Flawed Obamacare bridge to better system

President Obama signs his signature legislative accomplishment, the Affordable Care Act, on March 23, 2010. (Wikimedia Commons)

President Obama signs his signature legislative accomplishment, the Affordable Care Act, on March 23, 2010. (Wikimedia Commons)


The Fairview Range Regional Medical Center in Hibbing is the Iron Range’s largest hospital and urgent care center. Blue Cross-Blue Shield customers might soon find the hospital outside their coverage plan, adding tremendous cost to emergency and urgent care for people on the Iron Range.

When President Obama signed the Affordable Care Act in 2010, supporters celebrated the first major victory in a century of fruitless struggle to create a universal health care system in the United States of America.

For liberals, the ACA was a triumph over what had seemed an impossible political barrier. To conservatives, “Obamacare” represented a dangerous overreach. For some patients, the law preserved life and financial security. To insurance companies, the law posed a significant threat to vast profits.

In a divided nation these varied reactions created uncertainty and, eventually, political and market instability.

Because of widespread political division, many states never even attempted to participate in the health insurance exchanges at the heart of the Affordable Care Act. Minnesota did, but the rollout was bumpy. All of this created a sense of uncertainty that prevented most Americans from embracing the new law, even though it benefits millions. Can you imagine going back to a system that denied care to people with pre-existing conditions?

A spike in consumer health care costs this year shattered confidence in Obamacare across the country. Health insurers backed away from popular, affordable plans, leaving people to shop for more expensive alternatives.

That’s how Donald Trump was elected president with a Republican Congress. That’s at least part of why Minnesota Republicans won legislative majorities in the House and Senate, including surprising gains here in Northern Minnesota.

But repealing Obamacare will only transfer the current cost problems around the system, regressing to the very woes that caused the law to be written in the first place. The repeal process could hurl millions off of affordable health coverage. And we can see it happening already, even though the ACA is still on the books.

For instance, negotiations between Blue Cross-Blue Shield and the Fairview hospital system could affect thousands of people in our region. BCBS is the state’s largest health insurer, while Fairview operates the Range Regional Medical Center here in Hibbing, among many others. Without a settlement, Fairview would become an “out-of-network” provider for Blue Cross customers, adding significant expense for care at those facilities. Some might be able to switch clinics (although they would lose their family doctors), but in Hibbing it’s pretty hard to switch emergency rooms.

It wasn’t just Fairview. Across Northern Minnesota, Blue Cross Blue Shield announced this month it would no longer cover care at small clinics and speciality medical service centers in the region.

People who were never affected by Obamacare now feel the affects of a private industry trying to assert control over the profitability of health care.

Our private, for-profit insurance system is simply incapable of serving everyone. It works great for the healthy unlikely to make claims, or those who negotiate for expensive plans though their employers. But for-profit insurance constantly fails the chronically sick, people in non-traditional employement, and the working poor. Industrialized countries all over the world find efficient, effective ways to deliver care to these populations. Why can’t we?

The answer is that it’s not easy to blow up private insurance when it covers almost 60 percent of the population. Especially, when politicians and the insurance industry have successfully pitted Americans against each other.

As long as the healthy and profitable are the majority (and let’s hope they are!), the private sector will not address the continuing crisis facing the sick, very young, elderly, poor and — the worst wretches of all — the self-employed.

Health care coverage must be detached from our place of employment. We must approach health care as a right for all people, to be paid for by all patients based on means, and all employers based on size. We all pay our own way and a little bit more for those who can’t pay as much or at all.

If you can’t fathom the idea of a publicly-delivered system, then consider how the United States can better facilitate a private one. The benefits aren’t only health care coverage, but new financial freedoms for businesses and entrepreneurs.

We’re already paying more for health care — in taxes, insurance, fees and costs — than any other industrialized nation in the world — by a lot. That was true before Obamacare.

Repeal of our current law will disappoint voters, because so much money goes into a system that seems hellbent on excluding people.

The most depressing thing to me personally is all this has been written before, not that long ago. Here we are doing it all over again. Only, this time, our leaders seem to have no real plan whatsoever. We’ll “find out.”

The question isn’t whether we should retain or repeal Obamacare. The question should be how we do better.

Aaron J. Brown is an author and college instructor from northern Minnesota’s Iron Range. He writes the blog MinnesotaBrown.com and hosts the Great Northern Radio Show on Northern Community Radio. This piece first appeared in the Sunday, Nov. 27, 2016 edition of the Hibbing Daily Tribune.


  1. Obamacare is a bridge to nowhere Aaron. How quickly you forget.

    Back in 2009 and 2010, Democrats controlled the White House and the U.S. House and U.S. Senate. President Obama, Senate Majority Leader Harry Reid and then House Speaker Nancy Pelosi rammed Obamacare through without a single Republican vote.

    The Senate voted 60 to 39 for Obamacare. It passed without a single GOP vote.

    The House voted 219 to 212 for Obamacare. 34 House Democrats and all of the House Republicans voted against Obamacare. The NO votes were the only bipartisan votes.

    Obama, your president, signed the Affordable?? Care Act, Obamacare, into law on March 23, 2010.

    Even the Washington Post said of the Obamacare fight at the time “It has inflamed the partisanship that Obama pledged to tame when he campaigned for the White House and has limited Congress’s ability to pass any other major legislation.”

    And you call this a “major victory”? And then blame insurance companies because this colossal mess isn’t working? Wow…

    Ask some of your deplorable neighbors if they think this is a major victory and who’s to blame for their massive premium and deductible increases. If they answer wrongly, remind them of 2009-2010.

    • Your first sentence beat me to it. The ACA is truly a bridge to nowhere. Something better may replace it but it won’t be any tribute to the ACA as those elements which should survive were agreed upon as needed by most parties in the first place (notably addressing existing conditions).

    • I remember quite well. Actually, I’m more interested in remembering how it was when I was a middle manager overseeing a private plan for a small group of relatively low income employees back in the early 2000s. I knew people who couldn’t change jobs because they were cancer survivors who couldn’t be covered any other way. The costs were rising every bit as quickly as they have since. I know we laid off people, in part because of the cost of the company plan. Cost increases are rampant now, too, I grant you. One of the failures in the ACA, which I describe, is that we still haven’t figured out how to keep costs down by expanding the size of the group. Political games and the insurance companies have made it difficult for regular people to understand what their health care actually costs and how banding together really is the best way to keep costs down. Private companies get this, because they are motivated by the cost savings and resulting profits. I argue, and it is core to my beliefs, that we must treat human quality of life as a profit in itself. When markets fail, we must take measures to correct the neglect and crippling costs so many in our system have faced. Perhaps we disagree here, and so I will not argue the point all day.

      I do know in 2008, Republicans weren’t much interested in solving the pre-existing conditions problem. They certainly weren’t when they held Congressional majorities and the White House prior to 2006. I don’t have much optimism that they’ll do anything but repeal the unpopular parts of Obamacare, keep the expensive popular parts, and kick the costs down to the next Democratic administration or Congress — be it in 4, 8 or 12 years. The historical patterns here are quite clear. Perhaps your pals will surprise me. Do encourage them.

  2. John Wangensteen says

    Obama care is and was,designed as,a,barbed hook. While painful going in, it is even more painful and destructive coming out.
    Nationalizing the insurance industry is not the answer

  3. Ranger raves, per usual, and the other side dances around. Key point is that the Repubs have never talked about strengthening the ACA, fixing its problems…. They only talk about repealing it, and turning everything back over to the insurance industry. (I think it was always obvious that without a robust “public option” available to all, the ACA would never really serve the public interest.) Arguably, people gullible enough to believe the insurance-industy-owned pols deserve what they get. But what about the rest of us?

    • There’ll never be such a thing as a “robust” public option. Expensive, inefficient, slow-to-respond & poor quality maybe….but certainly not robust.

      The DEM’s put millions of hours into Obamacare, not to mention the lies and deceit…i.e. – Gruber confirmed the Obama administration knew the individual mandate was a tax, but that if Americans knew the truth “the bill dies.” So the bill “was written in a tortured way to make sure the Congressional Budget Office did not score the mandate as taxes.” He also said the “lack of transparency was a huge political advantage” and that “the stupidity of the American voter . . . was really, really critical for the thing to pass.”

      So now you want to “improve” on this pile of crap? I don’t think so, it’d be foolish to put another hour into it.

      You’re going to be amazed at how quickly and simply Trump handles this mess.

  4. Trump doesn’t know which end is up.

  5. Your “facts” are usually laden with your opinion, ranger. Ho Hum….

  6. I agree with Aaron that the basics of the ACA did cover people who needed it. The issue with the program is that the insurance, drug, and medical device manufacturer’s all had enough say that no cost controls were included other than some chances with Medicare. The program simply takes money from those that can easily afford insurance to pay for those that can’t. It did nothing to address the cost of drugs and equipment, costly insurance due to the litigation process, or preventative visits.

    What most insured people fail to recognize is that we were already paying for the uninsured when they would go to the urgent care or emergency room and could not pay. And because they did not have coverage, they did not have a regular physician and went to these higher cost options. Where do the facilities recoop their costs? From the insured of course.

    Until methods of cost control are enforced on the industry, whether through government dictates or a reform pushed by the masses, costs will continue to go up as the large insurance and medical industries keep profits in mind.

    • Well, actually, it takes money from people who used to be able to easily afford insurance and has now made it difficult or impossible for them to afford effective insurance.

      • It is just convenient to blame the ACA for for the price increases to premiums. The price increases have been happening for years before the ACA, as seen by anyone actually paying portions of their insurance premiums. The ACA forced those that were choosing not to buy insurance to pay in to the system (the risks and system costs of people not buying into the system as it stands are another discussion) and those employer/union plans that were premium plans and were often used as a way of compensation without taxes.

        The ultimate failure of the ACA is the lack of price controls on the medical industry and the insurance company. It did create some controls on rates plans in they system could increase in relation to “profit”, unfortunately executive pay as well as many other things can go against the books to make profits look lower as any business owner knows.

        • “It is just convenient to blame the ACA for for the price increases to premiums.”

          Reality has a convenience all its own…

      • I should also add, the lack of the price controls comes from both sides of the aisle in our government due to the lobbying and corporate interests. As is often the case, our government had the chance to do something right and messed it up due to special interests and money having a say.

  7. Opinions or fake media telling folks what they want to hear is the same as facts for almost half of Americans now. Pathetic.
    Do Trump voters love how Trump and transition team are already showing us how quickly and simply he is cleaning up the “mess”? There is Bannon, chief strategist, who worked for Goldman Sachs, delcaring Trump campaign is a platform for white supremacists and thought it might be a good idea to limit voting rights to property holders only. Many team advisors are establishment GOPers and very wealthy wall streeters and investment bankers (elitists) which is not a surprise to anyone who noticed Trump ran on yooge tax cuts for the 1%. Billionaire Betsy Devos, Trump pick for Secretary of Education, has no experience in the classroom, doesn’t even have a degree in education with her priority turning public schools into vouchered charter schools. Trump is considering General Patraeus for SOS. a man who had to resign from the CIA for giving classified intel to his mistress. Jeff Sessions, Trump pick for AG, was rejected by both Republican and Democratic senators for a Federal Judgeship under Reagan. These are but a few considered for Cabinet appointments. Didn’t Trump say he would “drain the swamp”? Looks more like he is filling in the swamp with a landfill.
    I believe Trump said there would be no changes to Medicare. Did you believe him, Ranger? Trump has picked Tom Price for Human, Health and Services. Do you know what plans Trump, Price, Paul Ryan and the GOP have for replacing not only ACA but Medicare and Medicaid? If not, you might want to check soon because Price and Ryan can’t wait to get their hands on all of our healthcare.
    Trump is a five year old in a 70 year old body. He is all ego and must be constantly adored or he has a meltdown. He is only interested in his businesses and profits, not learning how to be a president. He is too busy having twitter tantrums. He is a con artist whose whole life has been a bad reality show and knew exactly how to scam his supporters. He played them all like a fiddle.

    • Relax kissa, calm down….Trump will work through/clean up Obama’s messes just fine. Serving others is the best way to achieve peace. Now that doesn’t mean doing something foolish like volunteering for the Wisconsin recount. That’ll just upset you more.

  8. Let’s take ’em one at a time kissa. Here’s just ONE of the many messes Obama is leaving behind for Trump to cleanup…The failing health of the U.S. economny.

    1. The federal debt has doubled from $9.99 trillion at the end of FY 2008 to $19.95 trillion at the end of FY 2016. That $9.96 trillion increase in Obama’s eight years is about equal to the $9.99 trillion in debt racked up in the 219 years from the founding of the republic in 1789 to 2008.

    2. President Obama has overseen the worst economic growth of any President since Herbert Hoover. He’s the only President since Hoover who has not had a single year that saw an annual growth of GDP that reached or exceed three percent.

    3. The unemployment rate declined from 7.6 percent in January 2009 to 4.9 percent in October 2016. The number of employed increased by 9.8 million. However, during the same period, the number of Americans not in the labor force increased by 13.5 million.

    4. The labor participation rate has declined from 65.8 percent in February 2009, to 62.8 percent in October 2016.

    5. Median household annual income has remained stagnant in real terms under Obama. President Obama took office in January 2009, median household income was slightly above $50,000. The median household annual income in September, 2016 was $57,616. While that shows an increase of about $7,000 in median household annual income in nominal terms during Obama’s “leadership?”, when adjusted for the Consumer Price Index, real seasonally adjusted median household income was about $57,500 in January 2009, virtually the same as it is almost eight years later.

    6. The home ownership rate declined from 67.3 percent in the first quarter of 2009 to 63.5 percent in the third quarter of 2016.

    7. Health insurance rates, both for employer-sponsored programs and Obamacare, increased significantly between January 2009 and November 2016. In 2008, the average employer-sponsored family plan cost a total of $12,680, with employees footing $3,354 of the bill. By 2016, the cost of the average employer family plan was up to $18,142 for the year, with workers picking up $5,277 of the tab. In 2008, high deductibles were the minority, only 18% of covered workers had deductibles of at least $1,000. In 2016, high-deductible plans have become standard with 51% of all covered workers, and 65% of workers in small firms, facing deductibles of at least $1,000.

    8. The number of individuals receiving food stamps increased from 32 million in January 2009 to 43.6 million in August 2016.

    Now, maybe your one of the folks who’s somehow benefited from these horrible economic conditions created by Obama. But, the vast majority haven’t…and look forward to Trump’s leadership. Ask one of your deplorable neighbors.

    Should we summarize the state of education in the U.S. under Obama next??

  9. Not gonna bother reading your “facts”. I wouldn’t be surprised if you got a lot of it from Paul Horner.

    You must be one lucky ducky 1 percenter if you have no worries about Medicare and other health insurance getting gutted.

    • Someone once said – “To put an arrogant writer in his place, pretend to be illiterate.” The jury is still out if you’re pretending…or are.

  10. President Obama was handed the worst recession since the great Depression. He did not create it , and you know it, ranger. And almost every program he proposed has been obstructed by the Republicans.. Perhaps all the rollbacks that the Republicans are salivating over won’t hurt you , but they are going to severely impact the lives of the lower middle class, and below. Apparently you don’t consider yourself one of the deplorables. I do.

    • You can hijack the words “pro-choice” vs. pro-death, and “progressive” vs. socialist Jackie but good luck at redefining “deplorables”. We conservatives own that one. And that ain’t you…

    • As all folks who read know Obama, in his first two years, had Democratic control of the House and a filibuster proof majority in the Senate. Let us hear no more silliness about how Republicans stopped Obama from what was important to him.

  11. Oh, you definitely own that one. If the shoe fits , and all that

  12. From personal experience Obama care has funded very good insurance for 20 million people who previously had little or none. It has paid for this by forcing self employed individuals who previously had good,relatively low cost but high deductible plans into very bad, very expensive plans with even higher deductibles and mind blowing restrictions. The result for people like myself is a rapid depletion of retirement savings (which are treated as income) and an inability to actually pay for my healthcare a la carte because I am already spending so very much on premiums that cover almost nothing. Bill Clinton was dead on when he said it was “crazy” and Mark Dayton was right on when he said it was no longer affordable.

  13. Oh right, two years out of eight should have given any Dem president super dooper powers to not only claw back from the financial meltdown which has taken years, clean up a ton of Republican messes and slam dunk a multitude of liberal causes. You betcha.

    Now that Republicans own the Senate, House and Presidency, you do realize that they and their voters totally own the coming trumpocalypse.

  14. jg, it’s true self-employed hit very hard. Is the solution to repeal everything and put the reins back wholly in the health insurance industry hands again? Marco Rubio put a poison pill into budget plan to severely cut money for risk corridors which insurance companies warned would spike the insurance premiums, MN one of the states with highest increase. Dayton wants tax credit relief for Minnesotans, Republicans don’t. Everyone should know by now that Republicans would just as soon kill it and give us chump change vouchers. That’s the choice. Go back to 20 million with no health care access costing hospitals and taxpayers a lot of money as well as watching our friends, family and neighbors, us, getting critically ill and dying and employees insured with their employers getting socked with higher and higher premiums and deductibles, back to pre-existing conditions clause, back to cap on lifetime coverage, fighting with insurance companies on paying for treatments, surgeries. Or fund money for the risk corridor hole. That costs money too but nowhere near as much money as not plugging the hole and leaving millions of American very ill and dying.

    People need to be repeatedly calling their legislators, especially the Republicans who don’t want to help you which is almost all of them.

    • I’m not advocating repeal(replace is a lie) but rather repair and improve. The first step is for Democrats to admit that Obama care is seriously flawed and in a practical sense depriving more than 20 million people(previously insured) from receiving meaningful health care. People are also being robbed of retirement savings, the ability to travel and the opportunity to receive the best care available.

      Self employed people have no sick days, no pensions, no social security match, no maternity leaves, no vacation etc. Obama care formulas have no deductions to fund these needs. Everything we make is treated as income and our premiums soar as our safety nets, rainy day funds and retirement savings are bled off.

      You will still watch as friends and families get critically sick and die from lack of care but the big difference is that corporate providers will now be able to take their homes, savings, and what ever crumbs may be left.

    • kissa….I’ve been calling Anzelc and Saxhaug for years now, asking what they’re doing to get my $2,500 Obama promised me when he signed Obamacare. Silence, dead silence from both of them. I’ll bet I get an answer when I call Layman and Eichorn. I won’t like it when they tell me Obama lied about my $2,500 rebate but at least they’ll talk to me, tell me the truth. I know they’ll talk to you as well…call ’em. They’re representing all of us..

  15. Kissa doesn’t care about what, David?

  16. So little intelligent discussion here. What is done by every other developed country cannot be done by the United States? The single key thing is to break the chokehold of the insurance people on policy. Is Trump going to do that?

    • Driving the U.S. to be like “every other developed country” like Obama was, average at best with participation trophies for all, is the antithesis of intelligent (meaning destructive and stupid). That will soon be stopped.

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