Talk:Affordable Care Act/Archive 7

Copies of the Proposed *bill* hosted online or readily downloadable
The first link in this section implies it points to the law "...after consolidating the amendments ...", but it does not. While it is an 'official' compillation (combination) including ammendments made by both laws, it is provided for the public, but it clearly states that it is NOT the law.

I also recommend that entries in that section clearly indicate if they point to references regarding the BILL (that bounced between House & senate being changed), or the signed law(s). This may seem like a fine distinction, however, this can be confusing to readers and there are summaries at various stages of the process that are floating around the internet; some of which in no way reflect the passed law.

Also, I couldn't find the following referenced in the article. It appears to be a quite complete section-by-section summary as it includes the ammendments which were made later within the PPACA itself, as well as the ammendments made to the PPACA by the Reconciliation Act. I am not proficient in editing and leave this for someone who is...

http://dpc.senate.gov/healthreformbill/healthbill53.pdf

Located at: http://dpc.senate.gov/dpcdoc-sen_health_care_bill_archive_as_passed.cfm

-- Steve -- (talk) 01:57, 29 December 2012 (UTC)

GOP leaders want preexisting conditions covered sooner than 2014
I suggest adding the information from http://tpmdc.talkingpointsmemo.com/2013/03/house-gop-we-really-care-about-preexisting-conditions.php to this article. It seems rather important. EllenCT (talk) 04:31, 10 March 2013 (UTC)

I've noticed that you haven't added anything to any articles. We really encourage people to be WP:BOLD so go ahead and edit! We're all just volunteers and we need your help! With that said, generally we try to avoid using encyclopedia articles to report the play-by-play of politics. If this change happens, sure; and if you really want it in, please make it very short and put it in an appropriate spot (e.g., the Republicans reactions to it). II | (t - c) 08:10, 10 March 2013 (UTC)

Thanks for the encouragement. I promise I will try with other articles later, tonight I hope. I wanted to see how people added these news items I've bookmarked before I tried it myself. In any case, that one I think is worth keeping an eye on because it would be a major change to the bill and its economics if it happens. EllenCT (talk) 00:04, 11 March 2013 (UTC)

Public opinion
This section is underdeveloped and tendentious.

First problem: the public opinion facts may be untrue, appear secondary, and show manipulation.

It begins with an Reuters/Ipsos poll from June 25, 2012, without offering a source link. Unfortunately, the source at ipsos-na.com is behind a paywall. The barricaded poll was taken June 19 to 23, 2012. Also in June, Ipsos conducted a poll on the same subject with details posted on Huffington Post. Instead of simple for/against measurement, this poll included undecideds. The result: in favor (44%) and against (45%) is statistically even, with 12% undecided. This is suspiciously close to the 56% to 44% result reported by Reuters, which may be the source of this wikipedia entry. By adding the undecided percent to the opposition, Reuters built a case for their headline. But it was phony.

This makes the wikipedia entry invalid, and also points out the media's capacity to produce feedback that reshapes public debate, and thus public opinion.

Solution: Eliminate secondary poll sources, if they exist, and link to actual polling. Minimize single polls, which vary, and report how polling is manipulated to affect public opinion. Use charts, such as this [http://www.huffingtonpost.com/2009/07/30/healthplan_n_725503.html/ Poster.com chart. , do a quick job of showing dynamic trends. One can see that polls have high variance, so singe poll numbers fail to convey conditional probability. Polls also reflect polster methodology and intent. By surveying them together, these issues are better appreciated.

Second problem: "Public opinion supported healthcare reform proposals in 2008, but turned negative when the plan changed in 2009..." This is tendentious, implicit in the sentence's construction. In 2008 there were "proposals" with support. In 2009 "the plan changed" and support diminished. Note the shift from plural to singular. The predicate is "many to one," the conclusion refers to "one to one."

It might be logically correct to say "in 2009 the plans were modified and merged," but it still would be historically inaccurate to make this the cause of diminished public support. In this unreferenced, idealized assumption, public knowledge of different plans and their trade-offs would have to drive opinion change. In the fall of 2009, after a barrage of media reports, barely half the public could identify the "public option" as something to do with healthcare, and only 37% picked its actual definition from three choices, hardly better than random. Given the widespread attention on the "public option", one can safely assume that less reported plan details were less well understood. Indeed the media environment promulgated such a mash of information tidbits and misinformation slogans, it's not surprising the public lacked clear knowledge.

The proximate cause of the shift from positive to negative ACA poll response is the 2009 summer congressional town hall meetings. Perhaps this was a consequence of the Obama administration's delegation to congress of the bill's detailed writing, which succeeded at building Democrat consensus (missing in Clinton's 1993 effort). But it put congressional expertise in the heads of key committee members, not congress at large. Committees themselves differed. Sending congresspeople home with limited knowledge, and insufficient debate preparation, set them up for anti-reform ambush.

The angry individuals who disrupted town hall meetings were not bankrolled by insurance, pharmaceutical, or medical manufacturing companies. They represent a social phenomena not well understood, in that they made extremist claims, yet appeared mainstream. Their financial support came from ideological centers, not business sectors. I don't think it is established whether they represent a latent extremism responding to social factors (and far from the mainstream), or the tail of the American public's mainstream political distribution.

Mass media thrilled to these disruptors, and their publicity generated a negative feedback loop to undermine support for reform. Although like most social history this is a proposition, not a theory, it has much more supporting evidence than the wikipedia entry's notion that plan changes caused opposition.

Thus to correlate the public's negative turn to "the plan changed" is both illogical and tendentious.

I propose a complete remaking of this section, with adequate review of established facts, without misleading statements.

Brian Coyle

I've edited the section and hopefully adequately fixed the problems. I did try fixing the sources for it to but that is the only area of the section that may still need a bit of work imo (in terms of addressing the aforementioned concerns, which I agreed with). Sb101 (talk) 08:03, 2 April 2013 (UTC)

Why list of provisions gets hidden again?
Why list of provisions gets hidden again without any discussion? There already was a discussion about this subject, and agreement was reached that this is the most important part of the article. The main reason why people are coming to this page is to find of what in the law. This is a featured article, list of provisions has been here for many years, so please do not ruin it. The actual provisions are much more important to public, than history of vote or politicians old personal opinions about reform. If we want to make the article smaller, then we should move some of that history into the collapsed section or a new article. Innab (talk) 02:24, 3 April 2013 (UTC)
 * Could you point me to this discussion and agreement? I skimmed the archives and didn't see it. Listing basically every provision which is on a different date doesn't tell the reader much. The "10% sales tax on indoor tanning" receives about as much prominence as minors up to 26 being covered, or the upcoming opening of the exchanges and related changes in 2014 (biggest event). If people want to learn about the law, they should read the overview of the provisions which discusses the major provisions. And I certainly do not agree that we should have subarticles, as that just creates more articles which are never read, which have to be monitored on watchlists.  II  | (t - c) 02:46, 3 April 2013 (UTC)
 * Sorry, I didn't see any previous discussion. I agree that the content and impact are probably the main reasons people come to the page, to learn what the law does. But I would think in that respect the Overview and Impact sections are the most important (and in that regard I do want to add mention of the subsidies to 'impact on insurance premiums' to explain affordability vs price + get a mention of cost-control efforts in the overview). I still agree that it's a good to have the list of provisions by effective date given the level of details, but since provisions are given equal prominence regardless of importance (as II noted), and because I can't think of another non-arbitrary ordering, I thought it made sense to making it collapsible and non-indexed: it's a list instead of an explanation, the most important details have been covered in aforementioned sections, and I thought doing so kept all relevant content together while improving article navigation (by making the content panel easier to process). Sb101 (talk) 07:14, 3 April 2013 (UTC)


 * The infoboxes above make no mention of this having been a featured article. There is also no star that i would expect from such, nor even a plus that would indicate a Good Article. Please clarify. -- [ UseTheCommandLine  ~/ talk  ] # _  08:40, 3 April 2013 (UTC)

The evidence for being featured (in the News) and the general agreement the provisions should be the "key" to this article can be found in the last 3 "tan" infoboxes at the top of this talk page. When folks tried to "fork" the provisions to it's own page, it raised a backlash and were merged back in. Those discussions in particular took place across multiple talk and/or Rfc pages and may not be properly archived here anymore if ever. The above infobox notice declaring the initial atempt at the fork was never corrected to reflect the reversion to keep provisions here either.

The mistake being made (again) is convoluting this law (PPACA) with 'Health care reform in the U.S.', Title 42 -- Public Health & Welfare (the part of the law PPACA amended), and ACA (post -PPACA but still somewhat related to or subject to the original PPACA general vein).

These nuances, among some others, are hard to draw out primarily because there is no over-arching article on Title 42 (as amended), so one group of folks thinks it knows better than the other groups of folks at any given point in time and starts merging/editing stuff without considering each other's task at hand & it's evolution. -- George Orwell III (talk) 08:20, 4 April 2013 (UTC)

Health care reform in the United States article and this article
Looking at the talk page histories, it looks as if the Health care reform in the United States article has taken in a lot of information that probably belongs here. It seems like a fork of content that simply duplicates information that can be boiled down and inserted here. Thoughts? Thargor Orlando (talk) 17:22, 7 February 2013 (UTC)
 * Would support a merge, or potentially a splitting of content into both this article and the History of health care reform in the United States article. -- UseTheCommandLine (talk) 17:38, 7 February 2013 (UTC)


 * I agree that a merge is needed, with at most very short (e.g. 1-paragraph) summary in the Health care reform in the United States article. I made the same point 2 years ago. — Steven G. Johnson (talk) 17:49, 7 March 2013 (UTC)


 * Oppose Two articles need to exist - both Health care reform in the United States and Patient Protection and Affordable Care Act. Health care reform in the United States has a long history unrelated to the PPACA and the PPACA is not the only health care reform project happening right now. However, it is true that much information in the Health Care Reform article needs to be deleted and instead refer readers to the PPACA article.  Blue Rasberry    (talk)   21:28, 8 March 2013 (UTC)


 * good point. agreed. -- [ UseTheCommandLine ~/talk ] #_ 21:35, 8 March 2013 (UTC)
 * That article already exists at History of health care reform in the United States. Thargor Orlando (talk) 21:46, 8 March 2013 (UTC)


 * My reading of Bluerasberry's comment is that Health care reform in the United States should not only cover (briefly, and with reference to the History of article) past examples of efforts at health care reform, but notable current ones, which would maybe not be appropriate for a History of... article. -- [ UseTheCommandLine ~/talk ] #_ 21:53, 8 March 2013 (UTC)
 * It all becomes history sometime. And as the reform article is already basically history...I think there's a good argument to move the reform article to the history article as opposed to here, but I don't see the value in both. Thargor Orlando (talk) 01:23, 9 March 2013 (UTC)

I think it's probably best we just hear from other people. I think the health care reform in the United States article will need to stay. II | (t - c) 23:27, 10 March 2013 (UTC)
 * I went ahead and did most of this. The information at the health care reform page was mostly poor or completely duplicated here. I do think that we need both a broad healthcare reform page which can discuss contemporary ideas and a history page. However, I would like to remove Health care reform in the United States presidential election, 2008, Health care reforms proposed during the Obama administration, and Health care reform debate in the United States. Incidentally, we may be coming up on the time when this "timeline" based layout for the PPACA page is outliving its usefulness. II  | (t - c) 01:08, 10 March 2013 (UTC)
 * I was bold and merged the relevant election stuff to the 2008 presidential election article. I agree about the health care reforms proposed page as well, but I don't know where to send it.  As for the health care reform article, I noticed you wanted to keep the future changes possibilities by renaming it, but I'm still not sure it's appropriate, nor am I sure it is still a necessary article considering we have the history article.  Is there anything else we can merge so we can hit the redirect and move forward? Thargor Orlando (talk) 14:06, 10 March 2013 (UTC)
 * I don't think we'll be able to do that. The general feeling I'm getting here (particularly from Blue Rasberry but also others) is that we need a separate umbrella article on reform. Health care reform is still a very hot topic, and will be for the foreseeable future. The PPACA did not solve the problems in the United States with impending healthcare liabilities and different ideas continue to be written about, which means Wikipedia editors can document them. It's actually very common for articles to discuss proposals, ideas, etc as long as they can reference them. However, we should merge healthcare reform debate in the United States into the healthcare reform general article.  II  | (t - c) 19:35, 10 March 2013 (UTC)
 * Blueberry's point, however, is made by the existence of the history page where all that stuff would inevitably be moved to. The page is entirely duplicative in nature. Thargor Orlando (talk) 19:53, 10 March 2013 (UTC)
 * That's not true. Blueberry said "PPACA is not the only health care reform project happening right now" and that's why we need an umbrella reform article. I completely agree. Healthcare reform is not historical and PPACA does not cover it all. II  | (t - c) 21:29, 10 March 2013 (UTC)
 * What other health care reforms are actually being discussed, though? Single payer isn't considered a serious proposal in the US, for example. Thargor Orlando (talk) 21:33, 10 March 2013 (UTC)
 * There's a public option act already introduced in this session of Congress, plus Vermont and Montana are apparently going ahead with single-payer. If we deleted the article, we'd remake it again within a couple years. Plus, there's just too much information for one article. If PPACA turns out to be a huge success, perhaps it can be deleted. But for now it is too soon. II | (t - c) 22:14, 10 March 2013 (UTC)
 * Are we looking to start listing every act introduced, or should we be limiting it to noteworthy ones? Again, I'm not looking to delete any articles: I'm merely saying that the speculative stuff violates WP:CRYSTAL, and that the history stuff belongs in the history article along with a more expansive look at past proposals.  Thargor Orlando (talk) 22:20, 10 March 2013 (UTC)
 * I believe that major statutes such as the Affordable Care Act should have separate pages.  A general page on health reform would include information that is not in the ACA.  The ACA is specific and has a number of provisions that roll out over many years and keeping it separate from Health Care Reform makes it more difficult for people to misinform themselves about the ACA.  Health Care Reform allows for a historical perspective that includes successful and unsuccessful attempts at health care reform.  Examples would be the State Children's Health Insurance Program (SCHIP) (successful) and the Clinton health care plan of 1993 which was proposed during the presidency of Bill Clinton (unsuccessful).174.91.172.225 (talk) 20:55, 21 March 2013 (UTC)
 * I'll echo the sentiments of those who think there should be separate articles on health care reform generally and on PPACA. Soon enough, some other form of health care will come along that doesn't belong in an article on PPACA. Any and all notable reforms should be mentioned and linked to in the general article, of course. For the information of the group, we're hoping to soon start writing up notable bills in a timely manner. Those will be handy references, I hope, for the articles about legal reform in the general areas they cover, including health care. You can see info - and please join the crowd - at Wikipedia:LEGDATA. JimHarperDC (talk) 12:16, 22 March 2013 (UTC)
 * Oppose. If anything should be merged, Health care reform in the United States and History of health care reform in the United States are better candidates. –Prototime (talk · contribs) 03:57, 29 March 2013 (UTC)


 * Just to clarify here, I don't think the proposal is to merge the entire Health care reform in the United States article into this one, just to merge the discussion of PPACA (and replace it in the Health care article by a 1-para summary). — Steven G. Johnson (talk) 16:18, 3 April 2013 (UTC)

Oppose "Two articles need to exist - both Health care reform in the United States and Patient Protection and Affordable Care Act. Health care reform in the United States has a long history unrelated to the PPACA and the PPACA is not the only health care reform project happening right now. However, it is true that much information in the Health Care Reform article needs to be deleted and instead refer readers to the PPACA article." That sounds right to me. If we're not really talking about merging the pages, let's take the tag down. Leadwind (talk) 03:45, 13 May 2013 (UTC)

Oppose The PPACA isn't the first try at reforming health care in the United States, nor will it be the last. A separate article is needed for the more general subject. An article that refers to separate articles such as the one on the PPACA for the details. --Footwarrior (talk) 01:43, 9 June 2013 (UTC)

Is this info on the page?
I came to read more about it after reading this in the NYTimes:

"In at least 31 states, administration officials said, consumers will be able to sign up for a new kind of product offered by private insurers under contract with the federal Office of Personnel Management, the agency that arranges health benefits for federal employees."

Which states? What product is it? — Preceding unsigned comment added by Sellario (talk • contribs) 14:09, 2 June 2013 (UTC)

Found it, but it's only under Effective by January 1, 2017. Should be under 2014 as well because the MSPs will be active in over 60% of the states. Read footnote titled "Multi-State Plans Under the Affordable Care Act" (currently footnote 143). Sounds promising.

"Two federally regulated 'multi-state plan' (MSP) insurers, with one being non-profit and the other being forbidden from providing coverage for abortion services, will be available to all states. They will have to abide by the same federal regulations as required by individual state's qualified health plans available on the exchanges and must provide the same identical cover privileges and premiums in all states. MSPs will be phased in nationally, being available in 60% of all states in 2014, 70% in 2015, 85% in 2016 with full national coverage in 2017.[143]" — Preceding unsigned comment added by Sellario (talk • contribs) 15:11, 2 June 2013 (UTC)

Impact on the deficit in the opening lead.
Why is there no mention of the GAO report that says it will increase the deficit by $6.2trillion over 75 years or even another study to give both sides of the argument?

What is wrong with the statement in the opening paragraph after:

"The Congressional Budget Office projected that PPACA will lower both future deficits and Medicare spending."

to also add:

"however, a recent report from the Government Accountability Office suggests that it will increase the long-term federal deficit by $6.2 trillion over 75 years."

http://www.nationalreview.com/corner/341589/gao-report-obamacare-adds-62-trillion-long-term-deficit-andrew-stiles

Or something similar.

I think there should be some balance in the opening, to only state the CBO report saying that it will lower the deficit does not seem to be neutral. Either it shouldn't state in the opening lead about the impact on the deficit, or it should reference studies showing both sides of the argument as the impact on the deficit is based on so many variables and predictions, in reality nobody really knows how it'll end up impacting it. It's so easy to find studies that support both sides yet the opening lead implies it is universally accepted that it'll reduce the deficit as it only mentions that point of view. Wikipedia needs to be kept non-partisan. Hutchski (talk) 11:58, 28 March 2013 (UTC)


 * In principle - I totally agree with you on the balance point but this nuance concerning projections has come up a few times before and it was agreed we should be careful not to compare apples with oranges (and that again is what this seems like). To recap - the CBO baseline, for the most part, started basically with the premise of projections under the old laws in effect prior to PPACA enactment (i.e. doing nothing) vs. projections under the latest ACA related laws since enactment (i.e. doing something). Since the initial estimates, CBO has also made interim projections based on 10 year sliding scale - basically from one fiscal year to the next but sometimes they do a revision if some new law is passed as well. That said, if we take CBO's last revision for the net cost of the ACA covering the next ten years (1.33 trillion) and do the same "worst case scenario" for their ~75 year window with CBO's 10 year estimate instead, the ACA would seem to add ~10 trillion (7.5 times 1.33). So you see right off the bat, there is a problem trying to balance a 75 year projection with a 10 year projection especially when the former gives you an even higher cost (~10 trillion) than the latter (~6.2 trillion) when re-calibrated. Go the other way and divide 6.2 trillion into ten year windows and you'd get something like ~600 billion every 10 years instead of CBO's 1.33 trillion. Apples to Oranges. Second, the GAO report is still generally a comparison of the next 75 years if we left the laws the same in 2010 (i.e. January 2010 baseline) versus the next 75 years with the PPACA enacted (i.e. Fall 2010 baseline). That report isn't revised as much as it should be (every fiscal year imho), so it has a lot of old data in it (i.e. no ~4 trillion outlay/revenues calculated in by making the remnants of the Bush tax cuts permanent for example). If you read the report, and maybe you'll do better, I can't find any mention of 6.2 trillion either way; good or bad (can anyone cite how this figure comes from the GAO report?). In fact, the entire report is based on debt to GDP percentages & not in billions of dollars - as far as I can tell that is. Putting the other flaws in using this report for balance reasons aside, if we go by debt to GDP, sure we'll cross 6.2 trillion at some point, but it takes place ~15 years later than if we didn't pass PPACA according to GAO as well as CBO - same nuance, same conclusions, just different scales & timelines.
 * The nuance - as discussed, added and reverted a billion times by now - is most folks said stick with wording used in the CBO summary as quoted earlier rather than...


 * "The Congressional Budget Office projected that PPACA will slow the rate growth of both future deficits (when compared as percentage of GDP), as well as expected Medicare spending."


 * ... which was considered too much original research even though most folks agreed they pretty much meant the same thing.
 * Any better? -- George Orwell III (talk) 04:19, 29 March 2013 (UTC)


 * No I agree that they pretty much mean the same thing. I just think that stating in the opening lead only that it's going to reduce the future deficit is highly contentious as a lot of people would disagree with that, it's even stated within the article. There is a whole section dedicated to the impact on the deficit with both sides of the argument, so why is only one side of the argument stated in the opening lead? A lot of people who just read the opening will end up going away thinking that this legislation will reduce the deficit without having any idea that there is an opposing viewpoint, that's my main issue with it, I just think that there should be some balance, even if it means removing the statement so people have to scroll down and read the full analysis if they want to know how it may impact the deficit. Hutchski (talk) 17:13, 11 April 2013 (UTC)
 * Your points are well taken here and I'm not really disagreeing with your reasoning either, but having quietly witnessed -- if not outright participated in -- this particular sore point many times before, I'll cut right to the chase and work backwards from there if need be.
 * "Is there any CBO-authoritative scoring that concludes health-care and/or related costs, deficits, debts, etc. would have been more favorable in their desired & respective accounting if the PPACA was never enacted?"
 * The nuance re: balance here is not to compare or contrast what the cost/savings/etc. that were estimated in the period leading up to & beyond PPACA enactment against all the time-lines & revisions being made since then (all that is being taken care of, as mentioned, in its own section further down), but to compare passing something (enactment of PPACA) to doing nothing (keeping the status quo). No matter how bad the honest yet-negative-forecasting or the intentionally skewed-to-be-misleading numbers are on this or who those numbers are coming from -- to date -- not a single credible thing has come to light saying "things" would have been "better" had nothing been passed at all, never mind vs. the PPACA in particular. At this point, folks have previously recommended adding that caveat to read something like...
 * "The Congressional Budget Office projected that, when compared to the previously fore-casted alternative where Congress continued to remain inactive, enactment of the PPACA would lower both future deficits and Medicare spending."
 * ... which was kind of still OK imho - not so much for some other folks. Given the time, even that would wind up getting reverted (the reasoning behind reversion started with 'it made all the back-and-forth estimating and scoring taking place further below a fairly moot academic exercise in one sentence or less' all the way down to the simple 'original research - nana nana boo boo....'). So unless you can find a scoring that reverse-bends the cost curve the PPACA bends (to slow the rate of growth), we're doomed to keep repeating history here without actually learning anything from it again. - George Orwell III (talk) 06:49, 12 April 2013 (UTC)


 * Claiming that the GAO is projecting PPACA to increase the deficit seems totally misleading. If you look at the GAO report, it says that PPACA will only increase the deficit in an "alternative scenario" in which the cost-containment and cuts of the PPACA are repealed ("phased out over time").  Hence (putting aside the reliability of 75-year projections), what would be increasing the deficit would not be the PPACA per se but its partial repeal.


 * The question in all of this is not what a "lot of people" think, but what reputable, neutral sources say. — Steven G. Johnson (talk) 19:21, 11 April 2013 (UTC)


 * 100% agree with Stevenj: the GAO projection is not a projection of PPACA but a projection of a partially repealed PPACA. Or, to put it another way: http://nymag.com/daily/intelligencer/2013/02/jeff-sessions-wonk-mccarthyite.html - "So, yeah. If Congress keeps the parts of the law that cost the government money, and repeals the parts that save money, the law will increase deficits. Alternatively, if the government repeals the parts that cost money and keeps the parts that save money, it will reduce the deficit by more than we’re projecting. Who knows? If I were a senator, I’d ask GAO to model what would happen if Jeff Sessions acquires a loose nuclear weapon and sets it off in Manhattan, and then tout my incredible new report finding that Jeff Sessions is going to kill 4 million people."
 * http://nymag.com/daily/intelligencer/2013/03/sessions-not-happy-being-called-wonk-mccarthyite.html - (Same reporter) "I called Susan Irving, the lead author of the GAO report... Irving repeatedly told me, “This is not a projection.” And of course it’s not a projection — you can’t analyze the effect of a bill on the deficit while ignoring the impact of its biggest source of savings...
 * In any case, a few things are clear. Sessions’ request is not on record, but GAO agreed, in response, to publish a study that would measure the costs of Obamacare but not its net effect on the deficit. The GAO knew this, and then Sessions falsely claimed the study concluded something completely at odds with its actual findings...
 * In sum, I apologize to my readers, the citizens of Alabama, budget fans, and other concerned citizens for failing in my original post to adequately convey the full paucity of the intellectual standards of the junior senator from Alabama. I hope I have rectified my failure here." Sb101 (talk) 07:14, 14 June 2013 (UTC)

ACA's costs to employees covered by "employer" plan
My employer pays about $600 per month per employee for health insurance premiums ($7200 times 2000 employees - give or take). It gives its employees choices of level of coverage to purchase. So with a $30 monthly premium and a high deductible plan of $3250 out of pocket before any coverage occurs (okay, so the insurance company knocks off 5 to 10% of its normal charge for any given procedure), unless I have a catastrophic event in any given calendar year, this plan is costing me well over 20% of my net income. The insurer has the jutzpa to cut me off from making medical appointments if I'm $x "behind" in payments, knowing full well the financial details of my plan, even if the appointment is for a covered preventative procedure like an annual physical or mammogram. I have to choose the "right" level of coverage in November for the following year, with not a clue what my medical needs might be next year. Question: with ACA can I opt out of my employer's plan and go to the state exchange on an earnings-qualifying basis. If I have to come up with $3700 every year out of pocket I'll go broke real soon.68.168.172.102 (talk) 18:30, 9 June 2013 (UTC)
 * Re: I don't believe that this is the right place for these kind of questions, so I've replied on your talk page Please message me on my talk page once you've seen so I know to remove this bit of the talk page. =) Sb101 (talk) 07:19, 14 June 2013 (UTC)

Contents Order
I moved Legislative history ahead of Provision by end date because I think that makes sense: 1) after overview, it is a logical order - how it was formed, what's in it, the impact of those provisions; 2) if people what that level of detail, they need to merely scroll down the contents a bit, but the import context (background and links to the debate), I feel, were a bit eclipsed due to how long the detail provisions are. Sb101 (talk) 06:48, 14 June 2013 (UTC)


 * It's not a big deal to me, but I disagree. This is an article about legislation that's currently on the books, not an article about historical events. Most people primarily want to know the details of the law (especially for one that's so voluminous) and then proceed to its history.
 * I was going to point you to analogous article and say, see, they show the details before the history, but it turns out that's not true. It appears Wikipedia is all over the map on this. Every article is different. --Nstrauss (talk) 21:13, 14 June 2013 (UTC)


 * For what it's worth, I also think that having the provisions listed before the legislative history makes more sense. Putting the legislative history first was reasonable when the process was still happening, but now that it seems more or less setled, I think we should have a snapshot of the provisions up top before moving onto something that's mostly of historical interest at this point. --Jfruh (talk) 03:00, 15 June 2013 (UTC)


 * Whilst I do think this is the appropriate place for the relevant historical context already included in the article (and I think there's relevant lessons people can draw that apply beyond the context - for example, polarization, filibuster); I can see that the provisions' information may be more relevant to (most) other page visitors. I'm happy accepting the order that everyone else seems to prefer. Unless someone objects, I'll strike this section next week to show its concluded? =) Sb101 (talk) 07:33, 15 June 2013 (UTC)

Health plan availability
Here's a good new source:

--Nstrauss (talk) 18:19, 20 June 2013 (UTC)

How will this be enforced on individuals?
Maybe we need a separate section on enforcement? I'm not clear how the government will find out if a person does not have health insurance, will they only find out when a person goes to a hospital and can't pay, will doctor/hospital report them? 2) will there be a question on your income tax form about proof of insurance? This sounds like it will be very difficult for someone whose income fluctuates. Are applicants going to have to show their 1040 when they apply??? If a person is self-employed and does not get a W-2 Form (tax refund), how will IRS collect? Raquel Baranow (talk) 15:51, 12 July 2013 (UTC)


 * My understanding is that the question about whether or not you are insured will be a line on the 1040 form, i.e., "If you don't have insurance, put $[x] on this line and add to your total tax," where X is a percentage of whatever your taxable income for the tax year is. Enforcement will come the same way the veracity of most of the info you put onto a tax form is enforced: by the potential for a tax audit. Not sure how the self-employed issue factors into it, as self-employed individuals pay estimated taxes quarterly and also fill out 1040s at the end of the year.


 * So, if you didn't have insurance in 2014, you would (if you were being honest) note this on your 2014 1040 form that you fill out in the spring of 2015 and pay the penalty then. Health care providers will not be in the position of informing on people to the government. Many health care providers will have staff who are specifically there to tell uninsured people the ways they can get insurance under the ACA (i.e. via the exchanges or via the expanded Medicaid in some states).


 * As someone who is self-employed, I am definitely curious about how the tax rebates for moderate income people work if you buy through the exchanges. The tax credits are based on your income and are "advanceable" and go right to your insurance premiums if you buy through exchange. So, if you buy an insurance policy through the exchanges that cost $250 a month, and your income qualifies for a $600 annual tax rebate, your bill for insurance would only cost $200. But what if your income changes dramatically over the course of the year? The way it works currently in Massachusetts (where a law similar to the ACA has been in place for several years) is that self-employed people provide earlier years 1040s and those are used as an estimate for what your rebate should be; when you do your 1040 the following year, you either get some extra tax back or pay more taxes, depending on how accurate those estimates were.


 * I agree that we should have sourcing on all of this. Part of the problem is that some of the nitty-gritty aspects of how this all will work in practice still hasn't been made entirely clear. Will try to find some sources if I am able. --Jfruh (talk) 16:23, 12 July 2013 (UTC)


 * I don't know how to build this into the article, but for starters, here's a source: --Dr. Fleischman (talk) 16:36, 12 July 2013 (UTC)


 * Thanks. I'll add it in to the text. --Jfruh (talk) 19:10, 12 July 2013 (UTC)

What will happen to people who have catastrophic medical bills and exhaust their insurer's lifetime or annual limits. Are they still considered insured? EllenCT (talk) 19:36, 12 July 2013 (UTC)


 * As the article says, health insurance plans will no longer be permitted to have annual or lifetime coverage caps. --Jfruh (talk) 19:33, 13 July 2013 (UTC)

July 2013 decision to delay some provision
Hi All! I wanted to note here that I added a section to the article about the July 2, 2013 announcement by the Obama Administration that they would be delaying the employer mandate until 2015. If anyone has any improvements on that section (or comments about a better spot in the article where it should have gone), I'd be happy to hear them. Please feel free to check out the article I linked there - Authority for Mandate Delay Act (H.R. 2667; 113th Congress) - I'd be happy for comments (or help!) on that too (I know it could use expansion). Thanks! HistoricMN44 (talk) 18:54, 16 July 2013 (UTC)


 * I tried to clean it up, but it's permeated with bias against the delay. I did a first pass and added a pov-section tag. The subsection still needs a proper statement from the White House (rather than a clearly biased quote from the Cato Institute dressed up as a quote from the White House) and it also needs an opinion supporting the delay to balance the opinion opposing the delay. --Dr. Fleischman (talk) 19:34, 16 July 2013 (UTC)


 * Thanks. It's helpful to get a second opinion.  Interestingly, I'm actually in favor of the delay, not opposed to it, but based on your revisions I can see what you mean about the bias in some of my word choices.  I did find the Administration's statement here.  Thanks again. HistoricMN44 (talk) 19:42, 16 July 2013 (UTC)


 * Please don't take offense to this but I have a hard time taking the above comment in good faith when you somehow thought that a Cato Institute opinion piece -- whose title is "Yes, Delaying Obamacare’s Employer Mandate Is Illegal," no less! -- was a good fact source for the Obama administration's justification for the delay. Especially considering your educational background. --Dr. Fleischman (talk) 20:39, 16 July 2013 (UTC)


 * You're right - it probably was a mistake and a measure of laziness - I hadn't seen any other publications explaining the Admin's reasons for the delay. I should have taken the extra time to look for a statement from the Admin itself.  I apologize for that.  On the other hand, I'd point out that lots of organizations (think tanks, news sites, etc) use more... provocative... titles - that doesn't necessarily make their content incorrect.  In any event, the article is now better than it was, so let's just leave it at that.  Thanks.HistoricMN44 (talk) 19:46, 17 July 2013 (UTC)


 * This is just another exercise in circular legal-logic by those who know upon those who haven't a clue. By delaying the reporting requirement, its only by a subsequent "automatic" operation of law that the mandate cannot logically be enforced. Since nobody is "harmed" by such a delay in the reporting requirement (quite the opposite in reality; another possible year without facing the mandate can be construed as an unwarranted benefit if anything) nobody can take the matter to court to challenge the change in the reporting requirement since nobody would technically have the proper standing (e.g. nobody has been "harmed" by the delay and to have standing in court you have to show you've been affected [harmed] by the action). If Congress really felt legally slighted here they might be the only ones with any sort of legitimate standing to bring the matter before the courts, but if past history is any indicator, I don't think they will bother matching the rhetoric with the proper action on this occasion as well (more likely it will get used as political fodder instead). While its worth mentioning the change in the timetable for the reporting requirement, the question of its legality, the idea it circumvents congress and all the hyperbole sure to be manufactured surrounding anything else is just another fool's errand with no basis in the mechanics of actual law. -- George Orwell III (talk) 21:23, 18 July 2013 (UTC)

Lead (Resolved)
Prototime has raised a concern about a sentence in the lead: As he is on a wikibreak for a week, I'll quote him: "'Rate of health insurance coverage' can refer to the number of persons insured. However, I do think that saying 'rate of health insurance coverage' implies to lay readers 'insurance rates,' commonly meaning 'premiums,' and that this would be a source of confusion. While the wikilink can help to clarify, I don't think that readers should have to click it to understand what is meant."
 * "The ACA aims to increase the quality, affordability, and rate of health insurance coverage for Americans, and reduce the costs of health care for individuals and the government."

However, I'd argue that 'increasing the rate' (rather than, say, 'reducing the number of uninsured') is more accurate in a technical, policy sense - 'rate' is used frequently in relation to insurance coverage on the 'Health insurance coverage in the United States' page, for example; and is common enough to expect laymen understanding, just as we refer to the 'unemployment rate' rather than the 'number of unemployed.' I also think any potential confusion is made negligible given the inclusion of 'rate of coverage' within the hyperlink, and because 'rate' in the singular suggests, I think, that it's not to do with premium rates, plural. Therefore I quite prefer the current language.

Since I have nominated this article for GA status, I've agreed to consult a reviewer for their opinion. But I also wanted to see if others wanted to weigh in? Sb101 (talk|contribs) 06:59, 29 July 2013 (UTC)


 * I read it as you've explained it and don't see any need to make changes, but if this somehow remains a sticking point with folks, just have the term rate point to its proper definition instead. The resulting lede would then be . ..


 * "The ACA aims to increase the quality, affordability, and rate of health insurance coverage for Americans, and reduce the costs of health care for individuals and the government."


 * If folks are too lazy to make the extra click to Wiktionary whenever they are in doubt, then there is not much more to be said on the matter is there? -- George Orwell III (talk) 22:53, 29 July 2013 (UTC)


 * I agree with Prototime. Both "number of uninsured" and "rate of coverage" seem technically valid, though "number of uninsured" is clearer. If you look at Health insurance coverage in the United States you'll see that the lead section takes two sentences to describe the rate and then refers to it as "this rate of uninsurance." That's appropriate in an article that's specifically about coverage statistics. But this issue is only one factor of several for PPACA and doesn't merit such real estate in the lead section. I also disagree with GO3's comment that people can just click on the link to find out what's meant by "rate of coverage." Prototime's point was that the current language is ambiguous, which could lead some readers to be misled. That's much worse than using technical jargon. The misled reader won't click on the link as they (incorrectly) think they understand what Wikipedia is saying. --Dr. Fleischman (talk) 18:20, 30 July 2013 (UTC)


 * Thanks, Sb101, for bringing this up while I was on wikibreak. Dr. Fleischman accurately expressed my sentiments on the matter. I'll only add that where there is a question of ambiguity, it's wiser to err on the side of clarity. Here, "rate of health insurance coverage" is accurate but ambiguous. "Number of uninsured" is equally accurate but is unambiguous. Thus, I don't see a persuasive reason to choose the former. ("Number of uninsured" may require a new sentence to fit grammatically into the lead, so it may slightly increase the lead's length, but brevity is valuable only to the extent that it doesn't impinge clarity.) –Prototime (talk · contribs) 03:25, 5 August 2013 (UTC)


 * Sorry, took me a bit longer than intended to reply - life happens. Anyway: So, I do agree that clarity should not be sacrificed for brevity. But I disagree that the current language is ambiguous/potentially misleading for two reasons:
 * Familiarity: I think that people only use 'rates,' plural, to refer to premiums. 'Rate' is not merely technically more accurate (if only slightly so, since it connotes degree), but commonly understood even by lay people (through familiarity with things like - if not 'health insurance rate' itself - concepts like percentage rate, unemployment rate, tax rates, literacy rate, birth rate, etc). Rate in the singular is not something I would expect a statistically significant number of people to confuse with premiums/rates. Indeed, the way I read Health insurance coverage in the United States is that when it refers to the rate of uninsurance it does not clarify or define it (there is no colon, en dash, or parentheses to define or clarify that what is meant is the proportion of the population that is uninsured); rather, they use 'rate of uninsured' interchangeably with the specific percentage rate, taking for granted that people understand that’s what rate means, as I think we should do.
 * Context: I can concede I could be wrong about the likelihood of ignorance (but I would prefer evidence that I am given my - I would say reasonable - expectation above). But if I am, surely it is sufficient to hyperlink rate of coverage for Americans (i.e. how it is now) and use that to make it clear, as we do with other relevant and necessary terms (like reconciliation - which we aren't using to signify the act of settling or resolving an issue)? When I say make it clear, I don't mean by having to click, but that the mere construction of the sentence and hyperlink itself (by its highlight) serves to disambiguate what is meant: the sentence does not just wikilink to more in-depth information about health insurance coverage, but emphasizes that we are talking about the proportion of the total population that is insured - after all, I've never heard 'rate of coverage' used to mean premiums/rates/'insurance rates';
 * And yet, given that the sentence is 'increase the affordability... rate of coverage,' assuming someone did read the latter as premiums, that would prima facie contradict the idea of increasing affordability (so, at worst people won't be mislead but actually confused and then would click the hyperlink). In other words, the sentence disambiguates through context already.
 * Having said all that, please speak up if you still think I have come to the wrong conclusion (WP:BeBold). =) Sb101 (talk|contribs) 17:40, 13 August 2013 (UTC)


 * When you're having a discussion about the ambiguity of any particular language I think you should give the benefit of the doubt to those who say it's ambiguous. There are certainly arguments to be made either way, but it's not implausible for readers to misconstrue the meaning of the term "rate of health insurance coverage for Americans," particularly in light of the fact that it's sandwiched between the phrases "affordability" and "reduce the costs of health care." On top of that the title of the article has the word "Affordable" in it but nothing overt (for the truly uninformed) about coverage. ("Protection" is such a vague term.) In law, language is generally considered ambiguous if there are two or different but reasonable interpretations of it. In short I don't think it would be unreasonable for an uninformed reader to misunderstand the "rate" language, even with the mitigating factors you point to.
 * On top of that I continue to be confused by your assertion that "rate of coverage" is technically (slightly) more accurate than "number of uninsured." Both seem equally accurate to me.
 * I just thought of an idea that might be mutually acceptable: "uninsured rate." The term already shows up a few times in Health insurance coverage in the United States. Moreover it appears to be used much more frequently by reliable sources. A Google News search for "rate of coverage" (w/ quotes) currently brings up 6 hits while "uninsured rate" (w/ quotes) brings up 1,760 hits. FWIW "number of ininsured" (w/ quotes) brings up 990 hits. --Dr. Fleischman (talk) 18:36, 13 August 2013 (UTC)


 * There are times like this when I think it'd be nice to be able to experimentally test the issue at hand on a random sample of people. *Sigh* Oh well. In lieu of that, whilst I am inclined to think that it is an unreasonable interpretation, I hesitate if only because if politics teaches anything it is not to underestimate the limits of human reason. (Although, that is truly an ambiguous statement since it can go both ways, which is nice and true enough =P ) And also I am happy with the language you suggest; does this work:
 * "The ACA aims to increase the quality and affordability of health insurance and reduce both the uninsured rate (through expanded public and private insurance coverage) and the costs of health care for individuals and the government."? I will also probably add Health Coverage & Uninsured and Health Insurance Coverage of the Total Population where appropriate (probably 'Change in Number of Uninsured' section).
 * (Oh and the predominant reason I think 'rate' is at least slightly more accurate is that it refers to the explicit goal of the drafters: Universal Health Insurance, which is an inherently proportional concept aka rate rather than an absolute number). Sb101 (talk|contribs) 21:09, 13 August 2013 (UTC)
 * I like it and I'll ping Prototime for his/her feedback as well. --Dr. Fleischman (talk) 21:41, 13 August 2013 (UTC)
 * I like it as well and believe it adequately addresses the ambiguity. My only other comment would be to restructure the "(through expanded public and private insurance coverage)" bit to avoid deemphasizing this important point, perhaps like this: The ACA aims to increase the quality and affordability of health insurance, reduce the uninsured rate by expanding public and private insurance coverage, and lower the costs of health care for individuals and the government." –Prototime (talk · contribs) 00:27, 14 August 2013 (UTC)


 * Resolved Sb101 (talk|contribs) 05:43, 15 August 2013 (UTC)

More delays
--Dr. Fleischman (talk) 18:39, 13 August 2013 (UTC)

Requested move (August 2013)

 * The following discussion is an archived discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review. No further edits should be made to this section. 

The result of the move request was: no move. --  tariq abjotu  01:30, 1 September 2013 (UTC)

Patient Protection and Affordable Care Act → Obamacare – I don't think anyone can seriously argue that "Obamacare" isn't the WP:COMMONNAME for this legislation, nor that it's much more concise (and probably recognizable too). So the multi-billion-dollar question is whether WP:POVTITLE applies. There's no doubt that "Obamacare" was used primarily as a pejorative in its early days, it's also being reclaimed (see the following sources from the article for good background on the term: ). An important landmark in this evolution was Obama's own embrace of the word two years ago; usage by supporters of the law has increased since then. Neutral and left-leaning media use it now, such as PBS and The Washington Post. Finally, the use of common names for legislation is not without precedent; compare to Superfund. --BDD (talk) 20:23, 22 August 2013 (UTC)
 * Oppose – Still too recent, and the bill will be fully effective in 2020. Per WP:NC-GAL, "Obamacare" is commonly used name for this Act. But it was proposed in 2009 and passed in 2010, and there is the section Term "Obamacare". It has been three years since. Also, even commonly used "Spanish Flu" redirects to the 1918 flu pandemic, a deadly flu crisis in world history. Also, Obamacare is not even precise or accurate based on the article content, and I don't think historians want to call the Act an Obamacare. When did we have Reagancare or Clintoncare or Bushcare? --George Ho (talk) 00:33, 23 August 2013 (UTC)
 * There was "Reaganomics" as mostly pejorative for "Give tax money to the rich and the poor will prosper" but inflation was curbed by high interest rates applied by Fed chairman Paul Volker starting with prior President Carter. -Wikid77 18:54, 24 August 2013 (UTC)
 * I don't follow the recentism argument, George. Are you saying the topic as a whole is too recent to decide on a common name? The "Obamacare" term seems to predate the law itself, so I don't think recentism would apply to it. --BDD (talk) 17:20, 23 August 2013 (UTC)
 * I'm afraid so, and the fact that the term came "earlier" than the law is irrelevant. We can't change the article title to "Obamacare" just because it is widely used. I already pointed out that it is not precise enough. Well, I should say further: I believe that the term will be less used when and after Obama leaves the seat in 2017. --George Ho (talk) 17:27, 23 August 2013 (UTC)
 * Hillarycare not "Clintoncare" and remember Romneycare, though those articles are not currently using those names. Bushcare is about wilderness, not healthcare, Dubya's plan is usually called Medicare Part D. Though we are missing Brewercare. -- 76.65.128.222 (talk) 12:23, 26 August 2013 (UTC)


 * Oppose for reasons outlined above by George Ho. --Jfruh (talk) 01:23, 23 August 2013 (UTC)
 * Just want to add, re: Sb101's comments below, that I doubt Obamacare will have long-term traction as a name because of the somewhat disparate nature of the law. "Medicare," for instance, is a specific government program -- it's a government-run health insurance program for seniors. "Obamacare" right now refers to the reforms that are right now mostly in the future. Once they're in place what will people refer to as "Obamacare"? The expanded Medicaid? That's Medicaid, still. The insurance you buy through exchanges? You'll still be insured by a private company, so it seems unlikely that people will call that Obamacare either. And so on. --Jfruh (talk) 02:18, 23 August 2013 (UTC)
 * Conditional Support - I'm kinda of in agreement with both BDD and George Ho. WP:NC-GAL does say that we ought to "prefer titles that reflect the name commonly used in reliable sources." But reliable sources use both 'Obamacare' and 'the Affordable Care Act.' I should also point out that 'Obamacare' does redirect to this page, and this article is the first thing that shows up when searching Obamacare on google. At the same time, Medicare is not referred to as the 'Supplementary Medical Insurance Program (Under the Social Security Act).' And if PPACA -> Obamacare happened, keeping the subsection on the name would still be notable for historical interest. I think it boils down to the fact that Medicare is now used as the common term because that's how people (including historians) have come to refer to that program. I think it will happen with Obamacare, and if and when it does we should change it, but until then, to avoid controversy, we should leave it as it is. As per WP:POVTITLE, "Article titles and redirects should anticipate what readers will type as a first guess and balance that with what readers expect to be taken to." Until and unless users refer to it as Obamacare, I can easily imagine people claiming that use of the term would be biased in favor (readers expect to be taken to PPACA), but that this would change once fully implemented. The real problem then becomes, how do I create a 2-year reminder notification? =P Sb101 (talk|contribs) 02:09, 23 August 2013 (UTC)
 * Strong oppose - Agree with George Ho and especially agree with Jfruh. –Prototime (talk · contribs) 02:51, 23 August 2013 (UTC)
 * Re:Jfruh/Prototime: Well, I can easily see people referring to the reforms as a whole as Obamacare (precisely because the reforms are disparate, but the term refers to it all), and for specific parts of it (e.g. I'm covered thanks to Obamacare/guaranteed issue, subsidies, bans on limits; I got my insurance through Obamacare/an exchange; the state rejected Obamacare funding for Medicaid/Medicaid expansion; Obamacare's Medicare savings/IPAB). I mean, Obamacare is already used for these purposes (because its concise and efficient) suggesting it does have traction. But, as I said, it's mostly a matter of wait and see whether it becomes dominant among users and, as a result, reporters. But it sounds like you are saying 'We shouldn't rename it because it won't be referred to as Obamacare'; and I think we shouldn't rename it unless and until it does; but IF it did become the dominant term to refer to things as I have outlined, would you then support it (like 'Medicare')? (It wouldn't change present opposition, but I'm interested to know for the future)? Sb101 (talk|contribs) 03:00, 23 August 2013 (UTC)
 * Oppose - Per Jfruh. Teammm  $talk email$ 03:02, 23 August 2013 (UTC)
 * Strong support. With all due respect, Wikipedia ain't a crystal ball. We can't predict whether or not Iowa will be more commonly referred to as Aiwmeminoonoo in ten years (hey, it might!) but today, it is most commonly known as "Iowa", so that's where it's located. We can't predict what the common term will be for Obamacare in ten years, but we don't have to know. Today, "Obamacare" wins in naturalness, recognizability, and conciseness, and is clearly tied for precision, and is not inconsistent. Hey, that's the WP:NAMINGCRITERIA right there! That's a policy, btw, unlike WP:RECENT which is an essay. This is really not a difficult call to make. Thanks for nominating, BDD. Red Slash 03:38, 23 August 2013 (UTC)
 * Strong Oppose - It's clear that the dominant term used depends upon the type of citation. Of course opinion pieces, blog posts and the like overwhelmingly use the term "Obamacare" right now - Obama is still in office - while every other citation, like those generated by CBO, Kaiser & similar, use the proper legislative terminology or it's derivates more so. I agree with the other folks; its too soon to deviate from the official terminology. To me, "Obamacare" infers more of a executive policy (of which the PPACA is a but a single part of) right now & that's not what we're covering here (legislation, law). and as an aside... the given Superfund precedent for common-name article renaming does not exactly mirror this situtation 100%, if at all, since Superfund (Act) has been a recognized "Popular Name" since the late 1980's for that piece of passed legislation. Naming that (Superfund) article something other than the official short-title or full title makes perfect sense in that narrow single, instance thanks to this long-standing, authoritative recognition.... but we won't find "Obamacare" on any such authoritative Popular Name list (again, not anytime soon). -- George Orwell III (talk) 04:59, 23 August 2013 (UTC)
 * Talk:Superfund is now made. --George Ho (talk) 05:59, 23 August 2013 (UTC)
 * Weak support certainly, it seems the most common name, even amongst Democrats and "liberal" (read: progressive) groups in America. And amongst "conservative" (read: anti-Democrat) and Republicans. And Libertarians and libertarians (read: liberals). -- 76.65.128.222 (talk) 04:46, 23 August 2013 (UTC)
 * (Tangential: you might want to read up on Liberals (Modern Liberalism) vs Libertarians (Classical Liberalism)).Sb101 (talk|contribs) 04:54, 23 August 2013 (UTC)
 * Oppose: As noted above, the term "Obamacare" does not refer to a specific institution or government program. It also seems inappropriately informal, and carries particular polarizing connotations. My personal impression is that the term primarily originated as a (mostly pejorative) term for any healthcare reform supported by Barack Obama or the U.S. Democratic Party or anyone generally perceived as "liberal" or "progressive". It may have since been embraced to some limited extent by others, but I would still generally not expect to find it outside of quote marks in sources that try to maintain a dignified encyclopedic tone. Such sources seem more likely to refer to the law in question as the Affordable Care Act, or using some phrase that is not a proper name, such as "the 2010 healthcare reform act". —BarrelProof (talk) 11:22, 23 August 2013 (UTC)


 * I think it's fair to summarize the above as Consensus: Opposed Because:
 * 1) Currently, 'Obamacare' might be associated with (positive and/or negative) non-neutrality (WP:POVTITLE, WP:TONE). Reporters do commonly but not universally use it; and the most neutral and authoritative sources, such as the CBO + Kaiser, use the more formal PPACA/ACA to refer to it - Wikipedia strives to be among the CBO/Kaiser group, and that's what readers expect (WP:NC-GAL, WP:POVTITLE).
 * 2) There is disagreement over whether the term will either grow dominant (even in authoritative sources) due to its conciseness and efficiency (for which the best historical and Wiki-precedent is Medicare); or whether it will not outlive Obama. We can't assume one way or the other (WP:CRYSTALBALL).
 * 3) As for recognition (WP:COMMONNAME); beyond reason 1, Obamacare redirects to this article and the lead makes it clear this is the right place so it's not like there is harm in leaving it as is for now.
 * These reasons call for this to be resolved as 'No Change' for now, at least; and it will be possible to revisit this later, if appropriate (post-2014, once mostly implemented, and/or post-2016 once Obama leaves office). Sb101 (talk|contribs) 19:14, 23 August 2013 (UTC)
 * You're probably right, but the discussion has only gone on for a day. We might as well allow it the usual one-week period for RMs. --BDD (talk) 20:03, 23 August 2013 (UTC)


 * Oppose: Another reason not to use the term "Obamacare" as the title of this article is that this article is really about the law itself. The term "Obamacare" is commonly used to refer not only to the law itself, but to the entire program of health care that is going to result from the law. So, using the term "Obamacare" as the title of a Wikipedia article on the law itself would be imprecise, as the term "Obamacare" describes more than just the law itself. Famspear (talk) 22:43, 23 August 2013 (UTC)
 * Support Obama owns this thing, and it will be forever his legacy, even after both he and it are gone. DeistCosmos (talk) 06:30, 24 August 2013 (UTC)
 * Strong oppose: The word "Obamacare" began as an insulting name slur for President Obama's plans, as a pejorative often associated with doom and failure, but later reclaimed (see: ) which defuses the negative meanings by factual, or positive associations. Similarly, some use the term "Repulsemecans" for Republicans (as "repulse me") and that would be too pejorative for a rename or redirect. I advise to treat the term "Obamacare" as a separate notable article, with history and related issues, because it was not the same as the Act, but a separate word with multiple meanings over the years, and unnecessary clutter in the article about PPACA. -Wikid77 18:54, 24 August 2013 (UTC)
 * Do any Republicans self-identify as "Repulsemecans"? --BDD (talk) 16:00, 26 August 2013 (UTC)


 * Oppose, per WP:POVTITLE. That may change, but I don't think it has at this point. ENeville (talk) 18:00, 30 August 2013 (UTC)
 * The above discussion is preserved as an archive of a requested move. Please do not modify it. Subsequent comments should be made in a new section on this talk page or in a move review. No further edits should be made to this section.

Good Article
03:28, 23 August 2013 (UTC)

Just a general gripe
Out of 300+ citations, I'm more than a bit disappointed this article only cites Health Affairs and the NEJM once each. I would expect a quality version of this article to give much more due weight to those sources. To me, it suggests the article may not meet the broad or neutral requirements of the WP:GACR. Biosthmors (talk) 13:25, 13 September 2013 (UTC)
 * Can you explain a bit more why those two sources deserve more citations in this article? Do these sources contain information or views that this article is lacking? GACR's breadth and neutrality guidelines concern content; they don't mandate that such content come from any specific sources. But if there are notable views or information that this article is missing that is contained in these sources, we should give due weight to them. –Prototime (talk · contribs) 19:39, 14 September 2013 (UTC)
 * I strongly agree with Prototime: WP criteria (such as due weight, neutrality) pertain to content and its verifiability. I'm certainly not opposed to people adding more citations from Health Affairs and NEJM; they are good sources. I would be concerned if we were missing notable content that those journals cover. But, as far as I can tell, that's not the case and there is wide range of reliable, neutral sources cited. Sb101 (talk|contribs) 03:32, 19 September 2013 (UTC)
 * I think central concepts such as national health expenditure as a % of GDP (with or without the ACA) coming from peer reviewed studies generated by the CMS actuary are crucial and missing. But considering I'm largely ignorant of the literature, I can't confidently say other things are missing. But can anyone confidently say they're not?
 * My concern remains that this article is a significant departure from where it could/should be for a GA, in my opinion, due to an over-reliance on popular press and an under-reliance on more scholarly (reliable and weighty) sources.
 * Meanwhile, the article focuses much much more on giving us long quotes and reactions to old CBO numbers: Patient_Protection_and_Affordable_Care_Act. Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 21:08, 19 September 2013 (UTC)
 * Re: Re: expenditure - you don't think the section on the federal deficit covers that sufficiently (referenced with the CBO and CBPP)? As for the quotes and opinions - they still seem representative of opinion on the fiscal impact of the bill. And like my point about indirect references, at least for references I've added, many such popular sources are covering studies with language that is more accessible ensuring the content is more easily verifiable. That said, you're welcome to supplement existing sources with such studies. Forgive me since I think I'm phrasing this imprecisely, but shouldn't the onus be around giving examples (which we can then incorporate) of studies that aren't now but should be included rather than a generalized lack of assurance that everything is included? Sb101 (talk|contribs) 10:10, 20 September 2013 (UTC)
 * I cited a study as an example. Peer reviewed CMS actuary numbers from 2012 are much more relevant that 2009 or 2010 CBO numbers—to the extent that the old CBO numbers are made nearly obsolete, in my opinion. And who cares about old commentary? This isn't the "history of the American debate about the PPACA" article. I think the burden is on the person who proposes an article for GA status to demonstrate that their literature searches were comprehensive enough to find recent reliable sources. =) Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 10:54, 20 September 2013 (UTC)
 * And user isn't set to notify, by the way, it's U. So and Sb101 should both work, FYI (unless you've disabled this preference). Best. Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 10:58, 20 September 2013 (UTC)
 * Re: I don't see how the CBO is out-of-date since the CBO reaffirmed the numbers last year and, as far as I'm aware, the data hasn't significantly deviated; but I'm happy to add the CMS reference (NB: I'm working on LT90001's stuff just atm). As for the commentary, like I said the opinions on the fiscal impact of the Act included do seem representative even of current opinion. And I realize the burden is on the nominator to demonstrate comprehensive and reliably verifiable content, which I've done my best to ensure; among the prominent 'weighty' sources are references from CBO, CBPP, Kaiser, Rand Health, Gruber, Cohn, CMS - and there are in turn further references to other studies within the 'popular' articles that are referenced (I know several Cohn, NYT, and Rand references include additional studies from Health Affairs and NEJM, and I would presume more). My point wasn't that I don't have an obligation to ensure the article is up to scratch, but that you can't demonstrate insufficiency by saying we can't be confident that there isn't some important thing missing - no one can reasonably claim that. In terms of the substance, I think it is accurate and comprehensive. Sb101 (talk|contribs) 13:14, 20 September 2013 (UTC)

Inflation Images
Re: Biosthmors image removal; I'm inclined to keep them included. I realize that health inflation and its share of GDP are broader than the ACA, but that's what the written paragraphs put into context: both in term of motivation for and impact of the Act, these details are crucially important. I thought I'd leave it here for people to give their opinion. (Sorry; Belated signature) Sb101 (talk|contribs) 11:41, 20 September 2013 (UTC)
 * Correlation does not mean causation and these captions did not adequately explain the impact of the ACA per WP:GACR 6b. I found them to be WP:OFFTOPIC. Feel free to create the Cost of American healthcare article. It should exist, but it doesn't. Who am I talking to, by the way? Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 11:04, 20 September 2013 (UTC)
 * I realize correlation does not mean causation, which is why, in the paragraphs above the images, we've been very clear to put the changes in context i.e. the reasons for reduction + the studies implicating the structural changes. But the images so easily convey relevant information that I thought they worth including - by which I mean cost control was a big motivator in producing the act, and therefore it's impact on it is likewise significant. Sb101 (talk|contribs) 11:41, 20 September 2013 (UTC)
 * And those reasons are better explored somewhere else in depth. Of course they can be here covered briefly, that's what "Background" sections are for. This is Wikipedia where about 900 pages are created a day. =) Well if the pictures are reinstated, could we use better captions, at least? I still don't find them helpful, really, as the section is titled: Affordable_Care_Act. The CMS study cited above actually shows impact graphically. Can we not actually graphically represent this information, the relevant information that corresponds to the section heading? That's part of the WP:GACR. When I brought DVT up to GA status, I found big holes in Wikipedia's coverage, such as with prothrombin G20210A and endothelial activation, so I created those articles. I notice there is not a single WP:RED link in the article. So I think this article is "WP:Underlinked" in that regard. Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 12:42, 20 September 2013 (UTC)
 * Re Having read over it, the CMS image isn't ideal. National health expenditures doesn't convey either the net-deficit impact nor the impact on inflation. The CBO picture covers the deficit. And on the inflation front we don't have pictures for the impact; we have pictures of the change in health inflation and studies that say that the law plays a part. So I've included those both. As for new captions, what would you have in mind? And regarding red links, I'm not sure which concepts you think need pages but don't have them, but you're welcome to add red links to signal that - as far as I'm concerned, I just link where possible and appropriate. Sb101 (talk|contribs) 04:06, 22 September 2013 (UTC)
 * Red links are more than appropriate. =) They're a helpful signal. Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 09:30, 24 September 2013 (UTC)
 * Re: ; Sorry, I didn't mean to imply that red links weren't appropriate. I meant, 'I try to link where appropriate, but only when links are available.' =P Sb101 (talk|contribs) 09:16, 25 September 2013 (UTC)
 * Sb101, generally speaking (and this goes to everyone on Wikipedia), please put links on important things (without WP:overlinking, of course). It generates useful redirects, creates a record of articles that need creating, and stimulates progress. State of the Future is a good current example of an article that uses red links the right way. Thanks for all your contributions. Biosthmors (talk) pls notify me (i.e. ) while signing a reply, thx 09:30, 25 September 2013 (UTC)

Obstruction Section
I removed the Obstruction section because of severe NPOV violations, Original Research, and outright lies. The section was beyond fixing, even the heading was a blatant violation of NPOV. Their own website lists some suggestions and they have presented bills to delay the individual mandate. The first sentence of the section of clear Original Research and at the minimum a biased presentation of the sources. Granted, Republicans are very much against the law in general, but to this point they have not actually obstructed (much to the dismay of many I am sure) any actual aspect of the law. Arzel (talk) 17:58, 21 September 2013 (UTC)
 * Can you specify any specific original research? As you may be aware, the House just passed a continuing resolution which defunds PPACA and are threatening to shut down the government if the law isn't effectively killed. The article and section is well-cited and makes no judgments for or against the obstruction, but notes that it exists. The Republican party is not ashamed of their position, so I don't see why this is POV or unfair in any way. II  | (t - c) 19:05, 21 September 2013 (UTC)
 * I think the root of the problem might be the title of the section. It's less about obstruction than continued opposition in this case. Thargor Orlando (talk) 19:31, 21 September 2013 (UTC)
 * Agree; the section needs a "better" title than one using the term 'obstruction', but the notion the section "was beyond fixing" and thus, needed to be completed removed, is hard to justify. If anything, it seems to me the infered alternatives or reforms being mentioned simply need to be added, inter-linked &/or cited if Contributors feel they aren't currently in there. -- George Orwell III (talk) 23:18, 21 September 2013 (UTC)
 * Re: Arzel; NB: That suggestion page isn't improvements to the law, the first words you see are 'repeal and replace'. The first sentence of this section very closely mirrors language in the NYT articles - not OR at all. The obstruction refers to modifications, funds, and nominees - all elements of the law that they have attempted to obstruct as the sources identify. Sb101 (talk|contribs) 04:13, 22 September 2013 (UTC)

Is there a common title that could also cover the GOP alternative system? Hcobb (talk) 20:52, 21 September 2013 (UTC)
 * I think having it either in the opposition section or as its own separate section (Even under "Alternative proposals" or something) makes sense. Thargor Orlando (talk) 21:01, 21 September 2013 (UTC)
 * Well since anything short of a full & outright repeal of the entire enacted PPACA statue(s) would make any proposal (passed or not) just an amendment to/of the PPACA, we can also go with something like "Proposed amendments" ("Proposed changes" even). -- George Orwell III (talk) 23:18, 21 September 2013 (UTC)
 * I would disagree that they belong in this article. If and when they introduce a 'replace' bill, then you could create that a page. At most, I'd suggest including it on the 'repeal' bill's page. The suggestions listed are, from a policy point of view, not particularly compatible with the ACA; indeed, they're offered not as 'proposed changes' to ACA but 'repeal and replace' and this isn't the page to list any and all alternatives. Sb101 (talk|contribs) 04:13, 22 September 2013 (UTC)
 * Respectfully disagree. We can include Republican alternatives in my opinion. for those interested I'd like to see the draft. II  | (t - c) 04:55, 22 September 2013 (UTC)
 * From above: suggestions - Well, I'll reemphasize being careful about undue weight. Sb101 (talk|contribs) 05:20, 22 September 2013 (UTC)
 * Let me be clear - my earlier point was simply on renaming the section &/or adding a formal interlink, with the assumption (on my part) that a "jump" to some other page (like "Alternative proposals to the current PPACA reforms" or similar) was going to follow that. I wasn't advocating for anything like the replacement-over, the inclusion-of or the merging-with any of that alternative proposal subject matter stuff into the current article at all (well, not anything more than brief line or two describing what readers might find if they followed that "jump" maybe). It was my fault for assuming as much; sorry any confusion. -- George Orwell III (talk) 08:07, 22 September 2013 (UTC)

Lets break down the wording.


 * As with all complex legislation, the act contains provisions that must be tweaked to make the legislation work well in practice, and avoid unintended consequences. Strong opposition in Congress by Republicans opposed to the act has resulted in gridlock, preventing these routine adjustments to programs.[328][333]
 * OR and NPOV. The section starts out as an accusation against Republicans that all would be just fine if they would simply agree to work with Democrats.  This is a vast misrepresentation of the problem and Democrats/Obama have thus far been unwilling to solve the 30 hour week issue.  Republicans and Democrats worked together regarding the CLASS aspect and there has been bi-partisan work on the Medical Devices section and other "routine" adjustments.
 * I see no opening accusation implying "all would be fine if..." whatsoever. Basically, it's an atypical cause & effect literary setup where the desired effect is presented first. Your assessment seems to be borne from some other interpretation imo. As far as the alleged problem goes - the trend for anything less than full-time (a 40 hour work week) was well on its way to becoming a "new benchmark" long before Obama (or even Bush II) took office. However, one can legitimately argue (if a corresponding citation can be found) that with the passage of the PPACA, a renewed focus on lowering the weekly work standards was/is taking place but, again, this was the trend prior to anything having to do with the ACA so it really doesn't belong here. -- George Orwell III (talk) 17:53, 22 September 2013 (UTC)
 * While there may have been a trend to a less than 40 work week, there has not been any law which has encouraged it before now. Federal law still defines 40 hours as the cutoff for overtime.  It is well documented that the law is causing companies to reduce hours below 30.  It is disingenuous to suggest that the ACA has nothing to do with it when the facts are so plainly obvious.  Arzel (talk) 19:22, 22 September 2013 (UTC)
 * Then I suggest you try building that correlation using the standards, with citations and so on. Until then, at least my position rejecting you're advocacy for removal is clearly documented at the start. Help me to help you change my mind. -- George Orwell III (talk) 21:20, 22 September 2013 (UTC)
 * Here is one of many. I only desire for WP not to be used for Political advocacy, which is often the case and clearly the case here.  Arzel (talk) 21:26, 22 September 2013 (UTC)


 * Many Congressional Republicans and supporters argue against improvements to the law on the grounds that it will weaken the arguments for repeal.[334][258]
 * That sentence is not bad.


 * In addition to refusing to make routine technical corrections;
 * NPOV violation/OR. The statement that they are "routine" is purely opinion and the opinion of Obama and Democrats.
 * Not true. Since the ~1973 passage of Budget & Impoundments Act & the creation of the CBO, the premise since has always been to not budget from just one year to the next as was the general motivation before it was enacted, but to plan the budget(s) years out in advance based on predicted & continually revised scoring as the core rationale behind most major &/or regular legislation. At the start, nobody ever expected CBO's 10 year prediction to be anything more than putting us in the same ball-park, so legislation was drafted to be more open to amendment as economic conditions were being re-scored & refined. This premise was working fine from Reagan on thru Clinton right up until the Bush tax cuts started to be debated. That's the point where the timely changes to standing laws that needed to made to reflect new economic conditions, etc., and the eventual new scoring as result of those revised realties, started to get worse and worse with every passing year (and yes both sides added to this neglect once it was started) right on thru to this month's latest avoidance. To get into the weeds on this point/counter-point would be beyond the scope of this single article. We'd need to make a dozen or so additions elsewhere to give it the justice needed to properly explain this, imho. -- George Orwell III (talk) 17:53, 22 September 2013 (UTC)
 * The sentence claims that they are refusing. You can take issue with one or the other, but together is it opinion.  Plus it is documented as fact that they are not refusing to make what you would call routine technical corrections.  your argument that you would need to make many additions elsewhere to make it balanced is one of the reasons why I said it was hopelessly unfixable.  Thanks for agreeing with me.  Arzel (talk) 19:22, 22 September 2013 (UTC)
 * For the record, I said it's outside the scope of this article -- not contributing to an un-balanced condition -- but I still urge you to build that framework where it's apporiate as support for where ever it is within an article's scope. Fwiw, Stonewalling over correcting various technicalties discovered since the law's enactment... is how I would have described it but I'm too lazy/distracted to change the current wording until today's games are over. -- George Orwell III (talk) 21:20, 22 September 2013 (UTC)
 * When you only include one side of the story it is un-balanced. It is quite disingenuous to say that balancing the article is not appropriate because you believe that this balance is outside of the scope of the article.  I didn't realize that this article was "The Liberal view of the Patient Protection and Affordable Care Act".  Arzel (talk) 21:26, 22 September 2013 (UTC)


 * Republicans have also attempted to defund its implementation[328][335]
 * True.


 * (including threats to shutdown the government unless the law is defunded),[329][336]
 * Vast overstatement and NPOV. While Liberal reporters like Jonathan Cohn make these statements, but Boehner (and many others) have stated that they do not want to shutdown the government.
 * Sort of agree the sentence is over stating what was actually said & what is only being signaled by some or contrived by the pundits. -- George Orwell III (talk)


 * and block appointments to relevant agencies (like the IPAB[337]
 * This is a policy issue which Republicans think needs to be addressed because Republicans believe it will dangerously hurt health care in general. This is separate from the larger issue and it is Synthesis to connect with the previous.


 * and CMS[338]).[339]
 * All the opinion of Liberal reporter of Jonathan Cohn. And why is this whole section littered with little more than Liberal sniping?  Where is the objective views which would promote a neutral section?  Arzel (talk) 15:58, 22 September 2013 (UTC)
 * I agree that many of the things you pointed out appear to be POV, and I have made some edits that I believe cure most of the concerns. However, I have not had the time to investigate the veracity of whether congressional Republicans have actually called for a government shutdown to defund Obamacare, or who those Republicans may be, so I have left that material in and tagged it with for the time being. Others are welcome to conduct this research. –Prototime (talk · contribs) 17:44, 22 September 2013 (UTC)
 * Again, anyone can add anything at anytime if they feel it is currently missing. I just don't see the things Arzel is having a problem with being entirely (or just primarily) falling under the sphere of this PPACA article much more. If anything, policy shifts or whatever folk's like to call it should be developed in a new article or on one of the existing "Health Care in the U.S." type of articles instead. -- George Orwell III (talk) 17:53, 22 September 2013 (UTC)
 * This is not so much an issue of what is missing, it is the clear biased presentation of sources and use of biased opinion as fact and original research. Arzel (talk) 19:13, 22 September 2013 (UTC)

Just a comment: I'm really glad to see that cooler heads have prevailed and the section has been restored and is being discussed and edited piecemeal. A LOT of work by many editors has gone into hammering out this very controversial section. If there are indeed pervasive NPV issues then the correct approach is to address them and fix them rather than to erase a lot of hard work in one fell swoop. I understand there are times for that but this is definitely not one of them. --Dr. Fleischman (talk) 19:44, 25 September 2013 (UTC)