Talk:Affordable Care Act/Archive 18

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Anti-discrimination Provisions of ACA

I would like to add information about the anti-discrimination provisions in ACA, specifically Section 1557, which prevents discrimination in the provision of health care services under ACA, and some other provisions that affect people with disabilities. DisabilityAdvocacy4U (talk) 03:11, 5 April 2020 (UTC)

Hi, DisabilityAdvocacy4U. I don't know if you have done this already. I don't see other editor comments on it. It sounds like a reasonable proposal to me.

(However, note, there may be a reversion in a few days, owing to my dispute of a removed "ACA Problems" section. So you either might want to wait to put it in, or at least have a copy of your additions safely stored somewhere, to avoid any loss of your work.)

Pinging User talk:DisabilityAdvocacy4U for notification. The possibly destructive reversion that I had warned you might happen does not need to be done as, now via democratic procedure to restore the "Problems" section, I was able to do it not with "undo", but by copy and paste. So, you and your group are free to add your sections and/or parts, without worrying about destruction.NormSpier (talk) 19:02, 22 July 2020 (UTC)

NormSpier (talk) 22:06, 11 July 2020 (UTC)

Hi, NormSpier. Thank you for the feedback. There are a few of us from the disability community who are working on this and compiling all of the disability related sections of ACA to add. Thanks again. DisabilityAdvocacy4U (talk) 07:15, 12 July 2020 (UTC)

Removal of ACA Problems Section 7/2/20--Questioning That, especially pre-election

Issue Now Addressed: Section put back by me, NormSpier, 2/22/2020, following Wiki-democratic procedure. Me: replace No one else responded that they care, and somedifferentstuff has bowed out. Newslinger 8 months ago agreed to keep the section.==

Note on replacement technique--No one has to worry about there subsequent contributions being messed up: I was able to figure out how to avoid hitting "undo", which as far as I know, could possibly have deleted text added or changed post 7/22/2020 when my section was taken out. (I copied text from the just-pre-removal version in the non-visual editor, and put it in in the non-visual editor in the current live version.)

I will do the following, as well:

1)Remove the 3 tags "Bias", "Original Research", and "Questionable references". The latter was addressed in agreement with Newslinger, but neither of us removed the tag. The other two conceivably someone may take issue with, though Newslinger agreed to keep the section as it was. (Note the keeping of the tags caused a somewhat accidental deletion of the section, after Newslinger and I had months ago reached agreement that it should stay. This is why the tags have had to be removed. Otherwise, tags don't bother me, and suggest to the reader an accurate view that the subject matter is complex and politically contentious.)

2)To conscientiously address "neutrality", I do want to be careful that the problems of the problems section do not cause the less familiar with ACA reader to conclude incorrectly that the law is a failure. I will try to put in the major bottom line achievement that the uncovered rate has been lowered by a good percent. Right at the top of the section.

3)The point of somedifferentstuff that Wikipedia guidance requires that the problems be moved and distributed amongst other sections I think I have refuted in my discourse with somedifferentstuff (below). (He/she had referenced me to WP:Primary, but on reading that, I believe there is a good reason to have a separate section. It improves understanding.) Being conscientous, I will still take a pass through the section, looking for any violations, and fixing.

---

Spoke too soon: I see user:Newslinger has undone my re-insertion of the section, even after agreeing 10 months ago to keep it in its exact form. He has created this on the matter: https://en.wikipedia.org/wiki/User_talk:NormSpier#Controversial_topic_area_alert.

To the hopeful benefit of the development of the critical thinking skills of the many college students who visit this page as part of a project initiated by their instructors, I just quote for you a relevant possiblility with Wikipedia that another editor at Wikipedia passed on to me:

"::[Editors seeking to support a political point of view at Wikipedia] will then review your posts, looking for errors or to get an idea of your interests (to build a personal profile). Anyway }While the wisdom offered about editors acting in good faith with their edits is true in most cases. In some cases there are editors with allegiances, agendas, paid and unpaid, that monitor certain pages with the purpose of maintaining the "official line". It wouldn't surprise me that corporations, government agencies, political parties, religious institutions have interns or paid staff monitoring and"correcting" articles of interest. And these editors are quite adept at using WP guidelines and rules at maintaining the "party line". They revert wholesale paragraphs that disrupt their "truth", even where the paragraphs meet WP standards and are reliably source. It happens. You might be running afoul of one of these gate keepers, if so there is not much you can do. Leaving a notice on the article talk page will often be met with silence, especially if they can't justify their actions. It doesn't mean that you shouldn't try, but don't expect results. An editor isn't suppose to just delete or revert a paragraph wholesale unless it is vandalism or irrelevant if the edit was made in good faith but had errors of grammar and syntax, or needed a citation or some improvement, another editor can make corrections (which they often do) or notify the editor who made the comment or post via the article talk page. But if the article, even though valid and well sourced, threatens the "party line"or a persons personal agenda (for instance being a teacher or professor who uses WP in their syllabus,or identifies with a religion, ethnicity, or an ideology then they will pounce on the perceived heresy like a cat on a rat. I have even tried to engage some editors who do wholesale reverts on the article talk page..met with crickets. Which of course is suspicious,"

(which type of accusation I've also see on the Web.)

Have fun, kids. Think critically. Really critically. Doubt even your professors. (Not in Math or Physics, but in all the looser disciplines.NormSpier (talk) 20:29, 22 July 2020 (UTC))

Below for anyone is interested, is the PRIOR discourse between somedifferentsuff and me, when I discovered the removal.NormSpier (talk) 18:45, 22 July 2020 (UTC)

---

Hi user:somedifferentstuff.

In checking the ACA article, I noticed an edit of yours On July 2, 2020 with a removal of a section of approximately -18,643 characters‎ (→‎Problems: Rmv mainly primary sourced section tagged for a year undothank)

https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&type=revision&diff=965614396&oldid=965614011

I wrote the section. Let me give you the background on this section. I am contesting its removal. However, obviously whether it should be reinserted is subject to, under Wikipedia rules, majority or consensus.

I stuck it in around August 2019. (Along with 2 others, less important, and probably beyond the technical level of the intended readers for the article, that I subsequently removed, after user:Newslinger and I interacted around Sept 2020, with lots of noticeboards and stuff.)

In essence, the only people with an opinion on the content were [user::Newslinger] and myself. He wanted it mostly modified or deleted, and stuck on the tags, "biased", "original research", and "unreliable references".

After going through an official process (actually, in the middle of it) he indicated the section could stay, provided certain unreliable references were removed, and some numerical dollar examples that I put in were removed. I did both of these. (The unreliable references were redundant, so I was able to remove them without compromising the soundness of the article.)

The tag "bad references" thus, I really should have removed post those changes.

Newslinger, I imagine, still maintains the other objections that he tagged, though he agreed to leave the section in, with the changes.

I, myself, do not belief the section is biased, or is original research (everything is from a reliable, referenced source). I believe the section unbiases an article that otherwise has no malfunctions of the ACA included. (And there are many, as Paul Krugman tells us in a quote that I had in, and experts generally recognize.)

My own philosophy on this is that the tags remaining are fine, and indicate to the reader the real fact that Wikipedia is not a perfect reference, and that opinions on complicated technical issues exist. That is why I did not seek to have the tags removed.

But I do believe the "problems" section should have stayed in, as it indicates real, observed and written about among the more-knowledgeable about the ACA details. Further, no one anywhere has found any mistakes, by editors, or in the near a year since its been up an read by many, including experts I have forwarded the section to.

Note that when I placed the section in, there was a note in "Talk" saying the ACA article read like a brochure for the ACA, and was biased towards it. My own observation was that there was nothing indicating the various real affordability and other problems with the ACA, and that that was a significant weakness.

There is also an appearance (I am not saying an actuality!) of an attempt to doctor the ACA article 4 months before the election, by removing the ACA "Problems" section.

Also, note the conflict on the content was essentially between Newslinger and myself. I had attempted at a point to summon about prior editors of the article, via ping, with no success.

As I have learned since my new experience, the procedure at Wikipedia is apparently majority, or consensus. So I'm shooting for that, again.

My vote is to restore the complete "problems" section which was removed on July 2.

Can you comment on restoration, and perhaps give more detail (I see: "Rmv mainly primary sourced section tagged for a year")?

Other editors: can you comment on the removal of that section?

NormSpier (talk) 04:39, 11 July 2020 (UTC)

Other editors and others interested: the removed ACA "Problems" section is https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&oldid=965614011#Problems (The reversion proposed would be to that.)

Also, to help people not so familiar or fluent with the ACA rules and mathematical formulae and their affordability implications, let me give a link to an OLD, supersededed version of that problems section https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&oldid=914096360#Problems , only because it happens to have dollar cost examples on the "Subsidy Cliff" and "Out of Packet Maxima" problems. (These were removed at the insistence of newslinger, and I agreed. I am posting the version of the article only to help editors and user:somedifferentstuff determining the relevance of the sections and nature of the problems. (This old version has some bad practices, before the refinement post newslinger. I am not proposing to go back to this version! It's just for the Gold / Silver numerical examples.)

Note: As I understand the procedure, if I don't get relevant comments from user:somedifferentstuff or other editors here in a few days, it would it be reasonable and appropriate within Wikipedia policy including "no-edit-wars" to revert to the proposed section, with that action then possibly triggering debate here in the talk section between editors on that "Problems" section. NormSpier (talk) 22:00, 11 July 2020 (UTC)

Hi Norm. A section based mainly on primary sourcing is problematic per Wikipedia policies WP:Primary and WP:Weight. You stated that you wrote the entire Problems section; I'm curious as to why you didn't use more secondary sourcing and why it wasn't collaborative.

I don't recommend that you reinstate the section without addressing the aforementioned issue. Permanent tagging isn't a solution. If user:Newslinger and others agree with the removal then you'll need to figure out a way to wrangle a new consensus that is in favor of reinstatement. -- Somedifferentstuff (talk) 23:02, 11 July 2020 (UTC)

Hi, Somedifferentstuff

Thank you for your response. I have looked at WP:Primary and WP:Weight that you linked me to.

1)Your question: I did not work with others on putting the section in because I was new at doing Wikipedia entries last year, and was following the "be bold" stuff that I saw, and I put in stuff that seemed to me to improve the article and the understanding it would give to a reader with reasonable critical analysis skills to understand the law, and how if functions as a "mechanism", which would let such a person understand where the law works, as well as what might fail. (Actually, there were 3 sections. One of them was a very crisp, but perhaps logically demanding, description of exactly who was eligible for subsidies. After Newslinger got involved, I dropped that section, and another one, but we were able to agree on keeping the problems section. (There was no mention by Newslinger of remove tags or not.)

In any case, at the time, which was last summer and a bit after, there seemed to be no one from whatever ACA-knowledgeable editors who had put together the article to work on it an give opinions. (This is a retroactive observation--yes--but it apparently is the case, as once user:Newslinger got involved in a heavy handed and obvious way, with external policy groups notified, no one else showed up in the Talk section to discuss the "Problems" or other sections.) There were, I think two generalists, not familiar with the details of the law, who made some style comments on the ultimate RFC (which I incorporated), but I saw no evidence that they (nor actually Newslinger) had any particular grip on the law, its subsidy formulae, and how they would work.

Further, subsequent to the agreement by Newslinger and me to keep the "Problems" section, I actually, for collaborative engagement in improvement of that section, and any other sections, summoned by ping (username references) about 20 people who had worked on ACA article in the prior year or two on the talk page, and no one showed!

So I did try to be quite collaborative on further improvement of the "Problems" section by the summoning by ping, at least after the section was contended by Newslinger!

Thus, on your request of being collaborative, I will of course attempt that again here, now. I hope knowledgeable people show up this time!

2)I've looked at the tagged sections.

2a)On WP:Primary (apparently corresponding to the "original research" tag) and it looks the kind of thing you're getting at is from:

"Unless restricted by another policy, primary sources that have been reputably published may be used in Wikipedia, but only with care, because it is easy to misuse them.[d] Any interpretation of primary source material requires a reliable secondary source for that interpretation. A primary source may be used on Wikipedia only to make straightforward, descriptive statements of facts that can be verified by any educated person with access to the primary source but without further, specialized knowledge. For example, an article about a novel may cite passages to describe the plot, but any interpretation needs a secondary source."

I think of it is "any interpretation needs a primary source", up to what an educated, non-specialist can see (i.e. interpret).

I believe I have done this throughout the section, though I may have failed in occasional pecific places, say with an explicit reference.

Thus, may I request of you (or other editors) to be specific now in your comments: please tell me precisely where have I failed in this. (I suspect it's easy to patch in any cases you find, with a reliable reference. Possibly one or two assertions do need to be removed, or reworded. The complete removal of the section was not necessary.)

2b)On WP:Weight (apparently corresponding to the "neutrality tag), recall, this is a section called "Problems", designed to point out the problem cases, which the reader would be expected to understand is the not the whole effect of the law. (And in fact, I made this clear, with the opening line "Though supporters employed in the policy field have hailed PPACA as successful, they have also pointed out imperfections, and have proposed changes.[292]".) I am certainly open to being even more compelling about the successes in the section, by stating the "coverage rate" was improved from whatever it was to 91%.

Note that the intent of the Problems section, for the critical-thinking equipped reader, is to provide further specific insight into why our coverage rate, post-ACA, is only 91%, and not 99% or 100%, like the rest of the developed world. (Only about 1% of the coverage shortfall is explained by the 13 states not having expanded Medicaid. That leaves 8%. Some can afford insurance, but are choosing to go without. But of much of the 8% is people who actually can't afford the insurance. The smart reader will want to see what exactly the problem is with that affordability, which the section does.

(Further, unlike the rest of the developed world, some of the coverage, a few percent, is actually subject to estate recovery and no required estate repayment of bills. The reader needs to understand this to have a grip on the law and its effect.)

-->Thus, I am requesting of you Somedifferentstuff and any others, to now exert some effort, and be very specific on the failings of WP:Primary and WP:Weight, though I really can't see how WP:Weight applies.

-->As I've indicated, my belief is the Problems section should be restored. After Newslinger last Sept, and a few other criticisms on exposition (addressed) it has been maybe 9 months with no specific criticisms from the team on the section here in Talk. The section is still open, in my mind, to specific-line criticisms on the two policies (and any other points), and as a reasonable person, I will respond, and find or place the necessary references, etc. (Note that in trying to have every point referenced, and as well provide references useful to the reader who wants to learn more, I have been hit many times by "too many references", and I may have removed a reference that would solve the primary sources issue.)

-->user:Newslinger: I suspect you are sick of this article! As you can see that the tag "unreliable references" no longer applies. (I removed, and replaced where necessary, the ones you pointed last year, as part of our agreement.) I also can't see how you can reasonably maintain that there is bias. The section is devoted to problems, which exist, and have been pointed in numerous secondary sources. The law only covers 91% of people, and many are underinsured, or have just a loan. The section gives the needed explanation. (This still leaves the "primary resources" business, which I'm confident can be fixed, if you feel like making specific-line comments, that would be great! One of your objections was that you felt the gold and silver plan calculations in the original article were "original resource" and could be considered accepted "routine calculations", and that part was removed.)

NormSpier (talk) 19:39, 12 July 2020 (UTC)

---Otherwise, OTHERS EDITORS NOTE: as Somedifferentstuff indicates, it is best that we get a consensus on "removal", "put back in", but "put back in with these adjustments".NormSpier (talk) 19:46, 12 July 2020 (UTC)

Working to incorporate deleted material into the broader article

Hi Norm, I think the best way to move forward is to look at each section and see what material can be incorporated into the broader article. See here: [1] [2]

Hi, Somedifferentstuff. I'm certainly willing to do that moving of each part to sections, if that's the consensus. However, checking your first reference (the second seems to be only for biographies), I see this:

"A section dedicated to negative material is sometimes appropriate, if the sources treat the negative material as an organic whole, and if readers would be better served by seeing all the negative material in one location."

My own thought, is that that's exactly the case. "Readers would be better served by seeing all the negative material in one location." Specifically, people who want to live with, and improve the law (as, say, Biden and other policy specialists have proposed), should be looking for, "where is this law failing to provide affordable insurance so that we can fix, or consider fixing, it"? (Currently, it's not doing well by the standards of other developed countries. Neglecting the 13 red-state failure to expand Medicaid and intentional non-purchasers, still about 7% of the country has not even non-estate-recoverable coverage. Without knowing the exact numbers, since most people have employer-provided insurance or Medicare, it's left 1/3 or the 20% of the country without affordable insurance pre-ACA, so the law has only solved the problems of maybe 2/3 of the people it should have solved the problem for. (Less if the estate-recovery aspect, on maybe 2% or 3% of the 91% is included, as not well covered, as well underinsured with high copays as not adequately covered. The latter they call "underinsured".)

(My personal view of the best policy solution, which of course will not and should not make it into the article, is the ACA should remain, and will have to remain, since single-payer is not politically viable. But the really substantial defects need to be fixed. And, to any attempt to repair (as will be for Biden once he announces exact details), I go through this list of 5 specific problems, and ask, "which ones will be fixed, and how completely, by the proposal?".

(Thus, I am assuming critical thinkers will benefit from having the defects on actually providing affordable insurance in one place, instead of having to go through the whole article.)

(I note that in fact, the section "Problems" is of course not all ACA problems: we still have aggregate medical cost-problems (18% of GDP, substantially higher than all other countries) that may grow and bankrupt the country, etc. But I was trying to get in one place, for people to fix the affordability problems, the problems. Perhaps the "Problems" section could use a sharper name, like "Affordability Problems" or "Potential Affordability Shortfalls", etc.

Looking at subsection #1 --- Subsidy Cliff at 400% FPL [3] --- this subsection consists of 2 sentences, both from the Kaiser Foundation.

Since the article already contains a Subsidies section [4] let's work together to incorporate these 2 sentences. Since the material is from a primary source, attribution is required (in this case the Kaiser Foundation).

Have a look and see if this placement works for you [5] -- Somedifferentstuff (talk) 20:16, 12 July 2020 (UTC)

(As above, I can work with the relocate, but think one place on current affordability problems is better. The citation, where "citation needed" appears, can be copied up from the line below, or I can find one of numerous newspaper and other academic references.) I will have a look and check the placement.

{After examining placement:]. Sorry, Somedifferentstuff, NO. The wording is inadequate, and is indistinguishable from a sentence designed to cover up the real affordability problems.

I see you have placed in:

"The subsidies for an PPACA plan purchased on an exchange stop at 400% of the Federal Poverty Level (FPL). According to the Kaiser Foundation, this results in a sharp "discontinuity of treatment" at 400% FPL, which is sometimes called the "subsidy cliff".[56] After-subsidy premiums for the second lowest cost silver plan (SCLSP) just below the cliff are 9.86% of income in 2019."

You have placed that in without the title "Problems", for one thing.

You have also completely omitted my "People above the subsidy cliff can experience a sharp rise in premiums, making the premiums unaffordable."[citation needed]

A person reading this has hidden to them that there is a real affordabiity issue around the ACA and that cliff. In particular, as in my Gold and Silver examples in the Old version that Newslinger made me take out, https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&oldid=914096360#Problems , the affordability issues are copay plus premium of 40% of income! All covered up to all but the most knowledgeble reader. (The sentence further seems eager to point out to a foolable reader that many people, those below the cliff, have a 9.86% of income cap on premium, but omit any idea of those 40% of income premium plus copay, or 22% of income premium alone for high-maximum-copay plans!) NormSpier (talk) 22:50, 12 July 2020 (UTC)

Looking at subsection #2 --- Sometimes-Unaffordable Out-of-Pocket Maximums [6] --- I see a problem here: "Sometimes-Unaffordable" is subjective so we need to find out where this is coming from. After we get to the bottom of that let's see if we can incorporate the material into the broader article. -- Somedifferentstuff (talk) 20:24, 12 July 2020 (UTC)

"Sometimes unaffordable". I certainly will be able to find references to people finding copays unaffordable in say the NY Times and Wash Post, and probably "Health Affairs. If you object to "unaffordable" as a tendentious word, without backup sources saying that, you can suggest a change.

What it comes from is (quick math: I am a math person, and understanding the subsidy structure, I can quickly zoom in on the two trouble cases).

(1)People with incomes just over 250% of the Federal Poverty Level get pretty low (but not free) subsidized premiums, and have to bear potential copays to $15,800 for a family of two. A family at 250% FPL last year (https://aspe.hhs.gov/2019-poverty-guidelines) had an income of $16,910 x 2.5 =$42,275. This puts the potential copay alone at about 30% of income. (Specific-state subsidized premiums could be determined for those folks. That part is not that high, but adds maybe 4% of income, to total maybe 34%.)

(2)There is another case, of people with incomes are just over 400% of FPL, who have a combined problems of unbounded high premiums and still high copays. My original form of the article, before [[user::Newslinger]] and I interacted and I agreed to take them out (he found them "Original Research" rather than my "routine calculations") had examples, where in states like IL, people near but under 65 would have to pay something like 40% of income for insurance plus max copay. (These are the trouble-case "Gold Plan" and "Silver Plan" calculations that you see here in the OLD version https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&oldid=914096360#Problems that user:Newslinger made me take out.)

(3)All of these actually are a bit conservative, in that they omit unavoidable surprise out of network bills, which can be $5000 for a trip to the ER. (Newslinger would not let me add that.)

---

Thank you for being specific. That leaves 3 other sections, so I await your specific comments. I'd also like to hold to see if other editors perhaps will show up and agree or disagree with "Readers would be better served by seeing all the negative material [actually, non-affordability problems negative material] in one location."NormSpier (talk) 21:49, 12 July 2020 (UTC)

---

Let me try this to see if I can get the democratic participation on this of people who worked on the article in the year or two prior to when I made the list.

(It failed in about Sept of last year to produce any participants. However, now we have COVID. The same people may be virtually unable to leave their homes, and find they have nothing better to do.)

Pinging for involvement, if you have the time and interest, on the disposition and/or evolution of the "Problems" section, deleted as discussed above: user:Sb101, user:Lfstevens, user:Hammelsmith, user:Beland, user:Masem, user:Terrorist96, user:Sh76us, user:Farcaster, user:Casprings, user:Vchimpanzee, user:DrFleischman, user:Jfhutson, user:Wikideas1, user:Snooganssnoogans, user:Autoerotic Mummification, user:Innab, user:Bvfg7756, user:RightCowLeftCoast, user:TheMacDaniel , user:Revs438, user:ThomasMikael, user:Timtempleton, user:Crimson marble goldfish, user:MastCell, user:Cirrus Editor, user:Geraldshields11, user:Hcobb, user:Prototime

Walls of text

Hi Norm, I've noticed a pattern in the short time we've been working on this. You produce walls of text to questions that would generally be answered in a much shorter time. Concise is the term. I don't know if user:Newslinger experienced this but I find myself getting burned out and frustrated at the same time. Unfortunately I need to step away; good luck. -- Somedifferentstuff (talk) 09:37, 13 July 2020 (UTC)

HI, Somedifferentstuff. Yes, I've had that term "Walls of Text" used before, if not by user:Newslinger, by others here around on the "Talk" page around the prior point of contention.

However, as I see it, the issue is what to place in this article, and exactly how to say it, requires quite a bit of intellectual energy and skill, and would in fact tend to cause "burn out" in a person without enough time or intellectual energy.

Fundamentally, the ACA, and the rest of the health insurance system around it in the U.S. has such a byzantine complexity that it's extremely difficult to understand and get a grip on. We have an interaction of Federal employer laws, Federal Medicaid laws, Federal Chip laws, unwritten insurer and employer practices, 50 different sets of multiple state Medicaid and Chip programs, a Federal exchange, a state exchange in many states, 50 different state Medicaid agencies, with a mix of written an unwritten practices, a Federal Supreme Court, 50 State insurance regulators with different regulations, affecting the ACA and all other health insurance.

This complexity has none of the policy experts able to get an adequate grip, and I, who put substantial personal time into researching the system, don't have anything near a complete understanding, and learn new things all the time, often by happenstance.

So, as I see it, to do an adequate job on an article about the ACA, to my own standards of enlightening people, just takes an awful lot of work, time, and skill discussing policy details and their exposition.

I respect that you and Newslinger have large goals, across many articles, and may indeed be getting burned out by the necessary task.

After the involvement with Newslinger, realizing the editor resource magnitude issues for what I consider an adequate treatment of the ACA, I downsized my goals in terms of improving the article (I had had two other sections, and as well, I was hoping to eventually add info on employer-insurance aspects, etc.) I decided to just try to hold the "Problems" section, which I deemed would be the most useful to critical-skilled readers, with no future improvements in the article, and to leave it in what I consider an incoherent, uncomprehensive form.

I intend to continue to attempt that minimal goal of holding the "Problems" section, and respond to any forthcoming legitimate suggestions for improvement, and compliance Wikipedia rules. All while following the democratic Wikipedia procedures here on the Talk page.

I do know the word around here, or at least with the large-coverage editors, is "concise", but "concise" and "easy" will not work, for me, for an extremely complicated law, with complicated policy affects and implications.

I see you will step away. I respect that need, and will proceed through the Wikipedia process on the article without you.

During your involvement, I do appreciate you having pointed to a few relevant Wikipedia SOPs, and I have learned from that.

NormSpier (talk) 17:55, 13 July 2020 (UTC)

I'm not necessarily sick of this article, but I agree with Somedifferentstuff that your communication style (bludgeoning) makes it arduous to discuss this article with you. If you are willing to break your walls of text down to smaller sections, and present arguments gradually, allowing other editors sufficient time to review them, then I'll be happy to take a closer look. Until then, I support Somedifferentstuff's 2 July changes, which addressed the original research, reliability, and neutrality issues I tagged the section for. — Newslinger talk 06:16, 17 July 2020 (UTC)

You are correct in your little "reason" where you did your very quick reversion. I did miss your comment just above. (Perhaps you could have "pinged" me to make me aware of it? Sometime back [[user::Usedtobecool]] told me that was the courteous thing to do.)

Having missed your comment, I see it is either 1:1 voting, or possibly 2:1 voting against "replace", although somedifferentstuff seems to me to have bowed out over too-much-work-for-me issues. So your reversion, a half hour after my replacement of the section (that you had agreed to keep in exactly as it was 8 months ago) may indeed be democratically valid.

I'm certainly no going to "edit war" on this thing. My intent was only to follow the democratic and Wikipedia procedure, and try to keep the little bit of the article that would help people understand beyond what I consider to be an ignoramus level.

(My belief is that real substantial intellectual effort on the part of people willing to, and with time to strain is needed to get a decent product on a complex law like the ACA, with complex interactions with other laws, all different in 50 states. The editors should have to strain, and spend a lot of time, with back and forth over really technically complex issues. Then, for the reader, it should be as easy as possible, or at least some information should be in easy sections, with the most able readers taking some necessary intellectual challenge. NormSpier (talk) 19:33, 22 July 2020 (UTC))

NormSpier (talk) 19:27, 22 July 2020 (UTC)

Incorporation of NormSpier's additions into the article

Hi NormSpier, I think it's possible to incorporate some of Special:Diff/968987074 into the article, although I would prefer to expand existing sections (e.g. "Provisions", "Impact", and "Criticism and opposition") rather than create a separate "Problems" section. For example, the subsidy cliff is already mentioned in the "Premium subsidies" subsection, which is under "Provisions". Over time, I will gradually review your proposed additions and suggest ways for the content to be included into the article. My suggestions will be posted in this discussion. Please note that my attention is split among multiple articles, noticeboards, and projects, so I might not progress as quickly as you would like, but I do intend to carefully examine your content and your cited sources. — Newslinger talk 20:46, 22 July 2020 (UTC)

Hi user:Newslinger. Actually, on the placement of some mention of "subsidy cliff" into an earlier section, where you have observed it is already there, actually, if you go through the "Wall of Text" and Diff section https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&type=revision&diff=967361852&oldid=966695942 , you will see that mention was not in the ACA article when the problems section was deleted by somedifferentstuff on 07/02/20, and was placed up there on 07/12/20 by somedifferentstuff in an effort to address my concerns. I reviewed it, and found it inadequate due to deletion of material of mine which would alert the reader that the issue is serious (in unaffordability), with no replacement of such meaning in what somedifferent stuff put in.

I see you might get back to the matter when you have time. (I understand you are busy.) Success is uncertain, and someone else showing up deleting the info a month later is also a concern of mine.

If you do place comments in the Talk section here, if you ping me, I will certainly take a look. However, I am quite subject to the view myself now that any attempt to really inform the reader of this article on the ACA well on the complicated matter is impossible given resource constraints, and possibly Wikipedia rules not helping on this article in a politically charged area.

So, bless you if do place constructive comments here. You may need to rely on other the Wikipedia editors, perhaps when school goes back into session and students get drafted as part of courses by their professors, to assess, think, and consider insertions and text moves, etc. I don't particularly see adequate information-quality yield for further investment of a lot of time myself. (Already, some back and forth in other fora on the ACA has convinced me that the removal of Gold and Silver plan numerical examples for "unaffordable premiums" and "high copays", showing some people with 40% of income needing needed to go to premium plus copay, has weakened the article. In the other fora, I have had to cite the example myself, and direct them to healthcare.gov and FPL tables to verify for themselves if they want to. Recall, months ago, you had used your single-editor-veto to call those "original research" rather than "routine calculations".)

Thanks again for a constructive approach.NormSpier (talk) 21:38, 22 July 2020 (UTC)

Requested move 22 August 2020

The following is a closed 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 after discussing it on the closer's talk page. No further edits should be made to this discussion.

The result of the move request was: Consensus to move page. (non-admin closure) — YoungForever^(talk) 22:17, 29 August 2020 (UTC)

---

Patient Protection and Affordable Care Act → Affordable Care Act – The last discussion about moving to this name was 5 years ago and prematurely withdrawn to instead discuss a move to Obamacare, which failed. Since then, "Affordable Care Act" has stood the test of time and is now clearly the WP:COMMONNAME, even transpired into official use (CDC, HHS, healthcare.gov, medicaid.gov, IRS, CBO, to name a few). Looking at WP:TITLE, the current title also fails on recognizability, naturalness and conciseness. Then move will fix all three issues. ― Hebsen (talk) 20:36, 22 August 2020 (UTC)

• Support per WP:COMMONNAME and WP:CONCISE. Rreagan007 (talk) 23:38, 22 August 2020 (UTC)
• Support per the above. BD2412 T 05:25, 23 August 2020 (UTC)
• Support Mark D Worthen PsyD (talk) [he/his/him] 00:58, 25 August 2020 (UTC)
• Support per Rreagan007's reasons. QoopyQoopy (talk) 23:50, 25 August 2020 (UTC)

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Add California v Texas?

The case California, et. al. v. Texas, et. al., which is currently before the supreme court, questions the constiutionality of the individual mandate (26 USC § 5000A) specifically with regards to the seperability of the mandate from the remainder of the ACA.

   The case has recieved large amounts of attention during the presedential campaign trail. Notably, during the Vice Presedntial Debate, Vice President-elect Harris alluded to the case when she asserted that she believes that the pre-existing condition protection provisions of the ACA would not be protected due to the Trump administrtions appeal of the Act. 

   Furthermore, the wikipedia page which deals with litigation surronding the ACA includes the case.  — Preceding unsigned comment added by RayaanIrani (talk • contribs) 21:56, 18 November 2020 (UTC) 

Semi-protected edit request on 7 January 2021

Hello,

This is Daniel Smerin. I am a fourth-year medical student at University of Central Florida College of Medicine. As part of a class on wikimedicine, I am requesting clearance to edit the Affordable Care Act wiki page. I would like to expand upon sections 3.4 and 3.6 using peer-reviewed reviews, systematic reviews, and meta-analysis. I specifically want to add additional information on the effects of Medicaid expansion on annual mortality rates within various demographics, as well as the impact of Medicaid expansion on access to preventative care, primary care, and tertiary care such as advanced cancer care and complex surgery.

I hope you will consider my request, and please let me know if you require additional information.

Best wishes, Daniel Dsmerin (talk) 18:54, 7 January 2021 (UTC)

 Not done: this is not the right page to request additional user rights. You may reopen this request with the specific changes to be made and someone will add them for you. Terasail^[✉] 20:02, 7 January 2021 (UTC)

WikiProject Medicine Winter 2021 UCF College of Medicine

Hello,

This is Daniel Smerin. I am a fourth-year medical student at University of Central Florida College of Medicine. As part of a class on Wikiproject Medicine, I would like to expand upon sections 3.4 and 3.6 using peer-reviewed reviews, systematic reviews, and meta-analysis. I specifically want to add additional information on the effects of Medicaid expansion on annual mortality rates within various demographics, as well as the impact of Medicaid expansion on access to preventative care, primary care, and tertiary care such as advanced cancer care and complex surgery. I also plan on adding general and specialty-specific health outcome metrics from peer-reviewed secondary sources that assess the health outcomes of the ACA.

Work Plan:

3.4 Medicaid expansion: use recent peer-reviewed reviews, systematic reviews, and meta-analysis to add information on differences in annual mortality rates within various demographics, as well as access to and usage of primary, secondary, and tertiary care between states that did and did not expand Medicaid.

3.6 Health Outcomes: use recent peer-reviewed reviews, systematic reviews, and meta-analysis to add information on the impact of various provisions within the ACA such as expanded coverage of preventative care and delivery system reform on general health outcome metrics such as annual mortality rates as well as specialty-specific health outcome metrics such as rate of detection of early-stage cancer.

Thank you for your time.

Best regards, Dsmerin (talk) 19:28, 7 January 2021 (UTC)

Peer Review

Daniel,

Overall, I think your edits have improved the quality of the article and made the article more complete. I think you did well to accomplish your goals for this module. Here are some of my thoughts on what you did well and things that could be improved:

Strengths:

- Articles are relevant and seemed to be from reputable non-biased sources.

- Citations working and support claims of the article.

- Very detailed with lots of information backing up each section

- Updated information

Weakness:

- Viewpoints talking about strengths of ACA heavily overrepresented. Wording some what biased in favor of ACA. (ex. Importantly, issues with cost-related unmet medical needs, skipped medications, paying medical bills, and annual out-of-pocket spending have been significantly reduced among low-income adults in Medicaid expansion states compared to non-expansion states.) While I agree these things are important, it's not biased. I'm not sure if you're saying the impact of the ACA was significant or the reduction was statistically significant. If the former, it's another example of bias.

- Some things in the Medicare expansion might be more appropriate under health outcome, but it's really up to you because I can also see why you might choose to put it there (ex. “ Importantly, uninsured PLWH were 40% more likely to die in the hospital than insured PLWH.”)

- Lots of detail, but might be too specific specifically with the numbers? This is up to you but I thought having the exact number for the statistics for each health outcome made the article a bit hard to read. I feel like most reader are just every day people and does not benefit from knowing the specific number. Something you can do is maybe put it in the chart format. But, this is really just me nitpicking so do what you think is best. — Preceding unsigned comment added by 14jzl (talk • contribs) 21:33, 27 January 2021 (UTC)

Thanks for the review Ji! Dsmerin (talk) 19:26, 29 January 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 27 August 2019 and 12 December 2019. Further details are available on the course page. Student editor(s): William Khandkar.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 13:30, 16 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 4 January 2021 and 29 January 2021. Further details are available on the course page. Peer reviewers: 14jzl.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 16:55, 17 January 2022 (UTC)

Wiki Education Foundation-supported course assignment

This article was the subject of a Wiki Education Foundation-supported course assignment, between 28 June 2021 and 31 July 2021. Further details are available on the course page. Student editor(s): Sallypolus.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 16:55, 17 January 2022 (UTC)

Repeal now, replace later

When Donald Trump announced his plans around Obamacare, he first explained **Repeal and replace**, but later changed this to **Repeal now, replace later**. — Preceding unsigned comment added by 213.118.94.49 (talk) 12:43, 27 April 2022 (UTC)

Keep in mind the Kushner family is heavily invested in the ACA Exchange subsidies and so Trump was never going to repeal Obamacare. Clam chowdah (talk) 03:40, 12 June 2022 (UTC)

non-disabled adults

Hi. This term is not in common vernacular in US. I don't think its the best language to use in ACA article and I would not foresee it coming into common use.Scranton (talk) 13:43, 21 June 2022 (UTC)

SNL terminology

It's a minor thing, but in the In Popular Culture section, SNL segments are properly called "sketches" rather than "skits." Wikipedia's own entry on Sketch comedy delineates the distinction. 97.99.47.11 (talk) 21:24, 10 October 2022 (UTC)