Talk:Affordable Care Act/Archive 5

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The Rise of Socialism in America

This discussion has been closed. Please do not modify it.
The following discussion has been closed. Please do not modify it.
Is worth to note that this plan is just the beggining of american socialism and the fall of the conservatisms and capitalism? Is this act irreversable? A section about the theory of passive revolution citing Antonio Gramsci can be made? — Preceding unsigned comment added by 201.79.174.151 (talk) 18:50, 28 June 2012 (UTC) That information would be original research and wouldn't be appropriate for the encyclopedia. Ryan Vesey Review me! 18:53, 28 June 2012 (UTC) It would be almost worthwhile to set aside our content policies long enough to hear how an act that pushes people to buy insurance from private, for-profit corporations is "socialism". MastCell Talk 19:12, 28 June 2012 (UTC)  Ryan Vesey Review me! 19:16, 28 June 2012 (UTC) It's hardly the beginning of American socialism, considering that we've had progressive taxes going back to the 1860s. Not to mention the New Deal. — Preceding unsigned comment added by 76.174.4.92 (talk) 19:59, 28 June 2012 (UTC) The individual mandate was a conservative idea before the democrats passed it. C6541 (T↔C) 20:29, 28 June 2012 (UTC) As much as I'd love to debate this absurd suggestion, This is not a political forum. Please take this to the comment pages of www.any-where-else-but-here.com — Preceding unsigned comment added by 204.65.34.55 (talk) 21:18, 28 June 2012 (UTC) The IP is correct, I'm hatting this to prevent further misuse of the talk page. Ryan Vesey Review me! 21:22, 28 June 2012 (UTC)

"controversey" 4-1-1-3 - better sourcing?

Under the impact section there is a somewhat long bit about "controversy" over alleged double counting. As I was reading through the first couple paragraphs, I wasn't able to find anything in the cited sources that indicated there was a controversey. I don't want to debate over semantics, but nothing in the sources (191-193 if I remember correctly?) seemed to be anything but explanations of the mechanisms. For us to say there is a controversey, we should be referring to secondary sources that indicate it as such, not applying our opinion or OR based on base data in the cited sources. I'm not arguing that it shouldn't be called a controversey, just that if we do, it should be backed up by the citations. The first paragraph specifically refers to a controversey, but the single citation does not support that. Given the sensitivity of the article, I thought I'd bring it here first. However, unless there are any concerns voiced in a couple days, I plan to look for additional sources or change the wording, whichever is suitable. I would also suggest that this could be edited down a bit. It seems to be getting a bit of undue weight compare to more beefy issues handled is far less space...Hopefully the partisan slapfest will subside in the next couple days and the adults can get back to the real work here. Jbower47 (talk) 21:29, 28 June 2012 (UTC)

State legislation/constitutional amendments

[1] looks like a useful source for additional map information, but without looking into this a lot further I don't know for sure it doesn't duplicate existing charts i.e. opposition by court challenge. (What I'm really looking for is the names of the seven states that have already implemented the 133% of poverty level Medicaid expansion... still haven't found that) If the information is welcome I think I remember how to mark up an .svg ... Wnt (talk) 00:06, 29 June 2012 (UTC)

Proposed hatnote

This article is about a politically controversial topic. When making a statement of opinion or of fact, please cite an independent, reliable source.

How is it? Wer900 • ^{talk • coordinationconsensus defined} 22:29, 28 June 2012 (UTC)

Is there any grounds in policy for editing notes that appear to the reader? I think we could put a hidden note in, but I have had no experience with hatnotes like the one you proposed. In any case, it is semi-protected so we shouldn't have too many problems from inexperienced editors. Ryan Vesey Review me! 23:29, 28 June 2012 (UTC)

If the OP is suggesting we add a hatnote to the article, then I agree it isn't supported by any policy or guideline. We add hatnotes primarily for the benefit of readers not editors. For any messages to editors, either change the edit notice or add a hidden notice. Adding it to the talk page would be okay, but we usually use boxes not hatnotes for that, and it seems superflurous to the existing box saying it's controversial and may be in dispute. Nil Einne (talk) 10:47, 29 June 2012 (UTC)

Was the individual mandate actually upheld, or was the challenge to it just dismissed?

I've been reading the actual opinion, and Chief Justice Roberts never actually wrote that the Court found the individual mandate to be constitutional per se. What he wrote was that Congress could argue that the mandate is a tax. He then goes on to talk about the Anti-Injunction Act which prevents challenges to tax policy until someone has actually had the tax levied upon them, paid it, then sues for a refund.

From my understanding of the opinion, the Court merely dismissed the challenge to the individual mandate under the Anti-Injunction Act, but also left the door open for future challenges. FreakyDaGeeky14 (talk) 23:31, 28 June 2012 (UTC)

I have no opinion on that, but inclusion of that material would be original research. Reliable sources such as this and all of these state that it was upheld. I found some sources for "individual mandate dismissed" but those are not referring to this supreme court case. Ryan Vesey Review me! 23:35, 28 June 2012 (UTC)

How is citing the actual opinion original research? FreakyDaGeeky14 (talk) 23:50, 28 June 2012 (UTC)

It's not, if the editor merely makes a statement that reflects the actual content of the ruling. It is, however, a primary source and any interpretation or even selective quoting from the ruling would be problematic and likely POV or OR. Much better to use a secondary source for verification. Wikipeterproject (talk) 00:49, 29 June 2012 (UTC)

The use of primary sources in Wikipedia is not, in and of itself, prohibited original research or non-neutral point of view. Wikipedia guidelines do not prohibit the use of primary sources. What Wikipedia guidelines do is say that in most circumstances, an article should rely mostly on secondary sources. It is the misuse of primary sources that may constitute one kind of prohibited original research.

No, the Court did not "leave the door open" for future challenges to the individual mandate in the sense that I think was intended by my fellow editor above. Indeed, the door can't be "opened" or "closed" in this sense. In the United States, courts decide only the issues put before them. Anyone could theoretically challenge the individual mandate, or any other statute, on any theory the challenger can come up with.

In this case, some of the greatest legal minds in the nation -- on all sides of the health care law issue -- argued the best arguments they could find. The Court rejected every attempt to have the individual mandate declared unconstitutional. I won't get into a long explanation, but, essentially, under U.S. laws, once a provision is determined to be a federal tax, it is very difficult from a constitutional perspective to get that provision declared unconstitutional. There are very few constitutional limits on the power of Congress to impose a tax. Famspear (talk) 01:45, 29 June 2012 (UTC)

Oh, and just to be clear: Yes, the Court held (not "found," but held) that the mandate is constitutional. No, the Court did not merely dismiss the challenge to the individual mandate under the Anti-Injunction Act. Famspear (talk) 01:49, 29 June 2012 (UTC)

I see that through the day, editors have added secondary sources, such as the CNN material. Situation normal..... All is well..... Famspear (talk) 01:59, 29 June 2012 (UTC)

Actually, the SCOTUS did say that the Commerce Clause did not authorize a mandate in order to create commerce, so the mandate as a section of the Commerce Clause is unconstitutional, but since they ruled the mandate a Tax it was a provision of congress. Small victory for those that wished for some restraint on government control. Arzel (talk) 03:28, 29 June 2012 (UTC)

Well, to be more precise, the Court went through the analysis of the Commerce Clause and the Necessary and Proper Clause to illustrate that those particular clauses could not support the mandate. The Court then went on to rule that the mandate is constitutional -- because it is a tax and because it violates no provision of the Constitution that limits taxes. In other words, the Court refused to hold the mandate to be unconstitutional. That's a way of saying that the mandate is not "partly constitutional and partly unconstitutional". The only part of the law that was ruled unconstitutional was one provision relating to the "Medicaid expansion" codified at 42 U.S.C. section 1396d(a). Famspear (talk) 05:20, 29 June 2012 (UTC)

Note: I think the specific provision of the Medicaid expansion that was ruled unconstitutional may have been section 1396c, not section 1396d(a), but I haven't studied that part of the decision yet. Famspear (talk) 05:23, 29 June 2012 (UTC)

I would say it is all pretty much a distinction without a difference. Basically they punted this to 2015 when people will start paying the tax and have the ability to challange it under anti-injunction. When it is all said and done, I am not sure the left will be all that happy with this result either. Arzel (talk) 13:54, 29 June 2012 (UTC)

No, Editor Arzel, I think you're missing what the Court ruled. You don't challenge a tax "under" the Anti-Injunction Act. The Anti-Injunction Act (i.e., the one that relates to Federal taxes) is simply a law that prevents you from litigating the validity of a given tax that the IRS is asserting against you until you first pay the alleged tax. Essentially, the Anti-Injunction Act forces you to first pay the tax and then (if the IRS denies your refund claim) sue the government for a tax refund. (There are various areas where the Anti-Injunction Act does not apply, such as in U.S. Tax Court or in bankruptcy cases, but that's another story.) The section 5000A penalty, the "individual mandate", won't even be owed by anybody until the year 2014 (actually, I think, in early 2015, when the year 2014 tax returns will be due). So, one part of the thinking was: How can you litigate the validity of a "tax" that no one even owes yet? And: Is the section 5000A penalty (the mandate) considered to be a "tax" that is covered by the Anti-Injunction Act? The Court answered those questions by ruling that the mandate is NOT considered to be a "tax" for purposes of the Anti-Injunction Act. Even if it were considered a "tax" for purposes of the Act, it's not even located in the part of the Internal Revenue Code to which the Anti-Injunction Act applies. (By its very terms, the Anti-Injunction Act applies only to some, but not all, taxes imposed in the Code.) Therefore, the Court ruled that the Anti-Injunction Act does not prevent the parties in the case from litigating the validity of the section 5000A penalty.

The Court then went on to the next issue: Could the mandate be justfied under the Commerce Clause? (The Court also discussed the Necessary and Proper Clause.) And, if not, can the mandate be considered constitutionally valid as a "tax". The result was, essentially, that the mandate is constitutional because it is a valid exercise of the power of Congress to impose a tax. There is legal difference between ordering people to buy something (health insurance) and taxing people who do not buy that something. From the text of the Court's opinion:

The Federal Government does not have the power to order people to buy health insurance. Section 5000A [of the Internal Revenue Code] would therefore be unconstitutional if read as a command. The Federal Government does have the power to impose a tax on those without health insurance. Section 5000A is therefore constitutional, because it can reasonably be read as a tax.

I think relevant context for this philosophic distinction can be understood from the Marihuana Tax Act of 1937, though unless a source drops out of the sky with this I don't see a way to use it to clarify the article itself. Wnt (talk) 23:27, 29 June 2012 (UTC)

--from pp. 44-45, slip op., National Federation of Independent Business v. Sebelius, no. 11-393, U.S. Supreme Court (June 28, 2012) (italics added). Famspear (talk) 14:37, 29 June 2012 (UTC)

In short, the challenge was NOT dismissed under the Anti-Injunction Act. Instead, the Court ruled that the Anti-Injunction Act does not apply. The case was NOT "dismissed." The Court then specifically ruled that the individual mandate is constitutionally valid as a tax. Famspear (talk) 14:50, 29 June 2012 (UTC)

semi protected - I cannot make this edit

expands access to insurance to 30 million Americans,

should read

expands access to insurance to an additional 30 million Americans, — Preceding unsigned comment added by James Bayley (talk • contribs) 07:34, 29 June 2012 (UTC)

Done elektrikSHOOS (talk) 08:02, 29 June 2012 (UTC)

Fork?

This article is mighty long. Any thoughts on breaking part of it off into a new article? Perhaps "Provisions of the Patient Protection and Affordable Care Act" or "Challenges to the Patient Protection and Affordable Care Act"? I don't want to take away from this article, but it needs to be easy to read. --Another Believer _(Talk) 15:19, 29 June 2012 (UTC)

I like the idea of a Provisions of the PPAC article. Honestly, this article is already a TLDR for me. Ryan Vesey Review me! 15:21, 29 June 2012 (UTC)

Just created the Patient Protection and Affordable Care Act Provisions site, linked the provision section on this site to the new article and shortened the provision section here, but linked it to the new site. Should make the article shorter and more readable. --P3Y229 18:29, 30 June 2012 (UTC) — Preceding unsigned comment added by P3Y229 (talk • contribs)

Done. Created the Constitutional challenges to the Patient Protection and Affordable Care Act site. --P3Y229 19:18, 30 June 2012 (UTC) — Preceding unsigned comment added by P3Y229 (talk • contribs)

Provisions are the main part of the article, please do not move them anywhere. If anybody want to make the article shorter, it would be better to move some of the "Legislative history" into Health care reform debate in the United States. The article is about the law, not about political debate over healthcare, so most people look here for provisions and summary of the law. Innab (talk) 03:41, 1 July 2012 (UTC)

I disagree with this fork and have reverted it because three people in a day does not make a consensus. The actual content of the bill is the most important part of the article and should not be shoved away into a subarticle. I think this section is plenty readable because it is in several subsections and uses bullet points. It is some of the other long subsections that are more difficult to get through. But most importantly, people come to this article to learn about the law itself, and the recent court case, not the reactions and impact, which is all that's left. P3Y229, I encourage you to read WP:Summary style. If you're going to chop out the part about all the lawsuits, there still needs to be a summary of that material in this main article; leaving just two sentences behind is not a good replacement because moving the long, hard-to-read part doesn't help anyone understand the material, it means they either must go to the other article just to find the hard-to-read stuff, or they don't read it at all. Reywas92^Talk 03:46, 1 July 2012 (UTC)

Forking is badly needed. This article is too big, too detailed, and covers too much politically controversial material. I suggest splitting it into at least three separate articles. Belchfire (talk) 03:55, 1 July 2012 (UTC)

Agree, forking needed. Given that two others editors who've worked on the provisions article, they seem to endorse it too. There was no consensus to revert the fork. --S. Rich (talk) 04:22, 1 July 2012 (UTC)

PS: See WP:SIZERULE. --S. Rich (talk) 04:28, 1 July 2012 (UTC)

I concur with the reversion. The fork was nicely done and the editor who did it obviously put some effort into it (thank you!). Belchfire (talk) 04:34, 1 July 2012 (UTC)

I disagree that we should remove main body part about provisions, but I agree that we can move Constitutional challenges to the Patient Protection and Affordable Care Act into the separate article. Please remember that "Provisions" were there for almost 2 years now and many Wiki editors have worked on it. It was the main part of the article since the beginning, and when it was twice selected for "featured article" on the main Wiki page. If we remove this main piece, what will be left of the article? Irrelevant political debate, opinions of random politicians who contradict each other, religious views about abortion, jokes about "obamacare" nick-name, and history of the opinion polls which always change? There are a lot of other "undue weight" blocks that we can remove before we remove the main body sections. I trimmed these undue blocks a bit, so article size now is within 50Kb limit, there many other articles much longer then this one, so I see no reason to cut the main part out. Innab (talk) 05:49, 1 July 2012 (UTC)

Do try to keep WP:AGF in mind. Lecturing others about politics while you trim other peoples' from the article is risible. Belchfire (talk) 06:32, 1 July 2012 (UTC)

Forking the provisions out is a bad idea. The provisions are tied to the legislation's funding by design and only time will tell us the impact and/or efficiency of one over the other (or even both together). The focus will eventually have to shift to health care reform in general - once PPACA was fully codified and now ruled constitutionally sound, any future changes in this area will be amending the Public Health Service title, among a handful of others, overall more so than anything directly outlined by the PPACA of today or still to come in the near future. This is the case with most major pieces of legislation and the passage of time coupled with the annual budgeting & appropriations process.

I do agree the whole 'court challenge' thing is safe to move because its going to be pretty much static history if not already. Any remaining cases not immediately preempted by the recent SCOTUS ruling will be denied or dismissed by the start of their next respective sessions anyway. I wouldn't mind seeing some other parts get Forked as well but I haven't given the article the scrutiny it deserves with all changes since the 28th to be honest about it. -- George Orwell III (talk) 15:23, 1 July 2012 (UTC)

@Reywas92: 1.) Arms & Hearts told me on July 1, 2012 that there is a procedure i.e. Wikipedia:Splitting#Procedure that must be followed. I was not aware of this procedure. 2.) In addition this was the first time that I moved content of an article I didn't created. I was not aware that there is a procedure named WP:Summary style. So thank you for making me aware of it.

After reading the previous opinions I agree with George Orwell III. Moving the Act provisions section was bad. It is one the most important aspects of the PPACA article because it shows what the contents and reform implications of the PPACA are. The people wanna know what is at heart of the PPACA. Removing the provisions section to another site is therefore unwise. Because of this I suggest to delete the Patient Protection and Affordable Care Act provisions article and not to fork the provisions section. --P3Y229 18:17, 1 July 2012 (UTC)

I agree that the Legislative history could be split off, just as the constitutional challenges already have been. I think that Repeal Efforts should go with it. However, these sections should be summarized with at least a good-sized paragraph per WP:Summary style, which the constitutional challenges part doesn't presently live up to. Wnt (talk) 23:44, 3 July 2012 (UTC)

Public Opinion

I find the Public Opinion summary section near the foot of the article to be flawed. Why is there a separate public opinion summary? There is already a Public Opinion section earlier in the article. And if a public opinion summary section is necessary, why does it state that polls show sentiment is against the ACA, while ignoring that public opinion is pro-ACA's individual statutes? At the very least, I submit that the Public Opinion Summary should be modified to include one caveat that refers to the polls with positive responses regarding the individual components of the ACA. — Preceding unsigned comment added by 99.45.36.17 (talk) 04:54, 30 June 2012 (UTC)

Grammatical and semantic errors in the lede

The lede currently says

"... ruling that the mandate was a tax and therefore fell under Congress' taxing authority "

This is wrong both grammatically and semantically. The current wording also gives the false impression that the purpose of the mandate is to raise money though the court accepted that it is not. It also uses a wrong tense (was instead of is). Congress' is wrongly spelling (because the extra s is pronounced). To correct these errors I would suggest it be edited by someone (not me) to say

"....ruling that the shared responsibility payment, though intended as a penalty to induce people to become insured rather than to raise revenue, should nevertheless be construed as tax, thus making it and the mandate constitutional under Congress's taxing authority."

Reasoning

a) the mandate is a requirement to have insurance or else pay a penalty- Its the penalty and not the mandate that is the tax.

b) the terms in the law for the payment is both "shared responsibility payment" and "penalty"

c) the Chief Justice, when designating this as a tax, states that "..none of this is to say that payment is not intended to induce the purchase of health insurance" - i.e. he is accepting the government position that the mandate is intended to induce people to buy insurance and not to raise money.

d) the key element of the decision is that the framing of the penalty is constitutional

e) the tense in the original is wrong... the mandate WAS is wrong. It should be IS (sounds like it was written by someone with wishful thinking)

f) the correct spelling is "Congress's" with the extra s shown (because it is pronounced with an extra s) — Preceding unsigned comment added by 80.223.105.147 (talk) 01:00, 1 July 2012 (UTC)

Dear editor at IP 80.223.105.147: Not exactly.

First, the term "individual mandate" is not found anywhere in the Act itself. The term is a way that people have been using to describe certain provisions of the Act which are codified as Internal Revenue Code section 5000A. In some places, the term "individual mandate" is used to describe only the requirement to purchase insurance. In other places, the term is used to describe both the requirement to purchase insurance and the "shared responsibility payment," which is the section 5000A(b)(1) penalty (which, for constitutional purposes, of course, is treated as a tax, per the Court's ruling).

Just as many commentators have done over the two years, the Supreme Court used the term "individual mandate" in both ways in its decision on June 28, 2012. For example, on page 42 of the slip opinion, the Court concludes: "Upholding the individual mandate under the Taxing Clause thus does not recognize any new federal power. It determines that Congress has used an existing one."

Here, if the term "individual mandate" had been intended by the Court to apply only to the requirement to purchase insurance and not to the penalty imposed for failure to purchase that insurance as well, the Court's ruling would have made little or no sense. It is the PENALTY that is treated as a tax for constitutional law purposes. It is the PENALTY that the individual has to pay (if he or she does not purchase insurance). And it is the PENALTY (as well as the requirement to buy the insurance) that is referred to by the Court as the "individual mandate" in the text quoted above. Famspear (talk) 21:01, 1 July 2012 (UTC)

The court did not say that the mandate is a tax and neither should we. The mandate portion of the law is essentially two elements (1) a requirement to be insured (the MANDATE) and (2) a PENALTY (now deemed to be a tax for the purposes of establishing congress' powers) for non compliance. Nothing in what the Court said in that quote that can possibly lead us to believe that they are using the term "individual mandate" to mean both the mandate and the penalty. The Supreme Court did NOT diverge from standard English, and neither should Wikipedia. Frankly it smacks of politicking to say that the court regarded the mandate as a tax. Tt did not. It clearly makes plain that it is the PENALTY which is the tax. The text in the article must be amended to comply with Wikipedia standards of accuracy and normative use of English.80.223.105.147 (talk) 23:59, 2 July 2012 (UTC)

Dear us IP 80.223.105.147. No, I think you're hung up on your own terminology. I understand the distinction that you're making. The problem for your argument is that you're the one making it. The Court used the term "mandate" in a different way. You may not like the Court's terminology, but that's not really important. Famspear (talk) 01:53, 3 July 2012 (UTC)

By the way, Wikipedia editors cannot impose their own views about "normative use of English" on Wikipedia articles in the sense in which I think you're proposing. Law, science, etc., are technical subjects, and sometimes words that you and I think should be used one way are used in technical subjects in ways that we might think are weird or incorrect. We're not here to impose our own views terminology on the U.S. Supreme Court, or on the sources that are reporting on this case. Famspear (talk) 01:55, 3 July 2012 (UTC)

If you understand the distinction then you have done a poor job in explaining yourself. At no time does the court say the mandate is a tax. It is the PENALTY under the MANDATE CLAUSE that constitutes a tax. SO we can say that the Mandate is valid under congress's taxing powers, or that the mandate has a tax for non-compliance, but we cannot say that the mandate is a tax because (a) the court did not say that and (b) it would be incorrect use of English. A mandate is an order or request to do something and a tax is money you have to pay to government to finance its needs. We cannot and must not confuse these two things. Its not true that the court "used the term mandate in a different way". If you think that, lets have the direct quote from the slip opinion where you think it does. A tax is a tax and a mandate is a mandate. They are separate things semantically, and the court reflect this difference as far as I can tell.80.223.105.147 (talk) 21:32, 3 July 2012 (UTC)

Dear editor at 80.223.105.147: I think you are going around in circles. No, I have done a good job of explaining. And no, the Court does not need to physically use the phrase "the mandate is a tax". And no, using the term "mandate" in the way that the Court used the term is not an "incorrect use of English." A court of law is not bound by your beliefs, or my beliefs, about the correct use of the term "mandate."

Yes, in a sense, a mandate is an order, etc., and a tax is something that you have to pay. But we are not "confused," and we cannot impose the ordinary "sense" of these words on the United States Supreme Court. Courts of law use all kinds of terms in ways that may seem wrong to you or me. The quote I provided is from the text of the Court's published opinion. Famspear (talk) 22:40, 3 July 2012 (UTC)

I'm not sure what your exact quote was - of course exact quotes are OK - the current quote "must be construed as imposing a tax on those who do not have health insurance." is of course acceptable. But I really doubt they said "the mandate is a tax". It's like with an IRA account - if you withdraw your money early, there's a tax penalty. But being forced to keep your money in the IRA until retirement (to not get that penalty) is not generally described as a tax. Actions done to avoid a tax are not a tax; they are part of the impact of a tax. Wnt (talk) 23:38, 3 July 2012 (UTC)

I find myself having to agree with the above. Whether or not I personally feel that it IS a tax, the nuance of the decision and the way we're wording it do not match, as per user Wnt above. I think it's understandable in the final analysis, and it's certainly the way some aspects of the media have run with it, but we don't have the luxury of dumbing down the nuance for the sake of expedience.204.65.34.31 (talk) 03:11, 4 July 2012 (UTC)

Facts vs. Claims

In order to be factual and remain neutral, this article needs to differentiate between facts that we can all see with our own eyes and agree on, and claims which are nothing more than political selling points. This is an issue with the way the article's lede is written, and my attempts to correct it have met with stubborn resistance. Obviously, some discussion is needed to facilitate consensus.

To illustrate my point, I'll use an analogy. Let's say XYZ Company makes cars, and they are offering a new model. The FACTS about the car that we can all see are that it has 4 wheels, 4 doors, and a radio. No reasonable person would look at it and disagree. In its sales literature, the XYZ company CLAIMS the car will get 40 MPG, fully protects its occupants in a crash with a semi truck, and that its owners will enjoy a better sex life.

Now, while the car is sitting on the lot, all we can really know for certain are the facts. We won't know if claims are true until we've either purchased the car, or perhaps taken it for a test drive.

At this point in time, PPACA is still the car sitting on the dealer's lot. We bought it, but we haven't got it home yet. We don't know for sure what the actual fuel economy will be, nor have we had time to know if we're going to get laid more often.

So in order to have a factual and neutral article, we have to point out that the part about fuel economy and an improved sex life are only the claims being made in the sales literature. It is wrong to say that those statements are true just because somebody-or-other said so, regardless of who they are or where those opinions are published, or how many times.

Thus, when it comes to things that are necessarily in the future - i.e., deficit reduction or Medicare costs - the article needs to say that those are CLAIMS being made by PPACA's supporters. We should refrain from presenting those things as empirical facts. George Orwell III (talk) 20:19, 1 July 2012 (UTC)

The above is not my rant - an error in an above discusion made it seem like I signed it for the first time is all. -- George Orwell III (talk) 20:21, 1 July 2012 (UTC)

It's my rant. I borked-up something when I posted it and I couldn't see what it was, or thought perhaps there was a caching issue. Thanks for the repair! Belchfire (talk) 20:26, 1 July 2012 (UTC)

No problem. Still it seems like you're the type who gets caught by surprise out in the rain a lot. If you can't accept that - yes! there are indeed unfounded claims made by those with an agenda who are clueless as they come as well honest-to-God claims based on empirical evidence made by long recognized & well established people in their repsective fields of expertise, then I get the feeling when the weatherman says 90% chance of rain tommorrow you still somehow bank on the 10% left-open question when you get dressed that morning because he can't disprove the un-likelihood of rain well enough to your satisfaction the day before (hence, I get the feeling you get drenched a lot for no good reason:( -- George Orwell III (talk) 20:48, 1 July 2012 (UTC)

Gee, that was cute. OK, I get that you let your politics get in the way of your honesty, but your comment doesn't approach the issue here. Belchfire (talk) 20:58, 1 July 2012 (UTC)

There is no issue here. Ever since Tricky Dick reformed the Executive branch's budget arm into what we know as the OMB today - resulting in a legislative response in the form of the Budget Control and Impoundments Act of 1974; with its creation of the CBO, the Budget Reconciliation process and things like the Byrd rule - the CBO scoring has always been the authority in such debates.

It served Reagan well allowing him to hike taxes a dozen times without leaving as much as a fingerprint against his conservative credentials by doing just that, willingly, even after securing dramatic cuts just a few years earlier. The same was true with Bush the 1st until he out-promised the triggers built into the Budget years before his re-election run even kicked off. Clinton seems to have stepped into the best 10 year budget plan ever; (scaring the c-rap out of everybody by somehow proving it actually works when followed). Bush2, however, didn't follow the plan and didn't allow the built-in triggers to do what they were suppose to do when the scoring changed over time & events (You never heard anything about Reagan's, papa Bush's or Clinton's tax policies expiring right? That's because by the end of 10 years of adjustments there was little left to actually fight over). In fact, he bucked the entire system more than just once or even twice by doubling down with an unfunded mandate in the middle of a "war" or two.

All the way up to today and irregardless of who is currently in office, the scoring from CBO has always been the rule & not the exception. I don't know why folks see it any differently unless they want to reinforce a double standard or something. Everybody knows a budget is only one fiscal year long and can't be accurately predicted more than half of the 10 year limit imposed by the BR process anyway so why make an issue out of it either way? Its as much as a fact as human perception can reasonably allow for. If the government waited for every little thing to fully pan out into factual history, we'd still be squabbling over grain embargoes and possibly speaking Panamanian by now. -- George Orwell III (talk) 21:30, 1 July 2012 (UTC)

Good grief. Belchfire (talk) 15:05, 2 July 2012 (UTC)

• Belchfire, you said the sources are being misrepresented. How so? And you added, "Supporters claim". Please explain how these 2 sources are demonstrative of being "Supporters". Somedifferentstuff (talk) 00:17, 2 July 2012 (UTC)

Fine, don't call them supporters. That's an assumption on my part, based on the fact that the "supporters" are parroting liberal talking points. It seems like the logic choice of words, but I'm open to suggestions. The larger point is the distinction between claims and established empirical facts. Belchfire (talk) 15:05, 2 July 2012 (UTC)

You could write, "According to a report by "name of source", healthcare spending will be ......................" Somedifferentstuff (talk) 14:21, 3 July 2012 (UTC)

Yes, you could have done that. And that sort of verbiage is probably appropriate, so long as the key fact is spelled out - that the information is just somebody's opinion, and is a prediction of what they think will happen in the future. Belchfire (talk) 20:05, 3 July 2012 (UTC)

Please don't get sidetracked on politics or personal sniping. WP:WTA says to avoid saying "claim" as a general rule. We're not evaluating whether the claims are true or not - we're simply reviewing that A said this, B said that. What the article is actually reporting - that our sources said these things are true (or false) - should be clear from the sources. Wnt (talk) 23:31, 3 July 2012 (UTC)

Edit request on 2 July 2012

In the sub article "Term Obamacare" it says in the text *heath* instead of *health* somewhere. Please have that corrected, thank you.

178.82.254.7 (talk) 11:05, 2 July 2012 (UTC)

Done. Somedifferentstuff (talk) 13:06, 2 July 2012 (UTC)

CBO estimates

There seems to be some editorial confusion about the Congressional Budget Office analysis, and that confusion has translated into factual errors in the article. In my edit here, I removed one such error. Our article stated:

• In 2012, the Congressional Budget Office (CBO) projected the Act will result in net spending of just under $1.1 trillion over the period 2012–2022.

The CBO source document is here. It states that "... the insurance coverage provisions of the ACA will have a net cost of just under $1.1 trillion..." (emphasis mine)

The highlighted words are important - the insurance coverage provisions will cost $1.1 trillion, but those costs will be offset by other parts of the Act. The CBO goes on to state exactly this:

• Those amounts [the $1.1 trillion] 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.

See? The $1.1 trillion in spending is more than offset, according to the CBO, by increases in revenue and reductions in spending, so that the net effect of the Act as a whole is to reduce budget deficits. It's misleading in the extreme to claim that the Act will have a net cost of $1.1 trillion - and it's nonsensical, since a sentence or two later we correctly note that the CBO projects it will reduce the deficit. If there's any ongoing confusion, let's resolve it here instead of repeatedly reinserting factual errors into the lead of this high-profile article. MastCell ^Talk 05:26, 8 July 2012 (UTC)

I don't dispute what you've laid out one bit. The problem is trying word all that without specifying the spending and/or savings in such detail that it gets the opposing view's 'back up' to the point where they must add/subtract a rebuttal to that view. Neither should be in the lede if the reverts can't be stopped with some sort of compromise at the end... but I can't argue with your reasoning nor your ref'd sources personally. -- George Orwell III (talk) 05:39, 8 July 2012 (UTC)

I think it's pretty simple. In the lead, we should summarize the bottom line of the Act as a whole (in this case, per the CBO, a net reduction in the budget deficit). We can and should get into the projected cost of various subparts of the Act in the body of the article, where that level of detail is appropriate. But we can't present the net cost of one part of the Act as if it were the net cost of the Act as a whole. That's breaking our most basic pact of honesty with the reader. MastCell ^Talk 05:48, 8 July 2012 (UTC)

You'll get little argument from me on that point but that doesn't seem to be stopping the dozen of changes going back and forth on this recently. The additions about the poverty line, 30 million covered, etc. in the lede are not conducive to resolving anything either. -- George Orwell III (talk) 06:01, 8 July 2012 (UTC)

As the instigator of much of this distress, I apologize. I see now it would have been better to air my concerns here. If we simply state that the Act reduces the deficit, it will lead many casual readers to believe that this Act causes federal spending to decrease, when in fact it will increase spending by about $1.1T NET, just for the insurance related costs. Are the net total costs know? I agree that is a more germaine number. How about saying this: "The Act (ACA or PPACA?)reduces the deficit by $xxT through 20xx in comparison to health care legislation previously in place. New costs included in the Act are partially offset, primariy through the elimination of Medicare Advantage and the imposition of certain new or increased taxes and the mandate penalty. Net total cost of the Act is $xxx through 20xx." That seems balanced and sufficiently informative to me. Speaking of the 30 million, for balance it would be appropriate to mention that there will be 27 million remaining uninsured in 2016. Does it belong in the lede? I think so, as it is the main selling point of the ACT. I will be traveling the next couple of days and out of the loop. Also, as a newbee, I am struggling with the whole citation thing. (I hope it isn't as tedious as it appears at this point...) so if anyone wants to run with this, please have at it....Thomas Pain 67 (talk) 12:15, 8 July 2012 (UTC)

A neutral presentation focuses on the net effect of the whole Act (i.e. the net deficit impact) in the lede. Focusing primarily on the costs of one part of the Act taken by itself is just as deceptive as focusing primarily on the savings or revenue increases of another part taken by itself — we could just as accurately say that the "Act saves money and increases revenue by over a trillion dollars". — Steven G. Johnson (talk) 13:15, 8 July 2012 (UTC)

Exactly. The deficit / bottom line impact is what belongs in the lead. Discussion of the cost side should be balanced with the revenue and additional cost reductions. Just the costs alone is conservative spin.Farcaster (talk) 15:44, 8 July 2012 (UTC)

Text Image Overlap

In the overview section the second picture (white house staff react) can overlap with the text of the section. It appears to happen on Google Chrome, but not Internet Explorer or Firefox. It can be reproduced by resizing the Chrome window. At different sizes the text has a chance of overlapping. I've tested it on separate machines using Windows 7 and Ubuntu. It may be just an error with the layout of the page or it might be a more general problem with the way Chrome handles the image format being used. I haven't looked into it further than that. Golmschenk (talk) 19:11, 11 July 2012 (UTC)

The Mandate is not a tax.

The lede currently says

"... ruling that the mandate was a tax and therefore fell under Congress' taxing authority "

This is wrong both grammatically and semantically. The current wording also gives the false impression that the purpose of the mandate is to raise money though the court accepted that it is not. It also uses a wrong tense (was instead of is). Congress' is wrongly spelling (because the extra s is pronounced). To correct these errors I would suggest it be edited by someone (not me) to say

"....ruling that the shared responsibility payment, though intended as a penalty to induce people to become insured rather than to raise revenue, should nevertheless be construed as tax, thus making it and the mandate constitutional under Congress's taxing authority."

Reasoning

a) the mandate is a requirement to have insurance or else pay a penalty- Its the penalty and not the mandate that is the tax.

b) the terms in the law for the payment is both "shared responsibility payment" and "penalty"

c) the Chief Justice, when designating this as a tax, states that "..none of this is to say that payment is not intended to induce the purchase of health insurance" - i.e. he is accepting the government position that the mandate is intended to induce people to buy insurance and not to raise money.

d) the key element of the decision is that the framing of the penalty is constitutional

e) the tense in the original is wrong... the mandate WAS is wrong. It should be IS (sounds like it was written by someone with wishful thinking)

f) the correct spelling is "Congress's" with the extra s shown (because it is pronounced with an extra s) — Preceding unsigned comment added by 80.223.105.147 (talk) 00:57, 1 July 2012 (UTC)

It is a tax, that is what the SCOTUS defined it to be. If it were a penalty it would be unconstitutional. Those are the facts. Arzel (talk) 22:09, 2 July 2012 (UTC)

Aux contraire. The court said the PENALTY was a tax, not the MANDATE. It was because the penalty could be construed as tax that made the MANDATE lawful. You seem to be repeating Republican talking points which do not have to meet Wikipedia's strict rules regarding accuracy.80.223.105.147 (talk) 00:12, 3 July 2012 (UTC)

I suggest you actually read the ruling before presenting the Obama's administrations new spin on the wording and belittle the true wording as some Republican talking point. Here is the pertinant passage, I have bolded the important parts.

3. CHIEF JUSTICE ROBERTS concluded in Part III–B that the individual mandate must be construed as imposing a tax on those who do not have health insurance, if such a construction is reasonable. The most straightforward reading of the individual mandate is that it commands individuals to purchase insurance. But, for the reasons explained, the Commerce Clause does not give Congress that power.It is therefore necessary to turn to the Government’s alternative argument: that the mandate may be upheld as within Congress’s power to “lay and collect Taxes.”

Ergo, it has been defined as a tax. Additionally, the tax itself was not even ruled constitutional, only that since it is to be considered a tax it cannot be challenged until someone actually has to pay the tax. Expect future lawsuits in 2015 when the tax has to be paid for the first time. Arzel (talk) 01:26, 3 July 2012 (UTC)

Ergo nothing. The court used English normatively by saying that the mandate (i.e. the part of the law describing the mandate) imposes a tax on those without insurance (i.e. those that do not comply). That is a very different thing from saying that the mandate is itself a tax. A mandate is an order to do something and the penalty is a different thing, being a tax penalty for non compliance. We cannot and must not change the meaning of mandate to mean a penalty. That is nonsense.80.223.105.147 (talk) 21:20, 3 July 2012 (UTC)

Dear Arzel: No. Completely wrong. You're still not getting it. The Court ruled that the penalty imposed by section 5000A is a tax for constitutional purposes -- and that it is valid under the Constitution.

There is no need to wait until the year 2015. The Court also ruled that the Anti-Injunction Act does not apply. Period. If the Anti-Injunction Act applied, then yes, you would have to wait until someone paid the penalty, in the year 2015, in order to litigate its validity. That is not the case. The validity of the penalty was decided by the Court on June 28, 2012. It is incorrect to say that "since it (the section 5000A penalty) is to be considered a tax it cannot be challenged until someone actually has to pay the tax." That is completely incorrect. Famspear (talk) 01:50, 3 July 2012 (UTC)

I see you are correct abou the Anti-Injunction Act aspect, but I disagree that he ruled the mandate constitutional, I read it that he ruled that congress has the constitutional authority to levy taxes and that is constitutional. Regardless, it is a highly convuluted ruling which will only make things worse. What a sad day for the SC, Roberts made things worse for everyone on both sides of the issue. Arzel (talk) 17:14, 3 July 2012 (UTC)

If the authority for an action has been ruled to meet constitutional requirements, executing that action is then considered or construed to be constitutional. Yes, that conclusion is derived from an extrapolation and interpretation but it is one made based on & within the law. We will never find specific things like a "mandate" in the original Constitution by the founding father's own design - they left the language vague enough to allow future acts or actions to be deemed constitutional without having to list each every possible thing under the sun (something they were wise enough to understand they could never do no matter how long the list). -- George Orwell III (talk) 19:43, 3 July 2012 (UTC)

Nothing in this thread addresses the issue I have raised which is that the mandate is an order to do something and the penalty is a penalty which is constitutional because it is a tax. But we cannot say the the mandate is a tax because that changes the meaning of mandate. The Court did NOT say the mandate is a tax, only that the penalty payment is a tax. The lede should be changed.80.223.105.147 (talk) 21:20, 3 July 2012 (UTC)

Oh, I agree the lede does not reflect reality; only misplaced semantics and misinterpretation of the ruling. Its like saying a speeding ticket is somehow a tax; makes no sense. -- George Orwell III (talk) 21:43, 3 July 2012 (UTC)

There is no rule in Wikipedia that says that the U.S. Supreme Court must use every day terms (such as "mandate" and "tax") in a way that makes sense to Wikipedia editors, or in a way that must be approved by Wikipedia editors. This point has been covered already. No, neither the Court nor the article is displaying "misplaced semantics." Using the term "mandate" in the way the Court used the term does not constitute "misinterpretation of the ruling." Famspear (talk) 22:45, 3 July 2012 (UTC)

Dear Arzel: No, the ruling is not really that convoluted. It may seem convoluted if you haven't studied the actual texts of thousands and thousands of court decisions over many years, but these kinds of opinions -- especially by the U.S. Supreme Court -- are fairly common. American law, especially American tax law, is extremely complex, and Supreme Court opinions are not written particularly to be understood by the average person (although I think many courts try to use plain, non-technical language to some extent). Court opinions are written primarily to be understood by lawyers and judges. The Court ruled that the provision in Internal Revenue Code section 5000A that imposes a liability for a "penalty", a "shared responsibility payment", (to use the actual terms in the statute, which does not include the term "individual mandate") is constitutionally valid. The Court upheld that penalty as a tax. If someone goes to court and argues in a court of law that the Supreme Court did not uphold the section 5000A penalty, that person could be penalized for litigating a frivolous position.

By the way, I think the problem that some of my fellow editors are having with the Court's use of the term "mandate" (in a way that is not the "ordinary" way the term is used) reflects an "understandable misunderstanding," on the part of my colleagues, of how legal analysis works. Famspear (talk) 23:04, 3 July 2012 (UTC)

No - it seems to me everybody "gets" your point in general but you may not be realizing that such nuances in language, be they the norm in legal circles or not, should not being deviating so "far" from the common man's language in the opening summary specifically. It's better to have the nuance expanded upon down further in the analysis rather than "steam-rolling" over it just for the sake of some legal etiquette that is lost on most visitors at the beginning of the article. -- George Orwell III (talk) 00:07, 4 July 2012 (UTC)

It is not for us as Wikipedia editors to decide about "deviations" so "far" from the common man's language. Look, this is an article about a court decision. And it's not a question of "legal etiquette". And nothing is "lost on visitors." Indeed, the public at large almost surely views the term "individual mandate" (again, not a term found in the statute) as consisting of both the requirement to buy insurance AND the monetary penalty for failure to do so. That's how the media seems to be reporting the term, and that's how the Court itself used the term. The Court upheld the individual mandate. The Court upheld the individual mandate. The Court upheld the individual mandate. That's how the vast majority of people "hear" the result of this case. And what the Court upheld was the section 5000A penalty -- the requirement to PAY a penalty if you don't buy the health insurance. So, it's not a question of "steam-rolling" over anything.

I would respectfully argue that with some exceptions, as a general rule we as Wikipedia editors should not be here to "correct" the Court -- or the media -- when the Court or the media use terms like "mandate" in ways that we deem to be incorrect. However, if we can find a previously published third party source that says what you want to say, then I say go for it.

With all due respect from me as well, you're still missing the point (in my view) that I & maybe some others are trying to make by the second sentence in the 1st paragraph of your reply above,

"Look, this is an article about a court decision."

No, this is an article about a piece of legislation enacted into law that deals with health care reform and outlines key events as they relate to specific provisions found within the Act -- only one event of many was a constitutional test recently answered by the high Court. It seems there is a notable difference in the way I (or we?) see the primary task for this encyclopedic entry compared to what you think is the primary task, purpose, subject or topic is. I respectfully dare to say your POV on what amounts to a current event is not the majority view; the Act as an aggregate whole, through time and subsequent events is. -- George Orwell III (talk) 05:28, 4 July 2012 (UTC)

Let me give you an example of a situation where I might agree more with your approach -- and it happens to deal with taxes. (This would be an exception to what I am talking about above with respect to the "mandate.") I saw this again just the other day in a Wikipedia article. Members of the news media have a nasty habit of reporting anyone who is convicted of a federal tax crime as having been convicted of "tax evasion" when the individual has not been convicted of tax evasion. For example, a recent news story incorrectly reported Lauryn Hill's guilty plea for failure to file federal income tax returns as having been a "tax evasion." The headline for the story even used the term "tax evasion," if I recall. Now, that is a serious problem.

Failure to file a federal tax return is a misdemeanor, with a maximum penalty of one year in prison. You can be convicted of that merely by willfully failing to do something by a given due date. By contrast, federal tax evasion is a felony with a maximum penalty of five years in prison, and it requires a willful affirmative act (such as filing a false return, lying to the IRS, moving assets around to try to prevent tax collection, and so on). Merely failing to do pay or file is not an affirmative act.

Now, we as Wikipedia editors cannot change what is written in news media articles, and we cannot change the actual headings or titles of the media stories, even if those title are incorrect. What we can do, and what we are required to do, is make sure that the main text of the article itself is correct when dealing with a biography of a living person. In that case, we in Wikipedia have a special legal and moral obligation to make sure we get it right.

But this article on the Affordable Care Act is not that situation. We may not like the way the media and the courts use the term "individual mandate." But our choice is not to "correct" them. What we can do, perhaps, is to point out in the article that the "mandate" (as that term is used by some in the media and sometimes by the Court) does consist of more than one component: (1) the requirement to buy insurance, and (2) the penalty imposed on those who do not buy. Now, that may require using a primary source (the text of the statute itself) but Wikipedia rules do not prohibit the use of all primary sources in all situations. This could be a situation where use of a primary source is helpful.

Look, you are making far too many assumptions, imho. Let me be blunt with apologies in advance.

I get it just fine.

Its a tax as far as it relates to the Internal Revenue Code of 1954, as superseded by the Internal Revenue Code of 1986, as amended, and as currently codified to Title 26 of the United States Code.

No seriously, I do get it. Things like a lien arising from an unsatisfied order of restitution issued in favor of the victims of someone convicted for a federal crime under Title 18 can also be considered or construed as a tax even though the laymen scratch their heads and wonder to themselves 'how is it possible for the government to tax someone for the benefit of someone else'? I know that it is possible because I know the vehicle and language used to enforce such an order falls under the same statute(s) that say collecting a unsatisfied tax assessment would. You, however, seem to be assuming that type of intricate nuance is common knowledge in the public domain more so than not, as well as believing it is the most important aspect of this article overall rather than simply one aspect in an ever growing pool of many in passing & only framed by a perspective of nothing more than current events.

Sorry; Generalities and simplicities in the lede - details and nuances in the body of the analysis is the way that makes the most sense to me in spite of understanding the nuance in question personally. -- George Orwell III (talk) 05:28, 4 July 2012 (UTC)

If my fellow editors are amenable to this, I would suggest something like this approach as a possible solution. This might fall into line with the approach that editor George Orwell III has suggested. Thoughts, anyone? Famspear (talk) 00:49, 4 July 2012 (UTC)

I would like to make a general observation. What a court (including the Supreme Court) labels something is only of marginal bearing. Courts are generally deciding whether a particular thing falls into a particular legal category, e.g, whether something is or is not a "tax" or a "penalty" under such-and-such statute or such-and-such legal precedent. This does NOT mean that the court is an authority on semantics or lay usage. I would put much more stock in the terms reliable sources are using. If the Supreme Court says an apple is an apple but the newspapers say an apple is an orange, then I would go with what the newspapers say. --Nstrauss (talk) 21:19, 12 July 2012 (UTC)

Effects on the Economy

As an European who is interested in the US-Policy, I tried to find out what the effects of "Obamacare" on the society and on the economy are excepted. I just didn't find any good analysis - so I beg US-Wikipedians to answer that for me in short: If millions of US-citizen now don't have to pay so much for medicine anymore, don't become they a new class of consumers for the US Economy? If the poor have more money left they normally spend that on consume. So is "Obamacare" in reality not an Economy-Pushing Program ? Maxian D-C (talk) 22:59, 12 July 2012 (UTC)

Proposed new lede

Hope I'm not taking liberties here normally frowned upon on Talk pages by drafting a replacement lede for side by side review. If I have, just move it to my talk page or delete it completely.

1st run

Current

1st proposal

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. PPACA requires individuals not covered by employer- or government-sponsored insurance plans to maintain minimal essential health insurance coverage or pay a penalty unless exempted for religious beliefs or financial hardship, a provision commonly referred to as the individual mandate. The Act also affects certain aspects of the private health insurance industry and public health insurance programs, requires insurance coverage of pre-existing conditions, seeks to extend coverage to 30 million uninsured Americans, and increases projected national medical spending. Supporters[citation needed] claim it will slow health care cost inflation and reduce the national deficit. The Congressional Budget Office projects it will lower future Medicare spending. PPACA passed the Senate on December 24, 2009, by a vote of 60–39 with all Democrats and two Independents voting for, and all but one Republican voting against. It passed the House of Representatives on March 21, 2010, by a vote of 219–212, with 34 Democrats and all 178 Republicans voting against the bill. A majority of the states, and numerous organizations and individual persons, filed actions in federal court challenging the constitutionality of some or all of the elements of PPACA. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law by ruling that the mandate penalties, as a type of tax, were allowable under Congress' constitutional taxing authority. The court, however, prevented the federal government from withholding all Medicaid funds to states that fail to comply with the expansion of Medicaid, permitting them to withhold only new Medicaid funding from noncompliant states.

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute introduced with the general aim of providing new opportunities towards securing affordable, quality health care for substantially more Americans than was previously available or possible, to attempt to reduce the rate of growth in health care spending in national terms over a period of years following enactment, to improve health related outcomes while searching for savings in the delivery of those services, and several other health care reform related purposes. The legislation (along with the Health Care and Education Reconciliation Act of 2010) was the principal health care reform proposal introduced and passed during the 111th United States Congress. The PPACA passed the Senate on December 24, 2009, by a vote of 60–39 with all Democrats and two Independents voting for, and all but one Republican voting against it. The bill was later passed in the House of Representatives on March 21, 2010, by a vote of 219–212, with 34 Democrats and all 178 Republicans voting against the bill. It was then signed into law by President Barack Obama on March 23, 2010. The PPACA hopes to provide individuals not already subject to a designated qualified health benefits plan by a number of incentives to secure new coverage via a framework of subsidies and/or penalties phased in by the law over time. Additional reforms intend to improve health-care outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those health-care services. The Act also affects certain aspects of the private health insurance industry and public health insurance programs, mostly by expanding the coverage pool and extending the age limits of those who must be covered and requiring changes to existing industry practices; some of which being controversial due to participation in the new guidelines conflicting with religious objections. Estimates roughly project qualified coverage to expand to 30 million previously uninsured Americans fostered through an initial increase in national spending on entitlement related funding. Proponents of the the Act's reforms cite claims supported by the Congressional Budget Office's scoring of the law that it will slow health care cost inflation and ultimately reduce the national deficit since it will lower future Medicare spending in comparison to no reforms taking place at all over the same period of years. Twenty-six states, numerous organizations as well as several individual persons, filed various actions in the federal courts challenging the constitutionality of at least some if not all of the elements enacted by the PPACA's passage. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld key provisions in the law by ruling they were permissable under Congress' constitutional taxing authority while struck down other provisions in the law concerning an over-reach of Federalism.

Note: Ref notes and interlinks temporarily removed in hopes of better clarity. -- George Orwell III (talk) 05:07, 4 July 2012 (UTC)

I do like some of the changes you've proposed...however, I think the first paragraph reads too much like an advert/campaign ad. (And this is from someone who's an ardent supporter of the ACA. :) But some of the other edits/expansions are definitely good, and absolutely worth adding! I'd definitely change the tone of that first paragraph though; it's only going to be flamebait for an edit war in your proposed form, even if you do have references to back up all of the claims. – 2001:db8:: (rfc | diff) 10:03, 4 July 2012 (UTC)

Point taken and feel free to take a whack at it. Every formally introduced bill has a "purpose" statement at the beginning (An Act to..., to..., and for other purposes.). I took all the purpose statements I could find introduced in the bills prior to the one that first passed the House and tried to make a paragraph out of the points that kept (re)appearing. Admittedly, the statement that wound up being enrolled and signed into law was simply An act entitled The Patient Protection and Affordable Care Act. (talk about walking back previous statements!)

I'd have no problem dropping it all after (or about) Obamacare and elegantly transitioning to what is currently paragraph 2 of the first proposal dealing with the bill's passage, etc. (see second proposal. -- George Orwell III (talk) 11:50, 4 July 2012 (UTC)

I like the first proposal. I suggest however some changes.

1.) The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute initially introduced... --> Strike initially, otherwise it sounds like the ACA was introduced with other motives like the ones mentioned.

Good point - Done. -- George Orwell III (talk) 02:36, 6 July 2012 (UTC).

2.) The PPACA hopes to provide individuals not already subject to a designated qualified health benefits plan, or to an equivalent exemption from the law, a number of incentives to secure new coverage via a framework of subsidies and/or penalties, among other reforms, phased in by the law over time. --> The sentence sounds confusing. For example I don't understand what you mean by "or to an equivalent exemption from the law". Reword proposal by removing content: The PPACA hopes to provide individuals not already subject to a designated qualified health benefits plan with coverage via a framework of subsidies and/or penalties phased in by the law over time.

EDIT - I eventually saw your point re: confusion and I was indeed mixing individual participation with organization participation. Amended. See how you like it now. -- George Orwell III (talk) 03:06, 6 July 2012 (UTC)

3.) On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld key provisions in the law by ruling they were permissable under Congress' constitutional taxing authority while struck down other provisions in the law concerning an over-reach of Federalism. --> Wrong because of two reasons. 1.) The court upheld the individual mandate as constitutional under the Taxing and Spending Clause. Because of this there was no need to discuss whether the Affordable Care Act could survive if the Court strikes down the individual mandate. Hence no need to discuss the other key provisions of the law like the prohibition for insurers to impose lifetime dollar limits on essential benefits. 2.) The court struck down as unconstitutional the portion of the Affordable Care Act which enabled Congress to withdrew all Medicaid funding from the states, if the states don’t comply with the Medicaid expansion. The court deemed this as unconstitutionally coercive. Because of these points I suggest strongly to retain the old explanation i.e. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law by ruling that the mandate penalties, as a type of tax, were allowable under Congress' constitutional taxing authority. The court, however, prevented the federal government from withholding all Medicaid funds to states that fail to comply with the expansion of Medicaid, permitting them to withhold only new Medicaid funding from noncompliant states.

--P3Y229 18:50, 4 July 2012 (UTC) — Preceding unsigned comment added by P3Y229 (talk • contribs)

I don't know - what you suggest seems like it belongs in the analysis not the lede. I kept it simple - not mentioning specific provisions either brought by the states in front of the Supreme Court or not as well mentioning some of the law was held to be allowable while another part was not. The specific what and why should be in the analysis & not the lede in my opinion -- George Orwell III (talk) 02:36, 6 July 2012 (UTC)

2nd run

 

Current

2nd proposal

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. PPACA requires individuals not covered by employer- or government-sponsored insurance plans to maintain minimal essential health insurance coverage or pay a penalty unless exempted for religious beliefs or financial hardship, a provision commonly referred to as the individual mandate. The Act also affects certain aspects of the private health insurance industry and public health insurance programs, requires insurance coverage of pre-existing conditions, seeks to extend coverage to 30 million uninsured Americans, and increases projected national medical spending. Supporters[citation needed] claim it will slow health care cost inflation and reduce the national deficit. The Congressional Budget Office projects it will lower future Medicare spending. PPACA passed the Senate on December 24, 2009, by a vote of 60–39 with all Democrats and two Independents voting for, and all but one Republican voting against. It passed the House of Representatives on March 21, 2010, by a vote of 219–212, with 34 Democrats and all 178 Republicans voting against the bill. A majority of the states, and numerous organizations and individual persons, filed actions in federal court challenging the constitutionality of some or all of the elements of PPACA. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law by ruling that the mandate penalties, as a type of tax, were allowable under Congress' constitutional taxing authority. The court, however, prevented the federal government from withholding all Medicaid funds to states that fail to comply with the expansion of Medicaid, permitting them to withhold only new Medicaid funding from noncompliant states.

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, attempts to make a significant overhaul of the health care and health insurance sectors for Americans after a number of unsuccessful attempts at reform being made in the decades prior to its enactment. The legislation itself (along with the Health Care and Education Reconciliation Act of 2010) was the principal health care reform proposal introduced and passed during the 111th United States Congress. The PPACA passed the Senate on December 24, 2009, by a vote of 60–39 with all Democrats and two Independents voting for, and all but one Republican voting against it. The bill was later passed in the House of Representatives on March 21, 2010, by a vote of 219–212, with 34 Democrats and all 178 Republicans voting against the bill. It was then signed into law by President Barack Obama on March 23, 2010. The PPACA hopes to provide individuals not already subject to a designated qualified health benefits plan by a number of incentives to secure new coverage via a framework of subsidies and/or penalties phased in by the law over time. Additional reforms intend to improve health-care outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those health-care services. The Act also affects certain aspects of the private health insurance industry and public health insurance programs, mostly by expanding the coverage pool and extending the age limits of those who must be covered and requiring changes to existing industry practices; some of which being controversial due to participation in the new guidelines conflicting with religious objections. Estimates roughly project qualified coverage to expand to 30 million previously uninsured Americans fostered through an initial increase in national spending on entitlement related funding. Proponents of the the Act's reforms cite claims supported by the Congressional Budget Office's scoring of the law that it will slow health care cost inflation and ultimately reduce the national deficit since it will lower future Medicare spending in comparison to no reforms taking place at all over the same period of years. Twenty-six states, numerous organizations as well as several individual persons, filed various actions in the federal courts challenging the constitutionality of at least some if not all of the elements enacted by the PPACA's passage. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld key provisions in the law by ruling they were permissible under Congress' constitutional taxing authority while struck down other provisions in the law concerning an over-reach of Federalism.

-- George Orwell III (talk) 12:50, 4 July 2012 (UTC) Thomas Pain 67 (talk) 21:11, 4 July 2012 (UTC)

I think folks are getting caught up in too much detail for the lead. It was controversial and the Supreme Court upheld it. CBO estimates it will reduce the deficit and Medicare spending. These are key points for the lead. What other less credible folks think about the CBO estimates can go in the body. Likewise which specific parts were upheld or not can go in the body. 23:42, 4 July 2012 (UTC)

Way too much detail for a summary lede. Somedifferentstuff (talk) 09:24, 5 July 2012 (UTC)

While I'm more than likely to agree that there is still too much detail, I was only trying for the middle-ground in the form of a compromise. -- George Orwell III (talk) 19:12, 5 July 2012 (UTC)

As far as "['initial' suggests that this added spending will diminish over time. Is there an example of entitlement spending that ever went down, excluding of course Medicare Advantage and the Bush Medicaid Prescription coverage which costs less than estimated by the CBO; both eliminated by the ACA?] goes; Yes entitlement spending will have to go down as they always would when this wave of baby-booming retirees ultimately expire. As a nation we have only seen monthly blips in any decrease of entitlement spending but part of the whole reason for the increase in entitlement outlays now is the current and unusual amount of retirements from the workforce taking place. This particular population's spike will peak somewhere near the start of the next 10 year cycle and begin to decline rather rapidly unless life expectancy jumps dramatically in the interim. -- George Orwell III (talk) 19:12, 5 July 2012 (UTC)

I took the the word "initial" to refer to the new entitlements contained in the legislation. (Massive expansion of Medicaid roles and insurance subsidies for those with incomes under 140%? of poverty level) I don't think the number of poor people, the cost of insurance, or the definition of the poverty level are going to become smaller numbers any time soon. (although the latter would do a lot to motivate the un-motivated to move out of poverty, in my opinion.) Thomas Pain 67 (talk) 22:30, 5 July 2012 (UTC)

All points well taken here but I feel we must drill-down even further past the spreadsheet breakdowns back to the root of problem. The core issue(s) here are that most of that new 30 million are already taking resources out of the system as it is before any attempt at reform was ever made or has taken place since AND the high ratios of those currently working to those being subsidized have fallen quite a bit at the same time. Now the amount of folks receiving services, both in the public and private systems, that haven't or aren't paying into the system one way or another really hasn't grown all that much over the years. Its the spike in retirees that makes the rate of growth in health care costs go insane - not so much those who practice poor preventative care or make dozens of emergency room visits for even the smallest of things. If you get those folks into the system with subsidies, penalties and/or exchanges, the private sector has little to justify the roughly 10% of what they now claim as the reason for premium increases for the rest of the nation. Add to that more efficient health service delivery plus more preventative care across the board for everyone regardless of public or private coverage and you've then stagnated at least the rate of growth of costs if not eventually, one day in the not-so-near future, the costs themselves.

As long as after the spike ends there is still a ratio somewhat higher than 1 to 1, adjusted for inflation, etc., then the system is sustainable - just without the same tempting intra-governmental debt (money we owe ourselves) being accrued like we've had up until now with high worker-to-retiree ratios. The less money we owe ourselves the less likely the need and/or the means to "spend" any surplus or to "borrow" against it (not to mention any attempt at expanding benefits themselves [not the same as expanding coverage btw] will need some other way to secure funding other than the current "norms"). This is why I consider thing's like the [Privitizing] Ryan plan an extreme over-reach that tries to take advantage of a perceived crisis rather than the true realities at hand. All we need to do is find a way to get over the current spike without screwing those from getting what they've been paying into all this time, introduce things like means testing and tying benefits to birth-rates & population changes while moving forward, and we should be fine as far as this problem goes. Easier said than done - this law, while nowhere near perfect, is but one step in that direction imo. -- George Orwell III (talk) 02:13, 6 July 2012 (UTC)

G O III, thanks for the feedback, it brings some other issues to mind. But before I go there, can you explain why you describe the required coverage as "minimal essential"? Those words strike me as totally opposite of what is mandated. This is not catastrophic coverage, but instead broad (i e expensive) coverage with co-pays and deductibles designed to be within the reach of those with modest means. Forcing those who can legitimately self-insure to buy something they don't want or need is one of my main problems with this legislation. These folks are not free-riding the system, they simply are comfortable with their own ability to make health care choices that are best for them, and then pay the bill when it comes due. We need to show some respect for this type of citizen; they are the ones that tend to pull the wagon, rather than ride in it.

That "minimal essential" on the left is the current version & not part of my proposal on the right (click the expand button to the right near the 2nd run section if you don't see two columns)

The issue with who can afford coverage but don't because they are still young or whatever is just as problematic as those free-riding the system. Its the unexpected fall or accident that causes unexpected consequences which throws the rationale or notion of "self insurance" to the wayside. One might think their reserves can handle one catastrophic illness but what about 2 in a short period of time? I agree that that type of decision warrants respect but I'm more concerned with those folks getting hosed by the unexpected anyway -- George Orwell III (talk) 21:43, 6 July 2012 (UTC)

Re: "Its the spike in retirees that makes the rate of growth in health care costs go insane" I get the bubble argument, but the fact remains that neither Medicare nor SS have sufficient tax rates to collect the necessary funds over the average person's working lifetime to provide anywhere near the benefits promised. Now we have a populace that thinks they "paid for" their entitlements, and God help the politician stupid enough to admit otherwise. Defined Benefit entitlements are a bad idea and new ones are even worse unless the goal is to become a European style social democracy, IMO.

It would, and I don't mean to sound morbid here, if all the baby boomers expired tomorrow. The main problem is the spike exacerbated by the years of lacking any matching adjustments for population & workforce growth (as well shrinkage if that ever happens). We are still far from most EU systems where the number of years worked prevails over what you actually paid into the system over the same number years worked like we have here. Its really an apple to orange comparison imo. -- George Orwell III (talk) 21:43, 6 July 2012 (UTC)

Re: "... just without the same tempting intra-governmental debt (money we owe ourselves) being accrued like we've had up until now with high worker-to-retiree ratios. The less money we owe ourselves the less likely the need and/or the means to "spend" any surplus or to "borrow" against it (not to mention any attempt at expanding benefits themselves [not the same as expanding coverage btw]" I have never found a satisfactory explanation of why the "National Debt" that gets discussed in the media does not include the intra-governmental debt. It is just as much a true cost to the government when someone from SS walks into the Treasury and says "I want to cash in my inflation protected US Treasury Bond" as when someone from the Chinese Government comes in and says "Dawa prese". The only difference I can see is that the former $ stays in the US economy until someone buys something from China, while the latter $ leaves immediately, (unless used by the Chinese to buy some more American assets). For that matter, why aren't all unfunded mandates (at least as projected for the next 10-20 years or so) included in the "National Debt"? Maybe people will get excited over $60T?, even though $15T doesn't seem to matter too much. IMO, the politicians don't want us to understand how deep in the hole they have put us, for fear of losing their jobs, or worse...

Yes, many don't get intra-governmental debt at all and that's a huge hurdle to overcome no matter what we do in the future. Still owing ourselves is always preferable than owing others. Your point on China is well taken here but they only now enjoy the avenue paved by the U.K. in the decades before their "great awakening". The U.K. was 2nd largest holder of U.S. debt from WWII up through the rise of the Japanese economy in the early 80's followed by the Chinese today. A neat little trick since they didn't pay off Lend-Lease until the mid-1990's curiously enough (It happen the same time the Euro was introduced and the pound-to-dollar conversion rate was super beneficial btw). They are still the 4rth largest foreign holder of U.S. debt. -- George Orwell III (talk) 21:43, 6 July 2012 (UTC)

It's interesting to think about where we would be if the Government, instead of borrowing and spending all the surpluses over the years, had simply invested in randomly selected (to avoid corruption and/or picking winners and losers) investment grade U. S. corporate bonds. (Sort of like real insurance companies do things.) What a Capital idea....

We should have never securitized the surpluses into bonds. Let the Fed use the surplus rather than the money-press as the cash to lend out to banks at a modest rate of compounding interest in return. Not as flashy but slow and steady wins the game more often than not in my view. -- George Orwell III (talk) 21:43, 6 July 2012 (UTC)

Re: "...introduce things like means testing and tying benefits to birth-rates & population changes while moving forward, and we should be fine as far as this problem goes." Sadly, I thing means testing is probably on the horizon, and I will be one of its victims once the Progressives admit that it is going to take more than the top 1% to fix this problem. Obama harps on "fairness". Well, I don't think it is fair that I paid for my own college education, went without the big house, fancy car, frequent vacations, paid for college educations (no Stafford loans) for my two kids, saved as much as the law allows in my 401(k), and now my reward is to pay taxes and/or lose "entitlement" money so the dropouts, dopers, spendthrifts and Nth generation welfare crowd can have free health care, but that's just me....184.57.104.4 (talk) 19:22, 6 July 2012 (UTC)

Yeah but I prefaced that quote with making sure folks already playing by the rules and paying into system for some time are not part of the changes that must be made going forward and should not be screwed. You and those in the same situation as you are not to be left behind for the sake of some yet to be birthed children & grand-children the way I see it. -- George Orwell III (talk) 21:43, 6 July 2012 (UTC)

3rd run

 

Current

3rd proposal

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year's worth of overall consideration by both chambers of Congress. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. PPACA requires most adults not covered by an employer or government-sponsored insurance plan to maintain health insurance coverage or pay a penalty, a provision commonly referred to as the individual mandate. People earning less than four times the poverty line ($92,200 per year for a family of four) will receive tax credits to subsidize their purchase of insurance; those earning 133% or less of the poverty line will be eligible for expanded Medicaid coverage, although individual states may opt out of the Medicaid expansion. The Act also affects certain aspects of the private health insurance industry and public health insurance programs. It bars insurance companies from increasing premiums based on pre-existing conditions, and seeks to expand coverage to include 30 million uninsured Americans. In 2012, the Congressional Budget Office (CBO) projected the Act will result in net spending of more than $1.1 trillion over the period 2012–2022. The Congressional Budget Office also projected it will lower both future deficits and Medicare spending. Twenty-six states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law.

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year's worth of overall consideration by both chambers of Congress. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. The PPACA law hopes to provide individuals not already subject to a designated qualified health benefits plan, or employers not currently offering their workforce such benefit plans, with a number of incentives, phased in over time, to secure coverage via a framework of subsidies, tax-credits and/or penalties. Additional reforms intend to improve health-care outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those health-care services. The Act also affects certain aspects of the private health insurance industry and public health insurance programs; mostly by expanding the coverage pool to be more inclusive for the low-income, increasing the cut-off age for the offspring accepted under parental coverage and requiring changes to existing industry practices concerning, among others, the halting of any disqualification for preexisting conditions and the elimination of annual limits for various health-care or related services. According to the legislation's proponents, the Act's reforms aim to slow health-care cost inflation and ultimately help reduce the national deficit in predicting lower Medicare spending for the future. The estimates and their subsequent revisions, however, are frequently contested by detractors of the law's provisions and/or their implementation, putting the running figures into almost regular dispute. Twenty-six states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law.

-- George Orwell III (talk) 05:12, 6 July 2012 (UTC)

This version is fine for me. I would suggest to amend one sentence: "The PPACA hopes to provide individuals not already subject to a designated qualified health benefits plan by a number of incentives to secure new coverage via a framework of subsidies and/or penalties phased in by the law over time." Without the added "by" something is missing in the sentence and with it it makes imo sense. --P3Y229 07:43, 6 July 2012 (UTC) — Preceding unsigned comment added by P3Y229 (talk • contribs)

Gotcha & done. -- George Orwell III (talk) 08:54, 6 July 2012 (UTC)

sounds good to me.80.223.105.147 (talk) 18:35, 6 July 2012 (UTC)

I think still to much focus on controversy, discussion of entitlement spending, proponents this or that. I think the lead in there now is fine. CBO says this will reduce the deficit and future medicare spending, for a variety of complex reasons we don't want to get into. Religious objections are a tiny footnote in this bill. Too much conservative spin trying to find a home in the lede.20:07, 6 July 2012 (UTC)

What? The current lede brings up the specifics like pre-existing conditions the mandate and medicare where as the proposal merely aludes to them in generalities - like 'framework of subsidies and or penalties', expand the coverage pool and extend age limits. I agree the religous exception is better left to the analysis but I don't know how else to mention the duality of both Individual Responsibilities and Organizational Responsibilities when it comes to participation without out getting a little specific. Plus you mention minimal coverage whereas the law only asks for proof of designated qualified plans - this is misleading to the degree of coverage acceptable. -- George Orwell III (talk) 20:59, 6 July 2012 (UTC)

Again, I like some of your changes...but think some of them don't quite belong. E.g., your second paragraph starts out with "The PPACA hopes to provide individuals not already subject to a designated qualified health benefits plan by a number of incentives to secure new coverage via a framework of subsidies and/or penalties phased in by the law over time." That's a bit of a run-on and excessively confusing for the lead, even though it is essentially correct with a couple minor edits. My suggestion would be to just be bold and drop in your proposed changes in chunks, at least parts that you don't think would be objectionable. I suspect it'll be more productive than trying to rewrite the lead by consensus, when the lead is already changing over time anyways... There are also other issues in there which I think might be best addressed by, again, simply editing the lead with some of your proposals, so other folks can expand on your contributions. – 2001:db8:: (rfc | diff) 02:46, 7 July 2012 (UTC)

Hey, I'm no fan of my own work when it comes to the middle paragraph(s) - they are intended to foster debate here and/or independent changes on the main. The problem today, as is the case most days following a major event concerning the law and the re-energized focus that comes with it, is the lede becomes a battleground of ideas or views instead of just the introduction to the battlegrounds, rightly hashed out in the analysis found in the sections and sub-sections below it.

Instead of somehow phrasing a few simple, NPOV generalities reflecting the 3 primary areas of change in the law (indivdual responsibility - FMAP, mandate & penalty; employer responsibility - tax credits; health exchanges; and shared responsibilty - private insurance changes; public coverage expansion; streamling outcomes & delivery ), we are going the other way today by trying to 1-up one specific aspect of the law by adding another specific counter-aspect, and so on, from one hour to the next. We need more consensus built here rather than more reverts taking place on the main. -- George Orwell III (talk) 22:47, 7 July 2012 (UTC)

I merged the themes in the previous 3rd paragraph into the 2nd paragraph and continued to diffuse contested specifics with generalities in the lede to be discussed in pro or con detail in the sections and sub-sections that follow. -- George Orwell III (talk) 03:22, 8 July 2012 (UTC)

Basic informations are included in enough depth and presenten in a non-controversial way. This version is good. — Preceding unsigned comment added by P3Y229 (talk • contribs) 11:35, 8 July 2012 (UTC)

4th run

 

Current

4th proposal

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year's worth of overall consideration by both chambers of Congress. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. The PPACA law hopes to provide individuals not already subject to a designated qualified health benefits plan, or employers not currently offering their workforce such benefit plans, with a number of incentives, phased in over time, to secure coverage via a framework of subsidies, tax-credits and/or fees. Additional reforms intend to improve healthcare outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those healthcare services. Additional reforms intend to improve healthcare outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those healthcare services. The Act also affects certain aspects of the private health insurance industry and public health insurance programs. It bars insurance companies from considering pre-existing conditions or gender in coverage decisions, requiring them to cover all applicants and offer the same rates regardless of health status or gender. The Congressional Budget Office projected PPACA will lower both future deficits and Medicare spending. Twenty-six states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law.

The Patient Protection and Affordable Care Act (PPACA), informally referred to as Obamacare, is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year's worth of overall consideration by both chambers of Congress. The law (along with the Health Care and Education Reconciliation Act of 2010) is the principal health care reform legislation of the 111th United States Congress. The PPACA law hopes to provide individuals not already subject to a designated qualified health benefits plan, or employers not currently offering their workforce such benefit plans, with a number of incentives, phased in over time, to secure coverage via a framework of subsidies, tax-credits and/or fees. Additional reforms intend to improve health-care outcomes in the United States overall while updating the manner and streamlining the costs surrounding the delivery of those health-care services. The Act also affects certain aspects of the private health insurance industry and public health insurance programs; mostly by expanding the coverage pool to be more inclusive for the low-income, increasing the cut-off age for the offspring accepted under parental coverage and requiring changes to existing industry practices concerning, among others, the halting of any disqualification for preexisting conditions and the elimination of annual limits for various health-care or related services. According to the legislation's proponents, the Act's reforms aim to slow health-care cost inflation and ultimately help reduce the national deficit in predicting lower Medicare spending for the future. The estimates and their subsequent revisions, however, are frequently contested by detractors of the law's provisions and/or their implementation, putting the running figures into almost regular dispute. Twenty-six states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA. On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the majority of the law.

-- George Orwell III (talk) 06:27, 22 July 2012 (UTC)