BUYING GROCERIES FOR DIABETIC PATIENTS

By Robert P. Bomboy

The New Yorker magazine noted recently that the Geisinger Health System is giving free groceries to diabetic patients across its far-flung territory.

I don't know how many readers also subscribe to the New Yorker, but it's one of the nation's best sources of honest reporting and news analysis, much as the Saturday Evening Post was for our grandparents and great-grandparents from 1897 to 1963.

Geisinger has many diabetic patients. Diabetes can be passed down through families genetically and because mothers, fathers, and children eat too many unhealthful foods and not enough healthful ones.

The area that Geisinger serves has been historically prone to diabetes. Throughout the middle of Pennsylvania, many patients live in towns and villages that don't have grocery stores or supermarkets. Families buy the foods they eat in convenience stores or low-price outlets, a practice that feeds unhealthful diets.

Geisinger has sought to change that situation by giving diabetics healthful foods through a hospital pharmacy. Its first Fresh Food Pharmacy has opened at the Geisinger Shamokin Hospital. With a Geisinger doctor's prescription for it, patients who have diabetes or diabetic family members can get, for free, fresh vegetables, high-protein and low-fat meats, non-fattening flour, and other food products.

Giving patients and their families healthful foods costs Geisinger $2,000 a year for each patient, but it says it's saving an average of $24,000 per patient because fewer need kidney dialysis, eye surgeries, and care for other complications that diabetes causes. The diabetics eating better have seen their average weight and blood pressure fall too.

The New Yorker's financial correspondent, Adam Davidson, pointed out that - as might be expected - the effort to repeal and replace Obamacare isn't looking at cost-saving experiments like this at all. "The health-care bill recently passed by the House of Representatives would transfer money to the rich (in the form of a tax cut) and slash Medicaid," Davidson says accurately.

The House bill will strip millions of us of our health insurance coverage, destroy protections for mothers, fathers, and children with pre-existing conditions, and cut billions of dollars from Medicaid, which is providing the wherewithal to treat and protect 63,000 Pennsylvanians against death from drug overdoses.

Drug addiction is epidemic in Pennsylvania; of the 50 states, we are the sixth highest state for drug overdoses, higher than New York and New Jersey. A huge part of Obamacare expanded Medicaid, providing money to prevent overdose deaths here. As Governor Tom Wolfe has said: "Access to treatment through Medicaid is keeping Pennsylvanians alive who might otherwise face overdoses or worse.”

The House bill snatched that life raft away. I expect the same to be true of the Senate bill. No one knows, because the millionaires there - including our Republican Senator Pat Toomey - have kept their proposed repeal of Obamacare completely hidden from us, the American people.

As I wrote in a previous column, Toomey and his millionaire buddies haven't listened to anyone who might want to protest what they're doing - not a single hearing, not a single person or expert. Even the Republicans in Congress didn't know what was in the Senate bill until Thursday when Mitch McConnell, the Senate majority leader, showed a rough draft to his Republican colleagues, but not to the Democrats. He wants a vote on his Frankenstein next week.

Millions of people are outraged at what the Senate is doing.

I'm protesting and I hope you will too.

Call, write, or email Senator Toomey. His Twitter handle is: @SenToomey. Tell him you're not rich and you won't stand for this anymore.

If only three Republicans will vote against this blindfold Senate bill, it won't pass. It's possible that there are three real heroes among these six I've identified. Please find their emails or Twitter handles and reach out to them: Sens. Lamar Alexander, Shelley Moore Capito, Dr. Bill Cassidy, Susan Collins, Dean Heller, and Lisa Murkowski.

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A $20 BILLION CHECK FOR A TRUMP CRONY

By Robert P. Bomboy

On May's billion-dollar overseas junket, President Trump quietly squeezed out a really rotten political plum for one of his cronies.

            During the president's visit in-country, his longtime crony Stephen Schwarzman picked up a $20 billion check from Saudi Arabia to take control of our tunnels, bridges, highways, and drinking-water resources. Schwarzman, chief executive of a multi-billion-dollar Wall Street tiger called the Blackstone Group, also has Trump's ear as chairman of his Strategic and Policy Forum, where Big Business gets to put in its two cents - and a lot more.

Schwarzman is a back-door neighbor of Trump's Mar-a-Lago plantation in sunny Florida, and the two have been doing more there than kicking the golf ball around on Trump's weekends away from the White House.

Blackstone has a long history of taking advantage of working families - from profiting off the 2008 U.S. housing crash that repossessed nine million mortgaged American homes, to fighting worker efforts for decent livelihoods.

Its move to buy up some of our cities' and states’ most important infrastructure assets (highways, tunnels, and bridges) at the expense of our communities is no surprise.

When our infrastructure is bought up this way, cities and states lose out on the income that would traditionally go toward funding public services, like low-income housing and education. Instead, taxpayers are forced to subsidize billionaires and corporations who are raking in the dough.

            Traditionally, cities and states have built highways, tunnels, and bridges by selling municipal bonds and using earnings from the bonds for public projects. Sales of these municipal bonds amount to more than $3.7 trillion.

            This Blackstone deal could suck up those earnings and hit taxpayers with high tolls and user fees. “Why would we take some of the resources we have, hand them away to Wall Street, and give them control over the assets to do with as they want for 20, or 30, or 40, or 50 years?” asks Donald Cohen of the anti-privatization group In the Public Interest [CQ]. It's a good question.

The states and cities whose infrastructure will be involved in Saudi-Blackstone deals will need to look carefully for any loopholes.

In Virginia, a project to expand the Hampton Roads car and truck tunnel is costing more than expected because of a no-competition clause negotiated by a Swedish construction company and an Australian financier. If toll revenues are lower than contracted, the state might be required to make up the difference over the 58-year life of the contract.

In 2012, Bayonne, New Jersey, cut one of these deals with a private investment company to manage Bayonne's water system. Bayonne got immediate money to update its water system, but bills to water customers went up 28 percent so the investment company could make its profit.

The bottom line is that Saudi Arabia’s $20 billion check will get funneled through an-arm-in-arm Trump adviser in a grab for state and local infrastructure, with the expectation of billions of dollars in profits off the roads, bridges, and transit systems we have to use every day.

            I read a lot of history, and deals like this - which are a foretaste of how President Trump wants to manage his trillion-dollar American infrastructure program - remind me of the Teapot Dome Scandal, almost a century ago, when private companies had the squeeze, the influence, to use public assets at bargain-basement prices. Until Watergate came along, Teapot Dome - which had nothing to do with a teapot - was the greatest and most sensational scandal in the history of American politics.

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THE GOD-AWFUL STORY OF MEDICINES

By Robert P. Bomboy

            My wife and I live on Social Security, and last year we spent, out of pocket, more than $11,000 on GHP Gold, Geisinger physician visits, and prescription medicines. I consider myself in good health, yet between sun-up and sundown I swallow a total of nine different prescription medicines every day.

My wife also takes nine prescribed medicines, which include insulin. Her GHP coverage hit Geisinger's "donut-hole" last September, and for the final three months of 2016, despite this health insurance, she paid full price for her insulin and other prescriptions.

That didn't include a total of $50,263.74 for a hospitalization in September or the $2,568 that went directly to Geisinger from our Social Security.

            That was certainly a lot - the money we spent out of pocket came to one-third of our Social Security payments last year, and that's been about the same every year - but it paled in comparison to what families, many in this area, pay for medicines to fight major debilitating illnesses such as cancer, multiple sclerosis, Hepatitis C, and other diseases.

America's drug companies are gouging us every day with high prices on the medicines we - you and I - need to lead healthy and productive lives.

Our for-profit system rewards the biggest pharmaceutical companies with overwhelming monopoly power, and Big Pharma uses that power to charge Americans more than any other country in the world - so much, in fact, that nearly one in five Americans do not fill their prescriptions because they can't afford it. President Trump's god-awful health bill, now in the Senate, will make the situation even worse.

The prescription drug industry is one of the most profitable in the country. It is morally wrong that people have to choose between filling a prescription and putting food on the table for their families.

            Drug companies bleat like lambs about the cost of research and testing, but the truth goes to something much deeper and darker. The drug companies are shameless, and they charge what they can get away with. And, with President Trump's new budget, they will get away with much, much more.

As doctors at the Mayo Clinic put it, “The question is whether current pricing of drugs is based on reasonable expectation of return on an investment or whether it is based on what prices the market can bear.”

            Beyond that, investigators are drilling down to something worse: the rise of nationwide charities connected to Big Pharma itself. These charities say they are helping patients pay the out-of-pocket costs of their medicines, which can range, for example, from $150,000 a year for the latest cancer drug to $300,000 a year for Cystic Fibrosis medicines.

After all, if a patient can't afford out-of-pocket costs of $5,000 for a $100,000-a-year drug, for example, the drug company gets nothing. But if the drug company or the charity pays the $5,000, the patient gets the drug and the drug company receives $95,000 from the patient’s insurance. The drug company also gets very lucrative tax deductions on that money it's "giving."

I actually know someone who's made many millions of dollars on 15 little words you've seen at the bottom of your television screen: "If you can't afford this prescription drug, Big Pharma may be able to help you."

This guy looks before he leaps. He spent several years meticulously inspecting the laws in every state, looking for a loophole that would let him make a gazillion dollars on prescription drugs. When he found the loophole he was looking for, he pitched his tent in Texas.

          Here's the deal: He sets up, in Texas, a charitable foundation with all the trimmings. He and his foundation solicit contributions nationwide to help stricken families where a mother has cancer or a child has Cystic Fibrosis, one of the most heart-rending diseases imaginable. He has a big call center whose operators, with the most piteous voices, plead for donations.

          He rakes in a lot that way, and his foundation actually helps people. But his big money comes from the drug company itself, which paid him $84 million in one year alone. You heard right - $84 million! And there was plenty more after that. Remember, for every sick child he helped, Big Pharma was getting $95,000 and much, much more in round numbers, from the insurance.

          He built a big mansion. He bought a Learjet, had his own pilot, and flew his friends and family to Las Vegas. He had a condo in the Florida Keys and a tax-hiding offshore account in Guyana. He diversified, bought three restaurants, and made millions more on a range of other investments.

          Although he's a skonk, under Texas law he wasn't doing anything illegal, nor was the drug company unless it billed Medicare, which is a no-no.

How does all this affect the price of prescription drugs? In the situation I've been describing, the drug company raised the price of its medicine from $40 a vial to $28,000 a vial. Yes, you heard right, $28,000!

          To cut to the heart of this chicanery, Senator Bernie Sanders and 15 other Democrats are pushing a bill called the Improving Access to Affordable Prescription Drugs Act. It would:

·       Roll back Big Pharma's monopoly, to increase competition and make medicines affordable for everyone;

·       Hold to account companies that engage in price-gouging, fraud, and other abuses;

·       Let Medicare negotiate fair drug prices and lower out-of-pocket costs for older people;

·       Require transparency from drug companies, including financial information like profits and pricing data.

States, including Pennsylvania, are considering similar legislation. Some states  would require drug companies to disclose their manufacturing, marketing and advertising costs, the history of price increases ($40 to $28,000!), their profits on particular drugs, and the money they spend providing financial assistance to patients. Pennsylvania’s bill would let insurers refuse to pay for a drug if the drug company didn't file the required report.

But the drug lobbies are strong. It's one thing to write a bill; it's another to pass it. There are 18 lobbyists for every congressman and senator in Washington. Sadly, the Pennsylvania bill is languishing in the General Assembly.

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LEGIONS OF THE RIGHT

By Robert P. Bomboy

               They used to say you didn't have to look farther than your front door to know what was going on in the world. But it's worthwhile now to try to see the larger picture. If you do, you might be shocked.

            Over the past 25 years, by design, forces of which most of us are unaware have worked assiduously to make sure that Big Business and the richest one percent have gained the upper hand.

LOBBYING

               If you ask yourself, "Who makes the laws?" you'll be surprised at the answer.

Washington lobbyists get lots of money to put Big Business and special interests first. They do the research and actually write the bills that favor Big Business and work against us. Two thirds of congressional staffers say they depend on their favorite lobbyists for the information they use to propose and pass bills. Lobbyists provide the honey that individual congressmen and senators take and turn into law. And that law, by and large, benefits You Know Who - no, not us. We don't stand a chance.

There are 535 members of Congress and 10,000 lobbyists in Washington. Meaning that, if you take out your calculator, you can picture 18 lobbyists swarming like honey ants around each and every congressman and senator in Washington.

When Donald Trump declared that he would "drain the swamp" we can be forgiven if most of us thought he would get rid of those 10,000 pesky lobbyists representing Big Business and the rich. But that wasn't what Trump meant at all. He, after all, is one of the super-rich, and who he works for is Big Business. We saw that during the battle over Trump's Unaffordable Care Act. It came out that while he and his legions would slash away at the coverage of Obamacare, they were planning more than $600 billion in additional tax cuts for the rich.

GERRYMANDERING

As far back as the early 1800's, hardly 25 years after the founding of our nation, political parties were corruptly contriving to twist and elongate the boundaries of voting districts, making them look like writhing salamanders. A governor named [CQ] Elbridge Gerry did the dirty work, and a smart newspaperman tagged him for it, creating the word GERRYMANDER.

Pennsylvania is one of the nation's most gerrymandered states, and ranks very high up on the ladder of political corruption, higher even than our neighbors, New York and New Jersey with all their Mafiosos. The 11th Congressional District, where we live, is almost as twisted as the original salamander, weaving its way 170 miles from north to south, in, out, and around Carbon, Columbia, Cumberland, Dauphin, Luzerne, Montour, Northumberland, Perry, and Wyoming counties. Look on the map and see if you could follow a trail of breadcrumbs through that much twisted territory.

If you decide to gerrymander you do it to create as many voting districts as possible with majorities for your party. That's why our Pennsylvania voting districts have such strange "salamander" shapes: they ramble from pillar to post, from hither to yon, from A to Z, to capture as many Republican voters as possible.

            Across the nation in 2010 conservative Republicans had a plan to throw millions into elections where they thought they had a chance to take over state legislatures and governors' mansions. They wanted to win the state legislatures and governors' offices because it's the state legislatures that redraw and rearrange the voting districts; and, like the original gerrymandering governor, Elbridge Gerry, go-along governors can make that process easier.

Their plan worked. Across the nation in 2010 Republicans won majorities in 10 out of the 15 states, including Pennsylvania, that were due to redraw and reapportion their election districts. With that power behind them, here in Pennsylvania the Republican winners redrew our election districts to give their party uneven breaks. They created salamanders of every description, some so strange and irregular that they might have been the ink blots of Rorschach tests.

By 2012 and the next election, with the voting districts redrawn to favor the Republicans, they were in a position to run the table. In 2012, Pennsylvania Democrats won 51 percent of the popular vote for the House of Representatives, where the greatest and most unassailable power now is. But, thanks to the redistricting, they won only five out of 18 House seats -- fewer than one-third of them. The 13 Republican winners made the House of Representatives even more conservative than it had been before.

PACKING THE SUPREME COURT

               Since 2005 a little known but extremely powerful group of conservative lawyers, the Federalist Society, has been behind the appointment of three conservative justices to the Supreme Court: John Roberts that year, Samuel Alito in 2006, and Neil Gorsuch this year. With Gorsuch confirmed last month, they now represent one-third of the court's members.

               Since the early 1990s the Federalist Society has followed, most rigorously, a plan of its own. Find very intelligent students coming into law schools across the nation; help them in every way to get through law school (their support group numbers 75,000 lawyers); make sure these students graduate as lawyers; then keep them interested and involved with conservative lawyers. The Federalist Society has chapters everywhere, and they're not like the Odd Fellows. Lawyers in the chapters continually work on problems, participate in practice groups, take pro-bono legal cases where they confer together, author articles in law journals, create strong relationships with the news media.

As the law school graduates advance in their careers, they become known and recognized. Inevitably, with the support of the Federalist Society, these conservative lawyers have risen to positions of prominence in the courts, including the federal courts, where their conservative legal philosophies have led them to render conservative decisions.

The Federalist Society knows them and the conservative principles they stand for. John Roberts was known in this way. Samuel Alito was known. Neil Gorsuch was known.

               So when Donald Trump, in his ignorance, was campaigning and wanted a list of lawyers he might appoint to the Supreme Court, the Federalist Society gave him a list, and Neil Gorsuch's name was on it.

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WHO IS THIS STEVE BANNON?

By Robert P. Bomboy

            I never in a million years thought I’d say this. I shudder and gag even to think about saying it. But perhaps in the Alternative World of President Donald Trump, where everything is upside down and inside out, it might be useful to bring back the House of Representatives Un-American Activities Committee.

            And investigate Stephen K. Bannon.

            I jest of course. No fair-minded American would ever sit still for a return of HUAC (as it was known in the 1950s), though former House Speaker Newt Gingrich last June did indeed suggest bringing it back.

            The House of Representatives created its repellant Un-American Activities Committee to investigate alleged disloyalty and subversive activities by private citizens, public employees, and organizations it suspected of having “Communist” ties.

            Memories of the Un-American Activities Committee are so repellent because any stiff who had a grudge against you could drop a dime (phone calls then were 10 cents), call you a Commie, and you’d be haled up to face the committee: “Are you a Communist sympathizer?” they would ask. “Are you now or have you ever been a Communist?”

            But now comes this Steve Bannon, who sits in the White House and brags outright that he wants to destroy the government. He is a revolutionary with unprecedented power. He wrote much of President Trump’s savage inaugural address and January’s first immigrant travel ban that cost 60,000 people untold hardship and misery. Until this week he was in the inner circle of the National Security Council whose members can push President Trump to unleash nuclear war. "I am," he says, with relish, "Thomas Cromwell in the court of the Tudors." 

            He’s supremely ambitious for power. “Dick Cheney. Darth Vader. Satan. That’s power,” he believes.

               He’s an admirer of Friedrich Engels, who wrote the Communist Manifesto with Karl Marx. He says he’s a “Leninist.” Lenin was the alias for the Russian revolutionary who created the Communist Party and, with his fellow Communists, began the Bolshevik Revolution that gave birth to the Soviet Union. “Lenin wanted to destroy the state, and that’s my goal too,” Bannon has said. “I want to bring everything crashing down. It only helps us when . . . . they’re blind to who we are and what we’re doing.”

               In the old days, saying things like that would have put Steve Bannon first on the list for the Un-American Activities Committee.

HUAC! HUAC! God help us! HUAC!

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ADVENTURES OF THE NEW SUPERMAN

By Robert P. Bomboy

I'm sure you know that President Trump has made his callow 36-year-old son-in-law, Jared Kushner, his senior adviser in the White House. Jared is being questioned by Senate investigators in the Russian interference case, and has become a person of interest for the FBI, but the President is sure it will all blow over. That's the reason he hasn't bothered to fill 491 of the 553 key jobs in his government.

Jared has so many responsibilities here and around the world that it's tempting to imagine his daily schedule, literally flying from one vitally important job to another, like Superman, or Walter Mitty, or Charlie Chaplin in the silent movie Modern Times, or all the characters together in the 50 best bad movies run at super-fast speed. Yes! If you have Jared Superman Kushner, you don't need a government.

            Millions admire Jared. President Trump says he's a good kid. I've heard there's even a radio show on a low-wattage station called the Adventures of the New Superman.

            Only Lois Lane knows that the mild-mannered Jared, who eats Subway sandwiches every day for lunch, is really the all-powerful, all-knowing visitor from another planet, the man of steel who can do anything, everything.

            Let's listen now as he checks today's schedule with Lois:

            "You have a busy day ahead, Jared:"

            "It's nothing, Lois, I'm saving the world. Let's wrap it up by three so I can get off to the slopes to ski."

            "You have to fly to Iraq, Jared, to straighten out that whole mess."

            "Won't take a minute, Lois. With my superpowers I can be there and back in time for an early lunch and my Subway sandwich. After Iraq, I'll fly to Jerusalem to negotiate Middle East peace. Shouldn't take more than half an hour, should it?"

            "You have a one o'clock meeting with the Drug Czar."

"I have a super idea for dealing with our drug problem. Let's just say it doesn't exist."

"After that, there's a meeting with your father-in-law's contractors building the Wall."

"There's some hidden costs in that, Lois."

"President Trump wants you to go to jail to reform the criminal justice system."

            "Say, Lois, let's put that on my schedule for tomorrow. Those prisoners wear tacky orange uniforms anyway."

            Before you go off to ski, Jared, the President wants you to stop by the White House and give him some important advice."

           

            "Yes, he's considering changing his hair color."

            "While you're there," Jared, "I guess you'll meet with that awful Steve Bannon."

            "He hasn't forgiven me for forgetting about our Unaffordable Care Act. Ooops, sorry, off to the slopes."

Jared steps into the bathroom, emerges in an instant in his red Superman cape and spandex, and swooshes out the window.

"It was probably 'cause they didn't have Jared they couldn't get the votes," Lois muses. "He never even seems to know I exist," she sighs. "But I love him. He's SUPERMAN!"

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BIG BUSINESS WILL TELL YOU

By Robert P. Bomboy

 

Not many of us in our everyday lives look deeply into the political world around us. A generation of intense political propaganda has biased Americans against a federal government we know very little about.

 

The truth is that for 330 million American citizens – you and me – the federal government is the world’s greatest protector of individual freedom and our greatest shield against domestic danger.

 

That be it so, the average American doesn’t like the federal government – because he or she hates paying federal income taxes, as we did yesterday. In fact, for most Americans, the income tax is almost our only personal contact with the federal government. Yet we do hate it at tax time and hold a grudge against it throughout the year, even though 83 percent of us – more than four out of five of us – get income tax refunds year in and year out - refunds that actually average $3,120! (Rich people don’t get many refunds, but most rich people – like President Trump – don’t pay any income tax.)

 

President Trump and his associates have taken advantage of our ignorance, our hatred, and our bias, chanting that they will “smash the federal government” and wipe out the very parts of it that protect us most.

 

How’s that?

That’s what it said in one of his first executive orders, that the federal departments he controls must stop issuing new financial, environmental, workplace, health and safety, and other vital public protections. The President has reinforced his order by not filling

His executive order of February 8 allows Big Business to exploit workers; Wall Street bankers to rip off consumers; dirty energy companies to pollute the air we breathe and the water we drink; the big pharmaceutical companies to continue price-gouging; auto companies to sell dangerous cars, and to strip away many other protections that we rely on.

President Trump’s order will make it nearly impossible for the government to carry out its duties under popular and effective laws such as the Clean Air Act, the Motor Vehicle Safety Act, and the Occupational Safety and Health Act.

Even after the Wall Street crash of 2008 and the Great Recession, the BP oil disaster, and other failures that resulted from letting corporations "regulate" themselves, President Trump's order will endanger us and make us victims of still more recklessness and greed.

His presidential order will mean more contaminated food, an accelerated rush to climate catastrophe, more dangerous cars and trucks on our roads, more workplace injuries and deaths, fewer consumer rights, more oil spills, more human misery. All unnecessary. All preventable.

Who determines what will or won’t be done now? Why, Big Business will decide. I’m sure you all like Big Business. They’re the people who cheat you, lie to you, lobby against you. But under President Trump’s executive order, they’re the ones who get to decide the usefulness of regulations only according to what those regulations cost business, while completely ignoring regulations’ substantially greater – and real – benefits to society, which is us.

It’s a heck of a way to run a railroad – and the Trump train’s running right over us.

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FIVE WAYS TRUMP CAN SABOTAGE OBAMACARE

By Robert P. B0mboy

President Trump is the kind of man who holds a grudge and bottles up perceived insults until he can lash out and try to get revenge. He's about to take his own brand of revenge against Obamacare.

               He couldn't get his first cruel Unaffordable Care Act through the House of Representatives, where even Republicans spit on it. So he's thought up at least five ways to sabotage necessary medical care for millions of defenseless Americans like us.

               In the first place, he is threatening to kill an Obamacare provision that enables health insurers to offer plans with lower deductibles and fewer out-of-pocket expenses to about seven million low-income and Middle Class Americans like you and me. This kind of payment is a subsidy, and conservatives hate subsidies, unless the subsidies are going to the richest one percent of Americans. Conservatives have been trying for years to end these subsidies in an effort to wreck Obamacare. Nearly 60 percent of the 12.2 million people who bought Obamacare health insurance policies this year benefit from these provisions reducing their deductibles and out-of-pocket expenses. Without these subsidies, health care could be unaffordable for many of them.

Three years ago House Republicans ginned up a lawsuit contending that the Obamacare law doesn't have authority from Congress for these kinds of payments. That lawsuit is moving through the courts. As an easy way to sabotage Obamacare, President Trump can order federal lawyers not to put up any fight against the suit. Like Pilate, he can wash his hands and say, "It's not my problem!" Without any defense, with the federal lawyers' hands tied, the Republicans who filed the suit will get their way, and the little people, and their children, will suffer.

Another kind of subsidy in Obamacare is the tax credit. Big business gets tax credits all the time, but don't try to give a new tax credit to people who are not rich. Trumpsters say that's un-American.

Under the Obamacare law since 2010, middle-income Americans have been able to get tax credits as a subsidy to offset what we pay in health insurance premiums. As you might expect, President Trump wants to reduce the health-insurance tax credit. If he does that, millions of people will lose the benefit of lower monthly payments or an end-of-the-year tax savings.

A third trick that the President can use to wreck Obamacare is to sabotage the requirement that people must have health insurance.

The existing Obamacare law requires Americans to buy health insurance or pay a tax penalty. That was one of the reasons 20 million more of us went on health insurance with Obamacare - we're reasonable; we thought it was cheaper to buy the insurance, and we don't like tax penalties. Before Obamacare, a lot of people were trying to slide by without health insurance (I'm OK, right?); then they caught something awful, wound up in the Emergency Room, and had a $40,000 hospital bill.

Following one of the gross executive orders that President Trump so eagerly signed on his first day in office, those friendly guys at the I.R.S. - the people to whom we just paid our taxes - took on a policy that could weaken requirements for Americans to have health insurance, by shoving through tax returns without penalties, even when the taxpayer doesn't say whether he or she has health insurance. This will dramatically weaken Obamacare by undercutting public participation in it.

Also, the Republican health care bill that failed last month in the House of Representatives would have cut the amount of money the federal government gives to Pennsylvania and other states to help people on Medicaid. Governor Tom Wolfe has said some of that Medicaid money is treating and protecting 63,000 Pennsylvanians against death from drug overdoses. Access to treatment through Medicaid is keeping Pennsylvanians alive who might otherwise face overdoses or worse.

            Miffed at what happened to his Unaffordable Care Act, President Trump could waive normal Medicaid rules and encourage all 50 states to charge insurance premiums to more Medicaid recipients, making Obamacare unaffordable for them.

            Finally, the Trump Administration can redefine and restrict definitions of the benefits that Obamacare offers. Under the existing law, all insurers must offer 10 categories of essential health benefits, like maternity care and hospital treatment. But within those categories, with some tricky definitions, Trump could say how much and when those benefits would be available, or not.

Whatever tricks the President employs to injure Obamacare, they will be cruel and recompense for the insult done to him when the House of Representatives last month exercised its better judgment.

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