Talk:Affordable Care Act/Archive 17

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RfC: Recent additions

Note: In the process of the RFC, agreement was reached between the contending parties (shown in the RFC below) on how to handle the article in question. I have been told a formal closeout may take time, due to a backlog, but I have proceeded to make the discussed changes, and it would seem we are no longer seeking input.NormSpier (talk) 20:18, 1 October 2019 (UTC)

The following discussion is an archived record of a request for comment. Please do not modify it. No further edits should be made to this discussion. A summary of the conclusions reached follows.

Closed as withdrawn. I was summoned by the legobot RFC FRS EllenCT (talk) 03:48, 3 October 2019 (UTC)

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Over the past month, 54kb of content was added to this article. Should we restore the article to the August 7 version (before the additions) or should we retain the current September 7 version (after the additions)? — Newslinger talk 05:53, 8 September 2019 (UTC)

Introduction

The purpose of the Survey (!vote) section (below) is for editors to register their opinion. While the Survey (!vote) section might look like a traditional tally, where the majority would win, that is not actually the case. On the contrary, most decisions on Wikipedia are not made by popular vote, but rather through discussions to achieve consensus. Experience tells us that conducting a Survey (!vote) as part of a Request for Comments (RfC) usually facilitates consensus-building   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 05:08, 12 September 2019 (UTC)

Instructions

Explanations are not mandatory. If you choose to include an explanation, please make it concise, e.g., one or two sentences.

Indicate your recommendation (opinion) using one of the following three options:

• Restore (Revert the article back to the 7 Aug 2019 version, and carefully edit from there—with Talk page discussion before extensive edits.)
• Retain (Keep the current version and continue editing—with Talk page discussion before extensive edits.)
• Other (Briefly explain your recommendation.)

  - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 05:08, 12 September 2019 (UTC)

Survey (!vote)

• Good lord. Revert the changes and gain consensus for individual changes. I read enough to realize that there are pretty serious problems in unencyclopedic tone throughout. If nothing else, much or all of it needs to be rewritten. But ain't nobody going to sort through the 8,300 words in this section already, in addition 54kb of changes to the article, and 96 additional sources used. RfCs are not tools for deciding sweeping rewrites of an article. You need to discuss each individual change individually and if you cannot reach a consensus on some change in particular, then start an RfC. Everyone step away from the espresso and try to have a concise and targeted discussion. GMG^talk 18:06, 11 September 2019 (UTC)

• Restore - My eyes glazed over trying to read the current prolix version.   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 04:36, 12 September 2019 (UTC)

• Restore - Much, if not all, of the controversial additions are clearly problematic, and attempts to improve them without a complete reversion seem to have failed, probably because that was an impractical way to go about things anyway, for such a substantive addition. So, revert to the proposed uncontroversial version, and add those that can be, back, with rewrites and consensus, as GreenMeansGo suggests. Usedtobecool ^TALK ✨ 16:33, 13 September 2019 (UTC)

When there is controversy regarding content, I have read (in yet to be archived ANI discussions) that procedure is to revert to the last stable/uncontroversial version before a consensus is achieved for the controversial edits. So, anyone who can confirm this by citing relevant policy should probably revert the article to the uncontroversial version while this RfC is ongoing, or until consensus is reached by other means. Usedtobecool ^TALK ✨ 16:33, 13 September 2019 (UTC)

user:Usedtobecool and others: Probably too late to do this now. Starting yesterday, based on discussion with Newslinger, I updated the on-line article to meet all of his objections in the RFC. (Including my own proposal the dropping of all added full sections and subsections except "Problems".) Hitting the "rollback" button now would undo not only my own changes to meet Newslinger's conditions, but also some stuff that other people have added.NormSpier (talk) 22:09, 2 October 2019 (UTC)

-- End of survey (!vote) section. Record your opinion above this line. --

Discussion

• The added content contains significant violations of Wikipedia's core content policies, and is not fit for article space in its current state. Refer to my analysis (and the version without threaded discussion) for details.

  I would retain the most current version of the article if all three of the following happens:

  1. No original research: All of the content I have identified in my analysis as original research is removed, or cited to reliable sources that directly and fully support the content.
  2. Verifiability: All of the citations I have identified in my analysis as unreliable are removed. If this would leave content unsupported by reliable sources, then that content is treated as original research above (deleted or properly cited).
  3. Neutral point of view: In the "Outline of Coverage Mechanism" section, everything after the "Impediments and Imperfections to Design" label is removed. It can optionally be incorporated into the appropriate sections (such as "Problems" and "Criticism and opposition"), and is also subject to the other two policies listed above.

Otherwise, if the above conditions are not met, I would prefer to restore the August 7 version, and move the added content to the article sandbox for future development until it is compliant with our core content policies. — Newslinger talk 12:59, 9 September 2019 (UTC)

I think, now, I have met user:Newslinger's "retain" condition (just above), with my specific current proposal of today that everything I put in be rolled back (permanently) except the "problems" section. Except with the specific adjustment of user:Newslinger's take: that the Bronze and Silver calculations are accepted as routine calculations (as defined in the "original research" document here Wikipedia:No_original_research#Routine_calculations). And they are. I can give user:Newslinger a step by step page of text showing the exact calculation, with numbers filled in. The replacement of references by reliable references is easy -- I had not been aware of the always-reliable-references policy when I put the ones in that I chose. Minor "original research" sentences remain. I would remove them, unless I can find a clearly reliable reference. The citation overkill is within the subsection (i.e. particular problem) Patient_Protection_and_Affordable_Care_Act#Estate_Recovery_under_138%_FPL and can, in its first occurrence, be removed by less citations and a slight rewording ("many places" to "some places".) On the later two occurrences, state-by-state, I have to have the references to back up the status at each state. I can break the chain of references by listing states, and putting a reference or two on each state. As a bonus, I would even modify for POV by adding a sentence at the top of "Problems", something like "for many, the ACA has worked well", with a reference or two, at the start of the section. (See the green thing below "Original research in the "Problems" section", and just below it, the citation issues.) NormSpier (talk) 22:25, 12 September 2019 (UTC)

Detailing "what do the simple calculations involve?"

You look up the premium and out of pocket max for the couple in question, on healthcare.gov for the second lowest cost silver plan, and the second lowest cost bronze plan. (To get that premium, you put in a salary like $120,000 for the couple, putting them well above 400% of the Federal Poverty Level, so they get no subsidy, and you see Healthcare.gov tells you explicitly there will be no subsidy--you thus know you have the total premium not knocked down by a subsidy.) You then calculate the premium subsidies they get at 399% FPL and 401% FPL using the rules, and the rest is obvious additions, subtractions, multiplications, and additions on the calculator. The rules for the subsidies are simple, and taken from Kaiser Family Foundation Subsidies page, which I have inadvertantly left off as a reference for the calculation, though the reference appears elsewhere.NormSpier (talk) 22:25, 12 September 2019 (UTC) There is also an alternative to get premium subsidies for the 399% FPL couple and the the same couple at 401% FPL, by going to healthcare.gov, and getting direct the premium subsidy amount information for the couple. This is plugging in the couple twice, with two different incomes, rather than once. In the first case, there is a big subsidy, and in the second case, the subsidy will be 0. ("The couple has gone over the cliff".) In doing the calculations, heathcare.gov may have some slight rounding conventions, or may have already updated FPL from where it was last open enrollment, so the cliff-point might be very slightly different than exactly 400% of for-2019 open enrollment that I have used, but everything will be extremely close, unless I have in fact made a mistake.NormSpier (talk) 16:31, 14 September 2019 (UTC)

NormSpier (talk) 22:24, 12 September 2019 (UTC)

WP:CALC states "Routine calculations do not count as original research, provided there is consensus among editors that the result of the calculation is obvious, correct, and a meaningful reflection of the sources." There is no such consensus here, as the selected examples are arbitrary and not specifically discussed by reliable sources. — Newslinger talk 20:18, 1 October 2019 (UTC)

user:NewslingerWell, you are right on the consensus, apparently. My feeling actually is that if we had a pile of editors who understood the ACA and its formulae, they would see that I have chosen a good example to illustrate the subsidy cliff problem. Especially since I point out in the text that the example was chosen to be illustrative of the problem, with an older couple. And I could offer to add another younger couple, where there would be no or small cliff. But I feel it's not worth arguing about. I'll remove the Bronze and Silver calculations, and replace them with something I can find in a "reliable source", perhaps.NormSpier (talk) 18:00, 2 October 2019 (UTC)

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Reader, note, user:Newslinger's (just above) "all I have identified" refers to stuff below.NormSpier (talk) 22:02, 9 September 2019 (UTC)

Prior (superseded by above) discussion fromNormSpier

(3) could be done (on part of "Outline of Coverage Mechanism" after "Impediments and Imperfections to Design"). There is some loss of valuable information in a place where the reader might want it: in a little spot right where the mechanism is densely expressed with details on the interaction Perhaps I could reference it from Problems if needed. I'd have to think about whether there's any value in moving and keeping the "Impediments and Imperfections to Design", and putting it below. (It's not needed there.) Also, you can see the issue of requesting the removal is indicative of tight worrying about the exact emotional first impressions people get of the law--we're in image-manipulation-accusation territory. NormSpier (talk) 21:28, 9 September 2019 (UTC) (2)Looks OK. I don't need the references, though I think Huffington post should be allowed. It is for opinion, not fact. (1) is still problematic on what you consider "original research" on a few grounds. (a)My bronze and silver plan examples on two of the problems you are considering "original research" for just a few calculations, and I can't see that. It may be that the pair of examples, Bronze and Silver, is confusing, and there is an exposition problem therefore. Why not one example? The natural silver? Because of the potential silver loading, and that could be an unnaturally expensive plan, because it has to support cost-sharing-reductions. Thus, I would be tricking the reader by only silver. I could do just bronze, but the numbers calculation goes through silver. By dropping all examples, the numerate reader is left in the dark on magnitude of the problem. I can't see leaving the reader in quantitative la la land. (A numerate reader could regenerate the numbers in 8 minutes, but only after looking up details of subsidy structure, etc. and we should save the numerate reader the time.) (b)There is some economic mechanism understanding and law details needed to verify some of the things you pointed out in all 3 sections. (i)On outline of coverage mechanism, the whole thing has to be removed. That wouldn't be the end of the world for me, but I'd feel some enlightenment lost for the capable reader, forcing the reader into a weaker understanding, like they get from USA Today. (ii)Affect of loss of Penalty for Not Carrying Coverage on Affordability over the subsidy cliff: Could be removed, It's a shame. It's economically obvious. It's a bit of darkness we're leaving the reader in.NormSpier (talk) 21:58, 9 September 2019 (UTC) (iii)The "original research" you've listed in "cost-sharing reductions" is economically obvious. I had added the information to the incomplete information that was in the article when I got to it, which mentioned the Trump stopping of the payment to insurers of cost sharing reductions, but had a horrible omission of that the action was countered in many or most cases by states authorizing or ordering silver loading. But then, why did the states do that? Your "original research" is the explanation. The particular aspect may or may not be documentable in the Health Affairs blog. I'll take a look. If I can't find it, I can just knock the article down to its state of ignorance on silver loading, that it was in before I got to it. But I would find it a shame.NormSpier (talk) 21:58, 9 September 2019 (UTC) (I guess these removals would not be fatal. It's kind of a shame that Wikipedia can't support more complete analysis.) In summary, with your requests, I would not abandon the article, and have it rolled back. I would do the changes, under a bit of protest, with a mind towards stopping or reducing contributions in the future for non-hard-science / math stuff. But I still seek the RFC vote, because I'm not comfortable with all the stuff you are calling "original research": calculations and economically obvious things. I look at it as a real limit on the capabilities of Wikipedia, and I can't imagine how you would apply the sentence reference sentence reference verifiability model to, say, math.NormSpier (talk) 20:53, 9 September 2019 (UTC)

Extended discussion from NormSpier

(I'd call my goals of providing good information to readers 65% met with the "no original research" business with your interpretation of "original research", because I'm getting the important 5 ACA problems out there, though I really regret the squashing of the simple-calculated examples to make the reader be able to understand in a numerate sense, 2 of the five issues. The whole explanation of mechanism section I can remove. It seems to be above the intended level (in terms of thinking through mechanisms) of the audience for the article, which might be NY Times Upshot section, or a little below, possibly non-Upshot NY Times. (Note upshot section calculates its own numbers when they need them, though.) The other thing you have as "original research": silver-loading addition by me, seeming needed to me to complete the coverage of Trump cancelling cost-sharing reimbursements, is probably also above the mechanism-comprehension level of the intended audience, so I can pull all mention of the silver loading out, and then not have to worry about whether I can find the obvious economic consequences of the silver-loading somewhere.) So that would put us down at just keeping the "Problems" section, of the 3. That could be adequate if that's what the RFC group decides. That we be about that 65% of my information goals (weighted to importance) satisfied. It wouldn't take terribly long to do that. Two chops, and some substituted and removed references on problems. (Chopping the bronze and silver examples, in "problems", as well, if the RFC absolutely demands it.) But the quantity of references is needed, perhaps by writing states individually, and in "washington Post", "Seattle Times", etc.NormSpier (talk) 00:04, 10 September 2019 (UTC) Elaborating on math comparison: without plagiarizing an entire exposition on a matter, or being forced to public domain out-of-copyright expositions, only available for some stuff, and with archaic notation, the writer needs to understand the problem, and think. They can't the first sentence from one text, the second from another, the third from another (necessary to avoid copyright infringment). It seems crazy to me.NormSpier (talk) 22:15, 9 September 2019 (UTC) Another way to express the issue I am seeing with "original research" it is being applied here by user:Newslinger, is that it is being applied here to apply to the equivalent of "doing a calculus problem from the problems section of the calculus book", "filling out one's tax form", learning a modest amount of economics from a few texts, and applying it to a problem from a book, or, say, the book has an example: if the "price of milk goes up (all other factors being the same), consumed quantity of milk will fall", but the principles in the book, while implying, "if the price of iced cream goes up (all other factors being the same"), consumption will fall", the last statement is considered "original research". But I see where it might be coming from, since Wikipedia is "everyone can write for it", and, further, you may have no way of figuring out if a person knows what they're writing about--author or editor. And you may have a shortage of the right editors. So I respect the situation Wikipedia is in, and its chosen way to handle the problem. It's just capable of providing its readers with less than I had initially thought.NormSpier (talk) 23:54, 9 September 2019 (UTC)

NormSpier's objection

Objection by User:NormSpier to Framing by User:Newslinger as a binary "kill all" or "keep all"

• I disagree with the presentation of the question for RFC by User:Newslinger as binary, "keep all" or all "remove all". My choice would be to keep the article, and hopefully this broad-coverage RFC will attract enough eyes that any adjustments, additions, or deletions needed.

• I find the "in or out" method too blunt, and not useful in the construction of sharp, comprehensive wikipedia articles.

• Further, since Democratic debates about "repair or replace" are ongoing, the Problems of the ACA should be available to citizens right now.

• User:Newslinger has not explicitly stated his position directly above, but let me clarify that it is to kill all, in case it is unclear.

NormSpier (talk) 09:21, 9 September 2019 (UTC)

• Another reason I oppose a kill decision (which User:Newslinger I think intends may lead to eventual return of some or all of the content eventually in some form when editors with the right technical skills and areas of expertise set get to look at it), is that there don't seem to be any editors around with the needed skills and areas of expertise, so far, willing to invest the time. ( User:Newslinger has, prior to this RFC, sent around requests for help to a bunch of working groups, about a week ago. The list included the one I picked as especially likely to be able to help, on economics topics.) So I see kill as "kill permanently", due to a lack of willing and able editors for the topic.NormSpier (talk) 18:05, 10 September 2019 (UTC)

Scope of disagreement

• The content was added by me, and the contention is between User:Newslinger and me only at the point of construction of the RFC.

NormSpier (talk) 09:08, 9 September 2019 (UTC)

Scope clarification (number of articles)

• There were initially 6 wikipedia articles involved, which is to inform the readers as to why a link from prior discussion that User:Newslinger provided (WP:NPOVN § Medicaid estate recovery and User:NormSpier) mentions 6 articles. (I decided 4 of the articles were not that important, and further, that the content I added could be considered to violate "no original research", though I myself thought I was just guiding the reader to a better understanding by making an obvious-to-statisticians-like-me point, and not doing "original research".) Those 4 articles are not part of the issue before us now.).

• There are two articles remaining of contention between User:Newslinger and me. I think User:Newslinger intends this RFC to be on Patient_Protection_and_Affordable_Care_Act only. There is a second article, Medicaid estate recovery, which I think he may be conceding should not be rolled back. If he could clarify on that, or perhaps there will be a separate RFC, that would be great.

• Note that one of the Problems discussed in Patient_Protection_and_Affordable_Care_Act#Problems is the subject of a large part of Medicaid estate recovery. The latter article has a bit more detail. And, as well, I'm confident it is not perfect, so people may want to comment on that article for improvement.

NormSpier (talk) 09:08, 9 September 2019 (UTC)

Arguments Against The Position of User:Newslinger by User:NormSpier

• I note that the main contention points of User:Newslingers about violation of Wikipedia standards is Patient_Protection_and_Affordable_Care_Act#Problems, and at might appear to some that the action to remove the section may be a partisan attempt to cover up problems with the ACA. (User:Newslinger creates the appearance of attempting to cover up the defects of the ACA, you will see in details that follow. However, I don't believe he is doing such a nefarious thing, but rather that he is far too busy doing other Wikipedia tasks to focus adequately on this particular article or pair of articles. He has indicated he is very, very busy.) NormSpier (talk) 00:23, 9 September 2019 (UTC)

• User:Newslinger, nor anyone else, has asserted any information in my content is incorrect. (Some eyes have passed over my content, I know from typo and spelling corrections made, and such. But I have no idea if anyone in those passes was looking for incorrect information.)NormSpier (talk) 00:23, 9 September 2019 (UTC)

• The section Patient_Protection_and_Affordable_Care_Act#Problems is the one that User:Newslinger has pointed out 3 objections to, in the thing (maybe you call them "tags"?--note I'm new) he put at the start of the section.

• User:Newslinger objection 1. "Some of this article's listed sources may not be reliable." I respond that the facts on the existence and details of each problem, and all supporting minor calculations, are in reliable sources (newspapers like the Washington Post, reliable health insurance information sources like Kaiser Family Foundation and Health Affairs, and federal and state government sites, and a few others that I believe are reliable). However, for opinion, I have included some less reliable sources, like a physician writing in Huffington Post. I've done this particularly in the problem "Medicaid estate recovery", where opinion often has sharply hurled terms like "it's a big con". I think they help give the flavor of the controversial aspect, but the facts on the problems are documented in detail from sound references. (I note that Wikipedia reliability standards treat fact sources and opinion sources differently. Absolute reliability is needed only for fact, and I believe I am compliant with the intent of those standards.)

• User:Newslinger objection 2. "The neutrality of this article is disputed". I respond the section is called "problems". It points out problems. The article in question, on the ACA, in general, is quite positive about the ACA, overwhelmingly positive, and avoids any mention of defects in the functioning of the law. And, in fact, a year ago, in "talk", Talk:Patient_Protection_and_Affordable_Care_Act#POV_issues, I quote: "Too much of this feels like it was written by someone who heavily supports the law and it feels strongly as though it is purposefully omitting many studies which have shown to portray the effects of the law in a neutral or even negative light, while selecting studies mostly that show the law as achieving the results the creators proclaimed it would." ( I, in constructing the section, have tried to be careful to not claim the law is working for no one. I've used section titles like "Sometimes Unaffordable Out of Pocket Maximum", not "Always Unaffordable". On an example calculation, I've gone out of the way to say "The age was chosen to illustrate the case where the unsubsidized-premium cost issue is more severe—older people." Etc. If anyone finds other cases where better wording indicating that it's not a problem for everyone, please indicate that to me, or make changes yourself.

• User:Newslinger objection 3. "This article may lend undue weight to certain ideas, incidents, or controversies." I respond, again, it's a "problems" section. (And otherwise, as to "objection 2".) (Note: I actually supports the ACA, but want the problems fixed, and not ignored or covered up.)

• Note the above 3 objections by User:Newslinger seem to be confined to my section Patient_Protection_and_Affordable_Care_Act#Problems. The below one may apply in multiple places, because I took it from the top of the article, rather than the top of the section.

• User:Newslinger objection 4. "This article possibly contains original research. (I recollect from prior discussion with User:Newslinger that this refers to Bronze and Gold Plan calculations in two of the problems within Patient_Protection_and_Affordable_Care_Act#Problems, and as well, possibly a replacement set of calculations to those in the table in Patient_Protection_and_Affordable_Care_Act#Premium_Subsidies, which I replaced because the last column was entirely in error, another column was off by smaller amounts of a few hundred dollars, and because the table was for 2014. (Mine is 2019.) Additionally, User:Newslinger may also be referencing the looking up of some number of states which do and not do Medicaid estate recovery for non-long-term-care-related expenses, in Patient_Protection_and_Affordable_Care_Act#Estate_Recovery_under_138%_FPL.

• On objection 4, I, rather than "original research", view the modest calculations not to be "original research" but rather as the author (and also a subsequent checking reviewer) not being lazy, and trying to provide information useful to a numerate, critical thinking reader. The numbers are verifiable from sources I have referenced with simple calculation, though at end of Oct. or around there, the healthcare.gov numbers will be updated for 2020. (Someone should indeed check the calculations and not rely on just me. It shouldn't be hard, at least for many people, who, say, fill out their own tax forms. I can help guide them, if they are unfamiliar with the details of ACA subsidy determination, etc.) In the term "lazy", I realize that there's a real available resource issue for suitably qualified editors at Wikipedia, so I'm using the term light-heartedly, but intentionally, to mean that we have to put in the work to do a good job. I think at Encyclopedia Brittanica, they would put in simple calculations of their own, where helpful to the reader. Also, I consider the listing of some states doing and not doing the non-long-term-care-related estate recovery to not be "original research", but rather, doing necessary minor work, in an effort to give necessary information to the critically-thinking reader. The critically-thinking reader will want to know if the issue applies in a significant number of states, and the reader can see that it does, because the author did the work. The reader also will want to know about the timing of the decision of some states switching to not do non-long-term-care-related estate recovery, and see that it is timed to the start of the ACA main provisions, or soon after, and often timed in response to public concern over the issue documented in newspapers. (All kinds of Wikipedia articles have tables. Like lists of variants of linux. It doesn't count as original research there, apparently.) Also, note, there are reliable references for each looked up state in my enumerations. (NormSpier (talk) 22:59, 8 September 2019 (UTC) timing of signature: last 2 bullet items.)

• I want to point out that by deletion of all my content (3 sections) that User:Newslinger is requesting, two of them in fact answer requests on the talk page for the article in question. Already discussed, the hotly contested by User:Newslinger Patient_Protection_and_Affordable_Care_Act#Problems answers the point of the Talk:Patient_Protection_and_Affordable_Care_Act#POV_issues allegation of gross pro-ACA bias. Additionally, Patient_Protection_and_Affordable_Care_Act#Cost-sharing_Reductions fulfills the request in "talk" Talk:Patient_Protection_and_Affordable_Care_Act#Cost-sharing_subsidies. (Both sections were put in by me based on instinct of where the article needed fixing, without having spotted them on the "talk" page first. I noticed the requests at some subsequent point.)

Before and after versions of article, with explanation of why the "Cost-sharing reductions" section was needed

This is the article before I got to it https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&type=revision&diff=908286257&oldid=907734677. You may want to search for "sharing".) A main component of the flaw was not to mention cost-sharing reductions (less clearly called cost-sharing subsidies) as a provision. (This was recognized both by me, and someone else, as pointed out in the RFC Talk:Patient_Protection_and_Affordable_Care_Act#Cost-sharing_subsidies) It's a main provision, and it's also central in what Trump did to try to sabotage the law. (The article mentions the cost-sharing in the erroneous table, and then down in what Trump did. But the silver-loading response by many states and insurers is also omitted--a major omission.) I have not proposed to keep the section I added on the cost-sharing reductions, Patient_Protection_and_Affordable_Care_Act#Cost-sharing_Reductions, and also on the silver-loading later on, because I can't get around "original research". The silver loading has to be explained, and that is "original research". The article with my additions and changes is (i.e. Sept 7 version is) https://en.wikipedia.org/w/index.php?title=Patient_Protection_and_Affordable_Care_Act&type=revision&diff=914372500&oldid=914371529. Note that on 9/12/2019, I made a proposal to revert permanently everything but my added "Problems" section. So the badly-needed section on "Cost-sharing reductions" will be out permanently. I made that proposal because I am unable to overcome "original research" issues, as interpreted by at least some, and further, it is so far just me willing to put time into the article. NormSpier (talk) 15:46, 13 September 2019 (UTC)

NormSpier (talk) 09:08, 9 September 2019 (UTC)

• In the apparent attempt to immediately remove all of my additions until it can be made more or less perfect by every Wikipedia standard, User:Newslinger appears to be working under the theory that Wikipedia information is perfect, or else that he will make it so. In fact, Wikipedia has errors and omissions and miserable presentation all over the place, and there is nothing he will be able to do about it. I have noticed the errors in applied math. I have noticed them in the article in question, on the ACA. A fully erroneous last column in a table. (I fixed it.) An incoherent failure to cover "cost-sharing subsidies" in the section on ACA features. (I added it.) A failure to add to the Trump blocking of cost-sharing subsidy reimbursements to insurers with the response silver-plan-loading. I'm pretty sure people who know the ACA and have a head for its mechanisms, will conclude its not a real good article. (Not much said on rules affecting employer insurance. Pretty muddy and mish-mashy in many places. I see from the blue "Categories" box at the bottom of this RFC that the article is generally rated C class, and that's about where I'd put it.) (Wikipedia is extremely useful with its problems, but the reader has to take into account the massive quality problems that may be present.) NormSpier (talk) 09:59, 9 September 2019 (UTC)

• Wikipedia invites its users to contribute. The ACA article invited me to contribute. It said "be bold". (The particular article said "be bold, but don't be reckless" because it is in a touchy area. I have not been reckless. I have been going "straight for the truth".) The Medicaid estate recovery article was a stub when I got to it, and it said "please help expand this article ...". By insisting on completely removing imperfect content after the user has been invited to put it in, when, as before, Wikipedia content is generally all so imperfect and often quite defective, is an inconsistency. Be consistent, people.NormSpier (talk) 10:44, 9 September 2019 (UTC)

Comments on RfC

• This RfC is a continuation of the noticeboard discussion at WP:NPOVN § Medicaid estate recovery and User:NormSpier, and asks for a version of the article that should be used as a starting point for discussion. If you have identified specific portions of the added content that you believe should be included or excluded, please say so. If this RfC concludes that some of the content should be removed, it can optionally be added to the article sandbox for future improvement.

  Three sections were added during the past month: the "Outline of Coverage Mechanism", "Cost-sharing Reductions", and "Problems" sections. Please refer to Special:Diff/909824345/914372500 for a full comparison of the August 7 and September 7 article versions. — Newslinger talk 05:53, 8 September 2019 (UTC)

  Both NormSpier and I have written plenty on this subject. At this point, I would really appreciate some more opinions from other uninvolved editors. — Newslinger talk 04:29, 10 September 2019 (UTC)

Notified: Wikipedia talk:WikiProject Economics, Wikipedia talk:WikiProject Health and fitness, Wikipedia talk:WikiProject Law, Wikipedia talk:WikiProject Medicine, Wikipedia talk:WikiProject United States, Wikipedia talk:WikiProject United States Government, Wikipedia talk:WikiProject United States Public Policy, Wikipedia talk:WikiProject U.S. Congress, Wikipedia talk:WikiProject Taxation — Newslinger talk 06:02, 8 September 2019 (UTC)

Notified: Wikipedia:No original research/Noticeboard, Wikipedia:Reliable sources/Noticeboard — Newslinger talk 05:00, 11 September 2019 (UTC)

• At least , some of the additions seem to be non-encyclopedic.

So we have total medical expenses potentially at 42% of MAGI in that case...

... it should be noted that we have presented premiums and out-of-pocket maximums.

Who's we?

Also, the RfC should probably be edited to make it easier to !vote. For example, word it so that Support or Keep clearly means the current version, and oppose or revert means the August 7 version, without a need for more words. Usedtobecool ^TALK ✨ 15:19, 8 September 2019 (UTC)

agree w/ Usedtobecool--Ozzie10aaaa (talk) 21:53, 9 September 2019 (UTC)

Emphasis on "retain" and "restore" is probably enough. Usedtobecool ^TALK ✨ 15:22, 8 September 2019 (UTC)

Hi, User:Usedtobecool. Note I am new at the process, and may have place my response in the wrong place. So please let me know, if I did that, and where I should put it.

The calculations "42% of MAGi", etc., were done by me, User:Usedtobecool. They are verifiable from sources I have referenced with simple calculation, though at end of Oct. or around there, the healthcare.gov numbers will be updated for 2020.

("we", in both case, is me, User:NormSpier.) I thought that was how it's done. (I used to be a statistician, and I think that was the way we often wrote. It was a while back. Anyone: Feel free to supply a better way to write it than "we".)

"Encyclopedic" stuff, I don't know about. I'm new to the standards. My thought was that to be a decent presentation, informing the reader, that the numbers should be available. (In the "talk" section, I actually ask, on all 5 problems, is the magnitude of the financial or health problem illustrated to keep the reader out of quantitative darkness?, and I answer yes, with the Silver Bronze examples needed on the two problems where I have them.) I think Encyclopedia Brittanica can come up with helpful, accurate tables where they are needed. Wikipedia may or may not be different.

Also note, I have expressed disagreement with the whole binary "in or out" voting that you talk about. More nuance is needed then a yes or no vote. I can't imagine good work on complicated issues or topics is possible with such a coarse approach.NormSpier (talk) 19:57, 8 September 2019 (UTC)

From MOS:TONE: "Articles should not be written from a first- or second-person perspective." — Newslinger talk 07:31, 11 September 2019 (UTC)

Thanks, user:Newslinger. That's helpful. I guess that means it should be something like "The premiums presented ..." (on the second table).NormSpier (talk) 00:23, 13 September 2019 (UTC)

Newslinger's analysis

Please refer to my original analysis, without threaded discussion, at Special:Diff/914836520#Newslinger's analysis. — Newslinger talk 02:34, 10 September 2019 (UTC)

The added content (Special:Diff/909824345/914372500) contains significant violations of Wikipedia's core content policies (mostly the no original research and verifiability, and neutral point of view). This analysis focuses on the three new sections, "Outline of Coverage Mechanism", "Cost-sharing Reductions", and "Problems". Content was also added outside of these sections.

"Outline of Coverage Mechanism" section

• No original research: Substantial portions of the section do not cite any sources, or make extrapolations that are not directly and entirely supported by the cited sources:

Original research in the "Outline of Coverage Mechanism" section

Uncited content: (The ACA attempted to be make the policies provide strong coverage by requiring essential benefits, and by not allowing yearly or lifetime caps on coverage, as well as having maximum annual out-of-pocket payment caps.) Essentially, for people without employer insurance, if incomes are through 138% of the FPL, the ACA design intends all people either get Medicaid coverage, or expanded Medicaid coverage. For the remaining individuals, a major medical policy will be available, with a sliding-scale subsidy for individuals with incomes below 400% FPL, to attempt to make the policy affordable. Part of the mechanism was also from a mandate to carry coverage (or else pay a penalty). This was designed to keep insurance costs lower than they would otherwise be, by limiting adverse selection due people just picking up insurance when they got sick, or if they were more likely to get sick. It should be noted that, while the intent of the ACA's design was to provided affordable coverage to all, it was not designed to lower premiums for all people. Certain individuals were expected to pay higher, but still affordable, premiums, compared to what they would have without the ACA. A specific case of this would be people who had no pre-existing conditions, and might have, without the ACA, been able to purchase pre-existing-condition-screened insurance at a low premium, made possible by the fact that the pool of people insured by the policy had few sick people in it. The ACA, by requiring people with pre-existing conditions also to be covered by all plans at the same premium, would yield higher raw (before-subsidy) policy premiums for the people without pre-existing conditions. In the case where incomes were greater than 400% of the FPL, there is no subsidy under the ACA, so the post-ACA premiums that have to be paid by the individual would be higher. However, the theory would be that, did those same people need insurance when they had serious pre-existing conditions, they would often then be better off post ACA. While provisions (4) for individual major medical policies are designed to make them strong policies with good coverage, other coverage post-ACA may not be so strong. Large group employer policies are not regulated by the ACA, and may provide weaker coverage. Content not directly and entirely supported by cited sources: Removal of the mandate to carry coverage (effective in 2019) may increase increase adverse selection in states which do not have their own mandate to carry coverage, increasing costs of individual major medical policies, particularly for those not eligible for the ACA's federal subsidies. References

Much of this I look at as that to explain the law and how it is functioning, you need people who understand the mechanisms. My analogy is to some science / engineering things, where there is a lot of acquired understanding. I think you user:Newslinger may have a model: sentence 1, reference 1, sentence 2, reference 2, sentence 3, reference 3,..., where an editor reviewing can easily go "looked up sentence 1 ref, see it there, look up sentence 2 ref,... . I'm not sure complicated things can be well described if article construction requires verifiability by that standard. I had prior brought up with you these examples: Internal combustion engine, Calculus, and Banach space, and I said "they don't do it there" and you responded that it was because they were older articles before the new Wikipedia rigourous standards. As I see it, you're not going to find quite the description I put down anywhere. I think Paul Krugman once put some explanation of the mechanism, close to this, but less detailed. Jonathan Gruber has a graphic novel where he tried to explain. However, yes, based on understanding, and careful looking up of precise details, I have designed the exposition to be clear (to a suitably analytical reader), in order to make it possible for people to be able to see where the thing will work, and not work, by putting in exactly the right details. The several "moving parts" needed to understand how the law works: employer coverage, traditional Medicaid & CHIP, expanded Medicaid, ACA insurance plans, and ACA subsidies, are listed, and the critical factor, who is eligible for subsidies on the ACA plans, is presented. The user is supposed to see all the working parts in one place, all together.

Verification would need people who understand the law and how it works, like economists and possibly health economists, or other people fluent in (very simple) economic mechanisms. (A large number of people already know how the law works, and to them the correctness or any incorrectness would be obvious after looking up one or two details.) I'm thinking like Internal combustion engine, where there are few references, and the writer understood how an engine works, and probably the reviewer, as well, or at least the necessary physics. But I see your critique. It does pull down the level of understanding available from what people can write at Wikipedia too much, in my opinion. NormSpier (talk) 18:14, 9 September 2019 (UTC)

You might consider it like a calculus teacher, who knows calculus. There's a text, maybe, but the presentation of the teacher is designed to be as helpful as possible. That's not research. But I see Wikipedia capacity is taxed in able to handle that, and that's a real world problem for Wikipedia that it may not be able to fix. NormSpier (talk) 18:26, 9 September 2019 (UTC)

Here's another example, from elementary economics: Supply and demand. This is an elementary topic, ideas from Econ 101 or an elementary Price Theory course. It's impossible to do sentence 1 reference 1 sentence 2 reference 2 sentence 3 reference 3. Similarly, from a economics GA-rated article, Risk_parity#Equally-weighted_risk_contributions_portfolios, its a presentation of basic well-known theory by a mind that understands the theory. In certain economics articles, the topic is substantially history, so what happened needs references about what happened and when, and they have them here Panic of 1907, and where the article focus is who came who came up with the idea, or where the analysis is sufficiently non-elementary that it has to come from research papers, the research papers of course have to be referenced.NormSpier (talk) 01:25, 11 September 2019 (UTC)

The verifiability policy only requires inline sources when the content is "challenged or likely to be challenged". The content above is currently being challenged. Regarding the other articles: if content is uncontroversial, then it does not need to be sourced with inline citations, but it must still be verifiable to some reliable source(s) cited on the page (and the editor who added the content should be able to point out which ones when challenged). Lead sections are exempted, but only if the uncited claim summarizes properly cited content in the rest of the article. You are welcome to improve the sourcing of any article on Wikipedia, including the ones you pointed out. — Newslinger talk 01:47, 11 September 2019 (UTC)

• Verifiability: Substantial portions of the section reference unreliable sources, including:
  1. Paying for Senior Care, a blog

That link is just used for Federal Poverty Levels. The reason I chose it over a more reliable site like Kaiser Family Foundation or U.S. government, is that it has specific percent of FPL values calculated, like 150% of FPL, 200% FPL, etc., and might be more helpful to readers. It could, of course, be replaced with Federal or Kaiser, or something.NormSpier (talk) 18:22, 9 September 2019 (UTC)

• 1. healthinsurance.org, a shopping tool for insurance

The information looks roughly accurate to me, who knows the law, so I'm confident the information is at least not bogus. I see your point--it's not enough. It could be replaced, though I chose it because it has a nice direct definition of "Medicaid expansion" that pops up for the reader, rather than having to go through more complicated reading. (The reference could even be knocked off entirely, under the assumption of a reviewing editor who understood the law. But you won't do that here.) (No point in me making the joke "but it says "A TRUSTED INDEPENDENT HEALTH INSURANCE GUIDE SINCE 1994" on the top of the page.) — Preceding unsigned comment added by NormSpier (talk • contribs) 18:36, 9 September 2019 (UTC)

• 1. ElderLawAnswers, a shopping tool for legal aid

This could easily be removed. I find the site myself quite reliable, and it comes up first on the google search for "Medicaid estate recovery". It's not essential. Everywhere I use it, the same in information is referenced on the Federal Medicaid site. I had placed it here to help the reader, who might find it clearer and more direct to the point than the Federal. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. a former version of the Wikipedia article for Medicaid estate recovery (see "Wikipedia is not a reliable source")

This is me not knowing that a reference is used at Wikipedia only as something that makes something airtight. Apparently, I used it as a see also. My view, before being informed, had been that you could use it to help a reader get more of a sense of the issue, if not with perfect reliability. (Being only, roughly as reliable as the place it is linked from, another Wikipedia article.) It could, of course, be removed. Somewhere, there should be a "see also", though, because why not help the reader get additional information?NormSpier (talk) 18:58, 9 September 2019 (UTC)

• 1. a former version of the Wikipedia article for National Federation of Independent Business v. Sebelius

This could be replaced. I'm sure it's somewhere considered reliable. — Preceding unsigned comment added by NormSpier (talk • contribs)

• Neutral point of view: All of the content after the "Impediments and Imperfections to Design" label is inappropriate for a section named "Outline of Coverage Mechanism". This content should be merged into appropriate sections (such as "Problems" and "Criticism and opposition").

The whole thing could be dumped, I guess, even. The whole thing is teaching kind of exposition, not original research, but you might consider it that by Wikipedia standards. It needs people who understand the law, and can reason about the law in an economically sound, but not especially demanding, way, to determine if it is correct. The whole adding of "Outline of Coverage Mechanism" was to provide, close together, in one place, an exposition on that mechanism, including where it might go wrong. (Actually, a sharp reader will see implications on the financing of ACA: access to subsidies is tight for apparently Federal financial resource reasons.) Rather that the reader having to think more independently themselves, and have to go through all the parts, and really need a lot of skill to see what might work, and what might go wrong. (This kind of thing may be impossible at Wikipedia. There may also be an article-readership-level decision, reasonable, to keep it at New York Times level. I am writing at a higher level, demanding more skill. Maybe of an undergraduate of graduate health economics course.)NormSpier (talk) 18:58, 9 September 2019 (UTC)

"Cost-sharing Reductions" section

• No original research: Portions of the section do not cite any sources:

Original research in the "Cost-sharing Reductions" section

Uncited content: Where there is silver loading, the effect is to often give people who received premium subsidies who purchased silver plans, roughly the same net-of-premium-subsidy costs as before the Federal payments were stopped. (This is because premium subsidies are determined by a formula to make the second lowest cost silver plan cost a certain fixed percentage of MAGI, so that the increased premiums were accompanied by a commensurately increased subsidy.) Further, where there is silver loading, premiums for bronze, gold, and platinum plans are unchanged. (So a person not receiving a subsidy could avoid increased costs by avoiding silver plans.) It should also be noted in the cases of states or insurers who did not do silver loading, the cost of all plans will increase, and this will yield increased costs to those who receive no premium subsidy

For these babies, you really need a reviewer able to work competently with basic economic mechanisms, and able to put the mechanisms together with the structure of the law. If you can do that, it's obvious. Really, it is. This is like Internal combustion engine or Banach space. Whether [[user::Newslinger]]'s model of sentence then reference, then sentence then reference will work for more complicated things is in question, in my mind. It may limit the capacity of Wikipedia, due perhaps, ultimately, to a set of certified-know-what-they're-talking about reviewing editors in fields.NormSpier (talk) 19:11, 9 September 2019 (UTC)

• Verifiability: Portions of the section reference unreliable sources, including:
  1. Google Docs, a self-published document

This baby seems a little reliable to me because its linked to by Health Affairs. It's not essential. I put it in to let a sufficiently curious and able reader see that the matter of the silver loading is complex, state by state, it changes from year to year, it has some variations. NormSpier (talk) 19:11, 9 September 2019 (UTC)

• 1. healthinsurance.org, a shopping tool for insurance

This one I chose because it has a nice, complete explanation for the reader. The essential content can be found elsewhere, on a reliable source.NormSpier (talk) 19:11, 9 September 2019 (UTC)

"Problems" section

• No original research: Substantial portions of the section do not cite any sources, or make extrapolations that cannot be directly and entirely supported by the cited sources:

Original research in the "Problems" section

Uncited content: (These are not unique to ACA insurance. They are an issue with many categories of health insurance coverage in the U.S. insurance system.) Content not directly and entirely supported by cited sources: However, upon crossing the cliff, the cost of the plan may rise sharply. Silver plan numbers example: For example, in Cook County, IL zip 60617, in 2019, one gets from Healthcare.gov a SCLSP rate of $21,266 for a married couple 63 years of age. If the couple's income is 401% of the FPL, just above the cliff, that works out to $84, 731. If the couple chooses the SCLSP, it will cost them 25.1% of their Modified Adjusted Gross Income. If their MAGI was 399% of the FPL (i.e. not over the cliff) at $84,308, the SCLSP would only have costed them 9.86% of their MAGI, or $8,312. The jump in cost at the discontinuity is $12,954. (It should be noted that, for the example, an older couple, at the high end of the through-64 ACA age range, was chosen. The couple would face higher premiums than younger couples. The age was chosen to illustrate the case where the unsubsidized-premium cost issue is more severe—older people.) Bronze plan alternative numbers example: In the case of certain states and certain insurers, for people above 250% of FPL, who don't get cost-sharing reductions (CSRs), plans besides silver may provide better value. (This is because when payment by the Federal Government of cost-sharing reduction compensation payments to insurers was stopped by the Trump administration, certain states either ordered insurers, or allowed insurers optionally, to assess actuarial costs for the cost-sharing reductions that they had to pay for silver plan enrollees with FPLs below 250% FPL, to silver-plan-premiums only.) So, we provide also the Bronze plan numbers here for the same couple. The second lowest cost bronze plan for the example couple above was $18,513. At income levels of 399% of FPL and 401% of FPL, the net cost of the second lowest bronze plan would be $5,559 a year and $18,513 respectively. The jump in cost at the discontinuity point is $12,954, but the percent of MAGI that these represent are 6.6% and 21.9%, respectively. Thus, the second lowest cost bronze plan, though it has an out-of-pocket maximum about $2000 higher than the second lowest cost silver plan, may be slightly better value, but, above the subsidy cliff, at 21.9% of MAGI, it may still be considered unaffordable. Note that for the gold plans, all gold plans were more expensive than the second lowest cost silver plan, and so those would have all cost more than 25.1% of MAGI for the over-the-cliff case. Affect of loss of Penalty for Not Carrying Coverage on Affordability over the subsidy cliff: Since the penalty for not carrying coverage was designed to reduce adverse selection from people not picking up coverage unless they were sick or more likely to get sick, the removal of the penalty starting in 2019 (in states that did not add their own penalty) may increase adverse selection, that is, the likelihood of the people with insurance being sicker than the average in the population, and this may increase premiums for policies. Since people over the cliff get no subsidy, they would be the most affected. (People under the cliff point of 400% FPL have a post-subsidy premium bounded currently at at most 9.86% of FPL, so they are less affected.) Example, sliver plan: reusing from the subsidy cliff example of Cook County, IL zip 60617, for a married couple aged 63, with an income around 400% FPL, in 2019, one gets from Healthcare.gov for the second lowest cost silver plan an individual out-of-pocket maximum per family member of $7,050 with $14,100 allowed total for the couple. Since the income is about $84,500, the out-of-pocket maximum works out to about 17% of MAG Income. So the couple has to allow that they may need to pay the out of pocket max, in addition to the premium, which for them in the subsidy cliff calculation, was 25.1% of MAG income if they were just a bit over the subsidy cliff. So we have total medical expenses potentially at 42% of MAGI in that case, and still about 27% of MAG income even if they were under the subsidy cliff. Example, bronze plan: switching to second lowest cost bronze plan: The out-of-pocket maximum is $15,800, or 19% of MAG Income. Above the subsidy cliff, since premiums were 22% of MAGI, total annual medical expenses could be 41% of MAGI. (1% less than silver.) References

No. If you have available reviewing editors who know or can learn the law, and reason a a light but competent way economically, it's either economically obvious, or else its light calculations that are easy to do for a person who understands the law, with sound sources like healthcare.gov. I believe user:Newslinger has the view that the calculations are "original research". Again, the question of the model: line, reference, line, reference, for complicated stuff.NormSpier (talk) 19:33, 9 September 2019 (UTC)

"Original research" is clearly defined in the no original research policy. Our core content policies, including no original research, are mandatory, not optional. Saying "No" to a policy because you don't like it is simply not acceptable on Wikipedia. You are welcome to publish original research on your personal webpage, or in some of these alternative outlets, but it doesn't belong on Wikipedia. — Newslinger talk 01:52, 11 September 2019 (UTC)

Within the "no original research" guideline https://en.wikipedia.org/wiki/Wikipedia:No_original_research#Routine_calculations (affecting my bronze and silver plan calculations, and also the updating and correction of an errroneous and dated table elsewhere) "Routine calculations do not count as original research, provided there is consensus among editors that the result of the calculation is obvious, correct, and a meaningful reflection of the sources." I will be glad to answer questions, and help editors see that the calculations are routine. Perhaps user:Newslinger can regenerate them right now, or someone else, straight from the references. (You look up the premium and out of pocket max for the couple in question, on healthcare.gov for the second lowest cost silver plan, and the second lowest cost bronze plan. You then calculate the premium subsidies they get at 399% FPL and 401% FPL using the rules, and the rest is obvious additions, subtractions, multiplications, and additions on the calculator. The rules for the subsidies are simple, and taken from KFF subsidies page, which I have inadvertantly left off as a reference for the calculation, though the reference appears elsewhere. I could, alternatively, type up the exact calculations used for you to examine.) NormSpier (talk) 15:22, 12 September 2019 (UTC)

Otherwise, I see at the top of "no original research" "The phrase "original research" (OR) is used on Wikipedia to refer to material—such as facts, allegations, and ideas—for which no reliable, published sources exist.[a] This includes any analysis or synthesis of published material that serves to reach or imply a conclusion not stated by the sources." So, I guess, outside of the "routine calculations", maybe it is original research as Wikipedia defines it. Though, it's also obvious stuff to a person who knows the structure of the ACA, and can reason a bit economically or actuarially. I'm interested if we have an economist or actuary visiting here, to indicated how they deal with actuarially and economically obvious stuff. (For the sake of anything I might try to add to Wikipedia in the future. As in next paragraph, I will drop my attempt to get in the sections that have "original research"--everything but "problems".)

Unless some actuary or economist comes in and says "man, no, that's not original research", my solution is to drop all of my additions except for the problems section. (Revert everything but problems permanently.) In the problems section, user:Newslinger objects, as original research, only to what I hope everyone will see as routine calculations (bronze/silver), and an expendable paragraph. Then the references quality objection, to all of user:Newslingers cited problematic references, is easily solvable by replacement.NormSpier (talk) 15:55, 12 September 2019 (UTC)

• Verifiability: This section contains many instances of citation overkill, but also cites unreliable sources, including:

on the citation overkill, sometimes I really need them, to back up state by state non-LTCR Medicaid estate recovery status. (On my Medicaid estate recovery, on that problem also in problems section, a fellow put in the talk section that I should put each state on a separate line or section or something. But I think that can't be done here. In the yes/no on estate recovery listings, I could put footnotes on each state, rather than at the end. (That would cover two of the three very long footnote listing cases I see. The other one is this: "The issue of the negative interaction of the ACA with Medicaid estate recovery was noticed in many places starting from the time of ACA passage.[356][357][358][359][360][361][362][363][364][365][366][367][368][339]". So it's about the reporting at various times, mostly 2014, and as well as outrage. On Medicaid estate recovery, the person may have suggested say noticed in "The Washington Post", "The Seattle Times", "Health Affairs", and put a footnote on each one. (I have a request for clarification from that gent to see exactly what he meant.) These references may not be essential to document the existence of the problem, but if I don't put them, you're gonna tell me "original research". But, more importantly, the curious reader will want to see that it was reported, and in certain cases, can trace that being reported yielded a quick change of policy, and as well, the reported of the reasoned outrage (mostly in newspapers, 1 or 2 non-airtight sources for opinion) has value. — Preceding unsigned comment added by NormSpier (talk • contribs) 20:02, 9 September 2019 (UTC)

• 1. eHealth Insurance, a shopping tool for insurance

The definition of "subsidy cliff" is in all likelihood elsewhere you would consider reliable. It's used for the name. That the subsidy cliff exists is economically obvious to people who know the structure of the lwas, and can reason a bit economically. I saw the potential for this type of problem immediately, on ACA passage. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Google Docs, a self-published document — Preceding unsigned comment added by NormSpier (talk • contribs)

I think was referenced prior. Linked to by Health Affairs. It's not essential to any support, but gives the curious and able reader the ability to see that it's being done in varying ways in varying states.

• 1. ElderLawAnswers, a shopping tool for legal aid — Preceding unsigned comment added by NormSpier (talk • contribs)

Was put in because it was nice clear explanation. Redundant with Federal sources. Could be removed.

• 1. a former version of the Wikipedia article for Medicaid estate recovery (see "Wikipedia is not a reliable source")

Same business as before. I didn't realize the purpose in Wikipedia is reliability for footnotes only, at least where they are used for fact, not optiono. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Marshall, Parker & Weber LLC, a self-published blog post from a private law firm

Could be removed. Redundancy of explanation, that a user might feel was clearer than what's on Federal government sites. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Daily Kos community post, user-generated ("This content is not subject to review by Daily Kos staff prior to publication")

I caught that it was removed by me after user:Newslinger and I had initial discussion. It was there for opinion only, and that it's still there was just my error. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. HuffPost contributor (RSP entry)

This one I think is perfectly fine. It's there for opinion only. It was written by an MD (unless that's phony, but Huffington post should catch. It's there to give the flavor of the one issue "Medicaid estate recovery", where people were saying there was a "Big Con" going on. If you understand the problem (existence backed multiply), you will see that it was reasonable to say that. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Open Minds, a consulting firm

This is not essential. It looked like a sound source, judging by the info on it. They have a lot of money, do and do research for people and organizations in the medical area. I liked it because it was a source that had attempted to get more information about which states do "Medicaid estate recovery", of those that did the Medicaid expansion. (I think its like 10, and at the time, they noted some changes were in process. I have myself done the work to look up for a bunch states, with references from government or sometimes reliable newspaper sources. It could be removed.) — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Iowa Legal Aid, a legal aid directory

The information used is present elsewhere, on an Iowa state site, lined to right next to it. It could be dropped. I put it in because I thought it had a clearer explanation, and maybe other info that Iowa residents would find helpful. (It was on .org, not a .com, whatever that was good for. Legal aid sounded pretty legitimate. It likes like a genuine "doing good" organization from https://www.iowalegalaid.org/resource/applying-for-help-from-iowa-legal-aid , but again, it can be dropped with no loss of backup of assertions. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Idaho Care Line, a blog unaffiliated with the state of Idaho

This one, I couldn't find a government site, which sometimes doesn't exist. So this looked pretty good. What happens is some states don't have anything written anywhere. VT is such a case. I have orally that they don't do non-long-term-care-related estate recovery, but they said it's not on paper or the web. (A person I know also called separately and got the same information.) But I digress. This can be removed, with removal on the not-really-necessary information on the small state of Idaho. (Sorry, Idahoans, its not that we don't care about you...) — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. Policygenius, an insurance broker

This could be removed. I used it redundantly to an also-reference MACPAC report. — Preceding unsigned comment added by NormSpier (talk • contribs)

• 1. healthinsurance.org, a shopping tool for insurance — Preceding unsigned comment added by NormSpier (talk • contribs)

I've used this either for terminology, or to provide a clear explanation for the reader of some things. Its not essential. Note that ref [534], not by me, uses that source.NormSpier (talk) 19:50, 9 September 2019 (UTC)

Comments

Content that complies with Wikipedia's core content policies isn't necessarily "perfect". Wikipedia also has a list of other policies and guidelines (and I haven't even mentioned the Manual of Style yet). Rather, the three policies I referenced throughout these discussions (no original research, verifiability, and neutral point of view) are minimum standards for acceptable content in Wikipedia. Not all articles meet these standards, and any editor is welcome to address violations when they see areas for improvement.

"Be bold" is a guideline, but disputed edits are usually subject to immediate reversions until they can be thoroughly examined and discussed. I did not revert all of the added content because it was made over the span of a month, and because I thought it would be good to receive input from more editors. This RfC is one of the ways I am soliciting additional input.

With User:Newslinger's prior line, I raise a serious procedural issue. There is an issue of editor authority and how disputes are resolved. I had raised the topic after interacting with User:Newslinger at Wikipedia:Teahouse#Determining_official_Wikipedia_editor_role_and_authority_of_editors_coming_in_commenting_on_a_persons_additions , where before my request, I had gotten the impression that User:Newslinger was some sort of authorized official policeman from Wikipedia. But, I got the response, that all editors are equal in authority. Content disputes are resolved by some sort of democratic procedure. (This was clearly stated at the Teahouse by user:RudolfRed and user:Beeblebrox, extending even to administrators, of which User:Newslinger is not anyway actually one). So I'm kind of shocked here, on the above section where User:Newslinger wrote "I did not revert all of the added content because it was made over the span of a month, and because I thought it would be good to receive input from more editors." I'm shocked because, the issue at that point, with my content, was, (and still so far is) between me, and User:Newslinger. So, where is the authority to roll back the edits that he indicates he had the right to do?? I am new to Wikipedia writing. You must have some wiki-way to wiki-explain what he wiki-thought he could do, in some wiki document, or by explaining it as informal unwritten wiki-culture or wiki-norms. Please, someone, explain to me on what authority.NormSpier (talk) 17:04, 10 September 2019 (UTC)

As I and other editors at the Teahouse discussion have explained to you, there is no editor "authority" or hierarchy for content disputes on Wikipedia. It is common practice for any editor to revert disputed edits, and the fact I opted to start an RfC instead of reverting your edits immediately is a courtesy to you. Wikipedia operates on consensus, and the result of this discussion (if more editors participate and express their opinions) will determine any changes that should be made to this article. — Newslinger talk 01:37, 11 September 2019 (UTC)

Thanks, User:Newslinger, for WP:BRD, which is very useful. I also caught just now that you had the link prior, and I failed to click on it. Hopefully, some people skilled in both the relevant field, and applying wikipedia rules, will show up at our party here, and take us out of deadlock.NormSpier (talk) 19:24, 11 September 2019 (UTC)

Regarding neutrality, I don't see a pro-ACA bias in the August 7 version of the article. The "Public opinion" section of the article was moderately negative, and the "Criticism and opposition" section was a very substantial portion of the article. However, I don't think the September 7 version has a substantial anti-ACA bias, either, with the exception of the issue in the "Cost-sharing Reductions" section. I posted the noticeboard discussion on the neutral point of view noticeboard because the content additions spanned 6 articles. NormSpier proactively removed the content from 4 of the articles, addressing the bulk of the neutrality issue, and I thank them for doing so.

I know about the public opinion part, so I guess that is a negative about the law in the article before I got to it. But public opinion is different than whether the law is really failing some people. I just read through the section, and its all what people think in a possibly emotional way. Nothing like public reactions to the 5 problems: sometimes excessively high deductibles, unaffordable premiums over the fiscal cliff, etc. So, yes, I guess there is a little something negative, but nothing with the real problems affording the insurance. (The closest in the public opinion section, which is not very close, is that people don't like the mandate.)NormSpier (talk) 20:20, 9 September 2019 (UTC)

In the "Criticism and Opposition" section, its mostly public opinion, not how the law is functioning. The exception is that unions indicate that their own union (non-ACA) plans are having their coverage disrupted, by things like driving up the cost of union plans. So, yes, this is a case where there is a negative effect on some health insurance, but not saying anything about a problem with ACA health coverage itself.

So I find my addition, of 5 problems with the ACA health insurance to be important fundamental information about the ACA prior conspicuously omitted prior to my arrival on the scene. (More fixes needed available to the reader in one of my references in that section--the article co-authored by Tim Jost of Health Affairs). As well as the "problems" answering the aforementioned pro-ACA-bias cited in Talk:Patient_Protection_and_Affordable_Care_Act#POV_issues, where, I note, one of the specific POV problems there was "It does not even take the time to mention in the very least, that for SOME people, many of the included studies do not reflect their experiences, especially concerning deductible increases etc." The POV concern was "deductible increases etc.". One of my 5 issues added is "Sometimes Unaffordable Out-of-Pocket Maximums", which is the same kind of thing as high-deductibles. It addresses out-of-pocket costs, which is the ultimate real concern with "deductible increases etc.". (This requires a little basic economic reasoning to see that. Insurance is supposed to mitigate the worst that can happen to you. Out of-pocket-expenses include both deductibles and copays, and the out-of-pocket maximum limits the worst than can happen to you--that is, the worst you can be financially hit from deductibles and copays. So what I've done to do the explanation here is "think a little and know just a little", or, "original research", depending on whether you ask User:Newslinger or me.)NormSpier (talk) 16:24, 10 September 2019 (UTC)

Overall, I appreciate all of the work NormSpier has put into expanding this article and the Medicaid estate recovery article, and I hope NormSpier continues to contribute to Wikipedia with these core content policies in mind. — Newslinger talk 12:59, 9 September 2019 (UTC)

I appreciate that thought, user:Newslinger. As raised above, the model "sentence, reference, sentence, reference" which may be ingrained in the new standards will likely keep me away from this kind or article in the future. (Some reviewers would need to be able to understand the policy in some detail, as well as light economics to keep me going.) Also, note, if you wind up keeping my contributions, G-d knows who will show up next week, and the week after, and the week after, and we have to start a whole new RFC each time. And who knows if it will say anything about the person's role, or self-appointed role, on their user page, when I click on it.)

Otherwise, its possible that I'm making too many demands on the reader with the quantitative stuff, with the purposeful parsimonious representation of the coverage mechanism, etc. It could be a reasonable editorial decision that demands at that level should be left to hard science and math articles in Wikipedia.

I'm interested in this content in the 2 articles, because there is public discussion by Democrats now of repair or replace. So I think problems should be easy for people to find. Also, people who resent the ACA should at least not have the feeling that real problems are ignored, and thus choose to vote for G-d knows who in response. Many have people have real problems with the premiums, deductibles and copays, and coverage gaps (i.e., a period of no insurance), and such. So I feel I owe the country, and truth, due perseverance on this content.

I may have to stop after this, and just contribute, when I feel in the mood, to math or engineering Wikipedia content.NormSpier (talk) 20:20, 9 September 2019 (UTC)

Also, I guess I'd like to request again (repeated from somewhere above) that User:Newslinger state what he wants to do with the related content of mine Medicaid estate recovery, whose content is equally in dispute between just the two of us, for similar reasons to ACA. Is he going to do a separate RFC? Etc. (I think this RFC is only on the ACA content, but I'm not even absolutely clear on that.)NormSpier (talk) 17:15, 10 September 2019 (UTC)

​The Medicaid estate recovery article is not part of this RfC. I'll address any issues on Talk:Medicaid estate recovery when I have time. However, as I have previously requested on your talk page, please reduce the volume of your comments (not just on this RfC, but everywhere). The length of your comments is disproportionate to the lengths of everyone else's comments, and it is deterring other editors from participating in these discussions. — Newslinger talk 01:12, 11 September 2019 (UTC)

​Another option for people would be to chime in on Medicaid estate recovery here, for the purpose of saving everyone time (overall), as I expect that will yield an RFC as well, and as it's the same just you against just me status. And the contested part of the content of Medicaid estate recovery is virtually the same material as one of the 5 "Problems" in ACA. Rather than making the community intellectually invest to understand that content twice. (To clarify that for people, Medicaid_estate_recovery#Non-LTCR_estate_recovery_and_the_ACA is an expansion on Patient_Protection_and_Affordable_Care_Act#Estate_Recovery_under_138%_FPL, and I suspect much of user:Newslinger's objections to the former are already stated above for the latter.) NormSpier (talk) 03:34, 11 September 2019 (UTC)

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

Semi-protected edit request on 3 October 2019

I wanted to edit the medicaid expansion part of the page to include information from a study published in 2018 that showed the impact of the medicaid expansion on buprenorphine prescriptions with naloxone and opioid pain relievers. The study showed that states that had the medicaid expansion had significantly higher buprenorphine with naloxone prescriptions per 100,000 county residents, which suggested that there was increased access to opioid use disorder treatment due to the expansion. Additionally, the expansion allowed more people taking opioid pain relievers to be covered under Medicaid, but the total number of these prescriptions did not increase. This study highlights the importance of Medicaid in pain management and addiction recovery. There was information in this section about the impact of the expansion on states that did and not expand, like Kansas, so I thought that adding another example of the Medicaid impact would be valuable to the page. 162.129.44.17 (talk) 17:00, 3 October 2019 (UTC)

 Not done: it's not clear what changes you want to be made. Please mention the specific changes in a "change X to Y" format and provide a reliable source if appropriate. Melmann 17:04, 3 October 2019 (UTC)

Short description

I edited the article's short description (diff) from "United States federal statute" to "Obamacare, ACA - U.S. federal statute". John B123 had recently edited the short description (importing the Wikidata version). In retrospect, I should have started this Talk page section first, and not edited the short description. I apologize for jumping the gun.

Short descriptions are relatively new to Wikipedia and it seems we are still sorting out best practices. For example, from Wikipedia:Short description#Content, "Wikidata has English descriptions of a significant fraction of Wikipedia articles. Where these are good, they may be copied to the relevant article." At the same time, Wikipedia:Short description#Content's first four guidelines (suggestions) indicate (to me) that greater specificity is better than generic descriptions. I included "Obamacare" and "ACA" because these are two terms visitors likely use to find information about the Act.

I am not wedded to any particular outcome. Thanks!   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 22:44, 3 January 2020 (UTC)

As you point out, short descriptions are in their infancy and what guidelines that exist are pretty broad, more objectives than specific "rules". As such, nothing it really right or wrong until discussions such as this evolve a more specific set of guidelines. Most legislation articles, where they have short descriptions, use "United States federal statute" or similar, dependant on jurisdiction, but I suspect that is simply because they have been imported from Wikidata. This doesn't necessarily mean this is the format that should be adopted. --John B123 (talk) 23:38, 3 January 2020 (UTC)

Well said John. Thanks!   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 18:30, 5 January 2020 (UTC)

Copyedit++

I may have stepped in something (did not examine Talk before editing). However, I bulldozed through this piece. Feedback encouraged. Changes:

• 20% word count reduction
• removed excess detail
• various updates of older material
• restructured various sections (including the notorious Problems) to put info where it belongs. e.g., moved descriptive information to the descriptive sections
• added some detail on lawsuits
• briefly mentioned fates of CLASS and co-ops
• (hopefully) moved in direction of NPOV
• noted lie of the year

This thing is still beastly long. I recommend splitting it up into something phone-friendly, which is where our readers come from these days. Cheers! Lfstevens (talk) 20:05, 1 December 2019 (UTC)

High praise for the bulldozer! Your copy edits and other changes are major improvements to the article. Superb work!   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 16:53, 2 December 2019 (UTC)

Editing note: I learned something new today. Isaidnoway made an edit on 7 Jan 2020 (diff), for which he wrote the following:

removed MULTIPLE unused refs creating cite errors after mass removal of content — list-defined references must be removed or commented out — use show preview after mass removal of content and check the references section for possible cite errors — refs can be found in the page history if needed for further use here or elsewhere

Good to know.   - Mark D Worthen PsyD (talk) (I am a man. The traditional male pronouns are fine.) 22:47, 7 January 2020 (UTC)

Pageviews Analysis for this article

Line graph, logarithmic scale, using Bézier curve showing 2019 monthly pageviews (all platforms; user agents) for the Wikipedia article, Patient Protection and Affordable Care Act. | Image file information | Pageviews Analysis information | Pageviews Analysis FAQ | What is a "page view"? | This article (Patient Protection and Affordable Care Act) was viewed 814,467 times during 2019 (monthly average: 67,872).   - Mark D Worthen PsyD (talk) (I'm a man—traditional male pronouns are fine.) 03:16, 23 January 2020 (UTC)

"Barack Obamacare" listed at Redirects for discussion

A discussion is taking place to address the redirect Barack Obamacare. The discussion will occur at Wikipedia:Redirects for discussion/Log/2020 May 7#Barack Obamacare until a consensus is reached, and readers of this page are welcome to contribute to the discussion. TheAwesomeHwyh 18:19, 7 May 2020 (UTC)