Talk:Affordable Care Act/Archive 16

Semi-protected edit request on 2 November 2016
The text under the 111th Congress roll call 165.svg|thumb|300px| currently has wrong information. Right now it seems like the vote was 397-34, when the House passed the Senate bill with a 219–212.

House vote by congressional district. Democratic yes (219) Democratic no (34) Republican yes (178) No representative seated (4)

This should be changed to No on the Republican house vote as follows: {{legend|#800000|Republican no (178)}}

67.131.103.99 (talk) 19:40, 2 November 2016 (UTC)


 * ✅ Thanks! --Dr. Fleischman (talk) 21:36, 2 November 2016 (UTC)

Repeated text
The 2013 subsection contains repeated text regaring the MLR Study.104.163.154.161 (talk) 00:28, 4 December 2016 (UTC)
 * Yes check.svg Done -- Dane 2007  talk 06:09, 4 December 2016 (UTC)

Cadillac tax
This article refers to the "Cadillac tax" without defining it. That provision is described on https://en.wikipedia.org/wiki/Cadillac_insurance_plan — Preceding unsigned comment added by 2602:306:CE9F:E3F0:A819:3CFB:DFA9:22B0 (talk) 21:27, 3 December 2016 (UTC)
 * ✅ --Dr. Fleischman (talk) 18:41, 5 December 2016 (UTC)

Women vs men rates
In the “Repeal efforts” section the last line reads: “He (i.e.,Paul Ryan) did not reply to a question about whether women will continue to pay the same as men.” (My emphasis.) But the actual citation reads thusly: "Scott Pelley: 'And women will pay the same as men? That didn’t used to be the case.’ ”  (Again, my emphases.) The article itself provides no context in which to understand what was at issue here. In other words, do women under ACA presently pay the same rate as men, as the article here suggests, or Is Scott    Pelley correct in his statement that under either Obamacare or what preceded it there was/is a rate differential for the sexes, and, further, what was/is the rationale for such a differential?  — Preceding unsigned comment added by Orthotox (talk • contribs) 19:12, 6 January 2017 (UTC)
 * Thanks. There are a lot of things wrong with that content. It partially fails verification, it fails our no original research policy, Ryan isn't an authority on Trump's priorities, and it's all recentism since positions by Ryan, Trump, and other Republicans shift are in tremendous flux. I'm just going to remove it. --Dr. Fleischman (talk) 19:36, 6 January 2017 (UTC)

Redundant information
Found some redundancies that should be checked.

First redundancy, present at "Impact" section, "Healthcare cost inflation" subsection and "Implementation" section, "Cost" subsection. Quote: "For example, the Kaiser Foundation reported that for the second-lowest cost "Silver plan" (a plan often selected and used as the benchmark for determining financial assistance), a 40-year old non-smoker making $30,000 per year would pay effectively the same amount in 2017 as they did in 2016 (about $208/month) after the subsidy/tax credit, despite large increases in the pre-subsidy price. This was consistent nationally. In other words, the subsidies increased along with the pre-subsidy price, fully offsetting the price increases."

Second redundancy, present at the introduction and "Impact" section twice, "Overview" subsection and "Healthcare cost inflation" subsections. Quote: "According to the Kaiser Foundation, healthcare premium cost increases in the employer market continued to moderate. For example, healthcare premiums for those covered by employers rose by 69% from 2000-2005, but only 27% from 2010 to 2015,[13] with only a 3% increase from 2015 to 2016." — Preceding unsigned comment added by Seiign (talk • contribs) 20:20, 16 January 2017 (UTC)

Empowering Patients First Act
An article comparing the PPAPA and the Empowering Patients First Act (EPFA) would be very useful at this time.MaynardClark (talk) 23:04, 18 January 2017 (UTC)
 * Agreed. It probably belongs as a section of Empowering Patients First Act. --Dr. Fleischman (talk) 01:08, 19 January 2017 (UTC)
 * There are distinct similarities, which I hadn't truly begun to notice until this morning when I was studying it. Look at where I work.
 * We could begin by studying Read the Law:The Affordable Care Act, Section by Section at HHS.gov.

The Affordable Care Act was passed by Congress and then signed into law by the President on March 23, 2010. On June 28, 2012 the Supreme Court rendered a final decision to uphold the health care law.
 * Read the Supreme Court’s Decision on the Affordable Care Act - PDF


 * Title I. Quality, Affordable Health Care for All Americans
 * Title II. The Role of Public Programs


 * Title III. Improving the Quality and Efficiency of Health Care
 * Title IV. Prevention of Chronic Disease and Improving Public Health
 * Title V. Health Care Workforce
 * Title VI. Transparency and Program Integrity
 * Title VII. Improving Access to Innovative Medical Therapies
 * Title VIII. Community Living Assistance Services and Supports Act (CLASS Act)
 * Title IX. Revenue Provisions
 * Title X. Reauthorization of the Indian Health Care Improvement Act


 * Read the Full panel-body of the Affordable Care Act


 * Full Text of the Affordable Care Act and Reconciliation Act - PDF
 * Certified Full-panel-body Version: Affordable Care Act - PDF


 * Certified Full-panel-body Version: Reconciliation Act - PDF


 * The first link listed above contains the full panel-body of the Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 in one document. It is not official and is provided for your convenience. The second and third links contain the official certified full panel-body of the law.


 * Note: The panel-body is searchable within each PDF file. Use 'CTR + F' on your keyboard. If you are looking for a specific page, try to enter just the page number into the search box within the PDF. To save a copy of a PDF to your computer, right click your mouse and select 'save link as' then click the 'save' button.

That would probably give the draft's editors some good starting points - perhaps (a) an outline of the different 'titles' and then (b) some lines connecting one title (title in PPACA to title in EPFA).MaynardClark (talk) 01:21, 19 January 2017 (UTC)

GOP repeal audio
, I grow weary of your POV pushing, edit warring, gamesmanship and generally disruptive behavior. Let's talk about your latest re-re-revert, this time to add an audio file of a behind-the-scenes meeting of GOP legislators discussing their concerns about the ACA repeal plan. There is no requirement that the first revert (namely, mine) include a full dissertation on exactly how the original edit violated our neutrality policy before POV pushers like yourself are obligated to follow BRD and come to the talk page. In any case, this audio is non-neutral because is about a behind-the-scenes meeting that (a) is not mentioned in the prose, (b) reveals a certain incompetence of the GOP, and (c) is not central to the repeal efforts. If we were to greatly expand this section, and if in doing so we described in detail how the GOP is in disarray and has no coherent plan to repeal and replace the ACA, and they met to discuss this, then the file would be appropriate. But until then, my feeling is that the video should be excluded. I would appreciate it if you read this entire comment before responding, and do not blow me off with some lame reference to WP:IDONTLIKEIT this time. --Dr. Fleischman (talk) 05:40, 1 February 2017 (UTC)


 * I'm going to ignore your inability to avoid discussing editors or impugning motivations to others. You're welcome.
 * a) Can - and should - be easily fixed. Just add the relevant text/description to the article.
 * b) That's not a POV problem. That's... well that just is what it is. It's strange that you even think that this is a POV problem.
 * c) Huh? Obviously what GOP lawmakers who want to repeal think about the repeal *is* central to repeal efforts.
 * Yes, the section should be expanded. But how does this justify the idea that the video is "POV"? That just doesn't make sense.Volunteer Marek (talk) 05:56, 1 February 2017 (UTC)
 * And it's sort of hard to avoid bringing up WP:IJUSTDONTLIKEIT where your entire justification boils down to a "feeling".Volunteer Marek (talk) 05:57, 1 February 2017 (UTC)


 * Yeah exactly as I thought. Thanks for the articulate, well thought out response. So the tag stays until we get a consensus. --Dr. Fleischman (talk) 15:54, 1 February 2017 (UTC)

Error in Legislative History
The first element in the Legislative History erroneously says that Rep Rangle introduced HB 3590 as the "Service Members Home Ownership Tax Act of 2009". I cannot change this. Can someone with higher privileges please edit this egregious mistake? MrCitizen (talk) 15:37, 26 February 2017 (UTC)
 * Actually I believe this is accurate:, --Dr. Fleischman (talk) 17:33, 26 February 2017 (UTC)

House Replacement Bill for ACA
I just started a page on the house GOP newly released bill to replace the ACA. The page American Health Care Act for 2017. — Preceding unsigned comment added by Casprings (talk • contribs) 17:37, 6 March 2017 (UTC)

Redundant information
I found an instance of redundancy in the "Impact: Coverage" section. It would seem that the first two sentences of the first paragraph are repeated again in the third paragraph.

"The law has caused a significant reduction in the number and percentage of people without health insurance. The CDC reported that the percentage of people without health insurance fell from 16.0% in 2010 to 8.9% during the January–June 2016 period.[189]" — Preceding unsigned comment added by 59.120.188.205 (talk) 05:35, 21 March 2017 (UTC)
 * ✅ Thanks, fixed. That section could still use a fair amount of cleanup and reorganization. --Dr. Fleischman (talk) 16:22, 21 March 2017 (UTC)

Obama's comments
Discussion started here. Do what you want with copying the discussion or whatever.— Vchimpanzee  •  talk  •  contributions  •  18:15, 5 April 2017 (UTC)


 * After my edit of April 8, 2017 was reverted and finding this talk page section I want to discuss if and how can Obama's March 23, 2017 statement can be incorperated into the Patient Protection and Affordable Care Act article. I am open to comments and proposals. Thanks. --P3Y229 (talk • contribs) 00:05, 9 April 2017 (UTC)


 * I don't see any way. The problem is that Obama has made hundreds or thousands of comments about the ACA. We can't possibly include a sentence about each one. What makes this one stand out among all the others? And what makes this one stand out among the many thousands of comments made by all of the ACA's other highly notable proponents and opponents? --Dr. Fleischman (talk) 15:28, 9 April 2017 (UTC)


 * What Obama's March 23, 2017 statement stand among all the others and the many thousands of comments made by all of the ACA's other highly notable proponents and opponents are the facts 1.) that the statement is the first post presidential statement on the subject by Obama after leaving office on January 20, 2017, 2.) the statement was made on the seventh anniversary of his signature health care law and 3.) the statement was released one day prior to replace the law with American Health Care Act. My proposal to resolve this situation is to include the statement with its sources and the aforementioned facts into the External links section. Can the issue resolved on the basis of this proposal? --P3Y229 (talk • contribs) 14:42, 10 April 2017 (UTC)


 * Those are not sufficient reasons to include Obama's statement in my view. And no, external links sections must not give undue weight to a particular point of view, as you're proposing. --Dr. Fleischman (talk) 05:09, 12 April 2017 (UTC)


 * Both sources were moved into the Other section of Barack Obama article. In this section are already written statements by former president Obama so it's right place for the two sources. The isssue is therefore in my opinion resolved. --P3Y229 (talk • contribs) 17:56, 22 April 2017 (UTC)

Semi-protected edit request on 7 May 2017
Change is to was Longestwikipedianusernameeverinthenationofindia (talk) 17:43, 7 May 2017 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. - Mlpearc  ( open channel ) 17:44, 7 May 2017 (UTC)

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60% of online Obamacare defenders 'paid to post'
I'll take the over on this page since I've witnessed thousands and thousands of edits as if it was full time job promoting the ACA on the Wikipedia prpject by the same editor over the last six years. Whatever take the over means. And I can't spell gud (prpject).

http://www.washingtonexaminer.com/obamascare-60-of-online-obamacare-defenders-paid-to-post-hits-on-critics/article/2615774 — Preceding unsigned comment added by 71.224.251.239 (talk) 20:58, 25 February 2017 (UTC)
 * Are you thinking of a specific editor? Bear in mind, accusing fellow contributors of paid advocacy is generally seen as a personal attack in the absence of compelling evidence. --Dr. Fleischman (talk) 05:10, 26 February 2017 (UTC)

The OP quotes an article that is dubious, at best, from an acknowledged conservative outlet; a story not covered or reprinted by any other news organization. The article quotes a few snippets from an interview on essentially a cable access network show. In it, a man named Brown, who is claimed (without any qualifications listed) to be a "digital expert", says that after "reviewing 226,000 posts by 40,000 sources on Facebook [and only on Facebook]", he concluded that "60% of all the posts [defending Obamacare] were made from 100 profiles, posting between the hours of 9 and 5 Pacific Time." From that one unproven datapoint, he concluded that, "They were paid to post."

I would argue strongly that Brown's conclusion is indefensible and unproven, thus rendering the article useless and the OP's argument based on a flawed premise. MrCitizen (talk) 17:04, 26 February 2017 (UTC)

No fear the beacons of objectivity CNN, NBC, CBS WashPo et al.....won't be picking it up anytime soon. The above analysis of the study is dubious at best. The study has been reprinted by amongst others American Thinker another at best dubious obviously doesn't agree with the Wikipedia bias outlet. Sources such as IBD, Forbes, WSJ etc.....are all dubious on this page, instead academics who directly profit from the ACA and selling similar systems are quoted all over the place.

By the way similar such obviously dubious analysis is exactly how they in part pinned stuxnet onto the US government. So as dubious at it may seem, that method was used in part to identify the originations of one of the most famous computer worms of all time.

Accusing specific editors of being obviously bought and paid shill and spin bots is highly disruptive. Compelling evidence to a normal human being would be considered editing ACA on Wikipedia as a fulltime vocation. One thing for sure-the time period from 2008-2017 witnessed the Wikipedia project turning from an interesting experiment into a chronicle of epic fail. Both are useful in their own regards. — Preceding unsigned comment added by 71.224.251.239 (talk) 02:07, 3 March 2017 (UTC)

Apparently, the facts have a liberal bias.Farcaster (talk) 15:42, 4 March 2017 (UTC)

Just change topics-can't be said any better. and of course like the endless material edited out of this page already-

of course this is relevant material. Same means used in the study were used to identify Guccifer, Stuxnet etc.... aka the spy agencies use time and date to include and exclude possible sources. Little different than the study above used time and date to pin down obviously bought and paid for POV pushers.

Just like it was relevant material that 100 CEO's of Fortune 500 companies cited layoffs due to the ACA while certain POV pushers still maintain no job losses based on academics who directly profited from the ACA.

I see no need to change the subject material to make same point as the editors below. 1000 net DNC election losses in eight years-the POV pushing is doing some kind of job.

The general problem here is that there is a group of editors who one can reliably count on to argue that any sentence that casts any doubt on the idea that Russia interfered in US elections is undue, fringe, POV, poorly sourced, a BLP violation, etc. The fact that this group of editors is so much more aggressive in editing the article, and so shameless about editing in this way, has horribly skewed the article. The article, as it is, is a real travesty for Wikipedia. -Thucydides411 (talk) 19:52, 11 March 2017 (UTC) Exactly, and this battleground editing climate has pushed some contributors to disengage. NPOV has seemingly been redefined as "anything that doesn't exactly match the official assessment by intelligence agencies is undue". Here's an egregious example: we had long discussions about James Clapper's integrity being tarnished by Binney's opinion, resulting in any counterpoints to Clapper's utterances labeled FRINGE and BLPVIO. The case was dropped. Now recently Clapper said that no evidence was found linking Trump's campaign to Russia, and suddenly his words have no weight, and the RS citing him have no credibility. The only conclusion is that when anybody, be they a concerned party, a politician, a geek or an intelligence analyst, says something reinforcing the official narrative, dominant editors defend it like Gospel, and when they happen to say something casting doubt on the Trump–Russia collusion story, any attempt to quote them is blocked. I don't see how to remedy this without being accused of POV-pushing and edit-warring, so I have mostly disengaged from the article at this point. Is there any venue where neutrality can be assessed and defended with concrete examples? — JFG talk 23:58, 11 March 2017 (UTC)I've also largely disengaged. I noticed that after I was sanctioned (unfairly, as several admins even admitted) for a week for my editing here, several editors who generally favor some inclusion of dissenting views in the article disengaged, and there was a major "cleanup" of the article by those editors who consistently remove any view that questions Russian interference in the US elections. The sanction seemed to have a chilling effect on one set of editors, and it gave free reign to the other set of editors. I've come to the conclusions that most of the time, admins are likely to rule in favor of editors who represent a certain political view. This is based on the discrepancy between the sanctions handed down vs. the behavior of different editors, and the really shocking views voiced by several admins on this talk page about US intelligence agencies being reliable sources.I really wish this page were not such a battleground. But there are active editors here who consistently remove any material that questions the idea of Russian interference, using flimsy and inconsistent justifications (e.g., the largest daily newspapers in Germany and France are somehow not reliable sources, or the famed US intelligence analyst William Binney is from the last century), and then slanted enforcement from admins. I'm not trying to do the reverse - to remove any material I personally disagree with - and it would be anathema to me to do so. I'd actually like to see an article that reflects the range of views given by reliable sources on this topic, but achieving this does not seem possible in the current editing environment. -Thucydides411 (talk) 01:30, 12 March 2017 (UTC) — Preceding unsigned comment added by 71.224.251.239 (talk)


 * I"m sorry, I'm having trouble understanding what content you want added to this article and why. Can you please explain concisely without criticizing other editors? --Dr. Fleischman (talk) 06:24, 12 March 2017 (UTC)

Ummm, you would think this wiki article would bother mentioning that the House recently voted to repeal Obamacare. Don't you think that is big news? — Preceding unsigned comment added by 2602:302:D173:BAA0:5D78:5903:8528:528 (talk) 16:07, 26 May 2017 (UTC)

Incorrect House vote
It says in the upper right box that it passed the house 416-0, while the source linked says it passed 243 vs 173. Dajasj (talk) 08:17, 28 June 2017 (UTC)
 * You misread the source. It doesn't say that. It says 243 Democrats voted yea and 173 Republicans voted yea as well. --Dr. Fleischman (talk) 16:42, 28 June 2017 (UTC)

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Patient protection
I came to the article to find out more about the patient protections in the PPACA. (Specifically, what are the protections legislated?) I am very inexperienced at editing wiki articles, but would request that be added. — Preceding unsigned comment added by 69.47.178.1 (talk) 15:36, 14 July 2017 (UTC)
 * Is this not clear from the second paragraph of the article? --Dr. Fleischman (talk) 17:00, 14 July 2017 (UTC)

Semi-protected edit request on 18 July 2017
The passeddate1 and passedvote1 elements of the Infobox are incorrect. They currently reference http://clerk.house.gov/evs/2009/roll768.xml which is for BILL TITLE: Service Members Home Ownership Tax Act NOT the ACA.

The House roll call link for the ACA is http://clerk.house.gov/evs/2009/roll887.xml which was on 11/7/2009 and was 220 to 215. Heatfanjohn (talk) 20:41, 18 July 2017 (UTC)
 * Yes check.svg Done jd22292 (Jalen D. Folf) (talk) 21:42, 18 July 2017 (UTC)

Semi-protected edit request on 26 July 2017
Change these source links on back from:


 * https://online.wsj.com/article/SB10001424052748704784904575111993559174212.html
 * https://online.wsj.com/article/SB10001424052702303561504577494682627914026.html

To:


 * http://online.wsj.com/article/SB10001424052748704784904575111993559174212.html
 * http://online.wsj.com/article/SB10001424052702303561504577494682627914026.html

They're now dead links (with "S" shoehorned into "http") redirecting to login or "unavailable" pages instead of articles. 103.232.25.47 (talk) 14:58, 26 July 2017 (UTC)
 * Yes check.svg Done DRAGON BOOSTER   ★  15:50, 26 July 2017 (UTC)

91., 127., 129., & 470.
As of this posting, citation # 91., 127., 129., & 470. have a "cite error." Are we repealing and replacing good sources? Sleyece (talk) 14:34, 26 July 2017 (UTC)
 * I added a notice in the references to acknowledge they are incomplete, and this article may not have accurate, current information as a result. Sleyece (talk) 15:06, 27 July 2017 (UTC)
 * Until the multiple incomplete citations can be addressed, this article is incomplete and not an encyclopedic source of information. Sleyece (talk) 15:18, 27 July 2017 (UTC)
 * This has been addressed. Thanks for noting this. Next time, please do not add page-level incomplete tags when 3 out of 470 citations are broken. --Dr. Fleischman (talk) 17:28, 27 July 2017 (UTC)

Actions to hinder implementation
I am seriously concerned about this section as it reads as non-neutral. It may be factually accurate, but it's poorly sourced, it includes weasely language (saying that unspecified "prominent Republican politicians") have done of these misdeeds, and non-neutral language ("then insisting," "among others," "Ongoing insistence, despite CBO assertions to the contrary"). This really reads as a little pro-ACA diatribe. Not only does it need to be cleaned up and cite checked, but appropriate contrary views need to be added, as I know some Republicans have tried to justify various actions. If these steps aren't taken then we should delete this subsection. --Dr. Fleischman (talk) 21:24, 3 August 2017 (UTC)

Off-exchange enrollment
Doc F reverted me, saying "this is not what the source says - and what the source says is highly misleading". That's not good enough. What is wrong with the edit? Lfstevens (talk) 08:30, 6 August 2017 (UTC)
 * For starters, your edit said, the number of individual policy holders declined by an estimated 29% from 2016 to 2017. That is not what the source said. The source said that off-exchange individual enrollment declined by 29%. The key word being "off -exchange"--this is the number of people who enrolled directly with their insurers not through the ACA exchanges (a comparatively small number in both 2016 and 2017). HUGE difference. I don't even need to get into the ridiculousness of the source's analysis, and its unreliablity. --Dr. Fleischman (talk) 09:17, 6 August 2017 (UTC)
 * My edit said:
 * As of July 10, 141 plans had filed initial applications to offer 2018 coverage, a 38 percent reduction from 227 in 2016, while the number of individual policy holders declined by an estimated 29% from 2016 to 2017.
 * I happily accept your correction adding "off-exchange" to the text. But otherwise, the edit is accurate. Lfstevens (talk) 18:20, 6 August 2017 (UTC)
 * Verifiability issues aside, what is the benefit of discussing off-exchange enrollment numbers? Not to mention that we'd need to explain what off-exchange means. --Dr. Fleischman (talk) 03:16, 7 August 2017 (UTC)
 * The article is not about the exchanges. It's about the Act. Off-exchange enrollment is an essential part of the overall insured/uninsured metric. Lfstevens (talk) 00:34, 10 August 2017 (UTC)
 * Sure, but why give the off-exchange enrollment figures for a single year, and not the on-exchange figures for the same year, or either for other years? --Dr. Fleischman (talk) 04:14, 10 August 2017 (UTC)
 * This section is about 2017...If you want to add stuff beyond what I did, go for it. Lfstevens (talk) 06:12, 15 August 2017 (UTC)
 * You didn't answer my question. It seems to me you're cherry-picking to support a particular POV. --Dr. Fleischman (talk) 07:49, 15 August 2017 (UTC)
 * How is it cherry-picking to present properly-sourced facts? They were what the source reported. I can think of lots of other things to add to this article. I may get to some of them. Lfstevens (talk) 23:24, 15 August 2017 (UTC)
 * The source itself cherry-picks and its analysis is bogus. Although its numbers are accurate, it is not a reliable source for its analysis or conclusions. --Dr. Fleischman (talk) 17:16, 17 August 2017 (UTC)
 * It's a reliable source for its facts. That's all I used. I made no conclusions. Lfstevens (talk) 23:30, 19 August 2017 (UTC)
 * Right. The facts are reliable; it also cherry-picked those facts to advance a faulty analysis. I oppose the use of them in isolation. If you're going to insist on using them then I suggest WP:DR. --Dr. Fleischman (talk) 17:22, 20 August 2017 (UTC)

Request split (September 2017)
I propose most of the content in this article be WP:SPLIT into a new, more general article about Obama's health laws. I have two reasons:


 * Less importantly: This article is very long. Its readable prose size is 89 kB; far into "probably should be divided" and approaching "almost certainly should be divided" in WP:SIZERULE.


 * More importantly: This article should be specifically about the Patient Protection and Affordable Care Act, but sections 2 through 7 (most of the article) make almost no attempt to distinguish between this law and its sister law the Health Care and Education Reconciliation Act of 2010. What's more, this is irreparable: the second law modified the first, so any discussion of the impacts, public opinion, implementation, etc. of the laws can only take the two of them together. If anyone thinks this is trivial because the first act was bigger, HCERA made major changes to PPACA, such as overhauling the tax credit schedule (which is one of the three legs of the law's individual market design), overhauling the Medicaid expansion federal matching, and replacing a third of the law's revenue. Keeping the effects of a two-part health reform under only the article for one part is very misleading to the reader. There is a reason the CBO always refers to the "Affordable Care Act" and specifies that it comprises the PPACA and the HCERA.

Because of these two reasons, I think all content that refers to the subsequent effects of the law (the impact, public opinion, political aspects, opposition, and implementation history) should be split off into a new article covering the two-part Obama-era health reform. It should also get most of the legislative history, though a condensed version of the legislative history should remain on this article. The new article should get a concise version of the still-law provisions of PPACA and HCERA.

The obvious names for the new, broader article would be "Obamacare" or "Affordable Care Act". Obamacare is used slightly more often by news sources, according to google's news searches (8,270,000 to 6,260,000), and much more often in searches by the public. Affordable Care Act is still preferred by some official bodies like the CBO, and was probably used more often by the Obama White House. Madshurtie (talk) 17:04, 23 September 2017 (UTC)


 * While I can see where you're coming from, I disagree with your analysis and proposed solution. HCERA was a significant amendment to PPACA/the ACA/Obamacare/whatever you want to call it, but that's all it was, an amendment. Obamacare was still created by PPACA, and PPACA was by far the dominant piece of legislation. I don't think it would make sense to split the two because of HCERA. That said, I do think this article should be moved to Obamacare. --Dr. Fleischman (talk) 03:48, 24 September 2017 (UTC)


 * I guess it depends how significant a significant amendment it's considered to be. One problem with the article at the moment is its very easy to forget this act had a major amendment. The page generally uses "the law" rather than "the laws" when referring to the effects, and refers to "ACA" without specifying whether this is a term for PPACA or PPACA+HCERA (many sources, such as the CBO, use it as a handy way of referring to the two). Madshurtie (talk) 11:51, 24 September 2017 (UTC)
 * I'd also add it's not an amendment of the same law in the sense the American Health Care Act of 2017 has been having amendments. PPACA and HCERA both have separate public law records. Madshurtie (talk) 11:56, 24 September 2017 (UTC)
 * I agree that more should be added to this article about HCERA's legislative/enactment history. --Dr. Fleischman (talk) 16:33, 24 September 2017 (UTC)

Semi-protected edit request on 30 September 2017
All specific bills were defeated, however. The revised BCRA failed on a vote of 43-57. A subsequent "Obamacare Repeal and Reconciliation Act" abandoned the "repeal and replace" approach in favor of a straight repeal, but failed on a vote of 45-55. Finally, the "Health Care Freedom Act", nicknamed "skinny repeal" because it would have made the least change to the ACA, failed by 49-51, with Collins, Murkowski, and Senator John McCain joining all the Democrats and independents in voting against it.

In early September 2017, Senators Lindsey Graham and Bill Cassidy constructed a bill to try and repeal Obamacare once again; however, by September 28, 2017, it was evident that the measure did not have enough votes either and therefore no vote would be held. https://www.self.com/story/twiwh-graham-cassidy-failed 107.144.71.246 (talk) 22:46, 30 September 2017 (UTC)
 * Red question icon with gradient background.svg Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format. Sparkling Pessimist   Scream at me!  22:49, 30 September 2017 (UTC)

Trump's executive orders in October 2017
Why is there nothing about these?

This is one source.— Vchimpanzee  •  talk  •  contributions  •  21:07, 16 October 2017 (UTC)
 * Because no one has taken the initiative to add them. Go for it! --Dr. Fleischman (talk) 22:17, 16 October 2017 (UTC)
 * I was hoping someone could tell me where to add the information, but I guess they'll find a way once I've added it.— Vchimpanzee  •  talk  •  contributions  •  15:12, 18 October 2017 (UTC)
 * I think where you put it was the right place. --Dr. Fleischman (talk) 18:49, 18 October 2017 (UTC)

Premature deaths
, I don't understand the link between the map you added and Obamacare. The source doesn't say anything about Medicaid, insurance coverage, or Obamacare. As a secondary matter I also question the source's reliability, since it's a blog and there's no indication that it's been fact-checked. --Dr. Fleischman (talk) 00:38, 8 November 2017 (UTC)
 * Regarding credibility, it's the FRED (Federal Reserve Economic Database) blog run by the Federal Reserve Bank of St. Louis. So you won't get a more credible source of information. The map shows counties where we have higher mortality, and the section in the article where I've attached the image explains how Medicaid affects mortality (e.g., not having health insurance is a killer that impacts mortality). You booted my first attempt to tie the map to Medicaid expansion, so I just left the map citation. If it helps, I'll take the citation from right next to the map and include that.Farcaster (talk) 01:45, 8 November 2017 (UTC)
 * I added some text in the article to clarify the linkage: 1) Coverage reduces mortality; 2) Medicaid expansion expands coverage; 3) Therefore Medicaid expansion reduces mortality. The map covers mortality. Hopefully that helps.Farcaster (talk) 02:07, 8 November 2017 (UTC)
 * The problem with the content as currently written is that it's classic original research. Why not just cite the Kaiser source for its summary of the mortality impact of Medicaid expansion, and drop the chart that isn't about Medicaid or Obamacare? The article is long enough as it is, no benefit of adding a big chart of only tangential relevance. Plus, the content you added overstates the Kaiser source, which said that one study found that Medicaid expansion did not affect in-hospital mortality, and another study only found that a decrease is preoperative mortality for cardiac surgery patients. --Dr. Fleischman (talk) 06:36, 8 November 2017 (UTC)
 * Granted, this article is long enough already. I've got the map in some other places. But sources indicate that lack of coverage increases mortality, and this map is about mortality, so I disagree on OR. You're the resident guardian of this article (a role I appreciate, having done so many times on other articles) so I'll leave the decision up to you and won't pester you about the chart.Farcaster (talk) 14:13, 8 November 2017 (UTC)
 * I fully support saying something about Obamacare-related coverage (Medicaid expansion or otherwise) decreasing mortality. But for starters we need a source that actually says that. Or, we can scale our content back to what the Kaiser source actually says, which is much less impressive. --Dr. Fleischman (talk) 16:44, 8 November 2017 (UTC)
 * Since Obamacare Medicaid expansion increases coverage (cited), and coverage decreases mortality (cited), therefore Obamacare Medicaid expansion decreases mortality. This is straight up logic (A implies B and B implies C therefore A implies C). It isn't OR, it's deductive logic, no citation linking A to C required. It must be true by definition.Farcaster (talk) 18:21, 8 November 2017 (UTC)
 * There are two problems with this. one is that it's classic WP:SYNTH, your logic is exactly what that policy forbids. But what I really want to know is which source (or sources) supports the claim that coverage decreases mortality. --Dr. Fleischman (talk) 20:24, 8 November 2017 (UTC)
 * How can irrefutable logic result in synthesis? The statement is true by definition, whereas synthesis requires some type of opinion. And the sources that support the claim that coverage decreases mortality is already in the article. Look at the first paragraph in the "Health Outcomes" section.Farcaster (talk) 21:40, 8 November 2017 (UTC)
 * Ohhh I thought you were pointing to the sources you added yesterday. Now I understand. I'll dig into this a little more sometime soon. --Dr. Fleischman (talk) 21:46, 8 November 2017 (UTC)

External links modified
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Origin of term Obamacare
I was the author and originator of the term ObamaCare - so there is incorrect information saying that the first to use the term ObamaCare were political opponents - Fox News picked up the term after seeing me use it on twitter and many began to use it after that - Scott A. LaFata : Wikipedia user ID Firstclasscool - ###  — Preceding unsigned comment added by Firstclasscool (talk • contribs) 19:25, 17 October 2017 (UTC)
 * , do you have links to back that up? To your tweets and to early Fox News reports? --Dr. Fleischman (talk) 19:42, 17 October 2017 (UTC)
 * Actually, no need. The term emerged in 2007, per the sources. Your Twitter account was opened in 2011. --Dr. Fleischman (talk) 19:48, 17 October 2017 (UTC)


 * Like many such appellations, many folk came up with it at the same time. We would need a reliable source for the origination. Which doesn't look likely. O3000 (talk) 21:34, 17 October 2017 (UTC)


 * As with many memes, there is the original coining, and then there is the earliest usage that seems to've put it into the general public consciousness. Presently, the early-2007 references appear to accurately (if not precisely) represent the latter. Weeb Dingle (talk) 19:22, 21 January 2018 (UTC)

GAR request
I am going through the Good article reassessment request backlog. This article has outstanding and valid tags so that needs fixing. It is also incredibly long (94KB readable prose), which is almost certainly split territory. Given the narrow scope of the article I would say it fails criterian 3b. I will give a chance for editors to respond before going through a more formal process. all editors with over 100 edits to the article (ping others if you want). Plenty of interested editors so hopefully someone will be willing to work on it. AIRcorn (talk) 06:40, 23 March 2018 (UTC)
 * Support fork The article is too long. I nominate the "Implementation history" section for a fork to its own article. This section is 37k and is of the least interest to most current readers.  Blue Rasberry   (talk)  13:06, 23 March 2018 (UTC)
 * Looks like your nomination wins by default. Will do the split and see what we are left with. AIRcorn (talk) 00:58, 6 April 2018 (UTC)
 * Split and trimmed. It was full of off topic and overly detailed information. It was self referential. Can someone double check it. I feel something similar needs to happen to the other sections. I will probably look to delist this if it is not improved in a week r two. AIRcorn (talk) 01:34, 6 April 2018 (UTC)


 * This article is not even close to GA. I wouldn't spend more time on an assessment. I support the split, because it may give this article a chance to stabilize. Lfstevens (talk) 00:29, 10 April 2018 (UTC)

Texas et al v. United States of America et al
Create Texas et al v. United States of America et al article, due to Fate of Obama's health law set to be decided by supreme court – again'' (15.Dec.2018) ? See Patient Protection and Affordable Care Act here in article. X1\ (talk) 20:04, 15 December 2018 (UTC)
 * There should be a 48 hour waiting period... Allow a couple of days for WEIGHT and further details to appear.  Cheers Markbassett (talk) 04:53, 16 December 2018 (UTC)

Title issues
I know this has been discussed before, but I'd like to give a different perspective on the subject. I know there are probably still some people out there that think this article should be moved to "Affordable Care Act" or "Obamacare" per wp:COMMONNAME. However, I don't think that is the whole story. From my experience, "Obamacare" refers more commonly to the provisions of the act, not the act itself. If this is true, then the common name of the act itself would most certainly be "Affordable Care Act." This exact issue doesn't appear to have come up in past move discussions. Bneu2013 (talk) 03:45, 11 June 2019 (UTC)

Cost-sharing subsidies
In the interests of clarity and neutrality I think we should create a new section or subsection specifically on the insurer cost-sharing subsidies. It would cover the problem in the original act, Obama's executive order, the lawsuit, Trump's executive order, the Murray-Alexander bill, and any subsequent developments. This would make things so much easier to understand than our current structure in which we have this content scattered among "Legal challenges," "Actions to hinder implementation," and "Murray—Alexander Individual Market Stabilization Bill." If it gets too long (likely) it could be spun off into a separate article. --Dr. Fleischman (talk) 16:40, 19 October 2017 (UTC)
 * Agree, I'll pitch in.Farcaster (talk) 21:47, 19 October 2017 (UTC)
 * Ask and ye shall receive. Initial draft done.Farcaster (talk) 23:13, 19 October 2017 (UTC)
 * Nice, thanks. Actually though, this isn't quite what I meant. You framed the section solely around the Trump administration's efforts to undermine Obamacare by not paying the subsidies starting in October 2017. But the subsidies story began way before this month, at least as far back as 2014. This 2015 opinion piece provides some good back story, even if it isn't reliable. Some of the story and sources can be found in House v. Price. --Dr. Fleischman (talk) 23:41, 19 October 2017 (UTC)


 * Aug 2019: I started looking at this article and adding to it a few weeks ago, and did just realized that a section of Cost-sharing reductions (under provisions) was needed, and then caught this section here indicating it was found needed two years prior. So I stuck it in today. I think I've matched the intent of the original poster.


 * (Note that I am using the term "Cost-sharing reductions", which mean the same thing, (according to a link in my section). I find "reductions" clearer, as there may be confusion when "subsidies" are used, since direct Federal payments were stopped by the Trump administration.)


 * Also, when I did the section, I noticed the omission of the silver-plan loading reaction in many or most states, by many insurers (or all insurers in the state, depending on state government orders). Where it was done, the silver loading more-or-less nullified the problem, as long as people not eligible for cost-sharing can figure out to avoid the silver plans.  (In the section, I have a reference to Health Affairs describing this silver loading, if you don't know exactly what I'm talking about.  It was started, and reported on by Health Affairs and others, at the time of the Trump action.)


 * NormSpier (talk) 21:35, 25 August 2019 (UTC)

Noticeboard discussion regarding User:NormSpier's recent edits
There is a noticeboard discussion regarding the neutrality of 's edits to this article (Special:Diff/909824345/912954601) and other articles related to Medicaid estate recovery. If you're interested, please participate at. —  Newslinger  talk   17:15, 30 August 2019 (UTC)

Please see my comments on the noticeboard.

Essentially, after {u:AnUnnamedUser} made comments a week or two ago, I have attempted to repair, but {u:Newslinger} is finding the same problems.

Thus, on my own, I lack the eye, at this point, to find the problems on my own.

Thus, if you could:

a)point out specific passages that should be removed, reworded, and exactly how, if a rewording. (Or, ask for clarification, where does the reference say that?, etc.)

or b)do the deletion or rewording yourselves, using whatever editor consensus procedures you have to make sure there is sufficient agreement on your end. (Delete whatever you need to, if there is no resource to make to conform.)

Thanks

NormSpier (talk) 14:11, 31 August 2019 (UTC)

Also, note. Of the various articles in question (in the messageboard), probably the most critical for it not to appear to others of bias in favor of the ACA, covering up defects, is the ACA article itself, where the section Problems (which I added) lists 5 problems,

5	Problems 5.1	Subsidy Cliff at 400% FPL 5.2	Sometimes-Unaffordable Out-of-Pocket Maximums 5.3	Family Glitch 5.4	Estate Recovery under 138% FPL 5.5	Coordination of Medicaids with On-Exchange Plans

Note that most of the problems, including estate recovery when it is done by states non-long-term-care-related, are in multiple sources, and in particular this reliable one: https://tcf.org/content/report/key-proposals-to-strengthen-the-aca/ (co-authored by Tim Jost, an academic lawyer who did most of the the Health Affairs "Covering the ACA" posts until a year or two ago.)

Specifically, 4 of the 5 wikipedia ACA section 5 "problems" are within the text of the single "proposal to strengthen" article:

5.1 is within "Increase Credits for Moderate- and Middle-Income Families" 5.2 is within "Reduce Cost-sharing and Out-of-Pocket Limits and Improve Minimum Employer Coverage Requirements." 5.3 is within "Fix the Family Glitch" (you only have to go so far as the title) 5.4 is within "Eliminate Medicaid Estate Recoveries from the Expansion Population" 5.5 is the only one not in "proposal to strengthen". But I have reliable references (last paragraph in the article), including actual continuity of coverage issues found in the GAO report. NormSpier (talk) 15:46, 31 August 2019 (UTC)

I have some prior comments on the noticeboard regarding my contributions, which now remain only on this ACA Wikipedia article, and also Medicaid estate recovery.

Here let me add issues relevant to the ACA article, in reaction to comments by Newslinger which are on the noticeboard. (They also may have relevance to the general ACA article, for future editing and such.)


 * From the bulletin board, Newslinger has written
 * (1) "It is fine to include some of the criticism listed at Patient Protection and Affordable Care Act § Problems, although the length of the content should be reduced. For instance, the listed examples for silver/bronze plans are considered original research since they're not covered in reliable sources, and they should be removed."


 * (2) Verifiability: Readers should be able to verify every single statement in a Wikipedia article with a reliable source.

These two principles, let's call them Newsl1 and Newsl2, seem to be causing problems with the ability of the ACA article here to have information to be useful to certain readers needing more than superficial information. In my opinion.

Thus, on removing the bronze and silver plan examples, which is used in two of the "problems" sections: the example provides useful information that a quantitative mind will seek about the issue. For example: over-the-cliff, total expenses, premium plus out of pocket max will be 41% of MAGI, and 27% under the cliff. Values in dollars are also there. The understand is too muddy and incomplete without an example like this.

Thus, the request of Newslinger (Newsl1) to remove the bronze and silver examples would make this Wikipedia article something that I would find, myself, substantially less useful for any kind of numerate understanding of the issue.

(Unfortunately, I see that the two examples, both silver and bronze, are more than we would like. Ideally, only say silver.  But the problem comes up from the states' and insurance companies mixed reactions to the Trump order on the stopping of Federal payments of cost-sharing subsidies, which may or may not have silver loading.  Doing silver only is flawed.  (See my first explanation of the need to avoid silver only, under "subsidy cliff". Silver only would be a flawed analysis, and note the references to Health Affairs, and as well a spreadsheet on silver loading that I think Health Affairs did. I can't do a flawed analysis. I have to respect the quest for truth. I understand the need to simplify. I cannot, however, oversimplify to the point of making the exposition flawed.)

Questions are raised here as to both what level this Wikipedia article is at, and also to how well it is equipped to give adequate information.

The ACA article looks to me roughly at the level of the NY Times. Higher than USA Today, but lower than a graduate math text, or mathematical economics journal, or say the wikipedia article Banach_space.

But, in trying to be at the NY Times level, it still fails. The examples the NY Times might put in, doing its own work. (They have enough policy people and people skilled at calculation to do it.)

However, here at Wikipedia, I was unable to find a reliable source with the information, so I did the numbers myself. I've been asked to remove it. (The calculations are my own, based on the information on the Federal healthcare.gov site, and are thoroughly traceable (for the duration of 2019). However, Wikipedia would hopefully have enough people around, both able to calculate, and with knowledge of the details, to verify.  Then, hopefully they would be able to archive the verification somewhere: maybe with a footnote on the table pointing to the verification.  Presumably, the NY Times has a procedure like this.

(Besides my own thought that a reliable, verifiable (with a little math and policy knowledge) table from a contributor should be acceptable, I caught that a table from 2014 apparently missed quality control. This was the original one under "Premium subsidies".  The last column was labelled "cost-sharing subsidies", but had numbers like $1000 for income at 350% of the Federal Poverty Level.  This was just wrong.  Cost sharing subsidies stop at 250% FPL.  I also manually checked some of the other numbers, and they were off.  (Small amounts only, fortunately, like a few hundred dollars.) (I replaced the table with my own, for 2019. Although it is completely verifiable with minor math, and the references I provided, you probably need to delete it under your policies.)

Otherwise, I'm seeking clarification Newsl2 ("Verifiability: Readers should be able to verify every single statement in a Wikipedia article with a reliable source."), because I'm finding articles where that's not the case. Thus Internal combustion engine, and Calculus, and to a lesser extent, Banach_spaces.

Apparently, in the case of those articles, people writing and editing both have an understanding of the technical details, and are not requiring every sentence to have a reference. However, on the ACA-related articles, I've been told everything needs a reference. (So, for example, the obvious assertion that a Medicaid that has all medical expenses being recovered is a "loan" needs references. So I put them in, but now I'm getting that some of the sources may not be reliable.)  (I suspect the different treatment of hard-science articles vs. the ACA may have something to do with that in the hard sciences, only people who know what's going on get involved, but in anything with any political component, everyone gets involved, and so controls, and everything verified in little baby steps becomes needed as a control against chaos.  But, as I see it, the current Wikipedia procedures are hindering and perhaps blocking a lot of information needed to keep from a muddy, emptyish presentation.)

As for this, I'm not intending on removing important information myself. I am more than happy to help in finding better ways to organize the material, but I can't myself do a gross removal of most of the important information. I understand that general written and unwritten Wikipedia policies and viewpoints will likely result in a gross removal of much or most useful information I have added by others, and that's O.K. with me. NormSpier (talk) 15:59, 1 September 2019 (UTC) NormSpier (talk) 15:59, 1 September 2019 (UTC)

I need to add another comment on this article in response to a third request of Newslinger. Somewhere (I'll save myself the time of finding), he said "too many references" or maybe it was "far too many references". There may official or unofficial policy on this, and I'm not seeking an exception, but I do see that the general policy, like other policies, is removing lots of useful information for certain people. Thus, I have many references at the point where I introduce the controversy around the ACA and Medicaid estate recovery ("The issue of the negative interaction of the ACA with Medicaid estate recovery was noticed in many places starting from the time of ACA passage.[355][356][357][358][359][360][361][362][363][364][365][366][367][345]") Some people may wish to find the original articles, which are from different sources, to get a complete and richer understanding. In separate places, the estate recovery practices of specific states are documented in references, and people might find them useful, or being necessary backup to my claim that a lot of states stopped non-long-term-care-Medicaid estate recovery timed in reaction to ACA, while at least 10 or so have not. I see there is an issue of visual impediment to reading of so many references, but somewhere I think Newslinger has a workaround to that--a "reference group" or something.

Let me repeat also my issue (originally posted on the bulletin board page https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view/Noticeboard)

Newslinger wrote "Reliability: On Wikipedia, sources are considered reliable if they have a reputation for fact-checking and accuracy, and if they are endorsed by other reliable sources."

This sounded to me (perhaps adding other of his comments) like he was saying referencing opinion is no good, you can reference only facts from reliable sources.

So I checked the reference, and found that opinion references are fine, as long as opinion and fact are clearly separated in the article.

My response was:

"I have looked at https://en.wikipedia.org/wiki/Wikipedia:Reliable_sources#Usage_by_other_sources, as one of the issues. (This is the 5th of your issues: Reliability) it says, under: Statements of opinion "Some sources may be considered reliable for statements as to their author's opinion, but not for statements asserted as fact. For example, an inline qualifier might say "[Author XYZ] says....". A prime example of this is opinion pieces in sources recognized as reliable."

This is coming up here in the ACA article, where I have references (repeating my example) on: ("The issue of the negative interaction of the ACA with Medicaid estate recovery was noticed in many places starting from the time of ACA passage.[355][356][357][358][359][360][361][362][363][364][365][366][367][345]"). My labeling does not say everything is absolute, uncontrovertible fact. There are accepted mainstream references, like Seattle Times and Washington Post and Health Affairs (academic journal) post. There are, as well, opinion pieces, notably one from a Paul Craig Roberts, who, though not a mainstream source, does have a Ph.D. in economics, and as well, served as an Undersecretary of the Treasury. Further, though many of his points are expressed heatedly, and he is to the right of me by a good bit, I see that many of the facts he brings up are important, sharp, and not made elsewhere.

Thus, my opinion is that it may be policy or practice to not have many footnotes, and I can understand that you have a policy or practice, and there may be good reasons for that policy or practice. Just please note that the policy or practice removes information that a person might find very useful to really understand both the economic mechanisms involved, and even the emotional flavor and feelings of the real people involved. For example, the reaction of some people from being compelled to sign up for the ACA under threat of penalty, and then as thanks for that, being forced to be exposed to Medicaid estate recovery both of capitations for services not actually used, as well as large recoveries for all medical expenses paid out (no insurance at all).NormSpier (talk) 17:28, 1 September 2019 (UTC)

Reference to One of the Problems (Medicaid estate recovery) in Archived Talk way back in 2013, for what it's worth
For completeness, I caught one of the "Problems" mentioned way back in 2013 in the archive for talk, on the one included problem "Medicaid estate recovery".Talk:Patient_Protection_and_Affordable_Care_Act/Archive_12, citing the Seattle Times article, one that I cited. I didn't catch any mention later in the archives. Views are mixed in the archive on whether that particular problem, at that particular time, should be in this article. NormSpier (talk) 21:18, 17 September 2019 (UTC)

Medicaid expansion quote likely false (A noticed significant error or two by an outsider)
Haven’t read this entry in a while. Seems to have been steered negatively by partisans to give a false impression over Medicaid expansion and Republican led efforts to deny it to red state citizens.

The quote that is false is “The subsidy tapered to 90% by 2020 and continued to shrink thereafter.”

Find out who made this edit, as IMO it indicates they have no business contributed to this website.

As I understand it and have read previously on this page, Medicaid expansion is fully funded for the first few years of expansion (six if 2020 is to be believed) however I think the SC enabled “Medicaid Donut Hole” that R states made a reality delayed that timeline for those particular states. For example, Utah/Indiana/Maine expanded in subsequent years of the law taking effect in 2014, so their gradual reduction to 90% didn’t start until they decided to expand. Please fact check me on this.

Secondly, the last half of that sentence must be a lie intentionally inserted. “Continued go to shrink thereafter”? This is NOT true. It gradually reduces to 10% and stays there per the law. I know because Republican lawmakers in my state used this detail of the law to throw up dust as an excuse not to expand. They would say the state can’t afford the eventual 10% portion and that the feds could lower their portion even more (a lie). Democrats and a few Republicans countered that they can simply write in the law that accepts Expansion funded that can be killed if the federal law changed to go a dollar over 10% of Expansion’s cost.

If I’m wrong, please let me know. — Preceding unsigned comment added by 2601:3C1:102:86A:61F6:E4D5:6031:8C73 (talk) 08:51, 13 September 2019 (UTC)


 * Since my changes and additions are under attack, I feel it necessary to say that I didn't put that in. (So far, blessedly, no one has asserted anything I put in is incorrect.)NormSpier (talk) 15:13, 13 September 2019 (UTC)


 * The sentence "For states that do expand Medicaid, the law provides that the federal government will pay for 100% of the expansion for the first three years, then gradually reduce its subsidy to 90% by 2020" was added by User:Sb101 on August 20, 2013 (diff). It was changed to "The federal government initially paid for 100% of the expansion (through 2016). The subsidy tapered to 90% by 2020." by User:Lfstevens on August 9, 2016 (diff). The phrase "and continued to shrink thereafter" was added by Lfstevens on August 10, 2016 (diff). -- Toughpigs (talk) 00:27, 14 September 2019 (UTC)
 * See, I told you I was clean. Without looking it up, the limiting subsidy is 90%, i.e. the final value, continuing forever. That's the important economic/finance fact, correct in the first two versions.  "Continuing to shrink thereafter" (the commenter's main concern) could, theoretically, be sabotage, making it look like the states get into a real hole financially eventually if they expand Medicaid.  Or, it could be an honest mistake.
 * I happen to have gone through the ACA article history list extensively, as well as "talk" archives. I see user:Lfstevens contributed a good bit around 2 years ago, and further, is present in the talk archives participating in constructive discussion about the content.  So I presume "honest mistake", and that user:Lfstevens is a valuable constructive asset to the team.


 * On the fixes needed for the error(s), note: the first two versions of the erroneous (overstated as "potential sabotage") section are consistent with the first two paragraphs of the subsection Patient_Protection_and_Affordable_Care_Act. (The commenter indicates as his/her less significant error finding, that that reporting in that sub-section is incomplete, though, regarding late-expanding states. Also, the commenter is indicating "fully funded through 2020", which contradicts both Patient_Protection_and_Affordable_Care_Act and the first two versions of the section where sabotage is suspected in version 3.)


 * Also, I think, but am not sure, that the 90% reimbursement is medical costs only. Not administrative costs.  So the state really would have to pick up a bit more than 10% for the expansion people.


 * You may want to note, the 3rd paragraph in the subsection (Patient_Protection_and_Affordable_Care_Act) is mine, from the last month. (One of my 5 problems is in the section I am expecting will be retained, Patient_Protection_and_Affordable_Care_Act, is Problems, and I thought the issue belonged under the Medicaid expansion as well, being a fundamental aspect of the Medicaids (once you know about it--few people know about it).NormSpier (talk) 13:18, 18 September 2019 (UTC)

POV issues
(AUG 2018) Portions of this article read as though they were written by the government and therefore should be questioned as political propaganda. Instead of reading in a more neutral manner, many of the points play out in a consecutively gratuitous manner toward the subject of the article. It reads more like a brochure and less like an objective analysis. There is far more positive POV description of the law than neutral or negative, and much time is spent in this article describing the components of the law AND "why that is good" for you, in a symbiotic relationship. Too much of this feels like it was written by someone who heavily supports the law and it feels strongly as though it is purposefully omitting many studies which have shown to portray the effects of the law in a neutral or even negative light, while selecting studies mostly that show the law as achieving the results the creators proclaimed it would. It does not even take the time to mention in the very least, that for SOME people, many of the included studies do not reflect their experiences, especially concerning deductible increases etc. — Preceding unsigned comment added by Lbredefe010 (talk • contribs) 12:48, 20 August 2018 (UTC)


 * I (during Aug 2019) added a "Problems Section" (i.e. Problems with the ACA).  It has 5 generally-recognized specific problems listed, including the "deductibles increases, etc." cited above by the POV commenter. This should add balance.  And as well, adds representation of an important aspect of the law--that even Democrats like Paul Krugman and Joe Biden are deciding there are problems, and propose that the law be adjusted, if it is to be kept.  This is not mentioned elsewhere in the article. (In Aug 2019, I added a lot of content--3 sections and a little more. All of my content was under attack for various reasons, many valid, including the "problems" section.  However, with details of the specific Wikipedia standards issues being discussed in an RFC, the section, the "problems" section seems that it will remain, with easy adjustments by me to meet the standards.  The other sections I am dropping.)NormSpier (talk) 21:13, 18 September 2019 (UTC)

Error 1
"The law is designed to pay subsidies in the form of tax credits to the individuals or families purchasing the insurance, based on income levels." (Within Patient_Protection_and_Affordable_Care_Act.) This is a significant misstatement, and would also be consistent with understating problems in the ACA. The correct statment would be "The law is designed to pay subsidies in the form of tax credits to some of the individuals or families purchasing the insurance. ("Some of" is people with incomes under 400% of the FPL, who are eligbible for subsidies.  Other people, those stuck with unsubsidized coverage, will be needing to pay higher prices  This is sort of brought up in my "Subsidy Cliff" problem withing the "problems" section.)NormSpier (talk) 18:30, 20 September 2019 (UTC)

Reference to One of the Problems (Medicaid estate recovery) that just got fresh (10/2019) attention at the national level in the Atlantic
The last national attention that I know of was the Washington Post in 2014. This is the article Atlantic Oct 2019 Article on Medicaid Estate Recovery.

Note that the article discusses both the recovery of nursing-home and other long-term-care-related expenses, which is not an aspect of Medicaid estate recovery being an impediment to the ACA (because ACA is only medical expenses) and the recovery of medical expenses for people 55 and older, which is the impediment to the ACA. It makes the "coverage" just a loan, and the article uses the terminology "loan".

This recent Atlantic article should be added as a "reference" or "see also" to the Problems subsection on Medicaid estate recovery.NormSpier (talk) 21:31, 20 September 2019 (UTC)

Cost-sharing reductions (section needed under "Provisions")
There was a 2017 or 2018 request in "talk" to add a section on "cost-sharing reductions", which was not actually done. (The message in "talk" was not that precise, and a person added it in a place just mentioning the stopping of the Federal compensation for cost sharing reductions. The original requester subsequently responed "that's not what I meant".)  Somehow, this section of "talk" got removed Sept or Oct 2019.

In Aug, 2019, I added such a subsection of "provisions", based on my own realization that the article needed such a section, and was kind of incoherent, discussing cost-sharing-reductions in certain places, but not saying what they were, and also in omitting a major feature of the ACA. (This was among 2 full sections and that subsection and some other changes that I did in Aug 2019, as a newcomer to both the project and Wikipedia.) However, in negotiations within a Sept 2019 RFC, I agreed to drop the cost-sharing-reduction section permanently. It had too much that was taken to be "original research" by the team, or perhaps by Wikipedia standards. It seemed virtually impossible to fix with reasonable effort, especially given the technically non-elementary silver-loading reaction in most states, to the Trump dropping of Federal compensation to insurers for cost-sharing reductions costs. These mostly eliminated the problem where it was done.

So, the section is now out. I would argue this is the biggest defect of the article--not to define cost-sharing reductions.

If anyone wants to take a stab at adding it back in, the provisions subsection on cost-sharing reductions that I removed is stored here: User:NormSpier/PPACARemovedCostSharingRedReference. (It would need to be reduced or researched with a lot of alternate references found, where I just used knowledge and economic reasoning.)NormSpier (talk) 22:51, 1 October 2019 (UTC)

Formal "Rollback" (per RFC) will not be done: Feel free to add your own content without fear of getting your changes lost in a "rollback"
During the RFC, it was resolved how to handle the issue of contention. There will be no rollback via software.

I am doing this:


 * a)On the article, just delete the two of my sections I have proposed to throw out ("Outline of coverage mechanisms" and "Cost-sharing reductions). DONE 10/1/19
 * b)Also remove what is probably controversial, and mention of the "Medicaid estate recovery" outside of the problems subsection on it. DONE 10/1/19


 * c)Also remove, elsewhere where I have it, the bit about the Silver loading, and perhaps let someone else figure out how to put it in, and possibly explain it there, without hitting "original research", and without making the average reader's eyes glaze over. DONE 10/1/19


 * d)Then I can pretty quickly adjust the section "Problems" to meet user:Newslinger's objections on the section (as stated in the RFC), presuming he will now agree on bronze and silver calculations being a "routine calculation" per Wikipedia standards. Also incorporating any additional advice on encyclopedic writing that anyone may chime in on.

(Starting 10/1/19) NormSpier (talk) 22:24, 1 October 2019 (UTC)
 * Item (d) has been completely done. The bad references cite by Newslinger in the RFC have been removed, and when not redundant to sound references, replaced by sound references. (10/2/19)  Further, I've removed all of the "original research".
 * I am likely to find official sources for data on the subsidy cliff, to replace my Bronze and Silver examples.


 * Otherwise, I am open to specific rewording suggestions for POV purposes from anyone.NormSpier (talk) 17:43, 2 October 2019 (UTC)

(UTC)

The top of this Talk page is a helter-skelter gallimaufry
The top of this Talk page contains a haphazard hodgepodge of statements and historical records, many of which don't seem necessary since they are dated. In addition, there are two archives search boxes, which might be confusing to some participants. I tried to fix the archive search box problem but my attempts did not work. The underlying HTML code shows two archive search boxes, but the wikitext does not. I cannot figure out how to change it.

Word geek note: Sorry for the esoteric word, gallimaufry. But I stumbled across it and I love how it sounds and its origins. ¶ gallimaufry, n. 1. A dish made by hashing up odds and ends of food; a hodge-podge, a ragout. 2. transferred and figurative. A heterogeneous mixture, a confused jumble, a ridiculous medley. (OED) ¶ gallimaufry, n. A jumble; a hodgepodge. French galimafrée, from Old French galimafree, sauce, ragout .... (AH)

Primary question: What do you think about removing the dated notices and historical record boxes? - Mark D Worthen PsyD  (talk)  (I am a man. The traditional male pronouns are fine.) 19:04, 2 October 2019 (UTC)
 * User:Markworthen Fine by me. (With the proviso you don't mean to delete the list of archives of "talk", and search archives, which I find useful, and have already used.)NormSpier (talk) 22:00, 2 October 2019 (UTC)
 * Thanks NormSpier. :0) I agree with you that links and a search box to the page's archives are a vital part of the Talk page.  - Mark D Worthen PsyD   (talk)  (I am a man. The traditional male pronouns are fine.) 00:33, 3 October 2019 (UTC)
 * I made some edits to prune some of the talk page templates (diff). I do not intend to circumvent the consensus-building process. My intention is to "show what I'm talking about" so that other editors have a visual displaying the type of changes I think will help eliminate the gallimaufry. ¶ The (awkward) little box with this text: "See also Archived talk page templates (not indexed)" near the top is temporary. If you know how to add a named archive page (as opposed to a numbered or month/year archive page) while using the template, please integrate the Archived talk page templates page into the list of numbered archive pages. I could not figure it out. (I'll ask for help on Village Pump or Teahouse). Thanks!   - Mark D Worthen PsyD   (talk)  (I am a man. The traditional male pronouns are fine.) 02:56, 3 October 2019 (UTC)

Archived Talk page templates
I created a new archive page for dated talk page templates: Talk:Patient Protection and Affordable Care Act/Archived talk page templates. I discussed this addition immediately above, but I'm adding this little section to make sure Archived Talk page templates shows up in a search of this talk page's archives (and other searches on English Wikipedia). - Mark D Worthen PsyD  (talk)  (I am a man. The traditional male pronouns are fine.) 03:06, 3 October 2019 (UTC)