Talk:Affordable Care Act/Archive 4

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New materials re: February 2012 controversy

Here are some recent materials about this issue. I hope they are helpful to the people who work on this article:

• Darrell Issa defending the exclusion of a woman from his all-male panel on contraception: She’s not “appropriate and qualified.” [1]
• Todd Gilbert re: a state-sponsored bill mandating vaginal probes: Abortion-seeking women already consented to being “vaginally penetrated when they got pregnant.” Using a vaginal probe instead of an external ultrasound is asserted to be meant to send a message. [2]
• Greg Gutfeld states that liberals support contraception coverage because “It’s more about getting rid of the poor.” [3]
• Foster Friess gives contraception advice on MSNBC: “You know, back in my days, they used Bayer Aspirin for contraceptives. The gals put it between their knees and it wasn’t that costly.” [4]
• Liz Trotta on the assualt of women in the military: “Now what did they expect?” [5]
• Bryan Fischer of the American Family Association on women in combat: “Women are not wired, either by evolution or by God…to be in those

positions.” [6]

• Rick Santorum explaining his concerns about women in combat: “People naturally may do things that may not be in the interests of the mission because of other types of emotions that are involved.” [7]

All the best, -- Ssilvers (talk) 00:59, 18 February 2012 (UTC)

Is there enough for a stand alone article. Obviously most of this interesting stuff does not belong in this article. What would the title be? User:Fred Bauder Talk 14:47, 18 February 2012 (UTC)

Framing

The controversy over contraceptive coverage is a good example of Framing_(social_sciences)#Politics and there is good authority for inclusion of that concept in this article, see http://www.nytimes.com/2012/02/16/us/politics/both-sides-eager-to-take-contraception-mandate-debate-to-voters.html Removal of that language and link is inappropriate given the obvious, and well-sourced, dual framing of the issue in political discourse. User:Fred Bauder Talk 18:12, 17 February 2012 (UTC)

Another discussion of framing: '“This is not a women’s rights issue,” said Senator Kelly Ayotte, Republican of New Hampshire, during a recent news conference with Mr. Blunt. “This is a religious liberty issue.”' "Democrats See Benefits in Battle on Contraception Access". User:Fred Bauder Talk 15:01, 28 February 2012 (UTC)

Overview

I've broadened the section title to Overview, from the previous "Overview of Provisions," and am writing here to explain why. The "Provisions" section title tended to frame the article in a POV way that led to talking points from the legislation being presented without any consideration of widely reported consequences. The euphemistic phrasing of provisions has led to disputes over such widely reported sections as the individual mandate, which one editor did not want to include because his text-search of the legislation did not find the phrase "individual mandate." (Section 1501 calls it a "shared responsibility requirement.") Presenting only the euphemisms, while excluding obvious and widely reported consequences, reduced the section to a sales pitch.TVC 15 (talk) 20:25, 2 February 2012 (UTC)

There you go again with your mission to sully this article (and the law along with it). Please, have some decency and realize that this not the place to bash the law by adding to every position a hypothetical negative under the guise of POV.Myownworst (talk) 07:00, 9 February 2012 (UTC)

Let me be clear though - I do not want to engage in childish back and forth edits such as what happened a few months ago - I respect and am thankful for your contributions to Wikipedia, but discussion should take place here before a major aspect of the article is changed - also, the specific percentages are clearly stated in the cited source. These percentages, along with possible unintended consequences or other problems definitely should be mentioned in the body of the article. That would most certainly prevent POV from appearing. The location of a sentence in the article is rather irrelevant when it comes to maintaining neutrality.Myownworst (talk) 07:10, 9 February 2012 (UTC)

If the location of a sentence in the article is irrelevant, then perhaps we can compromise by opening with the reasons why most people oppose the legislation, moving the sales pitch and euphemisms farther down. There is no need to sully the legislation, that would be redundant, but the article should describe it accurately.TVC 15 (talk) 20:16, 11 February 2012 (UTC)

Uh-huh...Well if this isn't WP:OR than I don't know what is (notably the part with stars around it), "Insurance companies are required to spend a certain percent of premiums on certain expenses. *******In what has been called a "quiet takeover," four of the five largest insurers have begun buying hospitals and medical groups as subsidiaries, keeping this spending within the same parent company.******* I would change it to preserve the neutrality of this statement, but as has been seen before, TVC 15 pounces on any edits that I personally make because s/he clearly believe I'm not worthy of editing this article nor trying to keep it as cut and dry as possible. This is getting really old. You're vendetta against the law is harder to hide than King Kong behind a translucent bed sheet. I REALLY BELIEVE ANOTHER EDITOR's opinion on whether this is WP:OR or not would be very helpful, because this edit especially out of the many by TVC 15 has got to be the most blatantly provoking. Myownworst (talk) 13:54, 13 February 2012 (UTC)

I'm really asking for another editor to step in here - TVC 15 continues to insert WP:OR into the article to sully what s/he sees as a "sales pitch" - which is rather troubling with all things considered in this article (highly negative feelings, perceptions) about the law. I know TVC 15 will re-insert his/her WP:OR because s/he will see I removed it, so I therefore am asking another editor to PLEASE step in here to clarify. The WP:OR added byTVC 15 in said section would seriously undermine both Wikipedia, and the users who honestly intend to improve articles, rather than drag policy issues that they dislike through the mud. Thanks Myownworst (talk) 05:33, 15 February 2012 (UTC)

A direct quote is not WP:OR. Also, WP is not a sales document, so it is inappropriate to present only what you consider the good news about the legislation while deleting the bad news.TVC 15 (talk) 07:03, 15 February 2012 (UTC)

This material does not belong in this article, however valid it may be. Perhaps in an article on the health insurance industry in the United States? User:Fred Bauder Talk 16:39, 15 February 2012 (UTC)

The sources tie it directly to the PPACA, so yes, it does belong here. Also, it is necessary to balance the magical thinking related to MLRs, which were an accounting tool and not a measure of quality until PPACA boosters began touting them as a benefit of the legislation. Insurers can easily sidestep the MLR requirement by shifting profits from their insurance subsidiaries to their medical subsidiaries; either way, the profits go up to the same parent company.TVC 15 (talk) 20:48, 15 February 2012 (UTC)

TVC 15 is now becoming a threat to the neutrality of Wikipedia. S/he does not agree with another editor, and has now repeatedly inserted WP:OR into this (and other articles, if you look at his/her contribution history). WP:OR from TVC 15 is obvious simply by looking at his/her previous contribution to the talk page "Insurers can easily sidestep the MLR requirement by shifting profits from their insurance subsidiaries to their medical subsidiaries; either way, the profits go up to the same parent company." Citations used for his/her claim are from questionable, biased sources, and furthermore - what is with this afterthought? No other overview point has a negative disclaimer attached to it. Note how nothing says something along the lines of "This provision will signifciantly lower premium costs, or something along those lines - that has yet to be proved with objective facts. The gauzy claim of "quiet takeovers" has not been proven with objective facts. I will unfortunately have to keep reverting this minor facet of the article until into which TVC 15 ceases inserting WP:OR.Myownworst (talk) 02:31, 16 February 2012 (UTC)

The threat to neutrality is certain boosters' insistence that the Overview must consist solely of talking points copied from the administration's paid advertising site promoting the legislation, with no counterpoint for balance. That is why the section lacks "negative disclaimers" and why the sales pitch reads as unreal. For now, I have at least corrected some of the misinformation in the MLR talking point, with links to the actual regulations and the list of waivers published by The Hill. The entire Overview section should be made WP:NPOV instead of the sales pitch that boosters have insisted upon.TVC 15 (talk) 22:22, 25 February 2012 (UTC)

Afters several compromises towards WP:Consensus, I had thought we had reached a WP:NPOV presentation of the MLR provision:

• Insurers must spend a certain percent of premium dollars on eligible expenses, subject to various waivers and exemptions; if an insurer fails to meet this requirement, there is no penalty, but a rebate must be issued to the policy holder.[8][9][10]

Unfortunately, User:Myownworst replaced that with a paraphrase of the administration's outdated advertisements on Healthcare.gov, which was misleading in light of what the regulations and waivers actually say. (Eligible expenses now include ICD-10 coding, "fraud reduction," and other activities.) The MLR probably doesn't need to be in the Overview anyway, because MLR is only an accounting tool, and was never intended as a measure of quality or service until certain politicians began using it as a talking point to advertise the legislation.[11]TVC 15 (talk) 04:35, 3 March 2012 (UTC)

At this point I think the best course of action is to remove this provision from the 'Overview' section of the article entirely as it is only a minor part of the law in the first place. I was simply trying to present information for those who wanted to catholicly understand the law. If I would have known then what a blow-back I would receive from the provision I would have never included it in the first place. As is for all users on Wikipedia, one must remember that everybody is entitled to his or her opinion, but nobody is entitled to your (and I mean all users on wiki) opinion. Also, just because one includes sentences within the article that they deem salient, does not give them the golden ticket to permanently in inject their opinion into an article, which must never be removed, altered, or challenged. Let's keep it real folks - this is, after all, just the internet. Myownworst (talk) 06:23, 3 March 2012 (UTC)

72% of voters say it's unconstitutional

"As of February 2012, 72% of registered voters believe PPACA's individual mandate is unconstitutional,[12] and 50% want the Supreme Court to overturn the entire statute."[13] When 72% of voters say that the "lynchpin" of the legislation is not even a valid law, that belongs in the lead. Alas, User:Myownworst deleted it, saying it should go in the public opinion section, but without putting it there. In the spirit of working towards WP:Consensus, I put a shorter version in the lead, and a longer version in the public opinion section. I would also appreciate the opinions of other editors. Considering that only 20% of registered voters believe the legislation is entirely valid, the article gives WP:Undue weight to supporters, while User:Myownworst goes so far as to delete the opinion of the overwhelming majority.TVC 15 (talk) 04:40, 3 March 2012 (UTC)I d

I definitely believe that this opinion poll should be in the article, since it is relevant information about the subject; however, given that public opinion on the constitutionality of a law is irrelevant in the U.S. legal system, where such decisions are rendered by undemocratic courts, I don't believe it would be appropriate to highlight this poll in the lead section. Another poll that merely assesses voter preference for or against the law (as opposed to voter opinion on constitutionality) would be more appropriate for the lead, as would a brief description of the various court rulings on the law. But I would place the particular poll in question in the public opinion section. –Prototime (talk · contribs) 06:01, 3 March 2012 (UTC)

thank you for your concurrence, Prototime. At this point I am wondering if it would be better for TVC 15 to contact his/her congressman and/or senators to vent frustration about the law being passed instead of trying to sully the article as much as possible, and I categorically do not mean to convey such as a personal insult. For posterity, I reviewed the Dodd-Frank Article (as it parallels PPACA in terms of scope, length, passed by the same congress, and signed into law by the same president), to which I helped contribute, and there is virtually no overwhelming negativity injected into the article as to try and drag it through the mud as much as possible. As much as TVC 15 dislikes the law, this is not the place to voice his/her frustration, especially with minor, petty facets of the article. Nevertheless, soldier on.Myownworst (talk) 06:09, 3 March 2012 (UTC)

Statistics such as the poll cited are thought to be in a constant state of flux as time passes. This is why its best to create a separate section dealing with subjective aspects such as opinions/polls and track them over time to create an accurate baseline rather than a rotating series of peaks and dips for any given moment in time. It definately doesn't belong in the lede.

Ultimately, the 9 Supreme Court justices' opinions will dictate the Constitutionality of this law - not the knee jerk uninformed blatherings of the masses in a general election cycle as asked by pollsters who make a living by splitting political hairs from one month to the next. -- George Orwell III (talk) 07:18, 3 March 2012 (UTC)

The relevance of public opinion on the constitutionality of a statute is of such marginal relevance that it shouldn't be in the article at all. Most people have little or no knowledge of constitutional law. Such polls are more a reflection on the popularity of the statute. There are plenty of polls assessing the popularity of PPACA without confusing the matter by adding the extra layer of its perceived constitutionality. Those poll results should be in the article, not this one. --Nstrauss (talk) 22:37, 4 March 2012 (UTC)

Based on the WP:Consensus above, I will leave public opinion on constitutionality out of the lead, but keep it in the section on Public Opinion.TVC 15 (talk) 21:56, 5 March 2012 (UTC)

Public opinion polls about the constitutionality of legislation are deceptive and not particularly informative. I say it should go completely. --Nstrauss (talk) 23:47, 5 March 2012 (UTC)

Sorry for not being more clear earlier - all I meant was in general that polling/statistics should never appear in the lede; if folks insist on including them - they should be isolated to their own section. This specific poll on belief of Constitutionality should not appear in that general section at all - the Supreme Court will determine that sooner rather than later at this current time so developing a meaningful basline of opinion over time is nearly impossible as well as pointless. This subject should not matter until the opinion is handed down. -- George Orwell III (talk) 00:14, 6 March 2012 (UTC)

One of the more notable polling observations, and I have never seen this with any other statute, is that a majority of voters within a major political party say the statute is unconstitutional and yet want to keep it anyway.[14] It seems like a recipe for crisis.TVC 15 (talk) 05:09, 6 March 2012 (UTC)

Meh... "they" say the same thing about the War Powers Resolution depending on which way the wind is blowing in the geopolitical arena from one week to the next. The point is the same - once the representative part (Congress passes a law) is over, the only opinion that is relevant is the Courts' opinion (if tested). The ignorance of government by this nation's people is an embarassment (in my opinion) and these polls feed on that ignorance more often than not so I feel they don't deliever much usefulness on WP (other than when methodology and baselines are developed over time). -- George Orwell III (talk) 23:34, 6 March 2012 (UTC)

Lobbying, campaign finance, and the revolving door

I suggest a section on the extraordinary lobbying, campaign finance, revolving doors, and other inducements that drove and shaped this particular legislation. Many WP:RS have reported on these,[15][16]. The legislation is a product of a process, yet most of the article seems unreasonably credulous, written by earnest boosters who failed to distinguish between paid advocacy and objective reality.TVC 15 (talk) 23:20, 5 March 2012 (UTC)

Hmm..OK TVC 15, but be sure to include the millions of dollars spent by the Health Insurance Industry to try and kill the legislation. Sounds reasonable, right? Myownworst (talk) 23:59, 5 March 2012 (UTC)

This could actually be a good team effort. I'll quote Howard Dean saying insurance companies "wrote the bill," back when AHIP was running the process, and you can add insurers' opposition after mandates were watered down.TVC 15 (talk) 00:13, 6 March 2012 (UTC)

And why should I do this? You're the one that brought up the Lobbying topic in the first place. Honestly at this point you should just create a new article - perhaps titling it "Flaws of PPACA," or any other creative title you may come up with. I'll try and think of one also, teammate!Myownworst (talk) 04:05, 6 March 2012 (UTC)

Well, for a moment I dared hope that you were willing to have a more accurate and balanced article, or was that only your WP:Sarcasm? Boosters try to delete inconvenient facts because their belief system cannot tolerate flaws in their holy grail, but this particular legislation has too many for the WP article about it to ignore them all. As for banishing flaws to a separate article, at least it would have many sources,[17][18][19] though I wonder if you would read them.TVC 15 (talk) 04:39, 6 March 2012 (UTC)

Sounds reasonable but you are going to have a hard time writing something that doesn't violated WP:UNDUE, since every piece of legislation involves the same issues. --Nstrauss (talk) 23:26, 5 March 2012 (UTC)

Exactly. Go way back in this article's history and if I'm not mistaken the previous attempt to do exactly this resulted in many fabulous reversion wars before the community agreed this is more a general issue than isolated to one aspect or even narrower to a single health care bill. -- George Orwell III (talk)

I do think that a balanced section on the legislative history of PPACA could be illuminating. It was huge news at the time, it was a major contributor to the rise of the Tea Party, it had a major impact on the 2010 midterm elections, and it will probably be viewed in the history books along with the Civil Rights Act of 1964 as one of the most epic legislative stories of all time. --Nstrauss (talk) 19:43, 8 March 2012 (UTC)

An update to this: I have re-added a legislative history section that was deleted over a year ago. See the talk section below. --Nstrauss (talk) 20:45, 12 March 2012 (UTC)

Reactions from legal experts POV

1. Should this subsection be removed?
2. Is this subsection neutral? --Nstrauss (talk) 20:26, 6 March 2012 (UTC)

The cited source from The Hill is interesting and worthy of inclusion but it currently receives WP:UNDUE weight. This section could be re-written so that it emphasizes the larger point that most experts think that the Court will uphold PPACA and the individual mandate. Randy Barnett is a prominent constitutional scholar but there are many others who equally deserve real estate in this subsection. --Nstrauss (talk) 00:34, 6 March 2012 (UTC)

Please read the Archive discussion on this point. Before the first judicial opinions, the section started out with a highly POV list of uncritical academic supporters; then the split decisions started arriving, which corroborated Randy Barnett's prediction of a split decision. The judicial opinions rendered the academics' predictions mostly moot, and disproved the unequivocal supporters.TVC 15 (talk) 01:02, 6 March 2012 (UTC)

No one has been "disproved" yet... that will come in June. In any case I actually agree that academics' predictions are not particularly informative at this late stage. Any objection to me deleting this subsection completely? --Nstrauss (talk) 01:10, 6 March 2012 (UTC)

I would object to deleting it, because The Hill and Randy Barnett traced the history of opinion quite succinctly and the prediction of a 5-4 decision remains very likely.TVC 15 (talk) 01:21, 6 March 2012 (UTC)

But you said that academics' predictions are mostly moot? You're confusing me. Are you saying that they're noteworthy only to the extent that they support Barnett's storyline? --Nstrauss (talk) 15:25, 6 March 2012 (UTC)

You started out saying the section should be re-written to say "most experts" (can you cite a poll?) thought the legislation would be upheld. There was a partisan Senate hearing in which a small parade of experts testified unanimously that the legislation would be entirely validated, before the court decisions disproved that prediction. I'm saying we don't need to return to a long section listing every academic who has ever opined on the subject, especially disproved predictions made prior to any actual decisions. A short paragraph, like we have now, that traces the history and notes the division is appropriate.TVC 15 (talk) 17:59, 6 March 2012 (UTC)

Can you please explain why you think that predictions about the vote count (5-4, 6-3, whatever) are noteworthy in the first place? Many of our articles on Supreme Court decisions don't include the breakdown, and the subject of this article isn't the Supreme Court decision, either. A more appropriate article for this type of information would be Florida v. United States Department of Health and Human Services. --Nstrauss (talk) 18:17, 6 March 2012 (UTC)

Then why did you begin this thread by asserting (without citing any sources) that "most experts think that the Court will uphold PPACA...." and proposing to re-write the section to emphasize that? The sentence in the article, citing The Hill, traces the change in opinion among "legal scholars generally." Are you saying predictions are noteworthy when you think "most experts" agree with you, but not when they don't?TVC 15 (talk) 18:40, 6 March 2012 (UTC)

1. I started by reacting to the WP:NPV and WP:UNDUE issues in this section, but then something you wrote ("The judicial opinions rendered the academics' predictions mostly moot") helped me realize that the bigger issue is that the subsection should be removed entirely because it's not particularly informative. I do not want to squabble about POV issues if the subsection might be removed entirely. So please, let's try to reach consensus on whether the subsection should stay or go first, and then if we agree it should stay we can talk about its wording and content.
2. You didn't answer my question: How are predictions about the vote count (5-4, 6-3, whatever) are noteworthy in the first place?
3. I don't agree or disagree with any of these people. Please try to keep the tension level down by focusing on the article rather than editors' intentions or views. --Nstrauss (talk) 19:21, 6 March 2012 (UTC)

I am glad to have helped you realize that we don't need to re-write a long section saying "most experts" believe something that they don't actually. The remaining paragraph in the section, citing The Hill, traces the change in opinion among legal scholars generally. It refutes the hasty predictions that had been spotlighted by a partisan committee but then disproved by split decisions. It also notes the change in scholarly forecasts, as part of that history. As the case remains ongoing, it remains notable.TVC 15 (talk) 20:08, 6 March 2012 (UTC)

• Remove - IMO, the bulk of this section/topic, among others, do not belong here under PPACA. Portions of current content may or may not belong under the article(s) titled after the case-name(s) now before the Supreme Court and should be moved accordingly for further development there - not here - if we must keep bits & piecess around in one form or another. Maybe a simple uncited, unbiased summary paragraph should remain here to point readers those other applicable articles if anything as a compromise.

  Plus, so much has happened since February of 2011 that it becomes hard to justify any expert's prediction as valid or sound given it was formulated prior to all events that have taken place since. The internet is peppered with predictions contrary to the range or change-in-range being offered both up & down. I still don't see why this so important when its obvious that any given expert's opinion is only as good as their last mistaken one. -- George Orwell III (talk) 02:19, 7 March 2012 (UTC)

Let's keep things moving. I'd like to hear arguments for the continued inclusion of this subsection specifically addressing (1) the value of predictions about the justices vote rather than the result (i.e. not who will win but by how much); and (2) whether this subject matter should be moved to Florida v. United States Department of Health and Human Services. If we don't get these by March 11 then I will delete this subsection. --Nstrauss (talk) 18:52, 8 March 2012 (UTC)

• Don't Remove I was the editor who brought in the article from The Hill, so hopefully I can partially address why it could be relevant. At the time, the subsection was massive, containing many paragraphs of outdated predictions on the fate of the bill. I added in the article hoping to bring the subsection up to date, and the rest of the subsection was later deleted (by another editor). That being said, I think the article is valuable in that (1) it shows how lower court rulings have brought about a change in expert forecasts on the law, which is relevant to the law's history, and (2), that a 5-4 decision is likely, indicating the extent of the debate regarding the law's constitutionality. For instance, if experts predicted that a decision by the supreme court on a given law would be unanimous, the constitutionality of the law is rather clear, and demonstrating a relative lack of debate. However, the predicted 5-4 ruling shows that to many, whether or not PPACA is constitutional is rather nebulous.

As far as to what article this subsection belongs in, I agree that it could be useful in Florida v. United States Department of Health and Human Services, however, it should also remain in this article in some form or fashion as it is relevant to A) the debate regarding the subject's constitutionality and B) the possible fate of the subject.

As mentioned above, I feel the subsection serves a purpose, and would be happy to see it discuss multiple perspectives on the subject, using multiple sources, so as to address any NPOV concerns. Mpgviolist (talk) 03:59, 9 March 2012 (UTC)

Normally I would agree with your first point (1), with the second point (2) being derived from the first, if we were still in the spring of 2011. The fact is, we are more than a year from the time that assessment was made & published. Since then, not only has the Florida case seen further review in higher court(s), so have most of the other primary suits out there dealing with the Act.

Nevermind the "overall" way those rulings went either "for" or "against" the PPACA, it is a bit absurd to think that the same Feb. 2011 assessment indicating a particular trend at that particular time would somehow still be valid to assert today given the sum of events since then. Any "expert" worth their salt would (re)evaluate their position when new information/facts materialize, No?. I'm not saying the original assessment is absolutely contrary to today's analysis - just that you have not proven that well enough to continue to warrant hosting the section here in the PPACA article. It most certainly is OK to keep over on the Florida article, which was the initial ruling that inspired the assessment in the first place, in my opinion however. Of course, if you can expand & cite a trend supporting that analysis using a more diversified sample of experts over time, then I'm open to revisting this discussion on keeping this. Otherwise; move or remove is still my vote. -- George Orwell III (talk) 02:33, 11 March 2012 (UTC)

Yes, the article s rather old (bear in mind I added it in a while ago), however, I can't find evidence that there has been a shift away from the thought that the decision will be 5-4. Of course, I'm primarily interested in keeping the section, as I feel that the subject's fate is relevant to the article, so if you (or anyone else) wants to add in more recent analysis, go ahead. No qualms here towards addition to its content. Mpgviolist (talk) 04:42, 11 March 2012 (UTC)

• Keep the existing text, for the reasons above, but remove the PoV tag. The reduced section summarizes the range of opinion fairly, and is also quite neutral. It doesn't even say which way the 5-4 split will go, so the PoV tag was misplaced.TVC 15 (talk) 03:44, 13 March 2012 (UTC)

I strongly disagree that it is "quite neutral." It emphasizes academics' shift away from the previous assumption that it would be a landslide for the government. But the more important point is that academics still generally think that the government will win and PPACA will be declared constitutional, even though by a narrower margin than once expected. The fact that we don't say which way the 5-4 split will go is precisely why this subsection is biased. --Nstrauss (talk) 18:37, 13 March 2012 (UTC)

You keep saying that "academics still generally think that...PPACA will be declared constitutional," but you never provide any published reliable sources to support that statement.TVC 15 (talk) 18:47, 13 March 2012 (UTC)

Here, here, and here. --Nstrauss (talk) 19:44, 13 March 2012 (UTC)

Thank you for finding those sources, but they don't say what you say, and they certainly don't support a PoV tag. The nearest is the Yahoo! article, which says: "How is the Supreme Court likely to rule? It's very hard to say."[20] That article then traces the same history that we already have, adding only that the DC Circuit opinion "had some [emphasis added, i.e. not "most"] experts predicting an eventual triumph for the administration." "Some" isn't "most," and makes no claim to represent academics "generally." The other two are PPACA advocates who don't claim to have a representative sample, so the comment "most experts I've spoken to" (emphasis added, i.e. expressly not a representative sample) and the blog comment "there is optimism that the mandate will stand" don't say anything about what academics "generally think" or "most experts" as a whole believe. I was hoping you might have an AALS or ABA survey, for example. CNN found college graduates opposed PPACA sooner and by a wider margin than the general public, but PPACA lobbying fees have paid for many lobbyists' new cars and houses, so it might have considerable support among lawyers who work for lobbying firms, even if it is opposed elsewhere.TVC 15 (talk) 22:14, 14 March 2012 (UTC)

I agree that these aren't the most ironclad sources, but then again, is the Bolton source any better? You don't really think that his analysis was based on an AALS or ABA survey, do you? And he also didn't claim to have a representative sample. The bigger point, though, is that the vast majority of articles I found about experts' opinions said there was uncertainty about the outcome. I also found some blog posts by Eugene Volokh saying that there is no consensus and that experts' predictions are determined largely by their own ideologies. Another reason for the deletion of this section. --Nstrauss (talk) 04:48, 15 March 2012 (UTC)

• Remove - I agree with George Orwell. The whole "Constitutional challenges" section gets way to much real estate in this article. A listing of every single lawsuit and its status may have been appropriate when the issue was bubbling up through the lower courts, but now that the issue is before the Supreme Court only a brief summary is needed. All the reader really needs to know is that the constitutionality of PPACA is currently before the Supreme Court, which is expected to decide in June 2012. A link to Florida v. United States Department of Health and Human Services should take care of the rest. Which way academics guess the Court will decide is a secondary issue that belongs in the Florida case article. Predictions of the vote tally are yet another tier down in relevance. --Nstrauss (talk) 18:37, 13 March 2012 (UTC)

There are multiple constitutional challenges raising multiple issues, so even if the Supreme Court rules for HHS in this year's case there will still be others. For example, there is at least one privacy case (which makes sense if you've ever read a health insurance application), combined with other issues, that is awaiting the decision in the Florida case before proceeding further.[21]TVC 15 (talk) 18:47, 13 March 2012 (UTC)

Perhaps that case (Coons) merits inclusion in this article. But the others will all be addressed by the Court in June and will determine PPACA's constitutionality on a broad scale. The issues raised in Coons are tiny by comparison. --Nstrauss (talk) 19:50, 13 March 2012 (UTC)

Would it make sense to pull all of the legal cases into a List of ... article and keep only the details of cases that end up at the SC here? Ravensfire (talk) 20:02, 13 March 2012 (UTC)

I'm not a huge fan of this approach because it seems arbitrary and too procedure-focused. I think legal challenges should be groups by subject matter. If there's a challenge to the privacy aspects of the law then it should go under a privacy section, which should explain what the law does in that respect before it mentions any legal challenges. --Nstrauss (talk) 20:13, 13 March 2012 (UTC)

public opinion POV

1. Should this subsection be removed?
2. Is this subsection neutral?

(Note that this subject was touched on in the recent talk section "72% of voters say it's unconstitutional".) --Nstrauss (talk) 20:24, 6 March 2012 (UTC)

I added a POV-section tag to the public opinion subsection because it reads like an anti-PPACA polemic. The broad-brush statements like "Public opinion ... remains opposed to the final version" - way over the top. Statements like that need to be qualified because, even if there is 60-something percent disapproval, public opinion is still mixed. Also, there is no reference to the other side of the argument. For example, I believe that polling demonstrates that most people are in favor of the individual components of the Act even if they oppose it as a whole. --Nstrauss (talk) 21:54, 5 March 2012 (UTC)

That section was debated at length months ago. Literally hundreds of polls show the same pattern. Please read the linked PBS Frontline transcript[22] for further information. Saying that people favor some individual components is like saying they like corn: whether they will buy it depends on the cost, and whether they will eat it depends on what else comes with it. They won't buy corn at $100/#, and they won't swallow a pile of manure simply because it contains some undigested corn. This article is about specific legislation. Separate articles talk about things that people like, e.g. universal healthcare, but those are different articles about different subjects.TVC 15 (talk) 21:58, 5 March 2012 (UTC)

That is a valid argument but it does not mean that people's opinions about the individual components of PPACA are irrelevant. All it means is that their relevance is in doubt. As for the agreement among polls, I don't care how many polls say that most Americans disapprove of PPACA, there are still way too many people who approve of the Act to say that public opinion is opposed to it. It would have to be at least 90-10 to make such a blanket statement. Finally, if you don't mind, can you please provide a link to the previous debate on this subject? Thanks, Nstrauss (talk) 23:00, 5 March 2012 (UTC)

The section tracks the changes in public opinion and concludes that opinion of the final version remains "opposed by a margin of 10 percentage points." That doesn't ignore the many people who approved of earlier versions, nor the fewer people who approve of the final version. You might also want to read the linked WSJ article, which points out how steady public opinion of the final version has remained.[23] Finally, if you look at the top of this page, you will see a search box to search the archives.TVC 15 (talk) 23:27, 5 March 2012 (UTC)

I think we're talking past each other. My point is that if public opinion is 60-40, then 40% still support PPACA, so you can't introduce the subsection saying "Public opinion ... remains opposed to the final version". Also, please do not revert my addition of the the POV-Section tag; that is censorship. I am disputing the neutrality of the section and the fact that you disagree with me only further demonstrates that the neutrality of the section is in fact in dispute. --Nstrauss (talk) 23:42, 5 March 2012 (UTC)

I think you're not reading the archive. Whether to put a lot of numbers into every sentence, "opposed 50-40" etc. Anyone who wants to see all the exact numbers from the hundreds of polls can follow the links to the WP:RS that compiled them, and from there to the individual polls. Also, please look up censorship.TVC 15 (talk) 23:49, 5 March 2012 (UTC)

Stumbling on this discussion, could we perhaps say that a majority of the public opposes the final version, and then provide several polls to support that statement? I think that avoids blanket statements and qualifies the extent of support/opposition. Mpgviolist (talk) 23:53, 5 March 2012 (UTC)

I'm not sure if you read the section and the existing links before stumbling on this discussion? Most WP:RS report that overall opposition is, in round numbers, 50-40. To call that "majority" would require taking sides among sources, and probably updating as they find slightly more or slightly less.TVC 15 (talk) 23:59, 5 March 2012 (UTC)

How can you say that we can say that the public opposes the Act but we can't say that a majority of the public opposes the Act? Makes no sense. In my opinion this entire subsection should go. There's no "public opinion" section for Dodd-Frank or any other comparable legislation. --Nstrauss (talk) 00:05, 6 March 2012 (UTC)

Americans voted for Bill Clinton twice, but never by a majority. It is funny that you accuse me of censorship while you try to delete the opinions of millions of people.TVC 15 (talk) 00:10, 6 March 2012 (UTC)

1. And to say that the public "supported" Clinton would violate WP:NPV. The mechanics of presidential elections is irrelevant to the issue we're discussing. 2. The poll subjects absolutely have a right to their opinions. I am not criticizing them or silencing them. I simply think that using their opinions under this subsection is deceptive and uninformative. --Nstrauss (talk) 00:20, 6 March 2012 (UTC)

Per WP:RS, the section uses secondary sources where available, i.e. compilations of polls on approve/disapprove or keep/repeal. There are only two polls of constitutionality so far, so we have only primary sources (as allowed by WP:RS where secondary sources are unavailable). Among individual polls, Kaiser is notorious for supporting the interests of Kaiser Permanente, for example with this legislation Kaiser reportedly over-samples Democrats in order to overstate support. (Kaiser is also reportedly worried about mandates being "de-fanged," so they want the legislation "expanded.") The Huffington Post compilation includes Kaiser polls but balances them with other sources;[24] the RealClearPolitics compilation excludes Kaiser entirely.TVC 15 (talk) 18:42, 6 March 2012 (UTC)

Compliance with WP:RS does not automatically mean compliance with WP:NPV, WP:UNDUE, or a well-written article. No one is saying that the cited courses are unreliable. --Nstrauss (talk) 20:32, 6 March 2012 (UTC)

Let's keep things moving. If there are no specific arguments by March 11 as to why this section should not be deleted on the basis of WP:UNDUE then I will delete it. --Nstrauss (talk) 18:41, 8 March 2012 (UTC)

I have to say it doesn't seem that there was consensus to do anything, let alone delete the whole section. Although I wasn't pleased with the state of the section either, I don't see how the opposition of much of the public is undue; after all I think we all agree that it wasn't irrelevant. Lets see if we can improve the section through consensus, or move its essential content elsewhere in the article; public opinion, protests, and the rather interesting scenes at the town hall meetings don't seem to be in the article at all at present, but are certainly relevant to the subject. I'm going to restore the section (with the POV tag) until there is a consensus. Mpgviolist (talk) 02:12, 13 March 2012 (UTC)

My Suggestion: Lets trim the "Obamacare" paragraph and also cite specific polls instead of saying "public opinion remains oposed" (as I advocated earlier). Also, I think the town hall meetings and protests would be relevant to the public opinion section; perhaps instead of spending two paragraphs on polls we could discuss this briefly as well? Mpgviolist (talk) 02:17, 13 March 2012 (UTC)

I have added ref links as per the suggestion above. Per WP:RS, the links go to secondary sources that combine hundreds of polls, rather than picking one or two polls in isolation. The latest reported polls I've seen, e.g. AP/GfK[25] continue to show the legislation remains clearly unpopular, with the same double-digit opposition reflected in the averages compiled by both The Huffington Post and RealClearPolitics. However, since the widely used term "ObamaCare" has been deleted from all other sections of the article, further winnowing that one remaining paragraph would be unhelpful. Mentioning the extraordinary Tea Party protests might be a good idea, citing PBS for example, but the coverage in ad-supported media tended towards caricature that put a false frame around the debate. (Count the advertisements on national TV news and see which industry the anchors get most of their salaries from, and you might form an opinion as to why.) In any event, presenting the opinions of the small % of Americans who participated in Tea Party events should not come at the expense of deleting the opinions of the majority of Americans, who stated cogent and well-founded objections to the legislation.TVC 15 (talk) 04:06, 13 March 2012 (UTC)

Mpgviolist, I deleted the section because I suggested it on March 6, and on March 8 I said that if there was no opposition by March 11. There was no opposition. I still waited an extra day and deleted it on March 13. All of that said, I'm okay with bringing it back until we resolve your concerns.

When I first suggested deleting the section on March 6, my comment was: "In my opinion this entire subsection should go. There's no 'public opinion' section for Dodd-Frank or any other comparable legislation." Could you please respond? I would also like to point out that saying that something "isn't irrelevant" isn't a defense to WP:UNDUE. The question isn't whether an issue is relevant but whether it is relevant enough to receive real estate in the article. --Nstrauss (talk) 18:25, 13 March 2012 (UTC)

The comparison to Dodd-Frank is inapposite because that legislation has not been the subject of huge protests, it does not face double-digit opposition among voters, and its constitutionality is not being challenged by a majority of the states. Likewise your earlier comparison to civil rights was even more inapposite, and historically uninformed because it denied the much more relevant and more recent protests against conscription during the war in Viet Nam. Considering that hospitals kill more Americans each year[26] than died in the entire Viet Nam war, public opposition to the subject of this article seems sufficiently relevant to merit space in the article.TVC 15 (talk) 19:00, 13 March 2012 (UTC)

Two points. First, can you (or anyone else) please point to any article about other passed legislation that has a similar section dedicated to public opinion? Second, you're saying that a public opinion section is only appropriate if there is double-digit opposition? What about double-digit support? Seems like a biased approach to me. --Nstrauss (talk) 19:12, 13 March 2012 (UTC)

Can you point to any other statute that was enacted despite double-digit nationwide opposition and massive protests, and then challenged in federal court by a majority of the states? If you can find an example that isn't mentioned on WP, it should be. And, can you please cite a published source once in a while? Or at least once? This endless typing back and forth is not a productive use of anyone's time, and makes me doubt whether even to respond.TVC 15 (talk) 19:23, 13 March 2012 (UTC)

Yes. TARP and ARRA (the stimulus package). TARP was even less popular than PPACA. Both have been heavily protested. Neither article has a public opinion section. --Nstrauss (talk) 20:02, 13 March 2012 (UTC)

You're right about TARP, and thank you for finding that excellent handy Gallup poll reference combining recent bills. It led me to read more widely, which is one of my favorite features of Wikipedia. The TARP article has a section for controversies, but it omits both the majority public opposition and the Tea Party protests. Even stranger, the Tea Party movement article doesn't mention TARP, even though TARP propelled the Tea Party[27][28] months before the eagerly anticipated promise of healthcare reform got hijacked into the deeply unpopular PPACA. In my opinion, the TARP article should at least mention its huge unpopularity, and the Tea Party movement article should likewise reference TARP. The Gallup link you provided shows majority opposition to PPACA, TARP, and ARRA, although the margin of opposition to ARRA was around half the others, so I don't know whether to include that in ARRA. The reason why I think it's significant is because a central idea of democracy is that the laws usually reflect the will of the people, as was the case for the financial reform legislation. If I were showing a clover to someone who hadn't seen one before, and the example at hand happened to have four leaves, I would mention that is an unusual feature, because most clovers have only three leaves. If we are explaining a statute enacted by an ostensibly democratic process (and a party named Democratic), it seems notable that the demos opposed it from the start and still opposes it now. Narrow opposition within the margin of error in a single poll might not be notable, but steady opposition exceeding the margin of error in repeated polling should be.TVC 15 (talk) 21:53, 14 March 2012 (UTC)

I don't think that whether we include a post-enactment public opinion section should turn on whether the margin in the polls is 5% or 10%. Neither seems to me like a big enough margin. Now if the margin were 30%, that might be a different story. Also, if there are post-enactment protests that make the news, then those protests would be worth including in their own right. Also if there are articles saying that PPACA contributed to the rise of the Tea Party (which I believe is true), that is certainly worth including. But polls showing 50-40 against, or even 60-40? Nah, they just show that the legislation is controversial, which is obvious from the rest of the article. --Nstrauss (talk) 04:36, 15 March 2012 (UTC)

I agree that protests that make the news/any connection to the origins of the tea party should be focused on more so than polls.Mpgviolist (talk) 20:36, 16 March 2012 (UTC)

I do apologize that I wasn't paying more attention to this section prior to the deletion; the conversation seemed to have died. Regardless, it is clear right now that we don't have a consensus. Hopefully we can change this. The Dodd-Frank bill, as TVC mentioned, did not receive the amount of opposition as PPACA, making a public opinion section here more relevant. However, as I mentioned, I do agree with you that we can improve the subsection, and to get started on that, I posted my suggestions above. I feel that there is certainly hope for making a better section, and we should work towards this as opposed to deleting it.

WP:UNDUE guides against the discussion of the views of a small minority (ie. those who believe in a flat earth) on a given subject. However, many Americans, not a small minority, are oppsed to the law as shown by the cited polls. No matter, a clear majority of Americans do have some opinion regarding PPACA, making a "public opinion" section due. Additionally, I don't see why a public opinion section inherently is biased towards those who are opposed to the law, so long as we provide specific numbers from polls. Although it hasn't been passed, SOPA is, in my mind, the best parallel, as it provoked protests and opposition in a manner similar to PPACA (albeit much hostility shown to SOPA was conducted online, as opposed to the marches and town hall incidents seen with PPACA). You will note that in the linked article, there are larges sections on both "Protest Actions" and "Opposition". That being said, every law has its own unique history, and I don't advocate copying the format used on the SOPA page, or that of any other law, with regard to public opinion on PPACA.

I did post my suggestions above; and feel free to add yours as to how we can improve the subsection. Mpgviolist (talk) 19:36, 13 March 2012 (UTC)

• From the RFC - the section appears to misrepresent sources. When using polling to gauge public opinion, it should be clear that polling was used. Further, there is disparity in the polling - Pew has it at +2, so saying that polls are unambiguously demonstrating a lack of public support is suspect. Hipocrite (talk) 12:53, 29 March 2012 (UTC)

Per WP:RS, this is why WP favors secondary sources rather than primary sources. The Pew poll is included in the secondary sources that the article links to. Each individual poll has a margin of error, but in the aggregate these errors cancel each other out. Both liberal (Huffington Post) and conservative (RealClearPolitics) sources show steady opposition by a margin of around 10 points, which would be a landslide if the issue were put on the ballot.TVC 15 (talk) 03:57, 3 April 2012 (UTC)

Effect on national spending - POV and proposed reorganization

1. Should this subsection be removed?
2. Is this subsection neutral? --Nstrauss (talk) 20:26, 6 March 2012 (UTC)

This subsection is confusing and violates WP:NPV. It reads like an anti-PPACA polemic. It also confuses spending by the federal government with overall spending including private sector spending. The $200k+ figure cited in the first sentence refers to overall spending including private sector spending, but the second spending refers to pressure on the federal budget. This needs to be sorted out in a way that informs readers rather than deceiving them. --Nstrauss (talk) 00:53, 6 March 2012 (UTC)

Not to mention that there is considerable redundancy between this section and the one called "Deficit impact." --Nstrauss (talk) 00:55, 6 March 2012 (UTC)

The "Deficit impact" section should be updated because the original estimate was based on subsequently disproved assumptions including CLASS and the 1099 reporting requirements, both of which have been abandoned. It's funny how you plaster the article with POV tags for every section that says something you don't like, without noticing (let alone fixing) problems elsewhere.TVC 15 (talk) 01:08, 6 March 2012 (UTC)

This is not about liking or not liking, it's about what's biased and what's not. If you find other sections that are biased, by all means, tag them or fix them. --Nstrauss (talk) 01:12, 6 March 2012 (UTC)

There doesn't seem to be any dispute that this section violates WP:NPV so I will take a crack at editing it in the next few days. The main thrust will be to move anything about federal spending into the other section on the effect on the deficit. If there's not enough left after that to justify a subsection on private sector/overall spending then I'll delete this subsection. --Nstrauss (talk) 18:45, 8 March 2012 (UTC)

Having created an WP:RFC you should wait for OTHER editors to weigh in. I hesitate to respond to your comments, but it would be inappropriate for you to launch an edit war while your WP:RFC remains pending. Please use this time to research sources.TVC 15 (talk) 20:02, 8 March 2012 (UTC)

Fair enough. If there's no dispute by March 11 then I'll start editing. --Nstrauss (talk) 21:25, 8 March 2012 (UTC)

Assuming good faith, you appear to have misunderstood the purpose of PoV tags and WP:RFC. They are intended to see if there is a WP:Consensus to support your proposed re-write. Upon seeing that your views are not as widely shared as you had expected, you should not careen regardless into an edit war, where your tags would be construed as WP:Vandalism. Rather, you should desist.TVC 15 (talk) 21:40, 10 March 2012 (UTC)

So far you have only weighed in to repeatedly criticize my editing process. Some of those criticisms are fair, and I have responded to them, and others are, IMO, below the belt. But so far you have yet to respond to the substance of this particular discussion.

Your last comment is laden with assumptions and inaccuracies about WP policies, but regardless, we do in fact have consensus. There has only been one opinion expressed about whether this subsection should fixed (mine), and that opinion is yes. Now I realize that there is room for disagreement, so rather than edit now and risk starting an edit war, I have decided to hold off and see if anyone else wants to weigh in. I believe 3 days is an appropriate waiting period, especially considering (1) the RFC and (2) there was never any dispute in the first place. If you think this is a bad approach then I invite you to say so and explain why. It would also be helpful if you proposed a different approach.

At this point I can tell that you're angry at me, but I don't know why or what I can do to satisfy you. --Nstrauss (talk) 22:38, 10 March 2012 (UTC)

Angry would be an exaggeration, although I have never seen anyone put up so many tags without a spray can. You began this particular thread saying that the section "violates WP:NPV" and that you found it confusing. In reality, the section quotes WP:RS stating that the legislation increases spending. (That is why the recipients of that spending, e.g. PhRMA, AHA, AMA lobbied so heavily for it.) Perhaps you were confused because certain politicians claimed the legislation would save money, a claim that a few flat earthers may even have believed. Neutrality does not mean saying "opinions on shape of earth differ." Neutrality means reporting what WP:RS say. As noted in the sections that you tagged as PoV, WP:RS say that the legislation increases national spending, including federal spending, which puts pressure on the federal budget deficit, and hundreds of polls have shown steady double-digit public opposition ever since the mandate proposals were announced in 2009. (BTW, after polls showed 72% of voters believe the mandate is unconstitutional, the White House is reportedly organizing a prayer vigil to pray the SCOTUS judges into upholding it anyway.) Presenting reliably sourced facts is WP's way of describing reality, not violating WP:NPV. If you would please take some time away from your typing to read more widely, you might not be as confused.TVC 15 (talk) 23:36, 10 March 2012 (UTC)

Once again, compliance with WP:RS does not mean automatic compliance with WP:NPV. It helps, but (1) sources can still be cherry picked, (2) material within sources can be cherry picked, (3) the issues can be framed and article can be written in a biased way composed from reliably sourced facts. I'm not saying this subject suffers from all of those infirmities, just that your absolute reliance on WP:RS is misplaced. Let me give you an example that addresses the issue of increased spending. First of all, the subsection does not explicitly distinguish among federal spending, state government spending, private sector spending, and overall national spending. If you are against deficit bloat (as most of us are), then you might be confused by "national spending" and think it means means federal spending, especially when the following sentence talks about the federal deficit. That is not only confusing but biased. Moreover, the CBO source that talks about the $200b increase in overall national spending explains that most of this increase comes from the fact that more people will be insured and insured people go to the doctor more than uninsured people. This is critical context that is currently lacking.

Please read the opening paragraph in the introduction, and the section on "Changes in the number of uninsured," both of which make the assertions that you wrote are "currently lacking." If you want to add the fact that insured people visit more doctors, who are paid to write more expensive prescriptions,[29] which cause more (possibly most) hospital emergency visits (more than 2/3 of ALL emergency hospitalizations among older Americans[30]), please add that to the impact on the uninsured. RomneyCare was the model for ObamaCare, and so far the people of Massachusetts see more spending, more insurance, more hospitalizations, and more medical bankruptcies, but this particular section of the article is about the spending; the other impacts have their own sections.TVC 15 (talk) 03:39, 13 March 2012 (UTC)

The trouble with the disjointed approach you are proposing is that it provides no context for the dollar figures. There ought to be an explanation of where the extra spending comes from, especially when that explanation might surprise some readers. --Nstrauss (talk) 20:45, 13 March 2012 (UTC)

• Comment - After going over both sections, including the edit histories and visiting the referenced links, its plain to see both of you have valid points rooted in sound editing. Still, there is room for improvement as well as clarification from both perspectives in my view.

  First its obvious the Deficit impact section should be something more like Impact on future Federal budgets and the national debt and this section more along the lines of Effect on the private health sector or something approaching that. That way, there is a clear distinction between what the government predicts, what it scores and, eventually, what it reports - outlining & updating any changes in the past, present & future whenever applicable - in one section and the generally the same but coming from non-government or private entities instead in the other section.

  Right now, we have two sections basically presenting the same opposing POVs on nearly identical subject matter minus the benefit of one section being more up to date on principle points and vice-versa. In short, I'd prefer some sort of reorganization on the content we currently have along what I have described before visting an opinion on what happens next. -- George Orwell III (talk) 03:12, 11 March 2012 (UTC)

I agree. IMO we should have two subsections, one called "Federal budget" and one called "Private-sector spending." Perhaps we should put these under a broader category called "Health spending" or "Heath expenditures" with a brief introduction on overall spending. I don't think we need "effect on" or "impact of" because the section title already includes that. --Nstrauss (talk) 04:45, 11 March 2012 (UTC)

Going back to this, I agree that one section with two subsections would be nice if someone cares to go and make the change.Mpgviolist (talk) 02:28, 13 March 2012 (UTC)

The issue with this thread seems to be, it started out with a tag and title regarding PoV. There definitely isn't consensus to support that. Points regarding the organizational structure, which evolved historically in conjunction with the public debate, are unfortunately off topic with regard to the title of the thread. If Nstrauss wants to delete the PoV tags, then we would have a more neutral context in which to consider how the spending sections might be moved in order to group them more logically than the legacy organization that evolved originally.TVC 15 (talk) 03:39, 13 March 2012 (UTC)

The problem is that it's difficult and inefficient to fix the WP:NPV issues when the subsection needs to be reorganized anyway. There does seem to be consensus about the reorganization plan. It makes sense to reorganize and then address any WP:NPV issues on a subsection-by-subsection basis. --Nstrauss (talk) 08:31, 13 March 2012 (UTC)

• This whole section (actually both national spending and national debt) should be moved / extracted. The sections conflate national versus federal spending on health care. Given the CBO statement "Putting the federal budget on a sustainable path would almost certainly require a significant reduction in the growth of federal health spending relative to current law (including this year’s health legislation)", there is a hugh imbalance in the trend with or without this act, it seems like this section is too long for the main article. Some of this seems to be part of a larger article about health care economics in the U.S. This article should be limited to a few sources about how this act will change the federal budget and deficit (not overall trends in health care spending. Dw31415 (talk) 02:53, 29 March 2012 (UTC)

Agree - after some trial revisions that did not go to resolving the issues as framed earlier in this discussion, I'm afraid that I agree that this area has become too long and burdensome to the main article and should be moved (or removed) from it. -- George Orwell III (talk) 02:56, 5 April 2012 (UTC)

It would not be neutral to delete the costs of the legislation while leaving in only the purported benefits. The original objection about separate sections for spending and deficit impact has now been addressed. Some of the earlier, outdated CBO estimates can be consolidated into a reference note, which would make the section shorter. The purported benefits don't just fall from the sky, there is no free lunch; they require more than $1 trillion of new spending, which is obviously notable.TVC 15 (talk) 03:22, 5 April 2012 (UTC)

Since cost is not being addressed (only spending & primarily in gross figures at that), both sections lack the uniformity and clarity (regarding outlays-to-revenues basics found in even the most germaine accounting practices) both subjects need to insure a balanced assesment exists with a nuetral POV all around. It is mischaracterization to describe the initial request for comment making a motion for removal and the ensuing discussion encapsulating the additional section was only an issue of "spending and deficits". It was clearly one where the hope was for a public budgeting & national debt section vs. private sector costs & profits (or lack there of) section primarily. Yes, steps recently taken updated a small facet of one position isolated to public (Federal) spending and the annual budget deficits but the overall consensus was that both sub-sections were also lacking N:POV as well. This disparity has only been furthered; not reconciled.

Reafirm to broadly summarize both the "public" and "private" sections dramatically here and point accounting specifics or accounting approaches content better handled by relevant article or articles elsewhere via a move (if at all). -- George Orwell III (talk) 04:44, 5 April 2012 (UTC)

After reading the comment above, your meaning doesn't seem very clear to me. Are you sure that the words germaine and insure are the words you intended? CBO's spending total seems to upset you, but the fact that the legislation requires over $1.7 trillion in federal spending is clearly germaine. In fact, it is one of the most conspicuous effects of the legislation, along with increasing insurance, and trying to write an article about the legislation without mentioning the spending would be like trying to talk about a new SUV without mentioning the price. On the other hand, reluctance in some quarters to look at price might explain why America and so many Americans are sinking ever deeper into debt.TVC 15 (talk) 06:20, 5 April 2012 (UTC)

Legislative History

I've restored the Legislative History section, which was deleted on 12 January 2011 with only a little discussion (rev 407447028). Hauskalainen said on the talk page that the article was getting too long, and his revision comment adds "Its all a bit academic now." The history of a bill is hugely important, and while I share the same concern about length, deleting the section entirely was going way too far in my opinion. This was the biggest piece of legislation in many of our lifetimes, so it is understandable that the WP article would be big too. Anyway, I make no claims about the quality of this section and I restore it only to serve as a starting (or re-starting) point. Edit away. --Nstrauss (talk) 08:38, 12 March 2012 (UTC)

When articles get too long, the appropriate action is to suggest forking individual sections while maintaining a summary in the original. 192.41.81.68 (talk) 21:05, 14 March 2012 (UTC)

Agreed, but the Legislative History section is one of the shorter ones in this article. By my imprecise estimates the Provisions and Impact sections are tied for the longest, with the Constitutional Challenges one a bit shorter. IMO Constitutional Challenges should be forked, not Legislative History. --Nstrauss (talk) 04:54, 15 March 2012 (UTC)

Is the legislative history box in the sidebar accurate? Some of the links lead to things that are very unrelated. 70.109.56.32 (talk) 20:09, 29 April 2012 (UTC)

Increased CBO Estimates for 2012-2022

As a matter of record, this morning the CBO released another 10 year window estimate of costs at $1.76 billion. I haven't seen the major media outlets picking up on this story yet, but as they do we should probably examine all of the reliable sources and include this new information. Clearly the examiner is not a source we would use in the article, but they have jumped on the story: http://www. examiner .com/conservative-in-san-diego/obamacare-estimate-rises-to-1-76-trillion 192.41.81.68 (talk) 15:57, 14 March 2012 (UTC)

Excuse me, I meant 1.76 trillion.192.41.81.68 (talk) 16:35, 14 March 2012 (UTC)

Thanks for noting that, with the corrected number: CBO estimated gross ten year (2012-2022) costs at 1.76 trillion. A neutral WP:RS would be The Hill,[31] which links to CBO's actual report.[32] As reported in The Hill, CBO revised its estimates to report that 2 million fewer people would get insurance, thus reducing the insurance subsidy cost, and increasing the amount of penalties people are expected to pay. From the federal budget perspective, the increased penalties count as a net cost reduction, even though from the perspective of the people paying the penalties, they are a cost increase. CBO did not update its income forecasts, so its revised deficit impact is based solely on net spending. It put net spending in each of the next 10 years under the heading "Effects on the Federal Deficit," so reading that the way they presented it, the net spending increases the deficit in each of the next 10 years, including by over $100 billion annually starting in FY2015. Definitely notable.TVC 15 (talk) 22:25, 14 March 2012 (UTC)

As per the comments above, I've updated and consolidated the federal spending and deficit sections to reflect the current CBO estimates.TVC 15 (talk) 04:52, 3 April 2012 (UTC)

The 1.76 trillion number is totally misleading, because it is the gross spending, not the net cost (spending - revenue). From page two of the CBO report:

Over the 10-year period from 2012 through 2021, enactment of the coverage provisions of the ACA was projected last March to increase federal deficits by $1,131 billion, whereas the March 2012 estimate indicates that those provisions will increase deficits by $1,083 billion.

i.e., the net deficit impact has actually gone down slightly. Moreover, these amounts do not include numerous cost-saving provisions in the ACA, which the CBO previously determined would have a net deficit reduction effect. From page two of the CBO report:

Those amounts do not encompass all of the budgetary impacts of the ACA because that legislation has many other provisions, including some that will cause significant reductions in Medicare spending and others that will generate added tax revenues, relative to what would have occurred under prior law. CBO and JCT have previously estimated that the ACA will, on net, reduce budget deficits over the 2012–2021 period; that estimate of the overall budgetary impact of the ACA has not been updated.

— Steven G. Johnson (talk) 19:14, 4 April 2012 (UTC)

Thanks I've updated to clarify gross and net spending. $1.76 trillion in gross spending is certainly notable. The projections changed for two reasons: (1) the calendar brings more of the spending within the 10-year horizon than was visible in 2010, and (2) 2 million people were shifted from the subsidized insurance category to the penalty category, causing a 5% ($50 billion) change in net federal spending. Partisans on each side have tried to spin the numbers, for example the WaPo blog cited above tried to spin it favorably while others spin it unfavorably. The facts remain, more than $1.7 trillion in gross spending, including more than $1.2 trillion in net spending, according to the most recent CBO projection.TVC 15 (talk) 19:59, 4 April 2012 (UTC)

Since when is gross spending a reasonable way to measure the cost of legislation? And where do you get the "1.2 trillion in net spending" number? Page two of the CBO report (quoted above) puts it at < 1.1 trillion net spending, not including savings due to Medicare reductions and other provisions of the ACA. — Steven G. Johnson (talk) 21:00, 4 April 2012 (UTC)

I don't know... Nearly everything that I've read starting from the links found within THIS PAGE, then the sub-links to each blog post linked from that page contradicts or clarifies much of what is being proposed as a change here. That 2 million shift occurs only in one of three alternate scenarios besides the latest baseline that GPO came up with for this March 2012 revision for example. We should stick to one GPO prognosis and not jump from one alternative scenario to another in a piece-meal fashion. Its mis-leading to say the least. -- George Orwell III (talk) 22:09, 4 April 2012 (UTC)

I gave you direct quotes from page two of the CBO report that you are talking about. I'm not talking about any "alternative scenarios," I'm just reading what they wrote. And the other CBO page you just linked says, and I quote:

The following figure shows CBO and JCT’s projections of the net cost to the federal government of all the provisions of the ACA. Our projections made last February (our most recent ones for all the provisions of the law) extended the original ones by two years, but again changed little, on net, from the original projections for each given year.

And this is followed by a graph showing a negative net budgetary impact. i.e. it is projected to (slightly) decrease the net deficit when all provisions are included. — Steven G. Johnson (talk) 22:24, 4 April 2012 (UTC)

Sorry - wasn't disagreeing with you or CBO's revision but with the assertion of the $1.76 trillion "price tag" among other new analysis. I think I can follow what's going on here just fine (comparing the new 10 year estimate to 8 years of the initial estimate then ignoring all the other changes in population, inflation, revenue forecasts, etc. to make it seem like cost nearly doubled) -- George Orwell III (talk) 22:37, 4 April 2012 (UTC)

Thanks for the clarification. The thing is, even quoting the $1.1 trillion "net cost" is misleading (much less the $1.76 trillion gross cost), because as the CBO report makes clear, that is only the directly insurance-related provisions; when all the other provisions of the ACA are taken into account the CBO clearly states that they are projecting a net deficit reduction (however, the projection for the other provisions wasn't updated this year). — Steven G. Johnson (talk) 22:43, 4 April 2012 (UTC)

In answer to the question where did the numbers come from, please read past the prose and look at the actual numbers, which are in Table 2. In answer to the question when did gross spending become a reasonable way to measure cost, the answer is it was always a reasonable way to measure cost; sometimes partisan spin tries to re-frame cost in some other way to make it seem smaller, but the bottom line is all the spending has to come from somewhere, and that's a cost. In fact, the gross spending is actually a clearer measure than the net spending, which subtracts the penalties from the gross. The net deficit numbers were not updated, so the nearest we have to current data is Table 2, but in any event the deficit reflects the difference between the new spending and the tax increases. Reading the comments above, I can't help noticing echoes of the partisan headline 'air war' (spending "doubled" vs spending was "reduced" by $50 billion), while WP should look at the actual current numbers. CBO projected the legislation will create over $1.7 trillion in gross spending during the period 2012-2022.TVC 15 (talk) 00:55, 5 April 2012 (UTC)

Corporations don't pay taxes on gross revenue & I don't pay income tax on gross income either - how is gross ______(whatever you like) the accurate measure for cost again?

If you're going to use gross costs then you'll need to match it to gross revenue or for the love of Christ just save everybody the time of doing the math themselves and stick to net figures across the board. -- George Orwell III (talk) 01:29, 5 April 2012 (UTC)

I don't know why you would choose to bring religion into this, but if you're planning to build a church, you really ought to consider gross cost, i.e. land+labor+materials+permits etc. Likewise I really don't know why you would bring your tax situation into this, but if you work for a corporation they probably have a very clear idea of the gross cost of each employee, including salary+benefits etc. Gross is the primary measure, i.e. before adjustments turn it into adjusted gross.TVC 15 (talk) 02:19, 5 April 2012 (UTC)

Its clear you don't get what I was driving at because you're focusing on semantics, syntax and literary license - not substance. The section was suppose to be split, as per previous discussion above, 1.) away from private sector impact content and 2.) made more neutral (i.e Future budgets and the national debt or something similar). You might have managed to separate some of the private sector stuff from the public content but you are still enshrining with undue weight to one side of the same budgetary coin. A budget is both outlays and revenue - you went with just Fedral expenditures & deficit impact in contrast to what was discussed earlier. So we now have Expenditures (a negative in both accounting-speak and public perception) and Deficits (also a negative in accounting as well as in perception). How can this section be considered balanced or nuetral when its title alone is only about one side of the budget coin? IMHO, your additions/edits are only about giving one side of the equation - or in this case the March 2012 CBO revisions. That's not what was hoped to come out of the earlier discussion. I'm starting to think revising these sections under this article was way too much to hope for given the constant polarization over one thing or another regarding this statute & that Dw31415 had it about right a week ago. -- George Orwell III (talk) 02:48, 5 April 2012 (UTC)

Regarding polarization, the solution would seem to be to work towards objective numbers. Gross spending is the most objective; net spending is less informative because it subtracts penalties even though the money is still getting spent. Alas boosters of the legislation seem not to want to mention any numbers unless they are basically advertisements, e.g. the $50 billion "reduction" compared to the previous projection. WP isn't an advertising site, nor is it a compendium of press releases. Quoting CBO's gross spending projection is WP:NPOV.TVC 15 (talk) 06:27, 5 April 2012 (UTC)

I don't see how any neutral observer could argue that "gross spending" is more important and neutral than the net deficit impact. The deficit is mentioned numerous times in the article, and numerous notable commentators (some of whom are already quoted in the article) focus on the deficit impact. How is it "boosterism", then, to accurately describe what the CBO clearly states about the entire bill's deficit impact (that it reduces the deficit in their projections)? It seems like pure partisan spin to focus on either the (a) gross spending of a portion of the bill or (b) the net deficit impact of only a portion of the bill. — Steven G. Johnson (talk) 15:38, 5 April 2012 (UTC)

I agree with you Steve. I tried to put the deficit first but its pretty clear TVC is fighting for a conservative bias to this section. The key number is the deficit conclusion, considering revenue and expense. I've updated the sections to spell this out and then will add a revenue section shortly.03:43, 14 April 2012 (UTC)

Probably the best answer to your question is here.[33] Most Americans recognize the legislation increases both spending and taxes. A neutral presentation would be, 'It increases spending by X, and taxes by Y, resulting in a net deficit impact of Z." If you delete X and Y, or bury them, you get spin one way or the other. But, I do believe you when you say that you don't see how gross spending is more important and neutral than deficit impact: part of the disagreement all along has been supporters don't see any problem with the spending increase as long as the tax increase is even larger, while most Americans look at the broader context.TVC 15 (talk) 20:05, 5 April 2012 (UTC)

But nearly everyone who has posted some tid-bit somewhere on this talk page is looking at this from the broader perspective - one that goes beyond simple spending and taxation. Regardless of your own personal situation, we are all paying, in one form or another, the additional cost of the bulk of the uninsured's end-of-life and emergency room care. It might not be an exact or equal dollar figure spread out amongst the curently "paying" population but it is most definitely fractions per citizens thereof in dollars. The whole point here is to reflect that cost - be it an increase/decrease in additional taxation or the increase/decrease in insurance premiums or the increase/decrease in career mobility or the increase/decrease in average wages and so on. I'm no fan of spin, but this is one case where it rotates both to left as well as to the right and there is not much we can do about it since most references are up to their repective necks on one side or the other on this issue since the 1990s already.

It seems all you want here is to focus on what you perceive is the paramount issue at hand (increased spending offset by increased revenue as it pertains to the deficit) while most of the other folks are looking for the overall cost as a whole and in the context of care. Again, your approach is better suited for sub-sections found under either the U.S. Public Debt article or with Title 42 itself (Public Health and Welfare - the entire codification of the Public Health Service Act, as amended, as part of the normal appropriation process. PPACA is but a handful of sub-chapters under Title 42). I don't believe anybody here is looking to hide X or Y for the sake of Z but to simply include all 3 plus their relevant tangents for this statute and this statute alone. At the same time - the position where increased spending is offset by increased taxes as somehow being wrong or invalid cries foul as far as N:POV goes. A lot of folks are able to differentiate between the current informal tax on premiums or the proposed regulated tax as its substitute will probably mean the same cost in the end anyway -especially if left unchecked. -- George Orwell III (talk) 21:23, 5 April 2012 (UTC)

I think we may be able to get to a consensus on how to present the numbers. But, respectfully, there has been disinformation from both parties, and cost-shifting by the uninsured is an example. If you look at the numbers, it's 2% of total spending, but supporters have used it as a distraction. Also, the legislation is projected to increase total spending even above prior law. I don't think it would be accurate to say that including the mandatory spending is POV, any more than listing the purported benefits would be POV. The legislation increases insurance, spending, and taxes. As the person who signed it said, it's based on Romneycare, which increased both insurance and spending, and hospitalizations, and btw the number of people filing bankruptcy with medical bills over $5k that they couldn't pay increased by a third. Rationalizing Romneycare or Obamacare by blaming the uninsured for "cost shifting" is definitely as incorrect as misspelling the word definitely.[34] One might even call it Orwellian. The reason PhRMA and AHA and AMA (and initially AHIP) supported it was because it would increase their revenues. If we're going to list the purported benefits, as the article does, then NPOV requires also reporting the costs.TVC 15 (talk) 21:37, 5 April 2012 (UTC)

Forgive me for not being more clear - I'm not saying listing spending is POV but listing spending without the expected offsets, the savings, revenues or curbing the growth curve and so on, makes it POV by omission. Listing the benefits (I prefer the term 'provisions' personally) is unavoidable. Provisions are likely to have corresponding sections dealing with funding that provision, yes, but it is too broad a brush to stoke when you argue that listing provisions equates to some required counter-balance rooted in listing the various vehicles of funding (i.e. not all provisions have a corresponding slice in the funding pie chart). This problematic because the 2012 estimate says to recycle the 2011 figures for those parts and goes on to say the differences, if any, are within the rounding to still cancel the changes outon net as the overall estimate moves forward in time the way I read it.

Nevertheless, we should have balanced assesment of the provisions on one hand as well as a balanced assesment of the funding on the other hand - neither necessarily ever fully meeting each other on every point nor being the justification for the existance of one or the other. Overly general devil's advocate... Say the mandate is severed by the Court but the rest of the law remains (as impotent as it may be) then Congress comes along and manages to pass something that passes for a substitute vehicle for current provision funding - what then? re-write both the Provision and Funding sections because we've made one the counter balance to the other? No thanks - I want both sections neutral & complete with enough legs to stand on their own (i.e. be easily trimmed when superseded by the next congressional adventure in health care if it happens in our lifetimes) if need be.

As far as "cost-shifting" goes - I'm not sure how else to describe it but that's what is taking place here. As far as I'm concerned - I know I was hosed before without this law, I'm most likely just as hosed in the future as well but the point in time where I eventual pay the piper (a predictable tax/penalty/exchange) shifts to a more agreeable state (away from unchecked premiums growing faster than inflation) for me at the personal level. With 230 out of 235 years of public debt and deficit spending under this Republic's belt, I find the moral-hazzard slipery-slope wealth-redistribution arguments quite laughable as well. -- George Orwell III (talk) 22:38, 5 April 2012 (UTC)

OK - I've added CBO's most recent comprehensive estimate (which was from March 2011) projecting a net deficit reduction of $210 billion during the period 2012-2021 into a new paragraph to combine all of the current estimates. Hopefully presenting all three numbers together in one paragraph will address the POV concerns. I do think it's appropriate to lead with the current estimates, as CBO has published many revisions and others objected previously to going through all of them chronologically. (Some felt listing all revisions chronologically undermined CBO's credibility, but personally I thought it was just confusing; better to start with their current estimate and then offer a brief summary of past estimates.)

Having the current estimate to start with is just fine. Nobody understands the CBO's mandate nor function anyway. It's too late to approach scoring correctly anywhere on WP now that so many examples exist where bits and pieces are used without context. Again, in my heart I believe most if not all of this should be laid out under its own fiscal year budget w/revisions; this topic specifically being explored in full as a fork of its parent appropriation section or sub-section there and only summarized here, but that's something vested editors everywhere rather not see for one reason or the other it seems. That summary should be supporting the various flavors of coverage. Anyway - it's closer to almost what I was looking for (though your citation bundling practice leaves room for improvement).

BTW by all accounts the legislation will require premiums to increase faster than inflation, that's part of why HHS found it would increase spending faster than under prior law.

Is it still not better than the previous trend & estimated annual growth rate than before it was enacted?

The existence or non-existence of moral hazard is more applicable to other articles (e.g. TARP), it isn't mentioned in this article probably because it's less relevant to health insurance.

Didn't think it should be. I was just lumping a bunch of positions (unfairly?) into one generalization was all.

Also, you might want to look at the article on United States public debt to get a sense of the history; the most recent decade of deficits and the estimates for next decade differ dramatically from prior periods.TVC 15 (talk) 19:56, 6 April 2012 (UTC)

Duh. Starting with completely ignoring the principle of a 10 year Budget Reconciliation (capital "b" capital "r") process the last time around that had previously allowed/mandated Reagan, Bush1 & Clinton to raise/lower taxes/spending according to triggers put into place at the time of the initial baseline estimates as soon as deviations from that baseline materialized in the years that followed - I blame the DeLay-Rove-Bush2 era more so than anything else here. The Iraq war should have triggered the end, or at least a major downward reform, of the Bush tax cuts as should have the passage of the unfunded presciption drug benefit but that never happened (politization of a principle that at its core is designed to be ubber impartial - how else can a 10 year plan be implemented in 10 one-year fiscal budgets unless you remove the partisan politics? You don't and that's why Reagan is viewed as a tax god in spite of dozens of increases and why Clinton & congress "got away" with a percieved milestone in balancing the budget). The Bush2 era ignored previous practices that made other administrations immortalized in recent times and now we paid for it many times more than what we should be when the financial crises is unavoidably factored in as well. (Worst President ever imho & I voted for him over Gore!).

Add that to the historical amount of retirements taking place & the explosion in debt/spending should be no surprise (in fact, it was long forcasted and expected to be factored into in the next Budget Reconciliation plan - didn't happen). We could have managed this change in the population far better had we followed what we promised to follow - even with a collapse of the housing bubble. Enough rambling - in short: I need no review of budget history nor national debt. Thanks.-- George Orwell III (talk) 01:36, 7 April 2012 (UTC)

Reference 20

Warning: this resource doesn't specify a title. I'll go look for one. 68.173.113.106 (talk) 02:37, 17 May 2012 (UTC)

2012-06-28 Ruling

Lets not get ahead of ourselves and do this the right way. The information is still pouring in. "on June 28, 2012, the Supreme Court announced it upheld the law in full" That statement is not completely true, from what I can gather reading the news, the individual mandate was upheld, but the Medicare clause of the Act was limited. --Wingtipvorte^X (talk) ∅ 15:01, 28 June 2012 (UTC)

Semi protect

The law was just upheld as constitutional, and the 5-4 Supreme Court decision upholding it will be a flashpoint for politically motivated IP editors. I have an account, I just forgot to log in. 67.169.4.243 (talk) 15:47, 28 June 2012 (UTC)

Seconding request of 67.169.4.243. -SusanLesch (talk) 15:48, 28 June 2012 (UTC)

As of right now, I'm not seeing a lot of vandalism on this article. If vandalism does start to appear, a request should be made at WP:RPP. Ryan Vesey Review me! 15:51, 28 June 2012 (UTC)

In this, though, we must also remember that an ounce of prevention is a pound of cure. Nobody wants Romney's or Obama's campaign or Conservapedia to edit this page and add their unsolicited opinions to the page. It is all in the interest of WP:NPOV. I will post this at RPP. Wer900 • ^{talk • coordinationconsensus defined} 17:08, 28 June 2012 (UTC)

Already true Republican warriors are editing the page, saying flat out that the individual mandate creates a tax, rather than mentioning the current RS consensus that it functions like a tax in that the penalties for not following are constitutionally taxes but functionally not. I understand that this statement may be somewhat POV biased, but the fact that completely anonymous IP editors can act like thieves in the night and edit without their edits ever being ascribed to some reputation. Hence the page should be semi-protected. Glad that you put my request on WP:RPP. Wer900 • ^{talk • coordinationconsensus defined} 17:23, 28 June 2012 (UTC)

Yes, already Democrat warriors are editing the page to push their POV. Semi-protect, please. HammerFilmFan (talk) 18:23, 28 June 2012 (UTC)

Yep, I put it in at the second hint of vandalism that appeared after I began watching the page. I don't want to deal with edit wars. Things like this are the exact reason I am not a republican. (Conversely, if this had failed the results would be the exact reason I'm not a Democrat). We should create an edit notice reminding all POV warriers that they can create Mywikimyway.wikia.com Care to poke some admins on the page protection? Ryan Vesey Review me! 18:07, 28 June 2012 (UTC)