Talk:Medicaid Estate Recovery Program

The Appearance of Neutrality: Oh, Am I having trouble. Here's why. Please help me figure out how to do it in the case of this weird issue
The issue is the one in here, Medicaid_estate_recovery. That is, should non-long-term-care-related expenses (that is, ordinary health-insurance type Medical expenses), be recovered from the estates of people who have Medicaid (including the ACAs expanded Medicaid). I am trying to present both sides, in a neutral sounding way.

To understand the problem I'm having, you really have to understand the issue. The issue has not been well-publicized. Most people who understand the ACA pretty well aren't even aware of it.

Note the issue restricts attention the the states that have expanded Medicaid, which is most of them, where the situation is supposed to be that the ACA now provides affordable health insurance to all who want it.

So, you might have thought all ACA "coverage" is like insurance. Bills come up, they get paid, up to copays and such, which have to be paid by the person with "coverage". And it stop there.

But, no: in certain states only, if you have a Medicaid, including ACA's expanded Medicaid (that people get as their medical coverage under the ACA if their income is <=138% of the Federal Poverty Level--regardless of how much in assets they have--no asset test--they can even be rich), the bills paid out will get paid, but then the person's estate has to pay the bills that were paid out back in full when the person dies. This is for people 55 or older when they had the coverage, only. (Note: we're not talking nursing homes and such--those are long-term-care We're talking ordinary medical expenses, like health insurance covers.)  So, the natural way to think of this is people don't have medical insurance. They have a loan for medical expenses. It all has to be paid back.

A problem here in trying to get editors to help review this article is that this will shock people who don't already know about it. And the editors really need to get their head around the issue--it may be unfamiliar territory for editors who don't already know much of the structure of the ACA. (I.e. perhaps they themselves have job-related insurance.)

The problem with neutrality is coming from the following 2 factors:


 * 1) it's almost impossible to defend the goofy structure of the ACA in states that still do non-long-term-care-related estate recovery (which is for medical expenses of people who were 55 or older when they had the ACA expanded Medicaid and other traditional Medicaid coverage, in certain states only). Because:


 * a)Everybody's been going around giving people the impression that ACA coverage was about getting affordable insurance, and not just a loan (until death), for an amount that could be $1,000,000 or $2,000,000.


 * b)There is an unequal treatment of people below 138% FPL vs those a bit above. Both groups get their medical bills paid, but those  below 138% FPL have to pay it all back, while those above don't.  Further, those above are getting very cheap, highly subsidized insurance with low copays, quite similar to what people below get (premiums may be 0, copays are small), except for that having to pay it all back.


 * c)There was a compulsion to have the coverage for people under 138% FPL (the mandate), and still is in some states. So people are compelled to pay back all medical expenses, and there is also a case of capitations: maybe $700 a month per person has to be paid back, even if the person didn't get sick, or go to a doctor, ever.


 * d)The notice of the Medicaid estate recovery is inconspicuous, in many states. In states that use the Federal exchange, it's actually non-existent when the person applies.  (It is unclear to me whether states are obligated to eventually tell the person.  If they do, using the Federal exchange, it may be after the person already has the Medicaid, and are exposed to all Medical expenses needing to be paid back.)


 * Now, the reason for the problematic situation is not the governments intending to be cruel, but rather that the law just sort of evolved that way. There likely wasn't enough money available when the ACA was passed to compensate states for whatever revenue they would lose by stopping Medicaid estate recovery. It was politically tight, with a 0 vote margin in the Senate. They were building on existing structure of laws, which has a big role for Medicaid, and the estate recovery of non-long-term-care (i.e. ordinary medical) expenses was in there for many states historically.  (The people affected have incomes <=138% of the Federal Poverty Level: possibly, not much money can be collected from them, anyway, but perhaps the state analysts don't have the skill to calculate this.)


 * 2)I am trying to put the "pro" estate recovery of medical expenses post ACA, and I have a subsection on that. But the problem is, due (apparently) to the 4 factors in (1), no one is defending the practice post-ACA.  The state governments that still do the recovery are completely quiet.  (The issue seems to be completely unpublicized in those states.  Whenever publicity does happen, as it did in WA, CA, MN, the state folded and stopped the medical expenses recovery.)


 * So I really could find only one "pro" argument. I used it in a case when it was stated post-ACA.  It was stated in MN by the state government,  “The general idea here is that people with assets should help contribute to the cost of their coverage, Many have incurred thousands of dollars of medical expenses at taxpayer expense. That’s the reason for these recoveries. It’s not intended to be punitive."  The argument doesn't address the 4 problems in (1).  It's not a post-ACA argument, really.  But it's all I could find on the "pro" side. (And, note, in fact, MN folded shortly after the guy making the argument made it, and stopped doing the recovery.)

So please, Wikipedians. I know I need to present neutrally. This is complicated for reasons (1) and (2), and I'm counting on you to help me get it right. (Do. please, if you don't already know the issue, perhaps first strain a bit to see the exact, likely unfamiliar, disorienting, and disappointing issue.)NormSpier (talk) 21:38, 14 September 2019 (UTC)

Note that the "Pro" and "Con" presentation that I now have may have hurt more than it helped. I structured it that way after user:Newslinger indicated something like "viewpoints need to be presented proportional to opinion in reliable sources".

The above 4 items (a)-(d) above are the essence of the information in the article, and it was all reported in places like the Washington Post and Seattle Times 2013-2017. ((a)is tendentiously expressed above, and it needs to be stated in any article something like "all medical expenses paid for a person 55 or older in certain states have to paid back from the estate".)

Also needed for the reader, though, is additional helpful content. The various newspaper articles and other places where the issue was brought up mainly talk about one or two states only, and in virtually all cases are unclear about how many states. Further, states may have amended recovery rules, as about 7 indeed did. I have tried to help the reader, and looked up the current status in a number of states on the recovery, to assist the reader to determine that there are a lot of states that currently do the recovery, and a lot of states that currently do not do the recovery. I have also placed timing, like 2014 or 2017, in cases where the recovery rules were changed, so the reader can figure out that it was in apparent response to the ACA.

So, the last 2 paragraphs are what needs to be conveyed. If you have suggestions on how to do it, that would be great. (At the moment, I am thinking drop the "pro" and "con", but then someone may again come at me with "viewpoints need to be presented proportional to opinion in reliable sources".  Further complicating the matter, the "pro" side is virtually silent.) NormSpier (talk) 16:23, 16 September 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/682619084/912949236) and other articles related to Medicaid estate recovery. If you're interested, please participate at. —  Newslinger  talk   17:13, 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) 14:09, 31 August 2019 (UTC)

Posting here discussion of matters in response to editor User:Newslinger broached on the noticeboard page https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view/Noticeboard#Medicaid_estate_recovery_and_User:NormSpier, with expansions as relevant to this Medicaid estate recovery article.

User:Newslinger pointed out the "undue weight" wikipedia editing guidelines, and felt I was in violation. (Which could be true.)

I was motivated to explore this, so I looked up undue weight, and posted it, with comments


 * 'WP:UNDUE "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources. Giving due weight and avoiding giving undue weight means that articles should not give minority views or aspects as much of or as detailed a description as more widely held views or widely supported aspects." Text later on is unclear to me if equal text space is mandated. I hope not. That wouldn't make sense from a pursuit-of-truth point of view. It may be that one argument is more complex than the other.'

I also commented that it might actually be that these standards were forcing Wikipedia to be an establishment voice, like the New York Times. (As in Chomsky /Herman Manufacturing Consent.)

(That could be OK for Wikipedia to have that goal, but I wanted to make sure all readers were aware of that aspect.)

I, myself, detest that standard "in proportion to the prominence of each viewpoint in the published, reliable sources", because we are really in Manufacturing Consent territory. (As I've remarked elsewhere, it might mean Wikipedia should stop wasting everyone's time each year when it asks for donations on the grounds of freedom from special interests, and just the needed money from big corporations. This is a bit of an exaggeration.)

There might also be, in the application of that standard by some, that on multiple sides of any particular issue, all arguments need to be represented with an amount of physical text space proportional to the presence of arguments in mainstream media. That also really irritates me, because the case for one side may be more complex, and need more text. A "proportional text" rule assumes the reader is just too stupid to figure out that amount of text doesn't correspond to importance. (In medicine, if the brain needs more space to describe in adequate detail than the liver because it is more complex, it doesn't mean the brain is more important than the liver. If certain parts of a car, like then engine, need more space to be described, than the wheels, it does't mean the engine is more important than the wheels.  Etc., etc.)

However, going with that detestable "in proportion to the prominence of each viewpoint in the published, reliable sources" for the case at hand, the Medicaid estate recovery for non-long-term-care expenses post-ACA (that section only; that issue only), note I did


 * add a subsection to the article, "Argument for non-LTCR estate recovery post-ACA". It's restricted to post-ACA, because the whole section discusses the controversial non-long-term-care-related Medicaid estate recovery post-ACA.  (If you follow the details of the ill-publicized issue explained in the prior sub-section, and think through the details, the issue arises only post-ACA, as Medicaid becomes substantially non-asset-tested in the Medicaid expansion, and as well there is a purported principle post-ACA of guaranteeing everyone affordable insurance, and as well there was a mandate to carry "coverage", and for many people, the only coverage even remotely affordable will be traditional Medicaid or expanded Medicaid)  So the whole justification of non-LTCR estate-recovery changes post-ACA. (So, I've put in what I could find on the contra side.)


 * The obvious fact is that nothing I could find addresses any of the new post-ACA factors. (The first argument is pre-ACA, but  threw it in to try and be balanced.  The second argument was made post ACA.  It ignores all of the roughly 5 identified problems post ACA.  So it's really a non-response.  But it's all I can find.)


 * Basically, although 10 or so large states that have expanded Medicaid still do non-LTCR Medicaid estate recovery, I've found nothing anywhere addressing the 5 or so problems with doing the recovery post ACA.


 * (You can check yourself. If you Google search for "Medicaid estate recovery", besides legal advice on avoiding it (in LTCR cases, mainly--these are irreleveant to our quest), you get a lot of state documents on recovery (with nothing addressing post-ACA considerations), and then a few pages in, you get many of the references I have incorporated in this article, and some others, all pointing out the problems. You get nothing defending against the 5 issues brought up post ACA.

In other words, the "other side" has really been silent, and not making any argument to address the complications post-ACA. (I have generously represented in the "pro" section the same argument twice, given once pre-ACA, and once, post-ACA.)

There is nothing else the "pro" (pro non-long-term-care-related Medicaid estate recovery post-ACA) side has to say on the matter. (Please, anyone, if you find something, point it out, or put it in yourself on the "pro" side!)

(If you understand the Medicaid estate recovery of non-LTCR post ACA issue, the reason no state governments or newspapers or journals can state support of it is that it really can't be supported. The ACA is just too goofy when it is done.  These all have be justified: a)Leading people to believe the ACA gives them insurance, when, no: whatever medical bills are paid out have to be paid back the estates when people die; (b)People observe just above 138% FPL, there is similar copay, very-low-cost (real) insurance coverage, with bills paid out not having to be paid back  (c)Similar unequal treatment for people over 55 and under 55, (d)similar unequal treatment for people in different states (e)compulsion under the mandate (until the mandate was revoked, and in some states, like MA, now, still), with the compulsion being of recovery of both all bills paid out and/or capitation payments even when no actual medical expenses were consumed; further, many of these people had passed pre-existing-condition screens and had cheap individual insurance pe-ACA. Now they have no affordable options without the recovery. (f)There are questions of notification before applying for ACA. The Federal exchange has no warning at all. (In which case, perhaps the state Medicaid agency issues the warning after approval for expanded Medicaid after the person is enrolled and already exposed to the recoveries; or perhaps the state agency just doesn't notify the recipient. Otherwise, in states with their own exchagnes, the warning is often inconspicuous.  Never does the application instructions say what it should to alert the ACA applicant: "If you don't want your estateto possibly be on the line for two million dollars in medical bills, and $80,000 in capitations, you'd better pay more, often unaffordable to you, for non-subsidized on-exchange coverage.")

The impossibilty of states defending their continued non-LTCR recovery post-ACA, 6 reasons described in the last paragraph, is more or less iterated by director of the National Association of Medicaid Directors, “There’s no way any state is going to see it as ... politically sensible to do that.” (The quote is taken here from the Medicaid estate recovery article.)

So, I think the current article is OK exactly as is, on the Wikipedia standard "in proportion to the prominence of each viewpoint in the published, reliable sources" (But I still detest it!)

Also, I had some time ago switched to neutral wording. I always say, in the article, stuff like "the viewpoint is". (This was before User:Newslinger reviewed the article, and in response to User:AnUnnamedUser, who did correctly point out neutrality wording, and other issues, that, due to inexperience with adding to Wikipedia, I had incorrect.

--Otherwise, note, in my new pro section, my middle paragraph has:

"It can be argued that the justifications were written before the ACA main provisions went into effect in 2014, and do not account for the changes in who is affected by the recovery post-ACA, and as well, that the ACA may reflect a changed attitude intended in the law, that affordable health insurance should be, post-ACA, available to all as an expected matter of national policy. Thus, some may consider it important to examine justifications post-ACA, under the assumption of expanded Medicaid." (It separates the pre-ACA argument and the one made post-ACA.)

I have no references, although User:Newslinger has asserting everything needs a reference. I am assuming that the person reading can think, and may have absorbed the issues, and will see that the post-ACA medicaid Expansion condition is necessary for the question post-ACA.

(I have quibbled elsewhere with why do we have to have a reference on every little thing, even things obvious. Thus I have brought up what they've done over on Internal combustion engine, Calculus, an Banach space, and note a paucity of references, with an assumption that readers and editors know about the subject matter, and/or are able to supply intermediate thinking, etc.)

A comment somewhere of User:Newslinger is that I have too many references. Elsewhere, I commented that an abundance of references could help people to really understand this issue. Policy and editorial considerations may wind up having them mostly cut, but I just wanted to point that extensive references are of intellectual value to certain readers. (There is an issue of too many references disrupting a smooth read. If I remember correctly, User:Newslinger has pointed that there is some sort of fix for this: a reference group or something.)

As I've indicated, I think the final action on this article is that the issues on post-ACA non-LTCR recovery will wind up being completely removed, thoroughly watered down, and perhaps muddled in the process, of necessity, because of Wikipedia written standards, or else unwritten practices. That's OK. Though I won't do the removal or muddling myself. (I am of course open to suggestions for maintaining a fully informative article, for compliance or expositional improvement purposes.) I do expect, and won't be mad, if editors remove all the stuff, or otherwise remove the bulk of it, themselves.

NormSpier (talk) 20:42, 1 September 2019 (UTC) (Note I have done substantial rewording to the above since 1 Sept; NormSpier (talk) 18:35, 4 September 2019 (UTC)}

I've added one sentence to a paragraph on the anti-recovery side. Since we have controversy, I'm noting it here to avoid being accused of being sneaky.

In:

"A further aspect raised was that notification of estate recovery, when present in the ACA application process, was inadequately conspicuous, and that ACA navigators, designated to help people enroll in the ACA, were not trained to explain estate recovery, or to alert people to it.[39][5] Further, it was pointed out that the Federal ACA application (used in states which do not have their own exchanges), and which is for both on-exchange-plans and expanded Medicaid, does not contain any warning about Medicaid estate recovery.[14][40]"

The second sentence is new.

That is, to that notification in the application is viewed by some as inadequately conspicuous, I've added that its simply not present in the Federal application process. (Used for ACA in states with no federal exchange.) On the references, I have a Paul Craig Roberts site, which points out the issue. Though Roberts has a Ph.D. in economics, his site is not considered reliable enough to be taken as always being fact, either by me or Wikipedia. So, my second reference the actual Federal ACA application, that everyone can examine, and see that no warning is there. (Here, I am following the principle that facts need to come from highly reliable sources, but less reliability is needed for opinion. To opinion, I would add, naturally, pointing out of things that can be verified from reliable sources. There was an issue that I brought up elsewhere, that I thought the editor, User:Newslinger, was misstating reliability policies it Wikipedia, in that he was insisting on recognized highly reliable sources for everything, but really the policy is only for fact.  In the indented text below.)


 * 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."

(My additions is concerned with the sufficiently detailed description of the approximately 5 problematic aspects that were brought up in various places at the start of the ACA regarding states doing non-Long-term-care-related Medicaid estate recovery in the presence of the ACA. This is so that a thoughtful person can clearly understand the issue.  My personal concern is that a reader should be able to get a real, not superficial, muddy, understanding of the issue.  I have attempted to use neutral language.  I have attempted to place any countering arguments from the other side of the issue, but the other side has apparently chosen to remain mute to counter the multiple problematic aspects that were brought up.)

NormSpier (talk) 18:13, 2 September 2019 (UTC)

Article issues

 * I just read through the article. Since I am well above 55, and having fallen into a trap of sorts, I find it interesting. I usually first read an article without paying a lot of attention to the tags then look at those, and then read the talk page. I see there are some extended discussions that I have not looked at. Some issues that immediately jump out are:


 * Thank you so much Otr500 for getting into detail. You are the first person knowing the Wikipedia standards getting into sufficient detail to help straighten out places where I am off.
 * Reply: You are welcome but please understand that article expansion and improvement is usually incremental. You may make many edits that are not contested. You may make edits that are reverted and you will have to make a decision of the overall importance of the edit, the validity of the revert which is a good reason for edit summaries and talk page discussions, and if you want or need to seek some resolution. Just remember that violating 3RR is seen as serious. Otr500 (talk)


 * I'm guessing you got here by the RFC on the ACA article (related to this; Talk:Patient_Protection_and_Affordable_Care_Act, but in case you don't know about it, I figured I'd let you know.NormSpier (talk) 16:27, 9 September 2019 (UTC)


 * 1)- Excessive citations. Fifteen and seventeen citations are certainly citation overkill. This means there could be more tags added.


 * As you might guess, one of the purposes of numerous citations is to allow a reader who is interested in learning a good bit more to get to the sources. (Possibly, in this short article, it could be done by "see also" at the end.)  With the loss of that "learn more" function, the long footnote lists are not essential.  However, in the case of each state, I have tried to be helpful, and list a number of states currently doing estate recovery of non-LTCR expenses.  (The various articles talk about one or two states each, often around 2014, and I am attempting to not be lazy, and give the reader recent status, and also the ability to see that the issue applies in many states.  Thus, as you see, the footnotes: at least one, sometimes more (when the state makes it difficult and you have to look what the various Medicaids are).  Your solution of split out each state makes sense.NormSpier (talk) 16:27, 9 September 2019 (UTC)
 * Reply: The excessive citations are specifically why I suggested individual state coverage, or smaller state group coverage where applicable. I understand your reasoning but the intent isn't to force a reader to stop reading and follow a source (or more than one), but that the information provided can be verified should one wish to do so. Some may not want to be diverted and some may be on a cell phone or have some other reason why this would be inconvenient. It can be a little perplexing if a subject is covered in part by several different sources so you have to figure out a way to present the information within editing practices. Too many citations will likely receive a tag, revert, or negative comments. A boomerang to providing too many sources, or arguing that are needed can be seen at Citation overkill. While essays do not carry the weight of policies or guidelines many are seen to reflect some community consensus and often community practices.
 * The purpose of in line citations are for text–source integrity. Note: I have never had an occasion to use it but there is a way to bundle (merge) citations. I would not think it prudent to use for 15-17 references. Otr500 (talk)


 * 2)- Original research. While in many places there is an over abundance of citation clutter there are some unsourced paragraphs such as the second paragraph of the Argument for non-LTCR estate recovery post-ACA section. The sentence begins with "it can be argued..." (basic copyediting needed for improper paragraph structure) and this clearly can be seen as original research begging a tag but the wording would be best avoided.


 * "argument for" is an interesting case. I put the section in because I was accused of being biased towards the view that post-ACA, non-LTCR estate recovery should be stopped,  (Because ya don't got insurance with it--ya got a loan.)  So I made every effort to get the other side in.  As I mentioned, and if you think about it, and especially focus on gross inequity-of-treatment issues, it's really hard for anyone to defend, and it will outrage many people to defend it.  (For example, MN actually was honest enough to send a notice of Medicaid estate recovery probate liens on people with ACA expanded Medicaid, and there was outrage, and the law was changed.)  So what I'm doing here is trying to be neutral, and throw in the other side.  However, the other side hasn't made any case anywhere, because they need to keep quiet about it to keep from having public outrage.  So I have no idea what to do with the "argument for" section.  The second paragraph is me trying to give an excuse to let the other side state its argument twice.  But they really haven't addressed post-ACA factors, except in places where they conceded (I think that's in the Washington Post article about Oregon, and maybe from the National Association of Medicaid Directors head.
 * Reply: I would have to re-read the section. It may be biased "against" some fact, but if a source does not cover that a recovery should be stopped, it becomes OR for an editor to assert this. One would think some coverage would be available but it is really simple: If reliable sources don't cover it, we can't cover it. Otr500 (talk)


 * I'm aware I have clumsy wording in the prior section "argument against", where you might call it original research. Perhaps my use of the term "loan".  An economics-minded person would say, where non-LTR estate recovery is done, you've got yourself, possibly, "a loan for uninsured medical expenses until death".  But I don't need to use the terminology "loan" if some consider using that term original research.  The important point is, they pay your bills now, and and death, from your estate, you have to pay back some mix of capitations and all medical expenses paid out.  The latter could be $1,000,000 or so.  That's the essential point. (Other subsequent essential and distinct points are the exposure was forced, under threat of penalty, and further, that some felt the notice inadequately conspicuous, and futher, where the Federal exchange was used, there is no notice, except possibly by the state Medicaid agency after the person was already exposed, and there's an unusual, hard-to-explain combination of estate recovery and a non-asset-tested-benefit.) NormSpier (talk) 16:27, 9 September 2019 (UTC)
 * Reply: If a source uses words that equate to loan, and others agree, then that would be up to consensus. As I stated, the article is interesting and many may not know some of the information. "Subsequent essential and distinct points" would still require sourcing.  Otr500 (talk)


 * I did not, or have not yet, looked at neutrality concerns or any particular citations. One specific issue seems to jump out. This is a broad topic and it may be that it is not specific enough. Jumping from "federal", to specific states, to groups of states, may mean it would be better served having subsections on individual states. I did not look closely but there is probably enough sources and available content for the article to possibly become a parent article at a point. My reasoning for separate state entries stem from the Post-ACA adjustments to recovery regulations section that mentions some states individually then lumps 12 states into one sentence followed by 17 citations. If one source does not mention this content then it very likely should be separated.


 * I think I commented above, this sounds good to me.


 * An article can easily become too complex to the average reader and can seem confusing. While recording a page hit, if clicked on, and an article is too technical, too broad, or bounces around too much, a reader (the reason for articles) will either give up or not understand it. The lead mentions "long-term-care-related (LTCR)" with four citations. Then there is the Non-LTCR estate recovery and the ACA section followed by fifteen citations. The lead is a summary of what is found in the article. As long as what is in the lead conforms to being a summary, and that content in the body of the article is properly referenced, it does not usually (with some exceptions) require citations, certainly not nineteen of them.


 * Wait. I'm not sure I see what lead you mean.  Do you mean the lead to the whole article? (That starts with The Medicaid Estate Recovery Program (MERP)...".)  In that case, I have critical details not present elsewhere, which seem to need a reference.  If that's the section you mean, I can restructure, and put the details into a separate section.
 * Reply: Information on the lead can be found at Manual of Style/Lead section. Otr500 (talk)
 * Also, note, I've between hit with "citation needed" by a bot and a person. So I went high on the citations, and now you are relieving me that they can, in certain parts, be omitted.
 * I do not think I came close to suggesting that material not be sourced. Properly referenced material presented in an article does not usually need redundant sourcing when summarized in the lead. In fact, material should not normally be presented in the lead only. Otr500 (talk)


 * There is, ultimately, a question of the intended level of the article. I had used examples Internal combustion engine, Calculus, and Banach space that popped up over another matter.  Some of the concerns about footnotes from you and others, and other things, may be about chasing away readers of more modest ability to handle details.  This would be reasonable editorial decision.  It looks to me like the articles (this and ACA) may be intended to be aimed at, oh, a NY Times reader, but without as much demanded as say, the slightly wonkier Upshot section.  I am possibly being a little more demanding than Upshot section, not to anything like graduate or advanced math or economics, but possibly a mathematically-light undergraduate or graduate health economics course.  I am intentionally writing making a bit more in demands than "Upshot", to satisfy my own desire that people understand the problem with some logical clarity and numeracy.  This just might mean I have to stop contributing to articles like this and ACA, and, just, whenever I have the interest put some things in mathy or science articles.  (Possibly, there could be "ACA for wonks and eggheads" as a Wikipedia, but that puts us into the hot potato area of elitism.)

NormSpier (talk) 16:27, 9 September 2019 (UTC)
 * Reply: A "concern" would be running off any readers. Another concern is presenting the article in accordance to community accepted standards. I haven't looked up "wonkier Upshot" so do not know that intended level. Just keep editing at whatever "level" you choose. Someone will likely tag or otherwise let you know if they deem there are issues.


 * In looking around I saw comments concerning "editor authority" and I hope your questions were answered. I didn't read it all, just glanced through it, but see this involves several aspects including some at Talk:Patient Protection and Affordable Care Act.
 * I have not read through any of this but would like to state that a certain amount of patience is required. There is no hierarchy on Wikipedia. There are editors (possibly that have been around awhile) and they may follow a subject or particular article. I have seen these referred to as article protectors. I suppose I might be considered one, and you will no doubt be or become one on articles you follow. This may become very noticeable on articles as the classification reaches B-class or better but can be seen on almost any subject. I have learned it is necessary not only to prevent vandalism but so an article does not become degraded.


 * Now that I know the editor in question is equal, only after asking in the Teahouse about it, we're going through the RFC process that I linked above. So far, it's been just me against just him.
 * Note that in incorporating your comments, I probably should wait until the RFC is closed. (The question on the RCD is killing all of my ACA contributions, and possibly all of my building up of this article from a stub.  Though I think the editor in question may have backed out on this article only.)
 * Reply: There are no restrictions, that I know of, on good faith editing articles while under discussion as long as they are not against consensus. In fact, attempts to make improvements can be seen as positive. If you boldly make an edit not agreeable you will find out if it is controversial. Again, I would have to read the comments to see what is being contested and why which I have not yet done. Otr500 (talk)


 * Your possible "experience" (education etc..) may very well place you as an expert in a field and as such your knowledge would be invaluable. We all have opinions. The policies and guidelines are intended to ensure that personal opinions are not reflected in articles. This is a reason not only for the importance of sources but also that editorial synthesis does not occur.
 * I note that you have expanded the article with many edits and it should be actually a good sign to you that other eyes have been cast upon it. Again, I have not looked at any of this farther than shown but I saw that you acknowledged the unsourced paragraph and made comments concerning citations in the Noticeboard discussion regarding User:NormSpier's recent edits section.
 * Citations: The guideline for citations ("A citation, also called a reference, uniquely identifies a source of information) follows the verifiability policy, that requires "inline citations for any material challenged or likely to be challenged, and for all quotations, anywhere in article space.". This goes beyond anything challenged as it includes content the providing editor may think (likely) would be challenged and becomes more critical when it becomes questioned. You stated "My additions is concerned with the sufficiently detailed description of the approximately 5 problematic aspects that were brought up in various places at the start of the ACA regarding states doing non-Long-term-care-related Medicaid estate recovery in the presence of the ACA." (whew! breath please). If that is an issue, then list the places this was brought up, because "various places" is problematic. Concerning  you stated that "he was insisting on recognized highly reliable sources for everything...". While I don't know about that I can state that it is common practice to question a source and "Exceptional claims require exceptional sources".


 * The "various places" are in my footnotes. "The ones on  forth in various places starting from the time the ACA was passed,[9][13][14][15][5][16][17][18][19][6][20][21][10][22][23]".  That's why I have all the footnotes there.  If you click on the footnotes, you will find the various places.  (Maybe you are telling me to mention "The Washington Post", "The Seattle Times", "The Minnesota Star Tribune", "Health Affairs following ACA blog"  Is that what you are suggesting?)
 * Reply: I think this was sufficiently covered above. Otr500 (talk)


 * Here is a thought! You became interested in a stub article and expanded it. This, for whatever reason, drew attention and involvement of another editor. Not every thing we think should be in an article will be agreed upon and I have learned that from experience a long time ago. What can seem to be controversy can just as easily be collaboration and any possible impasse can be resolved per the above suggested options to include the Reliable sources/Noticeboard. Otr500 (talk) 13:00, 9 September 2019 (UTC)


 * Thank you so much for, what I repeat, is the first sufficiently detailed commenting on particulars of the article. (talk) 16:27, 9 September 2019 (UTC)
 * Reply: You are welcome. I have just read some of the comments at the NPOV noticeboard. I have looked at the comments on neutrality, the Teahouse, your personal essay, as well as the stub-classification of around August 6, 2019, before your edits. I "have not" made an in depth review of the article.
 * I was glad to see 's suggestion to continue discussions here as the bouncing around was making me dizzy. His last comments should probably be copied here as I saw where article sandboxes were created. It is hard to not notice that you are a critical opponent of the MERP. There is absolutely nothing wrong with this. Every single editor on here will have some personal opinion one way or another on a subject. That is life. What we have to do is be able to present an article in an impartial tone. In noting sandboxes were set up :*I am surmising from what I have read that just plain removal of your content is not a goal. I will also add that when an article is being created or expanded it can be normal for there to be a degree of partiality. This can sometimes stand a good while that we refer to as consensus by silence, can garner tags, a discussion, a revert, or a combination effectively ending any implied consensus. A tag is not as bad as it seems, certainly not as detrimental as a revert, but just notification that issues were determined to exist. I have seen where some editors sling these on articles with no or a terribly vague edit summary, and certainly nothing on the talk page. If I review an article with a vague career maintenance tag, and I cannot readily see the issue, I will simply remove the tag with an edit summary as to reasons, and add talk page comments.
 * As far as your contributions, and what I deem a novel idea of a sandbox, I think this is a good idea. Please do not think your edits will be lost. One way to counter NPOV would certainly be adding my suggested state sections. A primary source and possible secondary on the subject can certainly have a referenced controversial section added. I have to go play work so will be gone awhile today. Otr500 (talk) 12:42, 10 September 2019 (UTC)

An editor comments on some style points, and also seems to be saying that the kind of information presented here has no place in Wikipedia.
Commented on user:Newslinger's talk page. I have copied it here because of its relevance.

Note that the quotation references a section of a related article (Patient_Protection_and_Affordable_Care_Act) at the end of the quote, the author asserts 'The POV issue with the "problems" section is the entire section '. Below is the full text, to avoid an out-of-context presentation. (The beginning refers to the related article Medicaid estate recovery )


 * A couple of quick notes looking over the estate article: There is basically no reason that we ought to ever be including a dozen citations to support a single sentence. It's unnecessary, and disruptive to readers, especially on mobile. We should also never use postal abbreviations on Wikipedia. How are you, as presumably an American, supposed to know that PDL is the postal code for Pays de la Loire? And that's probably the core problem with the content overall. You are pretty clearly writing as an American and for an audience of Americans. That seems to be the source of the overly-detailed state-by-state breakdowns, the excessive use of acronyms (DMAHS, LTCR, MAGI) and US-centric terms (e..g, Federal Poverty Level) while seemingly presuming people know what they are, and the overall approach of writing for people who "deserve the right to see the problems". That's not our job. The POV issue with the "problems" section is the entire section. Wikipedia does not advocate for any "side" and we are not here "make an argument". So long as you are making an argument for Americans who "deserve to know" then the content is not going to appropriate for this venue.  G M G  talk  13:28, 16 September 2019 (UTC)

My feeling about the assertion that a "problems" section is not appropriate for a Wikipedia article is that I can only see that perhaps the labeling "Problems" is tendentious, where it should more neutrally be "what some people and experts feel are problems" (more concisely, of course). The "Problems" section is NOT to advocate. (I do, of course, have an opinion that the problems with the ACA should be fixed.) The "Problems" section is intended to give readers needed information about the ACA. I do feel that it is especially helpful now for readers, with "repair or replace" discussions, and repair proposals, going on, to have some understanding of what the heck the politicians are talking about.

The assertion that a "problems" section is not appropriate for the ACA article seems to carry over to this article, saying perhaps that the entire section Medicaid_estate_recovery should be removed. (Though commenters on this article are infrequent, we do have one commenter, user:Otr500, who does not seem to feel that the content should be removed, and has made comments on how to improve POV and other issues, like "every state in its own section")NormSpier (talk) 14:40, 16 September 2019 (UTC)

Stylistic points from User:GreenMeansGo seem to be saying don't use Modified Adjusted Gross Income (MAGI), but rather use the ambiguous, but simpler, term "income". I could. Myself, I would want to know the specific income chosen, but the intended audience for the article may make just "income" a better choice. Ditto, where I have 'Federal Poverty Level (FPL)", I could do what is done elsewhere in the article, use Federal Poverty Level. "DMAHS" is from a quoted letter from the Obama Administration.  I could perhaps replace it with something in square brackets indicating what it actually is.NormSpier (talk) 15:38, 16 September 2019 (UTC)

Medicaid estate recovery / ACA Interaction in Archived ACA Talk way back in 2013 -- Saying the issue belongs at the very least somewhere Medicaid related (like right here)
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 the ACA article, with a lot of pro. But then, at the end, a person who has mixed feelings about putting it in the ACA article in 2013 indicates ' This nuance probably does belong aside somewhere "medicaid" related '.

Well, here we are in "Medicaid estate recovery", which is somewhere medicaid related.

(That view contra "the issue of Medicaid estate recovery and the ACA doesn't belong in Wikipedia", which I possibly detect is the belief of user:GreenMeansGo, and I think, at an earlier point, was the view of user:Newslinger.)NormSpier (talk) 21:45, 17 September 2019 (UTC)

Medicaid estate recovery interaction with ACA 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 current 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 discussed in my article/entry here. 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" in the article here.NormSpierNormSpier (talk) 21:36, 20 September 2019 (UTC)