and read a Kathleen Parker column, you will not know that someone else may have suggested a better word, or found that a fact was either lacking or incorrect (and corrected), or reminded me for the 100th time that there is no comma preceding “but” when the introductory clause begins “not only,” or that I keep writing Medicare when I mean Medicaid, dadgummit.

But, never is a comma changed without the writer’s approval. This, too, is a credit to Alan, whose respect for and deference to writers is never in question. Edits at The Writers Group syndicate are always offered as suggestions for the writer’s final say. Most times, too, Alan will write a note of appreciation before the bloodletting begins with a “nice job” or “good stuff here.” On those rare occasions when he jots “Brilliant” or “Fantastic,” my feet don’t touch the ground until the next day.

You see, there’s nothing quite like knowing you’ve written something not bad at all. It is a joy that should be shared by at least two people, beginning with Alan, if only one of us gets the public credit. Such is the ultimate gift of the editor to the writer, for which we finally thanked him.

George Will began his comments by spelling a word -- m-i-n-u-s-c-u-l-e.

“There,” he said, “I’ve finally mastered it.”

Apparently, even the longest-writing columnist among us is imperfect. I can’t account for how happy this makes me. Marcus said she was surprised to learn that Alan all along had been editing so many other writers as well as her. Like the rest of us, she had thought she was the only one. This is because Alan makes each writer feel that he or she is the most important, the most gifted, the most adored. (beg ital)How dear of you not to tell us otherwise. (end ital)

In addition to being the finest editor any of us have ever worked with, Alan is a thoroughly decent human being and a consummate gentleman. He is also kind. When I suffered a concussion and had to stop writing for a while, he held my place and my hand, reminding me of how rare he is in a media world that has become heartless and self-important.

So, for now, farewell, fine sir -- and thank you for bringing me to the party.

(BEG ITAL)Editor’s Note: Alan Shearer recused himself from editing this column.(END ITAL)

Kathleen Parker’s email address is kathleenparker@washpost.com.

(c) 2017, Washington Post Writers Group

Why having a diverse teaching corps matters

By esther j. cepeda
Why having a diverse teaching corps matters

CHICAGO -- When it comes to diversifying America’s teaching corps to better reflect the increasing number of Hispanic students, there’s a big question: If Latino public school students rarely see a Hispanic teacher, how will they ever come to see teaching as an attractive profession?

It’s not a trivial concern.

While there’s no specific research data showing that Hispanic students receive an outsized benefit from having teachers with the same background, there are studies that confirm a positive link between teachers of color and the academic achievement of all students.

And a recent study found that low-income black students who have at least one black teacher in elementary school are significantly more likely to graduate from high school and consider attending college.

But while the benefits to an increasingly diverse student body are easily imaginable, one aspect about recruiting more teachers of color is rarely spoken about: How challenging it is to actually be a Hispanic teacher in a teaching corps that is overwhelmingly white (only 8 percent of all teachers are Hispanic).

For starters, becoming a teacher is expensive.

Not only do you need to earn at least a bachelor’s degree but, depending on your state, there are a battery of general and content-area tests to take, each of them costing a nice chunk of change. The capstone test -- called the edTPA and now the standard for certification in 16 states and growing -- requires a high quality video-taking device, video editing skills and super fast internet access to create and upload an extensive submission.

This is in addition to 15 to 20 weeks of unpaid mandatory student teaching during which you’d have to be crazy to try to work elsewhere -- if your university even allowed it -- regardless of how dearly you needed the income.

And, as if that weren’t enough of a mountain to climb, for those altruistic souls devoted to teaching in low-income schools where the majority of students are black or Hispanic and the pay is likely to be low, the Trump administration is threatening to end the Public Service Loan Forgiveness program, which helps teachers who take on these extra difficult teaching assignments.

Then there is the actual experience of being a teacher in a school where there are few or no other teachers of color -- it’s not always a walk in the park.

I’ve been blessed to teach in schools chock full of absolutely caring, devoted, selfless and hard-working teachers and administrators who would do practically anything to ensure the academic success of all their students.

But even in such environments of pulling out all the stops to make sure all kids progressed, there were still obvious ways in which white students were seen as academically ready to thrive while black and Hispanic students were considered lesser -- too poor, too devoid of resources at home, too far behind peers or otherwise too downtrodden to succeed.

At best, some of these students of color were given extra resources and attention by adults, though sometimes these efforts were tinged with pity. At worst, some kids -- even as young as first grade -- were simply written off as unsalvageable.

Throughout my years in education I’ve been present at meetings where such students were referred to as stupid or hopeless. Their parents were savaged as being clueless, unhinged or having been purchased by a spouse as a mail-order bride from a foreign country. In one case, my presence was not enough to hold the tongue of a teacher who suggested that a male Hispanic student’s career trajectory would peak with becoming a janitor.

This behavior, however, pales in comparison to the impact minority teachers can make. It may sound trite, but there is relief and even pure joy when minority students experience having a teacher who shares their culture.

A more diverse teacher corps is not a panacea -- the single most important factor in student achievement is the quality of the teacher regardless of race or ethnicity.

But if more Hispanic college students can be recruited into teaching through a variety of supports and incentives, the way in which struggling students are perceived in schools can slowly begin to change.

Teaching is not easy or particularly lucrative, relative to other highly skilled professions. But walking into a classroom and being a living, breathing example of all the possibilities that a good education can open up offers its own rewards.

Esther Cepeda’s email address is estherjcepeda@washpost.com.

(c) 2017, Washington Post Writers Group

Heaven help us

By gene weingarten
Heaven help us

(BEG ITAL) Gene Weingarten is on vacation. This column originally appeared in 2010.(END ITAL)

WASHINGTON -- A Pew Research Center poll has found that atheists and agnostics are more knowledgeable about religion than are people of faith. Many of my fellow atheists are smug about this, which is a shame. Gloating is arrogant. We should instead use our superior knowledge to patiently educate the rest of you nincompoops. I shall now take your questions about religion.

Q: Is the pope Catholic?

A: Serious questions, please. This is science.

Q: How is religion different from superstition?

A: Superstition is silly. Religion is not.

Q: But how can you tell the difference between them?

A: If it’s what you believe, it’s religion. If it’s what the other guys believe, it’s superstition.

Q: That’s too glib.

A: OK, let me give you an example. Hindus and Jains worship Ganesha, an elephant-headed god who rides a mouse. Christians and Jews consider this quaint and adorable, and they are, of course, respectful of other faiths, but they know, deep down, that it is poppycock.

Q: Why?

A: Because Jews and Christians know there is only one God. And He cannot have tusks and a trunk, because He made man in his own image, out of dust and mud, and then made woman out of the man’s rib. So the whole elephant thing is obviously just completely preposterous.

Q: Why isn’t anyone named Job or Ham or Japheth or Abishag anymore?

A: Because those names sound stupid. Today we name our children Skylar, Jazlyn, Kaydence and Bristol.

Q: If Adam and Eve had only Cain and Abel, how did other generations happen?

A: Everyone’s forgotten about Jazlyn.

Q: Why are you so down on creationism?

A: Because it is an anagram for “I note racism.”

Q: Do you think evolution is inconsistent with the possible existence of God?

A: Theoretically, no. An all-powerful God could, of course, set evolution in motion. But it would mean a God who then completely washed his hands of us.

Q: Do you deduce that because of all the suffering in the world?

A: No. I deduce that because “evolution” is an anagram for “I love u not.”

Q: If God didn’t create the universe, how do you atheists think it began?

A: With a Big Bang.

Q: Oh, yeah? Well, what came before the Big Bang?

A: The Big Diamond Ring.

Q: You don’t know, do you?

A: No, but the prevailing scientific sentiment seems to be that because time began at the precise moment mass and energy did, there was no “before.” So trying to answer this question is like trying to taste your own tongue.

Q: That sounds like a cop-out.

A: Well, there are other theories involving “branes” and colliding dimensions, but no one really understands them, even the physicists who came up with them.

Q: So you just accept it all ... on faith?

A: The pope is indeed Catholic.

Gene Weingarten can be reached at weingarten@washpost.com. Follow him on Twitter, @geneweingarten. Chat with him online Tuesdays at noon Eastern at www.washingtonpost.com.

(c) 2017, The Washington Post Writers Group

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