Talk:Affordable Care Act/Archive 6

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ABC news has just reported: "Experts argue Obamacare mistake could doom key part of law."

ABC News has just published this article which is titled "Experts argue Obamacare mistake could doom key part of law." I think this information would make an excellent addition to the article. Tones shook 251 (talk) 16:35, 20 July 2012 (UTC)

That's a huge hurddle to overcome. They must prove the ommission existed by intent of Congress from the bill's first introduction, through all it's revisions, reports, mark-ups & amendments since, all the way up to the version before enrollment. Its not enough to show an ommission exists in the enacted version and that it automatically translates to Congress' true intent. -- George Orwell III (talk) 17:39, 20 July 2012 (UTC)

OK. I don't understand all the legaal technicalities of this. I just think it's interesting that no one noticed this until two and a half years after the law was passed, and that this deserves some kind of mention in the article. Tones shook 251 (talk) 18:34, 20 July 2012 (UTC)

Actually, this happens all the time. See the annotated footnotes at any of the results HERE. Ommissions, corrections and punctuation mistakes can exist for years before officially "fixed" by Congress. That's why lawyers like to rely on their own lawyer editions of the law and not the the govt's latest copy. They usually have all those little fixes added in whenever applicable already.

But go ahead - if you can find a place and a way to add this in; more power to ya'. -- George Orwell III (talk) 18:50, 20 July 2012 (UTC)

The key word is "argue." "according to a white paper by conservative health care experts." Cannon is at the Cato Institute and Adler is a law prof. It's their job to come up with novel arguments. This is far from noteworthy. --Nstrauss (talk) 18:59, 20 July 2012 (UTC)

Is the Penalty a "Tax Penalty"?

My addition of the word "tax" to modify "penalty" in the lede has been deleted as being "confusing". IMO the word provides important context. This landmark Supreme Court decision hinges on the single premise that the penalty, which is an essential part of the individual mandate, is constitutional only because it could have been levied under the auspices of the taxing power of Congress, but not under the Commerce Clause. If the penalty is not a tax, then the mandate is unconstitutional, and, arguably, the entire law is unconstitional.

I know that those who wrote the bill went to great lengths to assure that the word tax" appears nowhere in this massive document, but the fact remains that it is a tax collected by the IRS. I know that the fact that it is a tax creates another serious challenge to President Obama's credibility and re-election chances. However, failure to include it is an obvious Pro-Obama POV.

Perhaps "tax penalty" is quasi-redundant (all taxes are penalties, but not all penalties are taxes) If that's the problem, then I vote for dropping the word 'penalty". I think the word "tax" should precede the word "penalty" in every instance in the document.--Thomas Pain 67 (talk) 17:50, 7 July 2012 (UTC)

Yes. Arzel (talk) 17:57, 7 July 2012 (UTC)

Well, the official view seems to be that it is a penalty, even if it was upheld under taxing authority; that the IRS collects it is immaterial. I would say that the Constitutional Challenges section could use a bit of expansion, to note that different parties do disagree on whether or not it is a tax, though. I would not say that calling it a "penalty" is a pro-Obama POV, since it is officially a penalty. (Whether or not you agree with that description.) And again, the article can certainly mention the disagreements over the phrasing. I'd say that calling it a "tax penalty" would be even further from neutral, in the other direction...since there are plenty of sources stating both sides, it would seem to me that the correct action is to use the official government description: a penalty. – 2001:db8:: (rfc | diff) 18:25, 7 July 2012 (UTC)

Wait... as far as I can tell, exactly one member of the Supreme Court considered the penalty a "tax", namely John Roberts. The other 8 justices all considered the law under the Commerce Clause, with 4 finding it unconstitutional and 4 consitutional. The 4 conservative justices explicitly rejected the idea that the penalty was a "tax" - otherwise they would have been compelled to rule it consitutional, after all.

In any case, the most honest and WP:NPOV-compliant approach is probably to explain that the term "tax" is controversial and politically loaded, and that at various times both Republican and Democratic politicians have embraced and rejected the term. Personally, I don't really feel strongly about how it's described in the lead; I think "penalty", "penalty fee", and "tax penalty" are all adequately accurate, but I also understand the political motivation (both in real life and on Wikipedia) to favor one set of terms or the other.

As a separate matter, since we seem a bit obsessed with the word "tax", the lead needs to mention that insurance purchases are subsidized - with tax credits - for people earning <4x the poverty line. That's a central component of the law, but was strangely absent from the lead until I added it just now. MastCell ^Talk 18:37, 7 July 2012 (UTC)

Trying to read into the long, complex Supreme Court decision is part of the problem here really...since it can be interpreted in multiple ways, as is being done. Thus my suggestion of using the official description of "penalty", rather than arguing whether or not it's a tax, or whether or not "tax penalty" is accurate (because there will absolutely not be any consensus on that.) We use official descriptors elsewhere, so using the official "penalty" language alone makes sense to me, along with adding a bit about the controversy over whether or not it is a tax. – 2001:db8:: (rfc | diff) 18:52, 7 July 2012 (UTC)

The issue here is what does the PPACA say? It uses the terms "penalty" and "penalty fee". It does not say "penaly tax". So when we describe the provisions of the PPACA, we've got to stick to those terms. The justification for maintaining the individual mandate was the "construing" of the penalty as a tax. That info needs to stay in the article sections that describe the opinion of SCOTUS. Please, editors, don't get caught up in the election debate that is spinning around this law. We cannot use the terms "penalty tax" or "tax penalty" because those terms were not used in the opinion of SCOTUS. Roberts wrote the Opinion of the Court, which is the only part that matters in terms of upholding the law. The other justices used the terms "penalty tax/tax penalty", but those are simply their commentary, not the opinion of the court.--S. Rich (talk) 19:13, 7 July 2012 (UTC)

I think Srich has nailed it here. --SarekOfVulcan (talk) 19:20, 7 July 2012 (UTC)

Ditto. -- George Orwell III (talk) 19:36, 7 July 2012 (UTC)

We either say "a penalty that has been construed as a tax by the high court" (emphasis mine) or leave it as simply "a penalty" and explain it in detail further down in the analysis - or on the complimentary page dealing with the constitutional challenges preferably. Saying "a tax penalty" is inaccurate. When you get a speeding ticket - everybody else driving that day is not subject to your penalty. The Fine is not collected by your state's Dept. of Motor Vehicles but typically by your state's Bureau of Taxation and Finance. It can be construed as a tax in the legal sense since the taxation arm of the state is collecting the fine for violation of state law. The same is true of the penalty for not being subject to a qualified health benefits plan (or individual mandate).

When you are not in compliance with the PPACA, you are subject to a penalty. The fee or fine for your specific non-compliance has no bearing on others who are compliant with PPACA and, therefore, not subject to a fee or fine like you are. The taxation and finance arm of the Federal government, the IRS, is tasked with collecting the non-compliance with the PPACA fine - so it can be said the 'penalty can be construed as a tax' (construed being the key term that must appear if the word tax is to appear along with penalty   And   still be correct as far as the supreme court ruling goes) -- George Orwell III (talk) 19:26, 7 July 2012 (UTC)

I don't understand the distinction you are trying to draw. If I follow you, you believe that the term "tax penalty" is deceptive here because, for you, a "tax penalty" by definition would apply to everyone, not just the person in non-compliance. But this is simply not the way that the term "tax penalty" seems to be used in American English. For example, the IRS charges a tax penalty if you file your taxes late---this penalty applies only to the person who files late, not to all taxpayers. As another example, people have complained for years about the "marriage tax penalty" (aka marriage penalty), which is an (effective) tax penalty only for certain married couples. And, on the other side of the coin, people use the term tax break for reductions in taxes (the antonym of a penalty) that apply only under certain conditions to certain taxpayers. — Steven G. Johnson (talk) 21:08, 8 July 2012 (UTC)

Right, the IRS can charge a penalty FOR filing for taxes late. But it's a penalty paid to the IRS for filing for taxes late, not any sort of tax itself, even if you do pay it to the IRS. The ACA penalty is paid to the IRS; they could've structured it so HHS or whatever agency collects penalties, but going via the IRS is simply the easiest way to apply the penalty. Again, I don't think we're going to come to any reasonable agreement on this in general, which is why I think we should simply go with the official wording. Whether or not it is a tax, a tax penalty, or not a tax at all can be left to constitutional scholars, and can be mentioned elsewhere in the article as far as the controversy on that goes. Again, it depends heavily on how you read the decision; I read it as the penalty being upheld under the power to tax, even though it isn't a tax per-se, but maybe you disagree. That's fine, but there's no reason not to use the official wording, especially given controversy and disagreement over the issue. – 2001:db8:: (rfc | diff) 21:22, 8 July 2012 (UTC)

Not sure what the big deal is. The official determination is that it is a Tax Penalty. That is the ruling from the SC. Arzel (talk) 22:13, 8 July 2012 (UTC)

Wrong. The wording in the opinion of the court is basically that the penalty may be construed [explained in the only language a court can, the language of the law] as a tax. In the previous examples, the penalty and its collection both originate in title 26 and is collected under title 26. The PPACA penalty originates in title 42 but is merely collected under title 26 (with no criminal caveat occurring as well). All sorts of liens and junk can be assessed under fines & things that originate and are collected under title 26 - including possible jail time depending on the specifics. The most that can happen with things originating under some other title of the U.S. Code (save criminal conviction under title 18 or bankruptcy under title 11) but collected under tile 26 is they withhold your tax refund checks or subtract the penalty from it.

So its not the same thing. Its disingenuous to say otherwise. -- George Orwell III (talk) 22:43, 8 July 2012 (UTC)

There is a distinction: the "penalty" or "penalty fee" in the PPACA is there to 'encourage' citizens to buy health insurance. The IRS Code also has penalties, and they are there to 'encourage' people to pay their taxes. Why? Because Congress has the constitutional authority "...To lay and collect Taxes, Duties, Imposts and Excises." So one penalty is the tax collection penalty while the other is the no-health-insurance penalty. Again, one penalty is there to help collect the tax, but that penalty itself is not a tax. (Although Justice Roberts might disagree.)--S. Rich (talk) 01:44, 9 July 2012 (UTC)

We should call the thing whatever reliable sources are calling it. If different reliable sources are calling it different things then that fact should probably be flagged in the article. But the bottom line is that proposals to change what we call it should be supported by reliable sources. This whole thread is basically a wash since it doesn't contain a single argument citing a single news article. --Nstrauss (talk) 19:52, 16 July 2012 (UTC)

To move the conversation forward, I did some research and found very little. As expected the leading news outlets have generally been avoiding using the terms "penalty," "tax," and "tax penalty" since the Supreme Court ruling. The best I could find was this: "The mandate is a central piece of the health care law and is enforceable with a penalty assessed through the tax system." I rather like that description, "a penalty assessed through the tax system." While it's wordy it's educational, and it avoids the hyperpartisan debate of the day.--Nstrauss (talk) 16:47, 20 July 2012 (UTC)

Assessed taxes (or a tax assessment) infers the possibility under Title 26 to asset seizure, liens and even criminal prosecution. As used in the sentence cited, the enforcement is then subject to seizure, liens or prosecution. The author misstated the severeness of possible enforcement.

The 'penalty was construed as a tax by the high court' - nothing more; nothing less. -- George Orwell III (talk) 17:30, 20 July 2012 (UTC)

This doesn't move the conversation forward. Are you saying that we should call it a penalty (no "tax"), and if so, can you find any reliable sources to back up your position? --Nstrauss (talk) 18:52, 20 July 2012 (UTC)

The conversation had moved to its own Challenges... page some time ago. All we have here is a summary paragraph that points to it's main article now. The nuances are explained in full there. If you consider re-hashing what's been split off already as an attempt to move forward in this article then I am at a loss for what else I can add except read the court's opinion. -- George Orwell III (talk) 21:33, 20 July 2012 (UTC)

I'm sorry but I don't know what "Challenges..." page you're talking about. In any case we're talking about this article and the issue is whether the mandate should be described as a tax, a penalty, a tax penalty, or something else. This is the last thread on this subject, and I no one has disagreed with me that arguments for the use of one term or another should be supported by reliable sources. Agree or disagree? --Nstrauss (talk) 00:01, 21 July 2012 (UTC)

1. See: Constitutional challenges to the Patient Protection and Affordable Care Act.

2. What else is needed to describe & distinguish the "tax" "tax penalty" & "penalty" material? At most I'd add something like "penalty [tax] collected by the IRS" to one of the descriptive/explanatory sentences. Then the reader can draw their own conclusion as to whether it is a "tax penalty" or "penalty tax". Given, as you say, there is very little outside WP:RS material. I think we can leave the descriptions alone (and close this discussion). --S. Rich (talk) 00:28, 21 July 2012 (UTC)

Nobody has agreed or disagreed with you because this point was dropped entirely earlier this month by forking off the entire analysis to its own page, linked in #1 above. We don't get into the major nuances in this article anymore. All we have is a summary paragraph that the law was mostly upheld and point to the other articles for the specifics. -- George Orwell III (talk) 00:46, 21 July 2012 (UTC)

I must be missing something, because this thread was originally about the lead section for this article, and the challenges article doesn't have any discussion about "penalty" vs. "tax penalty." And this issue is far from resolved; it was raised only 2 weeks ago and there doesn't appear to be consensus. Clearly Thomas Pain and Arzel disagree with you guys so I don't think closing is appropriate. --Nstrauss (talk) 06:47, 21 July 2012 (UTC)

Penalty, tax, fee, tax-fee, penalty-fee, tax-penalty, penalty-tax and like terms are no longer mentioned at all never mind the lede. Whatever term one likes best has no bearing on the provisions or their performance in moving forward from June 12th on. As far as the PPACA was concerned, it was upheld as Constitutional except for a limitation on the implementation of the expansion of Medicaid coverage afforded to the States. The Challenges page gets into all the cases brought to court and also specifically points to the article titled by the case-name ruled on by the high court (an inline link in the lede here). That's where the analysis of 'what is; is not, a penalty' and similar nuances dealing with the various opinions takes place.

The provisions of the PPACA in question have been enacted, codified and finally upheld by the highest court. Any questions arising from that point on forward are Title 26 and/or Title 42's domain now. The opinion of the court is now precedent. -- George Orwell III (talk) 09:40, 21 July 2012 (UTC)

You're reading MUCH more into my position (and I believe Thomas Pain's and Arzel's, though I can't speak for them) than I mean. This has nothing to do with legal challenges to the Act. The lead section of THIS ARTICLE says: "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." The question is, instead of saying "penalty," should it say anything else? Like "tax penalty" or "penalty collected by the IRS"? This really has very little to do with constitutional challenges to the Act beyond the fact that the Supreme Court stirred up the hornet's nest and Republicans are seizing on that. But that's beside the point. Thomas Pain raised a legitimate issue and it merits debate until a consensus is reached. --Nstrauss (talk) 03:37, 22 July 2012 (UTC)

That's just it - reading. Nowhere in the text of the entire PPACA does one find the term "penalty-tax" or "tax-penalty" or any combination thereof. The term used, starting in Section 1104(b) in amending 42 U.S.C. 1320d [sub-section (j) being added], is "penalty fee". This term is then further abbreviated at times afterward simply as "penalty" or "fee" (but always understood to pertain back to Sec. 1104(b)).

The only place where the term "tax" becomes remotely associated with "penalty [fee]" is after June 12th, 2012, in one or more of the opinions handed down in the Supreme Court's ruling on the Sebelius case. I understand your point about mandate being mentioned (something I'm against personally; see 3rd run above) but to associate it here with the smallest sliver of tangent association, not from the legislation or the law itself but from the opinion(s) of the Justices of the high court, is wrong imo and gives it undue weight. The term used in the language of the bill, as subsequently enacted into law, is "penalty" or "fee" - or more accurately "penalty fee". Let's talk about removing as many of the 'specifics' in the lede as possible if you want to persist on this - not by adding quantifiers to those specifics (quantifiers given only as judicial opinion rather than part of the actual legislative content & interpreted in full in its own article(s) elsewhere to boot). -- George Orwell III (talk) 05:01, 22 July 2012 (UTC)

I don't think much weight should be given to what Congress called it. It's well known that the Democrats were intentionally avoiding using the word "tax" in order to get the legislation passed. It's our job is to avoid parroting the political talking points of any political party or any of the three branches of government. That's why we should be focusing our attention not on how the mandate is described by the Democrats, the Republicans, the White House, or the Supreme Court, but on what the newspapers are calling it. In short the legislation itself is not a reliable secondary source. --Nstrauss (talk) 05:44, 22 July 2012 (UTC)

Go Right Ahead!!! - have at the usual newspaper left-right slap-fight as much as you can stomach for a lifetime...just do it in the analysis where it belongs and not in the lede. The mandate shouldn't be in lede (otherwise you need to balance it with the penalty), the poverty level shouldn't be in the lede (otherwise you ned to balance it with the cost), 30 million covered shouldn't be in the lede (otherwise you need to balance it with the national debt) and so on and so forth for each and everyspecific component one could mention. Next thing ya know the lede IS the analysis. No thank you. I vote generalities in the lede - nuanced specifics in the analysis somewhere below the lede. -- George Orwell III (talk) 05:59, 22 July 2012 (UTC)

Problem solved. All three diffused by generalties. -- George Orwell III (talk) 07:05, 22 July 2012 (UTC)

Consensus has not been reached. But I'm not going to participate in this conversation anymore; the emotional level has gotten too high for me. --Nstrauss (talk) 17:11, 23 July 2012 (UTC)

Recentism

Regarding this removal... I'm not sure I agree that the material in question is WP:RECENTISM. The PPACA has been central to partisan political debate since its passage in 2009. The PPACA was a major, if not the major, issue in the Republican mid-term election victories in 2010. The repeal efforts have been ongoing for three years, from the day after the PPACA was passed right up through this month. I think that if we want to write a solid WP:LEAD that covers all relevant aspects of the topic, we can't completely omit the partisan and polarized political response to the Act from the lead. It's been an issue over the entire 3-year-and-counting lifetime of PPACA, not just a recent news item. MastCell ^Talk 17:54, 25 July 2012 (UTC)

Curious. I have restored it back to your version and tweaked it a little. NW (Talk) 18:55, 25 July 2012 (UTC)

NW, that was pretty rude of you. It's called WP:BRD, not WP:BRRD. MastCell took the courtesy of avoiding an edit war and starting a talk thread here. You hijacked a legitimate discussion. Please undo your your changes and tuck them away until we reach a consensus. --Nstrauss (talk) 22:09, 25 July 2012 (UTC)

Change in number of uninsured

An anon IP updated the "Change in number of insured" subsection to reflect today's CBO press release, and it's exposed some gaps or factual inaccuracies. The first sentence says that the CBO's estimate was a reduction of 30 million uninsured. All of the citations for this statement are either dead links or to other reduced estimates released by the CBO in March 2012. This needs to be fixed. Then it says that today the CBO has revised the number from 13 million down to 6 million. W-w-what? What happened to the jump from 30 million to 13 million? This needs to be explained. Someone with a decent understanding of the subject matter should sift through the citations, make sure we're comparing apples to apples, fill in the gaps, and fix the citations appropriately. --Nstrauss (talk) 03:27, 25 July 2012 (UTC)

I did a quick survey of the reporting on today's CBO press release and I can't find any sources that support the CNN's statement that the projected number of uninsured will drop from 13 million to 7 million. Here's an example of what I'm seeing. There seems to be widespread disagreement about the CBO's estimates. Maybe we should remove this stuff entirely until the media manages to sort it out. --Nstrauss (talk) 03:40, 25 July 2012 (UTC)

Not that I have a better feel on this or anything but the premise seems clear. The court ruled that the State's Medicaid expansion was only optional rather than mandated so it makes sense that CBO can no longer "honestly" score the amount of people expected to be covered until they know for sure which states are going to opt-in to the expansion and when (if ever). At the same time this would also mean a net decrease in the cost of the expansion since fewer folks are going to be available to it by the previous expansion effective date(s).

The jazz with the 30 million to 13 million to 7 million is beyond me too unless they are proactively deducting people previously barred from coverage for pre-existing conditions, kids up to age 26 on their parent's plan, and similar or something as they move from one year to the next and score 10 years out from the new date on top of this latest revision dealing with the Supreme Court's ruling. -- George Orwell III (talk) 09:37, 26 July 2012 (UTC)

I think perhaps the answer may be that the CNN statement was talking about the number of people who will be newly covered by the Medicaid expansion, not the number of people who will gain insurance through any means. This reading is supported by another statement in the same article that says, "Of the 6 million who lose out on the expansion, 2 million will get subsidized coverage through the new insurance exchanges that will be established by health care reform, according to the CBO." In other words, the CNN statement is speaking strictly about Medicaid and not about the number of uninsured. Therefore we're mis-citing the article, and even if we cited it correctly it would be comparing apples to oranges. I'm going to revise. --Nstrauss (talk) 16:46, 26 July 2012 (UTC)

PPACA and ACA are not the same thing

From CBO's latest PDF, footnotes for graphs at end & footnote #1

"The Affordable Care Act (ACA) comprises the Patient Protection and Affordable Care Act (P.L. 111-148) and the health care provisions of the Health Care and Education Reconciliation Act of 2010 (P.L. 111-152). As used here, the term "ACA" also includes the effects of subsequent related changes to statute. This estimate incorporates the effects of the Supreme Court’s opinion issued on June 28, 2012 (National Federation of Independent Business v. Sebelius, 132 S. Ct. 2566 (2012))."

Interesting. I wonder how many other entities beside the CBO use Affordable Care Act (ACA) to denote the entire amended statute and how many are just abbreviating Patient Protection and Affordable Care Act (PPACA). -- George Orwell III (talk) 10:11, 26 July 2012 (UTC)

I agree, that is very interesting. I don't think any conclusions can be drawn from that though, aside from that the water is somewhat muddy. Ginsburg and the conservative justices both used "ACA" to refer to PPACA. Roberts didn't use ACA at all. What to make of this? I don't know. My personal feeling is that we should just follow the reliable secondary sources, but we've been over that territory already... --Nstrauss (talk) 15:50, 26 July 2012 (UTC)

This suggests that the lead should clarify this point in the first sentence. Take care of potential confusion at the first opportunity. I wrote a sentence like that somewhere on this page in the past, not sure where,tho.Thomas Pain 67 (talk) 20:20, 26 July 2012 (UTC)

It may suggest it but it doesn't clearly define it for everyone using the term. I'd rather fork it off one day into its own article using the CBO definition than mix and match the term within this article. -- George Orwell III (talk) 22:00, 26 July 2012 (UTC)

ACA in the lede...

The article uses ACA and Affordable Care Act in quite a few places...without ever explaining them. That name/acronym is used semi-officially as well, as evidenced by Obama using it, etc; it's probably the most-common name other than Obamacare, though I don't have a ref for that :). (And it's not just a re-appropriated pejorative, as with Obamacare.) So, why doesn't this belong in the lede? My edit changed it to "also referred to as the Affordable Care Act (ACA) and informally as Obamacare".

If we're using ACA/Affordable Care Act throughout the article, it seems quite reasonable to have it in the lede. I realize it can be confusing, but it IS the common "official" name. If we're not going to do so, then perhaps the article shouldn't randomly mention the ACA, and should strictly refer to the PPACA. (Except that's not a good solution, of course.) – 2001:db8:: (rfc | diff) 03:09, 7 July 2012 (UTC)

Its not the name of the bill. Just because folks get lazy and shorten it, doesn't mean we should follow their lead. I count more uses of the full name instead of the shorten version in the actual content of the article than the opposite. Several of the sourced refs, however, have the shortened version in use (makes sense when you are publishing something that normally costs by the word).

I agree, the article content should not use the shortened version(s) at all. Unless that is exactly the way its used in a reference source or a direct quote of someone, it sould only be found in the colloquial names field of the legislation info box & nowhere else. I feel the same should be true for Obamacare but I know that is a bridge too far until Obama is out of office one way or the other and the next bunch start tweaking the law under their own names for their own legacies instead. -- George Orwell III (talk) 03:43, 7 July 2012 (UTC)

Right, but it seems to be the "official" shortened form. E.g., if you go to healthcare.gov...everything there is ACA or Affordable Care Act. Same when most Democratic politicians are talking about it (or Obamacare if they're Republicans. :) So I don't think it's being "lazy" at all, since it's what the government is commonly using in official statements and publications. I agree that if it IS going to just be PPACA in the lede...then it should be that everywhere in the article. If we have reasonable consensus I'm happy to stick with that, but I still think we need to call it the ACA as well otherwise. (Especially if we're also calling it Obamacare in the lede, since that's even-less-official.)

Its not for us to decide which tiles are in popular use, which titles are appropriate for use, which titles are offensive for use, which titles are favored elsewhere or why titles are favored and so on. The bill as passed is the Patien Protection and Afforadable Care Act. The bills purpose is An Act entitled the Pateient Protection and Affordable Care Act. Section 1 of the bill states Short Title.—This Act may be cited as the ``Patient Protection and Affordable Care Act‘’. Obamacare shouldn't be there. ACA shouldn't be there. I'm of the same view of anyone going by anything other than their given names in public - its insulting (I find they have something to hide as well). -- George Orwell III (talk) 08:33, 7 July 2012 (UTC)

Actually, it seems that "Affordable Care Act" may even be a better name for the combination of the original PPACA + the HCERA amendment, since the current law is the combination of both. I can't find any good reference for that though (other than [1])...and I just searched through the HCERA text and all references to "Affordable Care Act" refer to the fully-expanded PPACA. Hmm... – 2001:db8:: (rfc | diff) 06:05, 7 July 2012 (UTC)

The Parts of Title 42 & Title 26 that the PPACA first amended or added in 2010 have been subsequently modified by at least 3 other major amendments; HCERA only being the first. Again, refer to the Legislation info-box for the specific names, not some of the blogosphere's more infamous ones (aka CLASS Killing Act, No Mo' CLASS Act, Obama Gots No CLASS Act etc.) -- George Orwell III (talk) 08:33, 7 July 2012 (UTC)

I actually think Obamacare should be there (even though I dislike the name), simply because it seems to be fairly common on other articles to include alternate and commonly-used names. E.g., the article on the US includes "the States" as an alternate name, even though practically nobody here in the US calls it that, nor is it an official name of any sort. But again, I also think it should either be Obamacare+ACA, or just not mention either; both are nicknames, yet we're leaving out the "official" (and also popular) nickname in favor of only the "popular" semi-pejorative nickname. In any case, I noticed that you did go and change references to the ACA to PPACA in the article, which makes it less of an issue, so thanks for doing that. Anyways, probably not worth debating the point any more, unless someone else wants to chime in, since it's more trivial now. – 2001:db8:: (rfc | diff) 18:37, 7 July 2012 (UTC)

Well if you have any history with this article prior to the latest uptick for the most recent current event(s), you know that the include/exclude 'Obamaare' debate was a long drawn out affair, resulting in somewhat of a compromise that has been intruded upon by further "tweaking" done since. If I remember right, "we" were going to mention it in simple, un-bolded passing in the lede and have it wiki-link to its own section somewhere below where the pros and cons would be hashed out with all the proper citation work appearing there. At some point, it went bold without pointing to its sub-section at all and had its own source refs pinned to it to scare off any notion of reverting it back again I guess. Admitedly, I could be wrong about that & missed some interim discussion(s) about it since my last recollection of it here.

I changed the ACAs I could find in 1 section basically & agree its pretty clear we're on the same page about this - until someone else feels like speaking up that is.

Though I understand the point you were making overall, using 'the States' was a bad example in this particular case. As far as the PPACA law in general goes (& as it relates to changes being made to Medicaid specifically), there are really54 to 56 "states", depending on which provision of Title 42 is in question at any given moment. -- George Orwell III (talk) 22:21, 7 July 2012 (UTC)

I agree with db8 that the subject should be introduced as "The Patient Protection and Affordable Care Act (PPACA), also known as the Affordable Care Act (ACA) and informally referred to as Obamacare." If you do a Google search for "affordable care act" you'll see a bevy of references to that name, ranging from healthcare.gov and the IRS to the Washington Post, CNN, and Forbes. That's just in the first 15 results. In fact, across the board, "Affordable Care Act" appears to be much more broadly used than "Patient Protection and Affordable Care Act." --Nstrauss (talk) 23:51, 19 July 2012 (UTC)

Nothing is known as the Affordable Care Act or ACA. The Patient Protection and Affordable Care Act is just abbreviated that way for convenience. Its the same as saying "Washington" instead of "George Washington" while running the possibility half the folks thought you meant "Washington D.C.".

Full & Proper Names for the sake of the most possible clarity will always trump any perceived convenience or familiarity in my book. -- George Orwell III (talk) 17:18, 20 July 2012 (UTC)

Ok, then how about "The Patient Protection and Affordable Care Act (PPACA), often abbreviated as the Affordable Care Act (ACA) and informally referred to as Obamacare?" If so many media outlets are calling it ACA then there will be readers looking for it under that name. We need to be clear right up front that PPACA and the ACA are the same thing. --Nstrauss (talk) 18:43, 20 July 2012 (UTC)

No, thank you. Here's another reason why - N:POV. Leaving out Patient Protection in any way shape or form (other than direct quotation) is an attempt to diminish those provisions of the bill dealing with protections over time. The attempt to introduce the abbreviation(s) only aids in diffusing the specificity and accepted weight of the subject matter. The over use of Affordable Care Act instead of its proper & full name will inevitably lead to the [over]use of just ACA.

ACA can be confused with American Counseling Association, American Corrections Academy, American Camp Academy, American Chiropractic Association, American Canine Association, American Cheerleaders Association, American Crystallographic Association, Amputee Coalition of America, American Cichlid Association, American Country Awards, American Cable Association, Arms Control Association, American Communication Association and many, many, many more. I find no such phenomenon when doing the same Google search for PPACA.

Full & proper names insures no attempt, intentional or otherwise, to diffuse or lessen the Act can take place. The neutral point of view is not to follow what others are saying or doing for the sake of popularity but to stick to the terms and names officially given and used without bias. I can't give patient protections undue favorable weight when its already part of the proper title name. I can begin to diminish it by leaving it out over and over again as time passes, however. -- George Orwell III (talk) 21:38, 20 July 2012 (UTC)

I don't think you're being reasonable here. We're not talking about whether to refer to it as the ACA throughout the article, we're talking about whether the ACA should be one of the names mentioned in the opening sentence. That's all. You can't ignore the fact that most reliable sources are calling it the Affordable Care Act. That means that there are a heck of a lot of people looking for information about the "Affordable Care Act." We don't want to confuse them, do we? Don't we want to educate them that the proper name of the Affordable Care ACt is actually the Patient Protection and Affordable Care Act? And as for the confusion with other ACAs, that's what the disambiguation page is for, no? --Nstrauss (talk) 00:06, 21 July 2012 (UTC)

I'm not ignoring anything because I don't typically include simply because I can. You are ignoring the fact Affordable_Care_Act has redirected to this page for many months now. People "looking" for this information using that term have been covered by that redirect for months now as well - externally evidenced by the 2nd Google result pointing to this WP article. Inline citations would also be covered by that redirect internally.

The ability to verify references to reliable sources should not and does not guarantee, nor merit, the inclusion of such references in my view. Your POV may differ. -- George Orwell III (talk) 00:58, 21 July 2012 (UTC)

The disambiguation page isn't sufficient because I believe most people get to WP articles through Google or other search engines. If you google "affordable care act" the first non-.gov result is our PPACA article, which says nothing about the term "Affordable Care Act" outside of the infobox (which IMO people don't look at anyway). If you had never heard the full name of the act and you had just read one of the many, many articles that talks about the "Affordable Care Act" then you could well be confused. --Nstrauss (talk) 22:30, 26 July 2012 (UTC)

Now I know you are basing your POV on mostly opinion. The last time Alexa's clickstream was full view, if you added up all Google's and all the FaceBook's and all the MySpace's you still barely reached 40% of first-click in WP traffic. This the same on Google's Web Analytics today. The most-important site for Wikipedia is WIKIPEDIA (and its sister foundation sites in aggragate) which is where the majority of traffic originates from. Proper names for proper results - He said, She Said names gets you sloppy second results in my experience. -- George Orwell III (talk) 22:54, 26 July 2012 (UTC)

Please translate into lay speak for me, since I don't understand 3/4 of what you just wrote. And if you are challenging my assumptions (yes, they are assumptions, I'll readily admit that) with statistics then you should probably provide references. And I have no idea what you mean by your last sentence. --Nstrauss (talk) 04:59, 27 July 2012 (UTC)

Sorry about that. I just assumed you've already gleamed most of that from previous discussions elsewhere. Basically the only external metric that you would have access to is Alexa. If you view the clickstream tab, you will see a limited list of the top 10 sites a user was visiting immediately before (and after) landing on an en.WP page. The premise being to track what sites do people click-in from and plan for one's domain(s) accordingly. The internal stats basically mirror what Alexa shows for free there though admitedly I'm not privy to all that is en.WP, not being an admin here and junk. Google's Web Analytics is another useful resource for tracking and stuff but, again, you won't have access to that (not sure who does on WP now that I think about it). However, I do get morsels from the same veins and glimmers of hidden insight every now and then but only through being an admin over on WikiSource instead. The general point, if you can believe me without knowing me face-to-face etc., is that Google, etc. are indeed major contributors to WP traffic but the vast majority of traffic still is being generated from within the Wiki foundation sites in all their flavors and languages. Search engines only dominate when it comes to current events and even then they drop off like a rock off a cliff soon afterward. -- George Orwell III (talk) 05:44, 27 July 2012 (UTC)

Thanks for educating me on those sites. Although I'm far from certain about this I don't think we can draw the conclusions you're drawing, however. We would be interested in people who are going to WP specifically to learn about something they read in the paper (or hear about on TV) called the "Affordable Care Act." Raw click-in data would be much broader than that because it includes all the people who are surfing around WP more broadly, reading about Obama or the Supreme Court case or their senators' votes or whatever. The best statistics I could find about this is here. Of course it doesn't include internal traffic so I don't know how useful it is for resolving our issue. --Nstrauss (talk) 16:53, 27 July 2012 (UTC)

Proposed new look for the Lead

In my opinion, the lead of this article isn't very clear about what the PPACA is, or what it does, or the ongoing issues surrounding it. I took a look at the lead of the DOMA article (Defense of Marriage Act), a similar piece of legislation in many ways. Using that article as a guide, I put together the strawman below. The bulleted format is for brevity/clarity, due to the complexity of the Act. An alternative structure would be to use a bullet/sub bullet to interleave the Intent items with the Means items.

[I appologize that the links and formatting are lost. I edited this in a different program and cut/pasted it here. I'm sure there are errors and omissions in what I state; I am just trying to propose a different look/feel. I think that a reader would find him/herself more completely informed after reading this, compared to the current version. I try to use the words that best describe what the law means to the layman. Your comments are appreciated.]

The Patient Protection and Affordable Care Act (PPACA),[1] is a United States federal statute signed into law by President Barack Obama on March 23, 2010 after nearly a year of debate by both chambers of Congress. The law was narrowly approved using the reconciliation process to avoid a Republican filibuster. This law and the Health Care and Education Reconciliation Act are the principal health care reform legislation of the 111th United States Congress. Collectively they are, at times, informally referred to as the Affordable Care Act (ACA) and Obamacare. [2]

Key features of the legislation include; expanded eligibility for Medicaid, increased federal revenue and spending for healthcare, establishment of national coverage and underwriting standards for private health insurance, and various inducements for individuals to obtain, and private-sector employers to provide, private healthcare insurance.

The intent of the law is to:

• Reduce the number of uninsured U. S. citizens
• Reduce the number of under-insured U. S. citizens
• Expand revenues for government-provided healthcare
• Reduce the cost of government-provided healthcare
• Promote the use of preventive medicine

The number of uninsured is reduced through:

• Expanded Medicaid eligibility, at the discretion of individual States
• Insurance subsidies for individuals with incomes between 100 and 400% of the poverty level
• Insurance subsidies for small businesses
• Penalties collected by the IRS from individuals who don't show proof of health insurance
• Penalties collected by the IRS for some employers who fail to provide health insurance
• Requiring unmarried, uninsured adults up to 26? years of age to be eligible for coverage under their parents' insurance

The number of under-insured is reduced through:

• Requiring private insurance to cover, at minimum, approximately 60% of the total cost of healthcare, eliminating "catastrophic" coverage.
• Banning annual and lifetime coverage limits in private insurance coverage
• Banning consideration of pre-existing conditions in acceptance, coverage, and rate-setting decisions

Revenue for government healthcare is expanded by:

• Increasing the Medicare tax rate for the wealthy
• Imposing a new Medicare tax on unearned income for the wealthy
• Imposing a new excise tax on certain medical devices
• Imposing new taxes on the health insurance and pharmaceutical industries.
• Imposing a national sales tax on indoor tanning

The cost of government-provided healthcare is reduced by:

• Reducing expenditures for Medicare Advantage
• Reducing certain Medicare payments for home health care and hospital services

The use of preventive medicine is promoted by requiring that private insurance cover certain preventive measures free of co-pay or deductible.

The Congressional Budget Office projects the PPACA will lower both future deficits[6] and Medicare spending in comparison to previously enacted legislation.[7] The PPACA increases the Gross National Debt. (I don't have a citation, but we all know that it is true...... and then there is the “double counting” issue.....)

The number of uninsured U S residents is expected to decline from 52 million to 22 million when the bill is fully implemented.

Two features of the law have been repealed since passage:

• Increased reporting, to the IRS, of certain expenditures by businesses (1099s)
• The CLASS Act

Twenty-eight states, numerous organizations, and a number of private citizens filed actions in federal court challenging the constitutionality of the PPACA.[8][9] On June 28, 2012, in the case of National Federation of Independent Business v. Sebelius, the Supreme Court upheld the law, except for the penalty imposed on States that do not participate in the Medicaid expansion. The court found that the loss of all Medicaid funding was coercive, and should be limited to only those funds associated wth the expansion of Medicaid.[10][11][12]

Numerous Republicans and 2012 presidential candidate Mitt Romney have said they want to repeal this law. Thomas Pain 67 (talk) 17:52, 23 July 2012 (UTC)

Not much balance between contested points and is just a bullet analysis rather than a sectional analysis. A lot of good points are given that do need to be covered but I don't think its quite yet the layout for lede material. Plus PPACA is a far more intense piece of legislation than DOMA was & is being phased in over time to boot (the current lede looks more like DOMA's actually). -- George Orwell III (talk) 01:58, 24 July 2012 (UTC)

Although it could use some improvements, I strongly prefer the current version of the lead. Per WP:LEAD, the lead should generally be no more than four paragraphs. Thomas Pain's version is too much of an outline and is uninviting to the casual reader. I also think that it doesn't accomplish his stated goal of describing PPACA in a straightforward manner. My recommendation would be to make edits in a more piecemeal manner and we can follow WP:BRD for each one, as necessary. --Nstrauss (talk) 16:11, 24 July 2012 (UTC)

Thank you, Nstrauss, for pointing to LEAD and BRD, good new reading for me, especially LEAD. I have stripped out the key points from LEAD and use them below to propose an outline of content for the PPACA lead. Perhaps we can agree on the content first, and then flesh out the verbiage later. Here goes:

Paragraph 1: Introduction and Important aspects Introduction:

• name and aliases - PPACA, Reconciliation act, ACA, Obamacare
• Who and when - Obama, passage date, signing date

Most important aspects/aims -

• Affordability of Healthcare insurance to reduce number of uninsured and underinsured citizens
• Mandatory minimum coverage
• new taxes
• reduction in Medicare Advantage and other Medicare expenditures
• reduction in the cost of health care delivery
• Preventive medicine

Paragraph 2 Establish context, why is it notable

• Rapidly rising health care costs
• unsustainable government obligations
• cost-shifting due to unpaid emergency room services
• cost-shifting due to "government low-balling"
• uninsured "invincibles", adverse selection
• Healthy uninsured "wealthy" not in the insurance pool
• pre-existing conditions, non-portable insurance
• coverage caps and dropped coverage

Paragraph 3 Summarize important points

• Medicaid expansion
• Premium subsidies
• Penalties for non-compliance with insurance mandate
• Establishment of national minimum coverage requirements
• Taxes and spending cuts

Paragraph 4, Summarize controversies

• Constitutionality of insurance mandate
• Political statements, promises, and legislative tactics
• Single payer model
• Double counting of cost reductions
• CBO assumptions
• Death panels
• Religious freedoms
• Republican attempts to repeal the ACA

Paragraph 5, Developments after enactment

• CLASS act repealed
• 1099s repealed
• Supreme Court ruling
• Summary of most recent estimates of results; coverage, costs, etc.

Emphasis should be consistant with importance: This will probably be a challenge, due to different opinions of importance of various aspects.

Everything covered in the lead should be covered in the remainder of the article. Some additional details may be needed, but I think most of it is in there....

Create interest but don't tease the reader. I think there is some teasing in the current lead: e.g. ..number of incentives... Framework of subsidies...upheld the majority....

Avoid more than 4 paragraphs. I think this 2,700 page bill requires something more than a four-pound bag.

Use clear, accessible style with NPV. I think my style is clear, to the point of being blunt. Others will keep me on the NPV train. Hopefully this is a more straightforward approach than my previous effort.Thomas Pain 67 (talk) 17:28, 25 July 2012 (UTC)Thomas Pain 67 (talk) 17:47, 25 July 2012 (UTC) — Preceding unsigned comment added by Thomas Pain 67 (talk • contribs)

Way, way too much content, IMO. Strip out 2/3 of your bullets and let's talk. But then, what do we gain over the existing lead section? If there are specific issues that you think should be added, just add them. --Nstrauss (talk) 03:52, 26 July 2012 (UTC)

Nstrauss Below is what I propose for the descriptive paragraph. It's hard to piece-meal this, and its too large to survive in the Article space, so I put it here for your (and any other's) reaction. You will note there are no citations. If it is accurate and NPV, then can it stand in the lead, because what follows in later parts of the article will amplify on this "summary" with appropriate RS? Thanks for your help

PPACA is aimed primarily at reducing the number of uninsured and under-insured American citizens and reducing the overall cost of health care. Medicaid eligibility is expanded significantly, subject to individual state participation. Inducements, including premium subsidies, tax credits, and financial penalties, encourage the purchase of insurance by individuals and employers. Variability of premiums is reduced by requiring insurance companies to accept and rate all applicants regardless of pre-existing conditions or gender, and with limited consideration of age. The issue of under-insurance is addressed by establishment of national standards for the minimum level of coverage and the prohibition of annual and lifetime spending caps. Additional provisions are aimed at improving healthcare outcomes and streamlining healthcare delivery and administration. The various provisions are introduced over a period of several years.

New taxes and tax rate increases are levied on the healthcare and insurance industries, and the wealthy. Spending for Medicare Advantage is substantially reduced. The Congressional Budget Office projects that PPACA will lower future deficits and Medicare spending. Thomas Pain 67 (talk) 05:53, 27 July 2012 (UTC)

Four points in response. First, thanks for cutting this down, I was worried you were proposing something gargantuan. :) Second, I don't really understand how your proposal accomplishes your stated goal of explaining what PPACA actually does any better than the existing lead. Maybe you can break that down and explain. Third, I think it's a stretch to say "X is accomplished by Y," e.g. "Variability of premiums is reduced by..." PPACA attempts to reduce variability premiums but we won't know if it actually does for several years. Fourth, some of your statements (e.g. taxes and tax rate increases for the wealthy) are neither sourced nor supported by the body of the article. --Nstrauss (talk) 18:36, 27 July 2012 (UTC)

In addition, the part about Medicare Advantage isn't exactly clear. From what I've read, the thresholds used to negotiate compensation are being changed over time to bring costs more in line with the averages. HMOs and such will need to improve their baselines in both pools and in performance in order to maintain an "advantage" when it comes to rebates (compensation from the government). Enrollment in MA-type programs are up and premiums are down this year if I've read things right as well. -- George Orwell III (talk) 22:30, 27 July 2012 (UTC)

Supreme Court ruling re: "Medicaid Expansion penalty" in the lead

Nstrauss, The Supreme Court ruling boils down to two important findings.

1. The mandate is constitutional because it can be construed to be a tax.

2. The penalty for failing to implement the Medicaid Expansion is coercive, and must be limited to the new funds, not ALL Medicaid funds.

Nearly a quarter of a million people visited this page the day of the ruling. It is IMPORTANT. Much of the media (and Obama himself) mislead by saying that the court "upheld the statute", with no mention at all of the restriction placed on the penalty. According to LEAD, it is inappropriate to "tease" the reader in the lead. By noting less-than-full acceptance of the statute, but not describing the part not accepted, is this not a tease? 144 characters is a small price to pay for an important piece of the story. Regards Thomas Pain 67 (talk) 14:11, 27 July 2012 (UTC)

Hi, Thomas Pain 67. Did you look at the history of this article? "Nearly a quarter of a million people" who visited on the day of the ruling probably read Wikipedia's valiant attempt at being a newspaper, which included point #2 above. Since then Wikipedia's valiant editors decided to summarize (a strategy that I support). WP:NOT#NEWS. -SusanLesch (talk) 14:44, 27 July 2012 (UTC)

I agree that the "largely upheld" language could be read as a tease, but there's no other way to do it coherently. It was a complex ruling and the different pieces of PPACA are all interrelated. The only way to explain the part of the opinion on Medicaid is to first explain the Medicaid expansion itself, which in turn (in order to avoid WP:UNDUE) requires explaining the whole legislative scheme in considerable detail. That would take paragraphs and paragraphs, way too long for the lead. Also, technically, the Court didn't rule on the Medicaid expansion. --Nstrauss (talk) 18:22, 27 July 2012 (UTC)

Nstrauss,

Thanks for the reply. I understand the need for brevity. What if we said"...the Supreme court found the "Individual Mandate" constitutional, but ruled the penalty associated with the "Medicaid Expansion" must be limited to the new Medicaid funding."? The Individual Mandate could be Wiki-linked (I think that's the right term for the blue highlighting that takes you to another Wiki article) and Medicaid Expansion could be described in a brief new "stub?" and also wiki-linked. For good style, it would probably be best to use "individual mandate" and "Medicaid Expansion" earlier in the lead to create context. I'm not sure what you mean when you say they didn't rule on the medicaid expansion. Was it not a "ruling" but something else,or do you mean the ruling was about the penalty, but not the expansion itself? Can you find words to say it correctly in the one setence above?

As can be seen elsewhere on this page, I am causing some heartburn by trying to get my oar in the water. I read a lot of things as being half-truths and that makes me want to get the other half-truth "out-there" in the interest of balance, and for what I understand to be NPOV. Is there a better approach? I'm an old dog but not averse to a new trick once in a while. Thanks again Thomas Pain 67 (talk) 20:47, 28 July 2012 (UTC)

Re the "ruling" on the Medicaid expansion, see the discussion here and here. I don't see anything wrong with simply saying that the Court "largely upheld" the constitutionality of PPACA, that is correct and sufficient for the purpose of the lead section of this article. Re the half-truths you have read, why don't you identify each on specifically and we can discuss them individually? --Nstrauss (talk) 03:42, 30 July 2012 (UTC)

Should "This is the first federal legislation to mandate citizen engagement in commerce" be in the lead?

George Orwell III You deleted the following on the basis that the citation was disproven and out of date.

This is the first federal legislation to mandate citizen engagement in commerce.

When I first wrote this I almost didn't include a citation on the basis that it is a simple statement of apparently undisputed fact. I couldn't find a citation that presents an example of an individual federal mandate. (plenty about state mandates, but that's the whole point, you know, tenth amendment, etc.) The individual mandate in perhaps the single most contentious aspect of the law, and deserves a prominent place in the description of the law. It is one of the reasons the law is "notable". Does this simple statement even need a citation, and if it does, what aspect of the statement needs to be "sourced"? Also, please note that I didn't use words like unprecedented or ground-breaking or unpopular, in the interest of NPV. Regards, Thomas Pain 67 (talk) 14:58, 27 July 2012 (UTC)

This is a sweeping and rather extraordinary claim and, per WP:REDFLAG, requires accordingly high-quality sourcing. You've sourced it to the Heritage Foundation, a partisan political organization whose ideology focuses, in large part, on opposition to PPACA. (In one of life's ironies, the Heritage Foundation actually invented the individual mandate, defended its constitutionality, and promoted the idea right up until around the time Obama embraced it, when it suddenly became anathema... but I digress). The bottom line is that sweeping statements like this need excellent sourcing. MastCell ^Talk 17:48, 27 July 2012 (UTC)

I agree wholeheartedly with MastCell. In addition, while it may or may not be true, it's a talking point that has been drummed up by one side of the debate and not by the other. It is significant only to the extent that it supports that side's arguments. Therefore inclusion in the lead would seem to violate WP:LEAD, WP:UNDUE, and WP:NPV. )]--Nstrauss (talk) 18:22, 27 July 2012 (UTC)

Sorry. It was not meant to offend but was inappropriate for the lede nevertheless. The "mandate" has been upheld by the Supreme Court through Congress' power of taxation not Commerce. At this point, any argument that the provision is anything but Constitutional is academic at best and, therefore, belngs somewhere in the analysis (if anywhere at all). As far the mandate arguement goes specifically, National Flood Insurance is but a few legal degrees away from the mandate being justifiable under the Commerce clause. It was the scope ('where does Federal power end?) and not so much the premise that troubled the court in general. -- George Orwell III (talk) 21:50, 27 July 2012 (UTC)

(in response to MastCell) WP:REDFLAG WP:EXCEPTIONAL Any exceptional claim requires multiple high-quality sources. [My claim is not exceptional. Most people that have followed this issue know that it is a true claim. I now have a second, academic, citation that quotes federal judges who say that the mandate is an "unprecedented exercise of Congress' power"] Red flags that should prompt extra caution include: surprising or apparently important claims not covered by multiple mainstream sources ;[This was covered widely in many venues, and was a primary argument in some of the legal challenges] challenged claims that are supported purely by primary or self-published sources or those with an apparent conflict of interest; [my sources are secondary sources] reports of a statement by someone that seems out of character, or against an interest they had previously defended; [Yea, I guess Heritage flip-flopped on this one, but if that is a disqualifier, then most of Washington needs to go home.] claims that are contradicted by the prevailing view within the relevant community, or that would significantly alter mainstream assumptions, especially in science, medicine, history, politics, and biographies of living people. This is especially true when proponents say there is a conspiracy to silence them. [I'm beginning to think there is a conspiracy. You guys are working my like a rented mule, and all I want to do is add a tiny bit of content that might lead an alert reader to think that there might actually be some valid reasons that about half of the American public want this act repealed;>)]Thomas Pain 67 (talk) 03:44, 28 July 2012 (UTC)

(in response to Jstrauss) Do you seriously doubt the truth of the statement? In my view, talking points are generally arguments in which one side either has no counter-argument, or the counter-argument is so politically damaging it can't be made in public. That appears to be the case here, but it doesn't rally matter, because this is significant (notable) simply because, for the first time in 220+ years, the federal government is telling the citizenry what they must do with their money that wasn't confiscated through taxation, and if you won't do what we want, we have another special tax for you.] WP:LEAD, [Notable] WP:UNDUE, [very brief] and WP:NPV. There is no reason that the Big Government types can't point to this as a great accomplishment, a newly discovered method of doing what is best for you. (Thank you John Roberts!)

Yes, I doubt the truth of the statement, but not because I believe it's false but because I believe it's just one of many ways to characterize the individual mandate, and other provisions in the U.S. code could be characterized similarly. In any case, it's only notable to people who are opposed to PPACA. Observe that it only became an issue during the run-up to the legal challenges, and when it did come up it was heavily pushed by one side of the political spectrum. Perhaps if a historian had pointed it out after the fact then it would have been an interesting tidbit worthy of inclusion in the body (but not the lead). But it has become such a mantra for opponents of PPACA, honestly, it's become permanently tainted IMO. --Nstrauss (talk) 03:55, 30 July 2012 (UTC)

(in response to George Orwel III) My edit says nothing about the mandate being unconstitutional. (It doesn't even use the M word.)Regarding flood insurance, you don't have to live in a flood plain, and as far as I know, it is the state that "encourages" folks to buy it, but I'm not up to speed on that subject. A discussion for another day(or night). Regards to All (Ooops, I see now that interleaving my remarks, in italics, doesn't work so well, as far as being clear as to who is saying what... I'll do better next time.Thomas Pain 67 (talk) 04:38, 28 July 2012 (UTC)

That's all your reference did was build an un-constitutional argument via the now common set of legal gymnastics. The tax code is riddled with things that amount to suggestions for what you should do with your money and then goes on to penalize you if you act unwisely in spite of those suggestions by assessing you with a higher tax or tax rate. The so-called mandate doesn't even achieve the same status as those suggestions - they can't put a lien on your house for not having some sort of coverage while ignoring the fee at the same time for example.

As for a previous example of a federal mandate, look up the Uniform Militia Act of 1792. It was the 111 year-old law on the books before the creation of the National Guard in 1903 that required all able body males to secure firearms and gear at their own cost for possible militia service. Never Consitutionally challenged (and never really prosecuted after technology outpaced the requirements either). Still - its an example of the goverment not merely suggesting what you do with your money but commanding you what do with it specifically under penalty of lock-you-up-and-throw-away-the-key law and not just some deduct-a-fee-from-your-tax-refund-check law. -- George Orwell III (talk) 06:52, 28 July 2012 (UTC)

This thread has been rendered largely incomprehensible by Thomas Pain67's interspersal of his comments into those of other editors. I'm just going to reiterate that Wikipedia is not a soapbox - a rule that his comments, as best I can tell, violate rather badly. The stuff about conspiracies and your personal constitutional analyses isn't appropriate here. Let's focus on finding and using the best available independent, reliable sources. MastCell ^Talk 17:29, 28 July 2012 (UTC)

At the very reasonable request of MastCell, I have done my best to undo the mess I created with my interleaved comments. In the course of this exercise I see some other foul-ups in my comments, so in the hope of regaining some credibility I'll make the following mea culpae:

• I did use the "M word". I was vascilating between "mandate" and "require", and the devil made me do it...
• I did make a sweeping (and more importantly, incorrect, as demonstrated by George Orwell III) claim that this was the first-ever mandate to purchase something. Clearly I should have said ... first since the Uniform Militia Act of 1792 . Being the second, or perhaps even third such Act is clearly not as noteable.
• I failed to realize that the Heritage Foundation is self-published, and therefore generally not a great source for that reason.
• I did get on my soapbox, to the extent that I advocated for my position. I thought that would be OK on the talk page but I see now that it isn't.
• I learned that a ;<) at the end of the sentence won't negate the impact of the word "conspiracy", and I aplogize to all that took offense.Thomas Pain 67 (talk) 22:06, 29 July 2012 (UTC)

You're a gentleman and a patriot. Thanks for that but other than peppering in between other folks' posts I saw nothing wrong. Your source is what it is and they do support what they've argued. In light of the fact that argument didn't have a [known] counter-point to it was mostly the reason it didn't belong in the lede - it would start to get too long & too deep in the weeds again (which is what the section analysis is for). -- George Orwell III (talk) 22:41, 29 July 2012 (UTC)

Add Ronald Dworkin reference?

• A Bigger Victory Than We Knew August 16, 2012 Ronald Dworkin in The New York Review of Books

108.73.112.111 (talk) 04:17, 2 August 2012 (UTC)

Not done: This is an opinion piece and not a reliable source. It's also about the Supreme Court case and not about PPACA itself. If you can identify something particularly notable about Dworkin's views that directly relevant to this article, then by all means do so and it will be considered. --Nstrauss (talk) 17:17, 2 August 2012 (UTC)

lead section 3rd paragraph

The lead section of the 3rd paragraph is getting ridiculous with all of the political stuff about the Tea Party and repeal efforts and now legislative history. All of this stuff is WP:UNDUE WP:RECENTISM and does not conform with WP:LEAD. You will not find any comparable passages in the lead sections of any other passed legislation. Back on July 25 I reverted the addition of the first sentences about Republican opposition, and then NuclearWarfare re-reverted by adding the material back in. I'm removing it again, since no one has engaged in this discussion since then. I sincerely hope that we can have a meaningful discussion about whether this material should be included without ending up in an WP:EDITWAR. --Nstrauss (talk) 07:13, 8 August 2012 (UTC)

I agree. Innab (talk) 19:16, 8 August 2012 (UTC)

This section could certainly be streamlined, but I feel very strongly that you can't write a decent policy-compliant lead without even mentioning the PPACA's central role in partisan U.S. politics. I see absolutely no case for WP:RECENTism - the PPACA has been a focus of partisan fighting since its inception in 2009. And I see no case for undue weight - the vast majority of reliably sourced coverage of PPACA deals with its politically controversial nature. MastCell ^Talk 20:12, 8 August 2012 (UTC)

I agree with MastCell that the controversy must be addressed. How it is addressed is where we part ways. In another section, Nstrauss asked me to expand on a problem I call "half-truths" in the current lead. I am working on a response to that matter, and will post it as soon as it is complete. Regarding other articles' treatment of controversy, I suggest looking at DOMA. It does mention controvery, and even gives Bill Clinton credit and perhaps redemption for "seeing the error of his ways" on this legislation that is hated by the Left. If we were to model the PPACA lead after the well established DOMA lead, I think it would be far more balanced than the current PPACA lead.Thomas Pain 67 (talk) 16:21, 9 August 2012 (UTC)

I also agree with trimming that stuff out of the lede; your edit is fine. -- George Orwell III (talk) 20:22, 8 August 2012 (UTC)

MastCell, WP:RECENTISM is quite applicable. The recommended rule of thumb for applying the policy is WP:10YT: "In ten years will this addition still appear relevant? If I am devoting more time to it than other topics in the article, will it appear more relevant than what is already here?" In ten years the legislative history of PPACA (e.g. the fact that it was Democrats who pushed it) and the resulting political skirmishes (e.g. Tea Party politics) will have faded way into the background and will be much less relevant than, say, the provisions and effects of the bill. I suppose if a repeal were truly imminent then it might be different story, but that's not the situation here. --Nstrauss (talk) 18:05, 9 August 2012 (UTC)

Thomas Pain 67, DOMA is the only passed legislation I can find that has this type of information in the lead. You won't find anything like this in, say, the Civil Rights Act of 1964, which encountered huge political resistance after its passage, or the Copyright Act of 1976 or DMCA, both which are constantly subject to high-profile political fights. I also think the DOMA article is wrong to have it. It's fine that it has stuff about the legal challenges, but the sentence "Clinton and key legislators have changed their views and advocated DOMA's repeal" is definitely not noteworthy enough for inclusion in the lead and seems in violation of WP:NPV for pushing a particular agenda. There are lots of people out there who still like DOMA very much, and their voice is not included. The bottom line is that the lead section is not the place to lay out the political debate over whether a passed law should be repealed. --Nstrauss (talk) 18:05, 9 August 2012 (UTC)

In full disclosure, I have just edited the lead section of the DOMA article. --Nstrauss (talk) 18:23, 9 August 2012 (UTC)

Well, regarding WP:10YT, the Act has been a central focus of partisan politics for about 3 years now, and that shows no sign of letting up. Granting that neither of us has a crystal ball, I think it's fair to say that the political aspects of the Act will, likely as not, still be relevant 7 years from now. In any case, Wikipedia contains any number of items which are unlikely to be relevant 10 years from now - I don't think that's a realistic standard to apply here. An aspect that has been a central focus of innumerable reliable sources for the past 3 years belongs in the lead. MastCell ^Talk 20:05, 11 August 2012 (UTC)

I've never heard of any legislation for which a debate over repeal remained a major issue for 10 years. If you can find an example then I'd like to see it. --Nstrauss (talk) 02:35, 13 August 2012 (UTC)

Nstrauss, I posted my response to you regarding "half-truths" on my talk page. I put it there because I don't want to be seen as being combative, it is a bit on the SOAPBOX, and rather lengthy. Everyone is invited to take a look, just be forewarned... Regarding DOMA, you are correct as to the NPOV, it's unfortunate that your edit didn't survive its first day of life. As to your comment to MastCell that repeal is not imminent, I beg to differ. Repeal is no further away than a Romney victory, 9 or more new Republican Senators and/or weak-kneed Democrat Senators, and a well-worded Reconciliation bill. This is precisely why I feel so strongly about how the lead is written, as spelled out in my above-mentioned "half-truths" response.Thomas Pain 67 (talk) 16:29, 10 August 2012 (UTC)

But its just as fanciful to delve into the possible further expansion of the reform to a single-payer model or something just as controversial if Obama wins & more Dem. Senators get elected as it is to speculate a repeal can or will take place if the other side prevails in the lede never mind in any analysis. Would that be a truthful assertion or just speculation based on rhetoric? I'd think not and hope you see that the same way.

Besides that, you've got your facts mixed up a bit. Only a super-majority of (60) Senators voting in the affirmative can "repeal" the Act in its entirety; no Budget Reconciliation bill required. A simple majority of Senators (well 50 Senators and a vice-president tie breaker in the worst-case scenario) can only defund (or re-fund?) elements of the statute to some degree or another using the Budget Reconciliation process but cannot technically repeal anything; whatever they do - it must strictly be related to the budget (i.e. must be something that can be scored a la Congressional Budget Office per Budget Control & Impoundments Act of 1973/74). Please note: 46 to 41 is still a simple majority with 13 Senators pulling a Scarborough for a Budget Reconciliation bill to still pass. Also note: anything passed under the Budget Reconciliation process expires in 10 fiscal-year's time unless equivalent legislation is passed under normal congressional procedures/rules within that time in order for the legislation to truly become permanent. It may be extended beyond the 10 year limit but will always expire at the end of that extension unless repeated however. -- George Orwell III (talk) 01:39, 11 August 2012 (UTC)

TP67, thank you for the heads-up on DOMA. I agree with George Orwell. But more importantly, what you're talking about isn't an imminent repeal but a possible repeal at least 5 months away. When I say "imminent" I mean "imminent," as in, a bill currently on the floor with a likelihood of passing and a president who has said he will sign. By your logic every bill being pressed by Republicans is imminent, which IMO is an unrealistic position. --Nstrauss (talk) 06:29, 11 August 2012 (UTC)

As a side-note that supports the lack of any action taking place anytime soon - bills introduced but not passed by both chambers of Congress (and signed into law) during either session of a Congress proper do not automatically transfer over into the next Congress. This, for example, means everything passed by the House in the 112th Congress (1st and/or 2nd Session) will not be automatically picked up where they left off in the 113th Congress. The bills must be re-introduced and the process starts all over again even if it means going through all the motions again just to get back to where they left things off in the previous Congress (assuming there are no changes made to a bill in the interim that is).

The way things are with it being an election year; a lame-duck session of Congress regardless of who wins and with a divided Congress with each majority in control of their respective congressional schedules for now - the chances of any meaningful movement on this is not very likely to happen until at least early next year if at all. -- George Orwell III (talk) 07:46, 11 August 2012 (UTC)

$716 Billion in "Medicare savings" used to offset new Obamacare spending, and new CBO cost estimates at double the original.

Hi. Still would love to see some updates on this page. For example, why no discussion about Obama's "double counting" of the $716 Billion dollars in reduced spending on Medicare that then gets shifted over to "savings" to help his health care plan sound more fiscally appealing? Anything? Or, what about the latest CBO (2012) which now suggests that the true costs of Obamacare once it actually goes into effect (from 2014, not 2012) is double the initial costs sold by the ACA's supporters back at its signing? (You know what I'm talking about: CBO now says costs will be $1.76 Trillion Dollars, not the $940 Billion originally touted? http://news.yahoo.com/cbo-obamacare-price-tag-shifts-940-billion-1-163500655.html)

And while you're at it, can you address the following claims also made in the above link? "Revised estimates of ObamaCare's coverage provisions indicate that 2 million fewer people will acquire coverage by 2016. Moreover, the CBO estimates that 4 million Americans will lose their employer-sponsored health plans by 2016, a far cry from the 1-million-person figure forecasted last year (2011)." And "By 2022, according to the CBO, 3 million fewer people will have health insurance through their employer, while 17 million Americans will be added to Medicaid and 22 million will be getting coverage through government-run exchanges."

This is all relevant to the discussion here, and leaving your cost estimates woefully under-reported or neglecting to discuss the many accounting sleights of hand done to get the original bill passed does little to educate those in search of the political spin-free truth. Thanks114.148.175.172 (talk) 03:31, 26 August 2012 (UTC)

It would help to cite reliable sources - they're necessary for any content that you'd like to put in the article. (The Yahoo! News contributor pieces are basically blog pieces, and don't really fit the bill, especially for major claims about cost and budget implications). The revised CBO estimate is already covered in the article. MastCell ^Talk 07:13, 26 August 2012 (UTC)

Tsk.... this old bit back again huh? its just disproven GOP spin (... and that was before the supreme court decision in late June which, in effect, lowered gross costs for the same period(s) thanks to some states no longer being forced to expand their Medicare until they decide to opt-in by themselves if ever). Its all in the article like MastCell said. -- George Orwell III (talk) 09:32, 26 August 2012 (UTC)

Obama Care

Question: I have seen several commentators state that illegal immigrants will get free medical under the law. Is that true and can you quote me the page to read about this. — Preceding unsigned comment added by 24.214.105.235 (talk) 14:47, 27 August 2012 (UTC)

There's a section in the article on the change in the number of uninsured that mentions illegal immigrants. In short, this law won't do much for them. There's an existing law (since 1986) that requires emergency treatment be provided by hospitals to everyone. Ravensfire (talk) 15:37, 27 August 2012 (UTC)

No mention of the late Senator Edward Kennedy's role in pushing this?

I find it shocking there's zero mention of the late Senator Edward Kennedys role in seeing this healthcare bill through before his death. Even as his health floundered, he continued to push through and attend Senate meetings to see this healthcare bill through to completion. He didn't quite make it. But he was one of the strongest backers. CaribDigita (talk) 23:23, 29 August 2012 (UTC)

Introduced bill(s)

Seems to be a bit of confusion over which bill initially introduced for a different purpose actually became the vehicle for PPACA in the end. What matters here is the number assigned to a bill in the chamber of Congress it is first introduced in. The "short title" designated within most legislation only becomes effective & binding when the bill is signed into law. Before that; it is only happenstance that a pending title trumps or mirrors the weight of the number assignment.

So... the PPACA law owes its origins to H.R. 3590, a bill first introduced on September 17, 2009 with the purpose... To amend the Internal Revenue Code of 1986 to modify the first-time homebuyers credit in the case of members of the Armed Forces and certain other Federal employees, and for other purposes. It was proposed that the short title for this legislation should be forever known (if passed) as the Service Members Home Ownership Tax Act of 2009 (no apostrophe here).

The bill was passed in the House on October 8, 2009, sent to the Senate on the same day and placed into the calendar on October 13, 2009 (still no apostrophe).

In a 3 day span between November 19th to the 21st, the bill was closed from further debate, moved to be considered, attained cloture, and then considered for amendments. At this point, Sen. Reid proposed an amendment in the nature of a substitute for the bill and that was the death of anything to do with service members, home-ownership, taxes and the like and the birth of the PPACA. (apostrophe still MIA). The fact that it passed the House that way meant little - in effect it could have died much the same way as being scheduled but never acted upon after that.

All the stuff that was in the bill prior to being wiped clean and re-used for health care reform was reintroduced in the House on the same day the above bill passed the House, October 8, 2009, as H.R. 3780. Its purpose was...To amend the Internal Revenue Code of 1986 to extend the first-time homebuyer tax credit for members of the Armed Forces and certain Federal employees serving on extended duty.; its proposed short title: Service Members' Homebuyer Tax Credit Extension Act 2009 (Bingo - there is the apostrophe). This bill died in committee however.

So hopefully, we can now better see the time line of events & the reverts made back to the right bill without the apostrophe is both proper and legitimate. -- George Orwell III (talk) 06:09, 23 September 2012 (UTC)

"Obamacare"

NOT an informal term, instead a racist term used exclusively by ACA's opponents. — Preceding unsigned comment added by 219.77.103.50 (talk) 14:57, 29 June 2012 (UTC)

I disagree, I am certainly not an opponent of ACA and am fine with it being referred to as Obamacare. It is a descriptor of a healthcare package signed by President Obama. There is nothing racist in someone's last name. Ryan Vesey Review me! 14:59, 29 June 2012 (UTC)

While there are certainly are some racist undertones when it comes to Obama (The citizenship issue for one) I don't think that this particular shorting on the law's name is one of them. It should also be noted that the Massachusetts reform law passed by Mitt Romney when he was Governor is also similarly known as Romneycare.--174.93.167.177 (talk) 17:58, 29 June 2012 (UTC)

Obama himself has called it Obamacare, therefore Obama is a racist...against himself? Arzel (talk) 18:36, 29 June 2012 (UTC)

I don't think it is, or ever was, racist, but it did originate as a pejorative term. The irony is that as people slowly start to benefit from this law (and realize that the Republicans have been lying to them all along), they will start to appreciate what the law does for them, and "Obamacare" will become a compliment, not an insult! — Preceding unsigned comment added by Captain Quirk (talk • contribs) 18:00, 1 July 2012 (UTC)

It is certainly pejorative. It may not be racist, but one need not assert that it is racist to point out that wikipedia should be neutral and not use such a pejorative (that is not use it as if it is neutral; to cite it as a 'pejorative some use' is ok, though it does not merit first sentence mention. Two wrongs don't make a right and I don't think 'Romneycare' merits first-sentence mention either)

Yes, After months and months of wall to wall efforts by *opponents?* and afterr massive, massive efforts to get the term into the public light Obama finally did (listen to the tone of his voice at watch?v=V25HvZ_CJ9o) with an inflection of his voice he put the term in quotes as it were, and said if people want to use it, fine, it's ok with him, and tried to turn it around by saying it's ok with him since "I do care"

So (while I'm not suggesting someone here did so deliberately) it would be completely dishonest to suggest Obama just "uses the term" without this context. It's like a pejorative nickname used against you over and over again, finall you say, fine, call me [perojative] it's ok with me because [positive interpretation of the pejorative]

It's not just the right wing; I've noticed (many, not all) advocates of single payer like to use that term. It's still a pejorative in that case, too. And like when the right-wingers use it, it is an term that is focused on a criticism if not outright attack, that is focused on the person (Barack Obama) rather than criticizing how the law is structured. Sure, many years down the line it might (like the term "queer") be a formerly-pejorative term that has been assimilated by the group it was originally used against (in this case, against the Democratic Party 'group') but that is not the present case, it is not neutral

Given that above: 1) The pejorative should not be featured in the very first sentence 2) It should be made clear that not everyone uses the term 3) it should be stated who uses the term 4) It should be stated as "pejorative" or "usually used in a pejorative sense". In light of 2) and 3) I will add a "by whom?" wikipedia code next to the mention. That information can then be filled , and the mention should at the same time move to a lower paragraph in the entry, not the first sentence.(Again two wrongs or two biases don't make a right, and don't make good or neutral Wikipedia entries.--Harel (talk) 22:11, 25 July 2012 (UTC)

I believe that I could contribute something along the lines talking about the informal name of Obamacare. I do not believe that this term is racist, it is just linking an act passed by the president of the United States. I do believe however that it is putting blame on him for passing this bill and has caused him to lose credibility. Trying to fix the healthcare system has only added to the problems and it has hurt people by raising the cost in most situations and not actually providing more care which is what it sought out to do in the first place. finally it has also caused for the quality of the services provided in a sense to be downgraded. — Preceding unsigned comment added by Dalton.stogner (talk • contribs) 23:25, 10 September 2012 (UTC)

The article as it stands, with or without "Obamacare," is definitely not neutral. While many of the goals were laudable, the controversial and irrelevant cruft that mostly fills the 2900 pages needs to be included in the description. Start with the new taxes and fees. Continue with a debate about "death panels...." On balance, the bill is a terrible implementation of the goals of health-care reform. And, it shouldn't be called Obamacare, not because that term might be seen as racist or pejorative. It should be called Pelosicare, because she and her staff wrote it. — Preceding unsigned comment added by 137.79.7.57 (talk) 20:40, 11 September 2012 (UTC)

While I cannot comment on any new taxes and fees (many of which are already mentioned in this article), nor can I comment on the success or failure of the implementation of the goals (since the header on this page specifically says "this is not a forum for general discussion of the article's subject", and wikipedia policy in general is to remain neutral), I can say that the "death panels" idea has been debunked more than once, and has no place in this article. It shouldn't even be in a "common misconceptions" sort of section, since it could quickly become a target for partisan bickering, and I cannot recall seeing such a section in other articles. "Death Panels" is one of those talking points that took a good idea, then twisted and distorted it for political gain.

Also, the entire discussion about whether to call the law "Obamacare" in the article centers around whether it is used commonly (as it now is) or just in a pejorative sense (as it was until recently). I've certainly never seen it called "Pelosicare" except in a pejorative sense, where it was used to imply not only that the bill was pushed through by a partisan congress, but also that Obama is inept and unable to come up with policies on his own. This is certainly not a good name to include in a neutral article.

--Fritzophrenic (talk) 16:40, 29 October 2012 (UTC)

What is a "household"?

Can someone with a reliable source explain on the main article what exactly is meant by a "household," as it applies to the PPACA. Spouse and dependents listed on your income tax return? Four unrelated guys renting a house? Something in between the two? Thanks, Ncepts (talk) 02:12, 6 December 2012 (UTC)

Ncepts, This is really not the place to ask questions about definitions in the law. However, the actual Law (111-148) is a searchable pdf. I searched on "Household" and suggest page 219. It appears to be an IRS definition, but you need to look elsewhere for this answer.

Sorry for this diversion. -- Steve -- (talk) 01:57, 29 December 2012 (UTC)