Talk:Affordable Care Act/Archive 9

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Behind closed doors

I cannot understand why this article makes no mention of the fact that the final bill was crafted in secret behind closed doors, that few if any of the Democrats voting for it had read it, that Speaker Pelosi had famously uttered, "But first we have to pass the bill so that we can see what is in it" and the very real and now emerging evidence that when The President repeatedly declared directly to the American People that, "If you like your plan, you can keep it" he was not telling us the truth. — Preceding unsigned comment added by InterpreDemon (talk • contribs) 22:51, 14 October 2013 (UTC)

All of these things have an element of truth but aren't quite accurate:

• The final bill wasn't drafted entirely "in secret behind closed doors." Some of the committee bill writing sessions were open, but the most substantial negotiations took place privately. (source)
• I can't find any reliable sourcing for the contention that few if any of the Democrats voting for the bill had read it. Here's an article saying that Baucus didn't read the entire thing.
• Pelosi didn't say, "But first we have to pass the bill so that we can see what is in it." She did say, "But we have to pass the bill so you can find out what is in it, away from the fog of controversy." (source)
• Obama's statement "If you like your plan, you can keep it" was not a lie, but it was a "questionable" statement. According to ABC the law doesn't prevent insurers from dropping coverage but Obama says he didn't mean that, he meant it doesn't force them to drop coverage.

The pattern across all of these claims by InterpreDemon is that they're all semi-true. More importantly, they've been pushed largely in the blogosphere and on op-ed pages but not in the reliable sources. If we can find sufficient reliable sources for these then I support including them in a neutral way (rather than in InterpreDemon's oversimplified way). --Dr. Fleischman (talk) 00:03, 15 October 2013 (UTC)

I was just trying to point out what I considered to be viable areas of controversy regarding the representations made about the bill and the manner of its passage into law. Common sense needs no citation for the engaged, comprehending reader (more on this later), thus it does not take a specific citation to substantiate the fact that the bill was around 2,400 pages (depending upon font, Republicans apparently being a bit far-sighted) and that the final version was only available to legislators hours, not days, before the votes on passage without debate, and the idea that a human could even read all the words, let alone understand the net effect of the myriad of circular, internal and external references to arcane statute is, in my opinion laughable. In other words, even if any claimed to have read it and understood it, as far as I know a number that is at present even less than that of the sole non-reader citation of Mr. Baucus, such a claim would seem impossible... though of course I cannot directly back it up with a citation, On the other hand, using common sense in concert with an indirect citation, perhaps from the Guinness Book of World Records, I might be able to substantiate my argument. Indeed, having been clocked at 25,000 words per minute, Mr. Howard Berg could shoot through the entire 420,000 word ACA in less than half an hour, but for the average reader at 200 WPM it might take a tad longer, two full days of non-stop reading that would make Mr. Cruz envious. And that is without even factoring in a presumed requirement for comprehension of the Act by those voting for it, an understanding which so far appears to have defied the grasp of millions of collective reading hours of insurers, providers, "navigators", ordinary citizens and their legislators, made even more daunting if one dares to tackle the order of magnitude greater statutory codification and regulatory enactment thereof.

As to Ms. Pelosi, I can only say that the real controversy began after the fog cloaking the reef was lifted and Americans were able to see the dangerous shoals toward which they were headed.

Finally, The President's solemn promise given in unambiguous phraseology prior to and since the passage of the ACA. Right now millions of Americans are receiving letters from their insurers informing them that their existing policies are not in compliance with ACA, and the plans are either being modified to include coverage not necessarily desired by the subscribers or being cancelled outright. I have such a plan myself, I like it, and I am not going to be able to keep it. Instead, I will be forced to enroll in a new plan costing almost triple the premium for the same deductible and including coverage for things that are at odds with my gender, my age and desire. To try to nuance that issue (that it's not a lie but merely another "questionable statement", presumably to be lumped in with "Read my lips..." and "I did not have sex with that woman...") claiming that "the law doesn't force [insurers] to drop coverage" is a bit silly unless one seriously thinks that an insurance company would continue to underwrite policies that are essentially illegal even if not specifically stated to be so. For example, it is now law that insurers cannot screen for or discriminate against pre-existing conditions, which with my limited knowledge of law and common sense would suggest to me that continuing to offer rated policies such as mine, where such discrimination is in fact desired by the healthy consumer who "likes" being in a lower risk pool, would indeed be illegal. To suggest that it is not the government or the law that is responsible for the loss of my policy but instead the fault of the nasty insurance company being unwilling to flaunt the law on my behalf seems to border on the absurd. — Preceding unsigned comment added by InterpreDemon (talk • contribs) 01:34, 15 October 2013 (UTC)

A few things:

• If there's a reliable source pointing out that most of this multi-thousand page bill wasn't fully available to all of Congress until days or mere hours before the vote, then that time frame might be notable and worthy of inclusion. However, using that information to state an inference that most of Congress didn't read it would be prohibited original research; let the readers draw that conclusion themselves. That is, unless you can find a reliable source that directly states that most in Congress didn't have time to read it.

  This is merely the lack of familiarity with the mark-up/revision-print process long employed by Congress and the reason many folks claimed the legislation could not have been properly digested given the amount of time, etc. This is because unaltered text found in the previous revision of a bill sits along side with any striked-out text (like this) as well as any newly insterted/amended text (always depicted in italics). So if one had "read" the previous version(s), all one needs to do with a subsequent revision is to digest only the struck-out and italicised portions of the bill to remain up to date (e.g. everything else in normal text already existed in the prior revision & remained unaltered in the new revision).

  This lack of legislative "mark-up" understanding is why folks ran with the claim the bill was ~2,000 plus pages too-long-to-read when in reality, a third to a half of the content at that point was redundant strike-outs and italics & the rest was the exact same language found in the bill(s) passed months earlier. When all that interim mark-up jive was formatted out for the bill's final passage into law, it wound up being less than 1,000 pages total. -- George Orwell III (talk) 08:31, 18 October 2013 (UTC)

• Your point about Pelosi is poetic indeed, but her comment is not really notable.
• The article makes clear that the ACA is changing insurance standards, including standards for existing insurance policies. The article doesn't directly challenge Obama's statements about people being able to keep their plans (which was at best ambiguous, at worst dishonest), but it doesn't really need to; Obama's statement certainly is not as famous as "Read my lips, no new taxes" or "I did not have sex with that woman", regardless of whether it "should" be that famous. I wouldn't mind a brief mentioning in the article that there's debate over what "keeping current coverage" really means, but if it were to be included, it should be brief and stated in neutral terms. –Prototime (talk · contribs) 02:17, 15 October 2013 (UTC)

InterpreDemon, no offense, but after a few sentences my eyes start glazing over because all I read is POV-pushing. You really need to back up your assertions with citations. One of the pillars of Wikipedia is verifiability, which means we can't just include stuff and say stuff because of one editor's sense of common sense. Everything we include must be supported by verifiable facts. For instance, you write at length about the timing of the final draft of the bill and the words per minute a human can read. I don't know if your assertions are true and frankly it doesn't matter unless you back them up with some reliable sources. After that we can discuss any neutrality issues that arise. --Dr. Fleischman (talk) 03:09, 15 October 2013 (UTC)

In that case, where is the citation or set of "facts" supporting the following sentence from the article:

"The ACA aims to increase the quality and affordability of health insurance, lower the uninsured rate by expanding public and private insurance coverage, and reduce the costs of healthcare for individuals and the government."

Is it just from the preamble of the bill, propaganda of the folks who were imposing it, or the author's original research? How can we know the real "aim" of the legislation or motivation of the masterminds behind it? I could have instead written, "The ACA aims to make for a more egalitarian society by using taxation, coercion, subsidies, a regulated health insurance market and managed delivery of care as the means to transfer wealth from the healthy, wealthy and wise to those who are less so", and it would be equally as "factual" as the original.

There are many declarative statements in the article devoid of "facts" behind them, theoretical or otherwise, and I doubt that as real facts emerge to the contrary they will ever be corrected or revised, for example if in a few years we find that little if any of those "aims" have been met. — Preceding unsigned comment added by InterpreDemon (talk • contribs) 04:31, 15 October 2013 (UTC)

Not every sentence requires a citation. If there's no dispute over the validity of a statement then it often doesn't get a citation. However, if you truly dispute that sentence and you're not just trying to make a WP:POINT, then by all means, add a {{cn}} tag, or, better yet, do some research and try to find a citation that supports that sentence. --Dr. Fleischman (talk) 05:17, 15 October 2013 (UTC)

Mistake in the top right corner box

In the box in the top right corner of the article, it is written INCORRECTLY that PPACA passed the House on October 8th, 2009, on a 416-0 vote, and a link is given. The link is to the passing of "Service Members Home Ownership Tax Act of 2009" in the House.

Could somebody please correct the information and the link?

Judging by the article itself, the House passed the "Affordable Health Care for America Act" on November 7th, 2009, on a 220–215 vote, and then accepted PPACA as part of the "Health Care and Education Reconciliation Act" of 2010 on March 21, 2010, on a 220-211 vote.

132.76.61.23 (talk) 08:34, 15 October 2013 (UTC)Inna, 15-Oct-2013

The House passed HR 3590 titled "Service ... Tax Act" on October 8th. Then, on November 7th it passed the "Care for America" bill. But the latter one later died, while the former was amended: HR3590's entire text was deleted and replaced with the Senate text. So, the House voted 416-0 to pass the "Tax Act". It later voted to "amend" it. I agree that the summary creates the impression that Obamacare passed the house 416-0, which is misleading. I'd suggest striking the disucssion of HR3590 before it became the PPACA. WLior (talk) 11:29, 15 October 2013 (UTC)

Attempt to get a neutral point of view for the shutdown

My understanding of the shutdown came from Thomas Sowell, to quote:

"There is really nothing complicated about the facts. The Republican-controlled House of Representatives voted all the money required to keep all government activities going — except for Obamacare. This is not a matter of opinion. You can check the Congressional Record."

The article writes:

"House Republicans, supported by Senators Rand Paul, Ted Cruz, Mike Lee, and Marco Rubio, refused to fund the federal government unless accompanied with a delay in the ACA, resulting in a government shutdown." (Four articles as sources)

This talks about a delay, but doesn't necessarily contradict Sowell. The story as I understand it is that the process has gone from "we won't fund ACA" to "we will only fund ACA if accompanied with a delay" to "we will only fund ACA if you remove certain provisions".

What concerns me with regards to NPOV is the language used. One side (including Sowell) could argue that congress has the right to legislate by appropriation and that it is the Senate's fault for refusing to accept funding 95% of government just because they didn't get the 5%. The other side could argue--as I recall Obama doing in his latest press conference--that this isn't how laws should be changed, that the Senate shouldn't be expected to give in to tactics considered unacceptable.

So the question is how to phrase it. For now I have changed it to:

"House Republicans, supported by Senators Rand Paul, Ted Cruz, Mike Lee, and Marco Rubio, initially voted to fund all of government except the ACA, which the senate refused to authorize. Shortly before the deadline, they offered to fund government, including the ACA, if it was accompanied with a delay in the ACA. The senate refused to authorize this, resulting in a government shutdown."

That seems more accurate to me, but I am not a Democrat, so if other users believe the bias has been shifted the other way, then it may call for a discussion. J1812 (talk) 06:20, 16 October 2013 (UTC)

No, this isn't more accurate. MilesMoney (talk) 06:32, 16 October 2013 (UTC)

J1812, your Sowell source isn't reliable as it acknowledges it's just one person's opinion. In addition your proposal doesn't even adhere to Sowell and paints my Senate in a negative light, thereby violating not only WP:RS but also WP:SYNTH and WP:NPV. Of course you're welcome to use your source to enhance your personal understanding but it's not a proper basis for your proposed change. --Dr. Fleischman (talk) 17:31, 16 October 2013 (UTC)

A neutral point of view starts with high-quality independent, reliable sources. An opinion piece by Thomas Sowell is not a high-quality independent, reliable source. MastCell ^Talk 19:05, 16 October 2013 (UTC)

Would it be appropriate to directly source the congressional record? J1812 (talk) 19:53, 16 October 2013 (UTC)

Generally not, as roll calls are WP:PRIMARY sources and we try to find (reliable) WP:SECONDARY sources instead. However it might be appropriate in some situations. Beware that roll calls are notoriously easy to misconstrue, mainly because politicians have all kinds of weird reasons to vote one way or another. --Dr. Fleischman (talk) 22:14, 16 October 2013 (UTC)

I don't think anybody here is interested in a "neutral" view on the shutdown or anything else, otherwise they would not have completely failed to mention the disastrous roll-out of the Healthcare.gov web site and exchanges over the last two weeks during the already included shutdown. Rush to press on the "Republican" shutdown? Of course. Provide an update on the dysfunctional exchange web sites and dismal sign-up progress so far, something much more directly related to the topic of the article and the alleged "aim" of the ACA? Nothing but crickets. Doubtless not "notable", and widely reported rumors in all the press and media about millions being unable to create accounts or log on cannot be "verified".InterpreDemon (talk) 04:39, 18 October 2013 (UTC)

This article is about the law itself: it's evolution, impact, and legal challenges. It is not about the minute details of every related aspect. The glitches in the rollout of the health exchanges are not related to the law itself or even its impact, and will probably be irrelevant to the law itself in a few years. I'd expect a passing note at best in a section mentioning health exchange implementation, but I don't actually see a suitable section in the article right now.

The "aim" of the ACA is not affected by accidental software problems which occur with any big web service on release day. Video game companies have server issues on launch day all the time, but after getting over those initial difficulties, users can forget it ever happened and the game can stand on its own merits.

All that said, those glitches in such a high-profile system are certainly notable, and are covered in the article discussing the health care exchanges themselves: Health_care_exchange#Technical_glitches. --Fritzophrenic (talk) 14:33, 18 October 2013 (UTC)

I agree with InterpreDemon that the roll-out deserves space in this article, as it's directly related to the ACA itself, though it should probably be in WP:SUMMARY style per WP:SPINOFF with a link to Health care exchange. However, at the same time I'm deeply bothered by InterpreDemon's semi-regular failure to assume good faith. Please knock it off. If you're here to improve the article, then improve the article. But if you're not and you'd prefer to cast disruptive insults instead, then please go away before you're forced to. --Dr. Fleischman (talk) 17:27, 18 October 2013 (UTC)

I feel the same way as DrFleischman. I think the problems with the rollout are notable and should be covered in this article (again, using independent, reliable sources rather than the partisan nonsense that's typically favored on this talkpage). Brief coverage using summary style, along with a "see also" link to Health care exchange#Technical glitches, would be appropriate in my view. Sources might include: "From the Start, Signs of Trouble at Health Portal" and "Beneficiaries of Medicare Left Confused by Exchanges". It may be worth one sentence on efforts at the state level (in some Republican-controlled states) to sabotage the rollout, e.g. "Florida Among States Undercutting Health Care Enrollment".

At the same time, I'm with DrFleischman in that I'm unwilling to reward the behavior of InterpreDemon (talk · contribs), who seems dedicated to misusing this talkpage as a platform for his personal views of the ACA. MastCell ^Talk 18:13, 18 October 2013 (UTC)

I, too, feel that the rollout problems are notable. It doesn't need to consume much space in the article in light of WP:RECENTISM, but recentism doesn't totally prohibit mentioning the problems either, particularly given how long they've been occurring and how widespread the coverage of them has been.

I also agree on the other point Dr. Fleischman and MastCell brought up: InterpreDemon, please assume that other editors are acting in good faith instead of assuming they are editing with partisan goals in mind. If you have specific suggestions to improve article content and remove bias, feel free to discuss them; however, general complaints are not useful in identifying and fixing potential problems. And again, this is not a forum to generally discuss personal views on the article's subject matter. –Prototime (talk · contribs) 19:01, 18 October 2013 (UTC)

The problem with language like, "voted all the money required to keep all government activities going — except for Obamacare", "voted to fund all of government except the ACA, which the senate refused to authorize", "refusing to accept funding 95% of government just because they didn't get the 5%", and so on, is that this phrasing makes it seem like Congress was being requested to "authorize" funding of Obamacare, i.e. that their active assent was required, and they merely passively refused to provide this authorization. This is false: Obamacare funding was already authorized, which is why e.g. the exchange rollout (bugs notwithstanding) went forward despite the shutdown. (The shutdown only affected discretionary spending, not mandatory spending like the ACA funding.) The Republicans were demanding that it be defunded (and later modified this to a request for delay) which is a quite different thing. — Steven G. Johnson (talk) 20:57, 18 October 2013 (UTC)

It seems to me that the decision to include or not include information about the roll-out should not have anything to do with the "rewarding" or "punishment" of somebody as irrelevant as me, and by any of the measures to be utilized in determining what is "notable" or relevant content as such would doubtless prove neither. I just felt that if the shutdown, certainly "recent" and as Mr. Johnson pointed out above having little actual effect upon the ACA were to be deemed relevant, the progress of and problems with the roll-out to date would also be at least as relevant. As to my behavior and abuse of this space as a newcomer, I understand the viewpoints of all and offer my sincerest apology.InterpreDemon (talk) 22:03, 21 October 2013 (UTC)

Endorsing a YouTube video?

Are we allowed to endorse a YouTube video, like the YouToons one by the Henry J Kaiser foundation? It seems unencyclopedic to tell our readers to go watch a video instead. — Preceding unsigned comment added by JDiala (talk • contribs) 18:43, 17 October 2013 (UTC)

It's a great video! I'm not aware of any policy that forbids it. --Dr. Fleischman (talk) 22:15, 17 October 2013 (UTC)

Initial enrollment results:

Initial enrollment results:

Officials: 476,000 Obamacare applications filed http://www.usatoday.com/story/news/nation/2013/10/19/obamacare-applications-health-exchange/3071661/

5 things that have happened since Obamacare launched http://edition.cnn.com/2013/10/19/health/obamacare-enrollment-launch-overview/ — Preceding unsigned comment added by 109.65.213.231 (talk) 10:10, 20 October 2013 (UTC)

NFIB v. Sebelius

The article says that most of the law was upheld in NFIB v. Sebelius, but this is incorrect. The individual mandate provision was upheld as constitutional, thus averting the law from being entirely overturned. In terms of number of provisions, this is quite a small aspect, even if it is important to the overall functioning of the law. Also, in the same decision, the state medicare expansion provision was held unconstitutionally coercive and thus modified by the court. Jaykest1 (talk) 03:03, 23 October 2013 (UTC)

Yes, you're right, that's a pretty glaring error. Thank you for pointing this out. I have fixed the wording to be more accurate.

So that others are not confused, here's a bit more explanation: although a minority of the court would have struck down the entire ACA, it would have done so because it felt that the other provisions were not severable from the unconstitutional individual mandate; the minority opinion did not suggest that the other provisions were independently unconstitutional (other than the provision coercing the Medicaid expansion), but rather that if the individual mandate were unconstitutional, then the entire Act must fall because the other provisions are so centrally tied to it. Likewise, the court's majority did not directly rule on the constitutionality of the other provisions when it upheld the individual mandate; rather, the decision to uphold the individual mandate made the severability of the other provisions no longer an issue. Thus, it is improper to characterize the court as having upheld the entirety of the Act. –Prototime (talk · contribs) 03:20, 23 October 2013 (UTC)

Also, towards the bottom, it incorrectly mentions that the individual mandate was upheld as a tax. More precisely, the individual mandate was upheld because it could be construed as a tax (due to the lack of criminal sanctions and relatively light fee), not because it was a tax (which the act clearly labels as a penalty). This is made all the more clear by the ruling on the Anti-Injunction Act, which stated that, for purposes of jurisdictional analysis, the mandate was not a tax. Jaykest1 (talk) 04:05, 23 October 2013 (UTC)

This is a more difficult point given the seeming contradiction, but I think the opinion is pretty clear that the mandate is a tax (the word "construed" doesn't make it any less of one). However, because Congress described the individual mandate using the word "penalty" instead of the word "tax", the Court interpreted that Congress's intent was to exclude this particular tax from the Anti-Injunction Act. Thus, it is a tax for constitutional purposes even though it is outside the purview of the Anti-Injunction Act. –Prototime (talk · contribs) 04:18, 23 October 2013 (UTC)

This may be a more semantic point, but the opinion only reads it as a tax under the canon of constitutional avoidance, even though "the most natural intepretation" would be that of a penalty. Roberts decided that for constitutional purposes, to save the law from being overturned, he would read it as a tax, since Congress could have enacted a tax to do the same exact thing (even though it didn't). I think we're in agreement, but I think it is an oversimplification to say that it was upheld because it is a tax. Jaykest1 (talk) 13:24, 23 October 2013 (UTC)

I agree with JayKest1. Courts frequently refer to something as this or that but it's always within the context of a particular statutory or constitutional provision. The Supreme Court isn't an authority on what something "is" in an existential sense, only what it is in the context of a legal dispute. In this case the Supreme Court held that the individual mandate was a tax in the context of the Taxing and Spending Clause but was not a tax in the context of the Anti-Injunction Act. So while the word "construed" is not absolutely necessary, saying that the Court held the mandate "is a tax" without any qualifier is misleading and only half-true. --Dr. Fleischman (talk) 16:23, 23 October 2013 (UTC)

I don't think there is an "existential" definition of any legal concept apart from how courts determines something to be. The judiciary determines "what the law is", not just in the context of a particular legal dispute, but for all future interpretations and applications of that law—judicial supremacy means that how other branches of government or the public views a law must yield to judicial declarations of what the law is. That said, this is a highly jurisprudential and even philosophical point that probably is more trouble than its worth to hash out here, so if someone were to edit the article to say something like "the Supreme Court construed the individual mandate as a proper exercise of Congress's power to tax", that's ultimately accurate and I won't go out of my way to object. –Prototime (talk · contribs) 16:55, 23 October 2013 (UTC)

Jaykest1, Fleischman and Prototime are essentially correct, especially on the role of the judiciary, although I wouldn't necessarily use the term judicial "supremacy" (just a quibble on my part). The U.S. federal courts interpret the law (whether constitutional law, common law, treaty law, statute law, administrative law, etc.) in the context of actual cases or controversies. And, in interpreting law, context is almost always important. Just as is the case in life in general, a given word can have multiple meanings in law. Indeed, the very word "law" itself has more than one technical meaning in one particular sentence found in the United States Constitution. Famspear (talk) 01:32, 24 October 2013 (UTC)

I think "supremacy" is the perfect word, and anybody familiar with Marbury v. Madison and "Judicial Review", the self proclaimed right the Supreme court claims to original jurisdiction on all matters Constitutional (despite no such provision in the Constitution), would probably agree. It is only the Supreme court (and only due to its own decision) that can decide if a law is Constitutional, and if not just re-write it to make it so as Justice Roberts did.InterpreDemon (talk) 03:59, 25 October 2013 (UTC)

Current controversy is not mentioned

Where is the coverage of the problems with using the Obamacare website? Where is the coverage of the many people who thought that their existing policies would carry over, but then had them cancelled? JRSpriggs (talk) 06:16, 1 November 2013 (UTC)

For the problems with healthcare.gov, see Health_care_exchange#Technical_glitches and the discussion above in this talk page. There seems to be consensus that it deserves a summary in this article with a link to the primary "Health care exchange" article.

For cancellations of coverage, I'm not aware of the exact issues you're referring to. There is some discussion in the article about some businesses avoiding the requirement to provide coverage by artificially reducing their number of full-time employees, but I think you're talking about something else. It sounds like it may be relevant, so find some sources and I'm sure it could be included. --Fritzophrenic (talk) 15:45, 1 November 2013 (UTC)

A link was given (then removed) listing certain exemptions.[1] If these are verifiable, why are they not mentioned in at least one of the articles about Obamacare legislation, or have I missed something? While first of all this affects US citizens, there are readers of the article outside the USA who are concerned about the global knock-on effects of the long term budgetary impact of Obamacare, in connection with debt-ceiling, shutdown etc. Qexigator (talk) 15:53, 1 November 2013 (UTC)

Regarding my second question, see the fact-checker's reaction to Obama's pledge that no one will take away your health plan. JRSpriggs (talk) 13:33, 2 November 2013 (UTC)

Spriggs, Hell will freeze over before the masters allow any mention in the article of the "If I like your plan, you can keep it, if you like your plan you can <bleep> it" promise by POTUS, or any mention of IRS Bulletin 2010-29InterpreDemon (talk) 00:33, 3 November 2013 (UTC)

I agree that the controversy concerning whether people can keep their "current" plans is sufficiently noteworthy for inclusion in the article. The controversy has received quite a bit of coverage in the media, and I'd add a line about it to the article myself if the page weren't currently subject to full protection. –Prototime (talk · contribs) 01:18, 3 November 2013 (UTC)

There is a spin section called "myths" where the progressive Wikipedia editors protect Obama with such gems as: "On August 7, 2009, Sarah Palin falsely claimed that . . ." Will there now be added a section that says: [On occasions too numerous to count!] Barack Obama falsely claimed that 'if you like your insurance you can keep it!'" ? Didn't think so. "Palin falsely claimed stays in", and "Obama falsely claimed" would never get in. Why is that? — Preceding unsigned comment added by 71.190.14.194 (talk) 04:25, 5 November 2013 (UTC)

Quit the drama. I just said I intend to edit the article to add information about this controversy. Be patient; the article is currently under full protection and can only be edited by admins due to an unrelated content dispute. The full protection should be lifted soon. In the meantime, assume good faith and don't attack other editors—if for no other reason than you're unlikely to persuade anyone of anything by acting that way. –Prototime (talk · contribs) 04:41, 5 November 2013 (UTC)

Leaving aside "drama" and sticking to clear indisputable objective facts, consider: https://www.youtube.com/watch?v=JCUpJDzyRnY (collection of false claims). If the language "falsely claimed" was OK for Palin, it should apply to Obama too when updates are made, if Wikipedia is consistent. — Preceding unsigned comment added by 71.190.11.40 (talk) 13:52, 5 November 2013 (UTC)

I support the inclusion of language on this issue, but saying it's on par with the "death panels" stuff is way off base. The "death panels" thing became so notable not merely because it was false -- and more clearly false than Obama's statements, according to the fact checkers -- but because it became a meme among politicians and commentators and a widely held belief. Lots of statements by politicians aren't true, but only a select few are so brazenly false and become raised to such a high level in the public consciousness. --Dr. Fleischman (talk) 20:58, 5 November 2013 (UTC)

"more clearly false than Obama's statements" ? Obama's "If you like your plan, you can keep your plan." is false. Clearly. Very clearly. (and this adversely affects millions of people) Like I always tell my students: Use Wikipedia for Science, for references, and for non-controversial stuff. But political stuff? Truth and objectivity have got nothing to do with it, on Wikipedia. Clearly Obama lied, when he said "If you like your plan you can keep it." (hundreds of times!) Clearly the "locked" Obamacare Wikipedia entry will always be able to say "Palin falsely", and will never say "Obama falsely". Because Obama is better "protected" on Wikipedia than Palin. — Preceding unsigned comment added by 71.190.12.177 (talk) 02:49, 6 November 2013 (UTC)

If you're WP:HERE to make a constructive contribution to this article, then by all means, make it, but if you're here for another reason, like to share your personal views about Obama or to criticize Wikipedia generally, then please go away. --Dr. Fleischman (talk) 04:40, 6 November 2013 (UTC)

DrFleischman, I do have a genuine, non-partisan, interest as a citizen in talking about improving the locked encyclopedic content of the Obamacare article by suggesting it be consistent and unbiased in its use of strong language ("falsely claimed"), and that it accurately reflect the fact that the "If you like your plan you can keep it" Obama falsehood is in fact now a major element of Obamacare events. The specific constructive improvement to the content would be to include reference to Obama falsely claiming in excess of 29 times that "If you like your plan you can keep it." It is my understanding that Prototime above is already working on an edit on this subject matter, in accordance with core agreed policies and I look forward to seeing it. My focus is purely on encyclopedia building and to that end I think that if language such as "falsely claimed" is OK for describing conservative Republicans it should be OK for describing progressive Democrats, when the progressive Democrats clearly lie themselves ("If you like your plan, you can keep it."). Perhaps I added some sarcasm in my talk page comment. I don't think it detracts gravely from the positive and directly constructive contribution I was making with my observation. I take editing seriously, but this isn't article editing, it's talk page "editing" so please forgive me for being just a little bit human, in my talking. And yes, all 3 of the 71.190.xxx.xxx's above are me - not trying to sockpuppet here - just that Verizon DSL gives a different IP every time you log on even from the same location. Next step - becoming a registered user - yes, I know. But in the mean time, please forgive me for being human, on the talk page. It's been a while since I felt compelled to contribute to one of these conversations, and I had forgotten how strict you guys are with newcomers to the talk pages. I fully understand that none of us want these talk pages to be clogged with the old Usenet-style political debates. But I think my original point (be consistent with "falsely claimed") is legitimate, if not my "aside" comments on the likelihood of it happening. — Preceding unsigned comment added by 71.190.12.177 (talk) 06:48, 6 November 2013 (UTC)

Welcome to Wikipedia, and thanks for explaining yourself; it goes a long way. If Prototime is working on proposed language then let's wait for it, and then discuss. I'll also note my own personal observation that when you use the word "clearly" (as in, "Obama clearly lied") you're almost always setting yourself up for confrontation. What is clear to you will not be clear to others. My recommendation is to leave the "clearly" out and support your assertions with reliable sources whenever possible. --Dr. Fleischman (talk) 07:01, 6 November 2013 (UTC)

So IP-person is advised to avoid using "clearly" because it causes "confrontation", says the registered user who uses non-confrontational, professional, encyclopedic language like "please go away" (at 04:40, 6 November 2013 above). — Preceding unsigned comment added by 65.51.18.159 (talk)

Attacking each other will get nowhere. FWIW there's an attempt at the bottom of this talk page to put together some info on this topic, unless Prototime actually gets to it first (or to add to Prototime's content when it gets created). Feel free to contribute there while the page is protected and maybe it can eventually get included when both supporters and opponents of the law agree the coverage is fair. It helps when doing this to keep charged language out of it. A good encyclopedia does NOT read like a checkout-counter magazine or blog. It should be emotionless and boring when it comes to politics. Like watching CSPAN instead of Fox or MSNBC. :-) --Fritzophrenic (talk) 21:38, 7 November 2013 (UTC)

Section on enrollees?

I know the article's on lockdown now, but it seems that an important component of the ACA is the number of those who have enrolled. CBS News reported a couple of days ago that the 1st day numbers were low. Six. Then by the 2nd day of enrollment the number of enrollees jumped to 248.[2] Maybe add a new section--after lockdown is lifted--on those enrolled in the ACA? Maybe similar to Medicare article demographics[3]? -- Cirrus Editor (talk) 15:02, 3 November 2013 (UTC)

I'm not sure that an entire new section is merited, but I'd be fine incorporating this information into the "Public policy" subsection. A lot of the info currently there is based on enrollment projections and estimates; as the law continues to be implemented, we can add the actual enrollment numbers. –Prototime (talk · contribs) 18:40, 4 November 2013 (UTC)

I think an "Implementation" section would be a good idea, as suggested in a section below. If it gets to big it should probably be forked with a summary here. --Dr. Fleischman (talk) 05:51, 5 November 2013 (UTC)

Approval ratings

I dispute the article with respect to its stated Obamacare approval ratings. I believe the article as it stands in Wikipedia currently (I have not modified the article) is biasing readers towards the sentiment that most citizens generally feel Obamacare is good, and they will only increase their belief it is good- just like with Medicare.

Here are poll results that clearly show most citizens do NOT generally feel Obamacare is good for them: http://news.investors.com/politics-obamacare/100313-673712-obamacare-opposition-to-obamacare-reaches-new-high.htm http://www.american.com/archive/2013/october/top-10-takeaways-public-opinion-on-the-affordable-care-act http://www.washingtontimes.com/blog/inside-politics/2013/oct/16/gallup-obamacare-little-less-unpopular/ — Preceding unsigned comment added by 71.179.3.124 (talk) 15:09, 3 November 2013 (UTC)

Your point may be valid, but before it can be evaluated, can you please provide links to more reliable sources? All three of the sources you point to are well known for their conservative bias. Not that this disqualifies them, but it would be an improvement. --Dr. Fleischman (talk) 05:47, 5 November 2013 (UTC)

FWIW, here's the actual Gallup Poll behind two of his links: http://www.gallup.com/poll/165428/americans-desire-modify-healthcare-law-down-2011.aspx Cannot find the raw IBD/TIPP poll, only commentary.InterpreDemon (talk) 17:39, 5 November 2013 (UTC)

WP:SECONDARY sources are preferable. --Dr. Fleischman (talk) 20:59, 5 November 2013 (UTC)

I would argue that a poll by definition is a secondary source, the primary source being the opinions of the participants, the secondary being the compilation, analysis and results. Why do you need somebody else to look at the same poll and put their spin on it? Same goes for other things that are factual in nature... if HHS has rules and analysis buried in the Federal Register as a matter of public record, why do we first need NBC to report and opine upon it? InterpreDemon (talk) 15:32, 7 November 2013 (UTC)

Implementation

There should be a section about how the law is doing, which parts came online when and which will be pushed back. I think it should be call "implementation", or something like that. I read that only 6 people enrolled on the first day and woul like to know if that is true, and if so, why? — Preceding unsigned comment added by 64.134.65.101 (talk) 18:29, 4 November 2013 (UTC)

I think that's an excellent idea! Would you consider taking your contributions to Wikipedia to the next level by writing the new section yourself? --Dr. Fleischman (talk) 05:44, 5 November 2013 (UTC)

In fairness, that would be difficult for an IP user to do given that the article is semi-protected through the end of next month. But 64.134.65.101, you could write a draft of your proposed section and then post it here on the talk page, and an autoconfirmed user could then add it to the article (possibly with some modifications). –Prototime (talk · contribs) 17:03, 5 November 2013 (UTC)

Good point. 64.134.65.101, if you want you can draft something on this talk page and someone will post it in the article (assuming it complies with WP policies and guidelines). --Dr. Fleischman (talk) 00:43, 6 November 2013 (UTC)

Background

"The idea goes back as far as 1989, when it was initially proposed by the conservative Heritage Foundation as an alternative to single-payer health care."

The above statement is untrue.

The statement in quotes is a reference to a lecture series presented by Stuart Butler. There is a disclaimer prior to text presented by Butler, “Note: Nothing written here is to be construed as necessarily reflecting the views of The Heritage Foundation...”

Here is a link to Butler’s presentation: http://thf_media.s3.amazonaws.com/1989/pdf/hl218.pdf Horsappl (talk) 16:03, 5 November 2013 (UTC)

The operative word in that quote is necessarily, which means the content may or may not reflect the views of The Heritage Foundation. But the content of the presentation itself unambiguously states that the healthcare views presented in it are The Heritage Foundation's. On pages 3-6, the presentation indicates that the views are collectively known as the "Heritage Plan", that they were developed by and for The Heritage Foundation, and that one of these views was support for an individual mandate:

The fundamental defects of the existing system and the serious flaws in most solutions to the problem of uninsurance has led The Heritage Foundation to propose a national health system ... Developed in detail in a new monograph, A National Health System for America, the Heritage plan aims at achieving four related objectives[.] ... The Heritage plan has several key components: ... 2) Mandate all households to obtain adequate insurance.

Between this language in the presentation itself and the current source used to back up the sentence in question, it's verifiable that The Heritage Foundation supported an individual mandate. –Prototime (talk · contribs) 16:56, 5 November 2013 (UTC)

That still doesn't make it a good idea. Big Government conservatives like Newt Gingrich dream of imposing their master plans upon those of us who do not know what is good for us just as much as liberals do, the only difference being they have been less successful. InterpreDemon (talk) 17:49, 5 November 2013 (UTC)

The merits of the individual mandate aren't disputed in this discussion; only the verifiability of a particular sentence in the article is disputed. –Prototime (talk · contribs) 18:22, 5 November 2013 (UTC)

If that's the case, how can one verify that "it was initially proposed by the conservative Heritage Foundation" in 1989? Nobody ever proposed it prior to that? Japan has had compulsory insurance since 1961.InterpreDemon (talk) 20:28, 5 November 2013 (UTC)

That is a good point. Although the author of the source currently provided for that sentence (see 1) states that this Heritage Foundation report is the "first published proposal" for an individual mandate that he could find, that doesn't mean there actually weren't earlier ones. To clarify this, the word "initially" should be dropped, and the earlier part of the sentence should be revised to read something like "The idea goes back at least as far as 1989..." –Prototime (talk · contribs) 20:33, 5 November 2013 (UTC)

I would guess it goes back almost a hundred years or more, and doubtless there are scores of papers about public health policy buried at Harvard and elsewhere, written by folks like Ezekiel Emmanuel to support that guess. The real question is what the purpose or motivation for singling out the Heritage Foundation for the honor really is and, frankly, I believe it was to pin the tail on the opposition and suggest hypocrisy on their part. In my opinion the sentence should simply be eliminated since, as Japan and other countries demonstrate, the "idea" has been around for a very long time. InterpreDemon (talk) 20:56, 5 November 2013 (UTC)

Speculate all you want, but you'll need to corral some evidence if you want others to support your position. I can't find any evidence that Japan's "mandate" (there are no penalties for noncompliance) dates further back than 1989. --Dr. Fleischman (talk) 21:06, 5 November 2013 (UTC)

Why am I not surprised? No matter, glad to help out. Try going to page 2 of this world bank report: http://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN020063.pdf and you'll see that the Universal Coverage Act was passed in 1961 and, if you dare to drill deeper, mandated insurance for all. Like Japan, the ACA has no enforceable penalties unless one is foolish enough to find themselves in a position where the IRS owes them money. The claim that the Heritage Foundation invented the idea is as absurd as Al Gore inventing the internet. Again, unless agenda driven, I do not understand the purpose of the sentence in the first place and fail to see how it is informative as relates to the origin of the idea which, by the time the HF published their master plan, had already been implemented in one form or another in multiple places about the globe. If the HF's novel "idea" had been published in the form of a patent application it would have been rejected on the first pass by the examiner based upon "prior art" in Japan and "obviousness" when compared to its older, oft-cited compulsory auto insurance sibling which had also been widely in practice at the time. InterpreDemon (talk) 21:53, 5 November 2013 (UTC)

Adding info about similar mandates in other countries that may have served as an inspiration or model for the US mandate would be useful info to include, though I don't think including such information would negate the utility of the sentence about the Heritage Foundation, for that sentence identifies one of (if not the) first major proposal for an individual mandate at the federal level in the United States, which is useful information for readers. If there were earlier proposals from notable organizations that the US federal government create an individual mandate, that would be useful info to include as well, regardless of the ideological leanings of the proposer. –Prototime (talk · contribs) 21:57, 5 November 2013 (UTC)

My issue is with "The idea goes back as far as 1989...", not necessarily the mention that HF at one time supported it along with many others who still do, or even as you say was among the first more widely known proposals, though I doubt it earned much notice at the time or that anybody seriously thinks the ACA master designers were looking to HF for guidance. It is much more likely that they and their defenders are citing HF as cover, and if HF had never "invented" the concept they would have somehow given birth to it themselves. I recall such philosophical discussions and debates decades ago when I was obtaining my alleged education in the sixties, even Medicare is essentially a compulsory health insurance program, so the idea far precedes 1989. InterpreDemon (talk) 22:39, 5 November 2013 (UTC)

InterpreDemon, the PDF you point to doesn't include the words "mandate," "mandatory," "required," or "requirement" and I don't have time to read the whole thing. You may well be right that Japan had an individual mandate before 1989, but if you're going to use that to propose changes to this article then it's your job, not ours, to make a persuasive argument. --Dr. Fleischman (talk) 23:39, 5 November 2013 (UTC)

It's even easier than that... just go to the WP article (presumably as well policed as this one) https://en.wikipedia.org/wiki/National_Health_Insurance_%28Japan%29 and read "History". Excerpt: "The current NHI system, which is managed by local municipal governments, was introduced in 1961". Then the next section, "Joining NHI". Excerpt: "People are required to join NHI within two weeks of becoming eligible. This is required if a person moves to the municipality from another municipality or overseas and isn’t covered by Employees' Health Insurance, withdraws from Employees' Health Insurance (for example, due to job loss), stops receiving public assistance, or is born (and not covered under parents Employees Health Insurance). Those who do not register when they become eligible and register later, can be charged for up to two years of back payments." So it is clear it is a compulsory system that has been around long before 1989, and the only thing not clear to me is whether a newborn not covered under parents' insurance is required to begin making back payments for its pre and post natal care at the age of three. InterpreDemon (talk) 00:26, 6 November 2013 (UTC)

I don't see anything about the requirement to join having been around since 1989, and the statement about "the current NHI system" in the History section isn't sourced. I believe NHI has been around since 1961 (not a particularly controversial statement) but I have a hard time believing there were zero changes between 1961 and 1989. Based on personal experience I read everything on Wikipedia that isn't well sourced with a huge grain of salt. --Dr. Fleischman (talk) 00:49, 6 November 2013 (UTC)

Of course you don't, and you never will. One the one hand we have an incredible standard of proof required to substantiate that anybody on earth conceived or put into practice some form of compulsory health insurance program prior to 1989 (Like Medicare in 1965, which just like the ACA is a health insurance mandate on all who have earned income), and on the other no proof whatsoever that The Heritage Foundation invented the idea of a health insurance mandate. I will drill into Japanese law, get a translator, show exactly when the compulsory requirements were enacted even if not in 1961, then you will demand that I unearth every law from every municipality as well. Fast-track the "Republican" government shutdown into the article within days? No problem, like crap through a goose. Talk about the rollout, millions of cancelled plans and the biggest Presidential lie (as recently as Sept 26th) since "I did not have sex..."... not noteworthy and no proof. Truly amazing. InterpreDemon (talk) 03:03, 6 November 2013 (UTC)

OK, we'll try this one, from a scholarly article out of NYU: http://www.nyu.edu/projects/rodwin/lessons.html

"After World War II, the effort to rebuild Japan gave new impetus to the achievement of universal coverage. In 1958, the 1938 law was revised to include the remaining 30 percent of the population not previously covered. This revision broke the precedent of extending health insurance to occupational groups by calling for universal coverage on the basis of residence. Every government jurisdiction, whether city, town or village, was required to provide health insurance to every uncovered resident by 1961. Since 1961, virtually all Japanese have been covered by either employers or the government." "Health insurance expenditures in Japan are financed by payroll taxes paid by employers and employees and by income-based premiums paid by the self-employed. In contrast to the United States, where the federal, state and local governments finance roughly 42.9 percent of all health care expenditures and out-of-pocket payments contribute another 22 percent, in Japan, only 31.7 percent of national health care expenditures derive from national and local public funds and 12.2 percent from out-of-pocket payments. The largest share of health care financing in Japan is raised by means of compulsory premiums levied on individual subscribers (34.6 percent) and employers (21.7 percent) InterpreDemon (talk) 03:15, 6 November 2013 (UTC)

That doesn't say the compulsory premiums have been in place since before 1989, it just says there are currently compulsory premiums. The sentence "Since 1961, virtually all Japanese have been covered by either employers or the government" also seems to undercut your argument (though it's unclear). --Dr. Fleischman (talk) 04:48, 6 November 2013 (UTC)

On a separate note, if Japan did indeed have an individual mandate starting back then, that may be worthy of inclusion in the article, but only if there is a connection between Japan's individual mandate and the US's individual mandate (Japan's version served as a model for the US, or the US improved upon what Japan did, etc.) Otherwise, such information probably isn't sufficiently relevant for this article (though it may be for another article that discusses the history of healthcare or individual mandates around the world; I'm not sure). –Prototime (talk · contribs) 05:06, 6 November 2013 (UTC)

Now we're tag teaming, I see. As predicted it will come down to when the mandates were instituted in every municipality, then I suppose the defense will be made that nobody in the US could have known about it anyway, followed by the fact that it is not relevant in the English speaking world. The point is that the idea of a mandate was not novel at the time The Heritage Foundation proposed it, and to suggest so is just another example of the bias that runs throughout the entire article which, in overall scope comes across largely as a puff piece for the ACA and hit piece against Republicans and conservatives, which is obviously the way you want it. After a month of observing the circumlocutions and twisted arguments against anything that might cast the ACA in a negative light and rapid passage of anything that casts darkness upon those opposed, it is no longer possible for me to assume good faith. InterpreDemon (talk) 06:23, 6 November 2013 (UTC)

I know you won't believe this, but I welcome your views. I really do. It's just that your constant accusations of bad faith are becoming disruptive. WP is a collaborative project, so if you're not interested in building consensus in a civil manner then it might be time to step away from the keyboard and take a break. --Dr. Fleischman (talk) 06:51, 6 November 2013 (UTC)

InterpreDemon, I've about had it through the roof with your accusations. We're not "tag teaming"--do you really think Dr. Fleischman and I stay up all night plotting how to make this article as Obama-friendly as possible? You haven't a clue what my political leanings are, and I am going to politely ask you one last time to drop it. Now, you may be right that Japan or some other country came up with the idea for an individual mandate well before The Heritage Foundation, but does that other country's idea have any nexus with the Patient Protection and Affordable Care Act, which as you know is the subject of this article? Many reliable sources discuss The Heritage Foundation proposal in the context of the history of the PPACA; I am unaware of any that discuss how another country's individual mandate has in any way influenced the PPACA. That doesn't mean those sources aren't out there, but if you want that point mentioned in the article, then go find them. If you truly think that my reasoning is nothing more than a pretext for some pro-Obama agenda, I'm sorry, but it's not, and considering there's probably no way to convince you otherwise, this is going to be my last attempt to do so. I will only further suggest that additional accusations from you will cause you to be taken even less seriously by other editors, which in turn will make you less and less likely to successfully address any of the pro-Obama bias you identify in the article. –Prototime (talk · contribs) 16:29, 6 November 2013 (UTC)

Nah, I'm finished with it. If I ever see the phrase, "If you like your plan, you can keep it" or a discussion of the grandfather rule changes buried in the Federal Register a few months after passage, or their present impact upon millions of Americans, two items of far more significance to the public interest than the Heritage Foundation, appear anywhere in the article, maybe I'll reconsider. I was alerted this article by a national forum as an example of bias and my impression remains in agreement. Have fun with it. InterpreDemon (talk) 22:08, 6 November 2013 (UTC)

I'm just curious, what national forum is that? --Dr. Fleischman (talk) 22:15, 6 November 2013 (UTC)

(deleted per WP:BE and WP:SPAM)

No, it predates that. I was driving out through Ohio and I picked it up on an overnight radio program, I think Red Eye Radio, and a caller had cited WP about something to the hosts, and they got into a brief discussion about not believing everything you read on WP because a group of activists can corral control of the editing, citing this article as an example. Got home and thought I'd check it out. You're doing a good job... You like your plan, and you're keeping it. InterpreDemon (talk) 01:04, 7 November 2013 (UTC)

(deleted per WP:BE)

Yes, and as predicted I did not have to hold my breath any longer than when diving for lobster to see your edits wiped out. Next you will be banned as a user. In about six months this article will be even more of a joke and irrelevant than it is now. InterpreDemon (talk) 03:06, 7 November 2013 (UTC)

Reverted edits from the blocked user (above section)

I think the subject matter will need to be included at some point.

I don't think it deserves quite as huge a section as it got.

But the problems with the rollout of healthcare.gov have been going on for over a month, I think my toned-down version was not terrible. I think it could still be made better, but I know my personal opinions may get in the way here since I think the website problems will be a transient thing.

The "if you like your healthcare you can keep it" seems like a manufactured controversy to me, we could remove all those quotes probably. But it is notable that many plans are being dropped due to not meeting minimum requirements. It would be less biased to report how many of those were then replaced with similarly priced, compliant plans as well. Assuming, of course, that information is available.

If rates in general have gone up, that's probably notable as well. "Rate shock" is a terrible section title of course. Still my personal opinions may hinder me here, since I think personally that we can't say much about rates of health care under the Affordable Care Act until after the individual mandate is actually in place for long enough to impact rates as planned.

All in all the added content probably had some good info and relevant links, but should NOT have been presented as a list of inflammatory quotes under biased "headline" style section titles. I tried cleaning it up a bit before you deleted it but it was a big task. It probably would have taken several more edits to get into shape. Should we try again editing on this talk page or some other place before putting it live?

--Fritzophrenic (talk) 02:16, 7 November 2013 (UTC)

---

OK, so how about getting it looking nice here and then going live:

One main think I've done below, if anybody is wondering why so much got cut, is I removed a lot of the quotes and tried to hit their main points. A big list of quotes like that reminds me of sensationalist news stories on TV trying to get my attention, pull me in, and then make me angry to make sure I keep watching. It makes for good TV but a crappy encyclopedia. So I tried to avoid language and quotes with emotionally charged content. I think I'm done for now, but I'd be happy if somebody else picked it up from here. --Fritzophrenic (talk) 04:57, 7 November 2013 (UTC)

Early difficulties during implementation

Federal health exchange rollout

The high-profile healthcare.gov website did not work properly during its October 1, 2013 launch. CNN reporter Elizabeth Cohen reported being unable to apply for coverage after two weeks of trying, experiencing difficulties such as not being able to create a user ID or password, slow response times, and more. During the first 24 hours after the website had gone online, only six people had successfully used the website to enroll. CBS News likewise quoted Luke Chung, an online database programmer, as saying the healthcare.gov website was "not even ready for beta testing", citing a poor design, implementation, and apparent lack of testing. Indeed, integration testing on the completed product was not even started until a few weeks before the site went live, and was performed by government agencies instead of the involved software companies.

Losses of existing coverage

President Obama said in 2009 while the ACA was being debated, "If you like your health-care plan, you’ll be able to keep your health-care plan, period. No one will take it away, no matter what." On October 30, 2013, the Washington Post gave this statement a rating of four Pinocchios.

In February 2013, the Congressional Budget Office said that the law would cause seven million people to lose their employer provided insurance. As late as 2013, about half of the active individual health care plans on the market were not meeting the minimum required coverage requirements of the ACA and therefore will be ended or modified when the coverage requirements take effect in 2014. Failure to meet minimum requirements has resulted in insurance customers losing their existing plans, for example at least 146,000 plans in Michigan and 300,000 plans provided by Florida Blue have been ended due to the plans not covering enough medical services.

---

Some general thoughts:

1. The first two controversies (federal health exchange and loss of coverage) are real and notable and deserve mention in this article. Let's just get that out of the way: despite the numerous accusations, I don't think any editor here has argued they shouldn't be included.
2. The first controversy (federal health exchange) must be balanced against the success of the state exchanges. The section should be titled "Implementation," not "Early difficulties in implementation." And it should be written in summary style, with forks to Health insurance marketplace and Healthcare.gov, which are already quite developed.
3. The second controversy (loss of coverage) isn't an implementation issue. It should go under Impact -> Public Policy -> Change in insurance standards. And yes, Obama's famous promise deserves mention, but it must be presented in a balanced way.
4. The third controversy (increased costs) is a truly manufactured controversy as it's based on cherry-picked anecdotes that have no place here. There may be additions that are appropriate in Impact -> Public Policy -> Effects on Insurance Premiums. I just read a story yesterday about how some people not covered by Medicaid will be entitled to "purchase" bronze plans for free. Any additions on this subject need to be carefully balanced.
5. IMO we should start from scratch due to WP:DENY and widespread WP:NPV problems. There are a few lines here and there that we can use, but most of it either doesn't belong or desperately needs balancing material. The blocked user would love nothing better than to have his little opus be the basis for a substantial portion of this article, and obliging him would only embolden him to engage in more sockpuppetry and disruption. In fact with your permission, Fritzophrenic, I'd strongly prefer blanking the material that you're proposing here. Don't worry, it's not gone, as it can be salvaged from the edit history as needed.

--Dr. Fleischman (talk) 05:07, 7 November 2013 (UTC)

I wholeheartedly agree with Dr. Fleischman, especially on the need to blank this material to remedy WP:DENY and WP:BE concerns. That said, I had just begun to work on some of the issues raised here, and I definitely support their inclusion--stated in a neutral, summary fashion (unlike the edits that Grundle2600's socks continue to push). –Prototime (talk · contribs) 05:20, 7 November 2013 (UTC)

I agree to remove the third section and start over on "rate shock". The first section on the website rollout problems relies on some weird sources at the moment, but I think we can find better sources for what's there (as I tried to do with the NPR/associated press source). Let's keep the 1st and 2nd sections here for now. I agree they aren't ready to include but at the moment it's the best we have. I like the statistic about 6 users and if we can find that in a source that isn't "a blogger on MSN said that CNN said that a government report said..." then it's worth including. Let's re-reference that one and keep it.

I also agree with the summary form, but last I looked the section in the other article detailing the rollout problems was very sketchy. I'd like a good solid summary here at least, and at this rate we're not going to get it if we keep reverting it every time it gets mentioned.

--Fritzophrenic (talk) 06:20, 7 November 2013 (UTC)

As for the "weird" blog-type sources I mention for the healthcare.gov rollout problems, maybe this article I stumbled on today can help: http://www.bbc.co.uk/news/world-us-canada-24844268 --Fritzophrenic (talk) 15:29, 7 November 2013 (UTC)

Three notes:

1. In the first rollout section you need to add that while phone and paper (navigator) applications can be accepted, and phone banks have been ramped up, all the applications still have to ultimately be processed through the healthcare.gov hub, which remains the principal bottleneck. There were also reports of improper pricing data and garbled or incomplete application data in the interchange between the "hub" and the insurance companies.

2. In the loss of insurance section it needs to be pointed out that the bill as passed in March 2010 included a robust grandfather clause, essentially grandfathering almost all existing plans, but the subsequent enabling regulations written by HHS (in June 2010) tightened the grandfather requirements such that their own projections at the time estimated that 40-67% of individual plans and over half of all large and small employer group plans would become ineligible by 2014 (for individuals) and 2015 for employers (due to extension).

The data for above can be obtained directly from the Federal Register in the form of HHS-OS-2010-0015-0001.pdf, directly linked here: https://webapps.dol.gov/federalregister/PdfDisplay.aspx?DocId=23967 A table of their estimates (Table 3) is at the top of page 34553 of that document. Based upon those HHS as well as some IRS data in Bulletin 2010-29, some industry analysts estimate that the total number ultimately affected could be as high as 129 million.

Also on-topic with the grandfather issue but perhaps better covered in the political or even legislative section(s) is the fact that the effect of these stringent provisions was made known (even to those who did not read it before voting for it, find out what was in it after passing it, or bother to follow the HHS rule making thereafter) at least as early as Sept 29th, 2010, when Senator Enzi of Wyoming brought to the floor of The Senate a resolution explaining the impact of the HHS grandfather rules and proposing to overrule them such that the promises of The President and the law's proponents could be kept ( http://www.gpo.gov/fdsys/pkg/CREC-2010-09-29/html/CREC-2010-09-29-pt1-PgS7673-3.htm ). The resolution was debated and rejected in a vote, 59 Nay (all Democrat) to 40 Yea (all Republican).

3. I agree that section three is (was) anecdotal, the net effect cannot possibly be known for some time, for each one paying more for the freight there are probably five to ten who were uninsured before and now getting it for free, and others of low income paying less thanks to subsidies. The real "rate shock" effect is upon those who were paying the most into the system already and from who the wealth needs to be transferred, the young and healthy fortunate enough to have a good paying job and the middle and middle-upper class, many of the latter who already had plans they felt appropriate to their needs and almost all of who are seeing dramatic increases in premiums for the same or higher deductibles, coverage for things they don't need and much narrower provider networks. It is "only" by those tens of millions that the "rate shock" is being felt, and even there we cannot yet know whether their actual costs will go up at all since many will either not be able to afford it or decide it is not a wise investment... which will drop their actual insurance costs to zero. I fall into that category, a bronze plan in CT would cost me $1530 per month for the same 10k deductible I have now at $580 per month, so when my plan is cancelled at the end of the year I will just pay the fine (actually not, because the IRS never owes me money) and self insure until sanity is restored. The actual "paid" enrolment numbers if and when they come out will tell the story, if nobody is enrolling you can assume they are all saving money. InterpreDemon (talk) 07:12, 7 November 2013 (UTC)

On that last note, I just watched an interview on "The Kelley Files" this evening with a gentleman being treated for a terminal illness whose $180 per month policy has been cancelled and the most affordable option available to him is a policy with a $10k deductible costing $1,500 per month, which is unaffordable. He has decided it is best for his family to save the money and "let nature take its course". There will be thousands more like him "saving money" on their insurance costs, just as the President promised. InterpreDemon (talk) 05:14, 8 November 2013 (UTC)

Fascinating. Another triumph of unverified anecdote. Bill Elliot didn't say where in South Carolina he lives, but "randomly" picking the state capital's Richland County, healthcare.gov shows a catastrophic plan available at $192.36 or a bronze plan for $282.10 (picking age over 50). Where's he shopping? Fat&Happy (talk) 06:55, 8 November 2013 (UTC)

Re point 1: I think this is getting way too detailed in light of WP:RECENTISM and particularly WP:10YT. Bear in mind that we're an encyclopedia, not a newspaper. If there are reliable sources saying that signed up through other means than Healthcare.gov has been difficult or impossible, then that is worth mentioning, but language about garbled data and interchanges is just too deep in the weeds, IMO.

Re point 2: This all requires reliable WP:SECONDARY sources (e.g. newspaper articles), not WP:PRIMARY sources such as the federal register and not Congressional floor votes.

Re point 3: I think statistics here would be appropriate, if available. Also, I'm open to the possibility of vague language describing the variability in rate increases/decreases, provided it's carefully balanced (and reliably sourced, of course). --Dr. Fleischman (talk) 21:50, 7 November 2013 (UTC)

In re-reading I agree with your point about the weeds in #1, and doubtless the points of pain in the IT rollout are going to be a moving target in real-time. In point #3 I also agree that it is too early and doubt that any statistics are available as of yet since HHS claims to have no reliable numbers, or will not have any until next week. I don't even think it is a topic worth covering at this time because it is being widely felt by individual Americans already and the number will increase ten-fold during the next wave of cancellations in the first quarter of 2014 as the employer look-back requirements queue up.

However regarding point #2, it seems to me that the secondary source requirement is the instrument by which known, public facts can be deep-sixed at will simply by claiming the secondary source is biased. If the Heritage Foundation points you to the Federal Register, somehow the information therein is not valid due to the bias of the messenger, but if the NYT does it everything is OK. The Heritage Foundation claims the Sun rose today, everybody saw it but the editor of the NYT who was indoors all day, thus the Sun did not rise. To say that a resolution did not exist on the Senate floor because the Federal Register reported it to the public but no other un-biased secondary source did seems to me to be stacking the deck either way. Please show me where I am missing the relevance or value of the secondary source in these circumstances. InterpreDemon (talk) 22:11, 7 November 2013 (UTC)

In reviewing the requirements regarding primary sources, they are certainly not prohibited, but they cannot be used for analysis or interpretation:

Policy: Unless restricted by another policy, primary sources that have been reliably published may be used in Wikipedia; but only with care, because it is easy to misuse them.[4] Any interpretation of primary source material requires a reliable secondary source for that interpretation. A primary source may only be used on Wikipedia to make straightforward, descriptive statements of facts that can be verified by any educated person with access to the source but without further, specialized knowledge.

Thus one can certainly, as a matter of fact, state that a floor debate and vote on a Senate Resolution regarding proposed changes to HHS grandfather rules occurred on September 29th, 2010, state the outcome of the vote and the voting, point to the Senate Congressional Record of the debate and proceedings and enable the reader to go read the record for themselves. InterpreDemon (talk) 22:58, 7 November 2013 (UTC)

I'm hesitant to support anything on this subject that's not supported by secondary sources, as I can't imagine coverage in the secondary sources being inadequate. If you think the New York Times missed out on a story, then by all means look elsewhere, say, in the Wall Street Journal or in FoxNews. If you still can't find a single secondary source that covers your angle then perhaps there's a reason for that? --Dr. Fleischman (talk) 23:22, 7 November 2013 (UTC)

OK, here's your Fox News article, on the day the resolution was disapproved: http://www.foxnews.com/politics/2010/09/29/senate-gop-test-drives-another-limited-health-care-repeal-but-comes-up-short/ InterpreDemon (talk) 23:43, 7 November 2013 (UTC)

And another from the National Journal: http://www.nationaljournal.com/congressdaily/hcp_20100929_1019.php as well as the Senate Democrats' proud reporting of the event that day: http://democrats.senate.gov/2010/09/29/s-j-res-39-providing-for-congressional-disapproval-of-the-rule-relating-to-status-as-a-grandfathered-health-plan-under-the-patient-protection-and-affordable-care-act/ and even the White House published its opinion on the matter: http://www.whitehouse.gov/sites/default/files/omb/legislative/sap/111/sapsjr39s_20100929.pdf Of course there are many other current articles related to the event and, in particular, certain Red State Senators now in trouble due to their vote on that resolution, but those veer from "just the facts", whereas these articles (except for the last two) seem to be relatively balanced and present the arguments proffered by both sides at the time. InterpreDemon (talk) 00:11, 8 November 2013 (UTC)

...And still another from The Hill a week prior to that fateful vote, which describes Enzi's demands for a vote on the resolution and cites the HHS estimates of plans that will lose grandfather status: http://thehill.com/blogs/healthwatch/health-reform-implementation/120285-enzi-demands-do-over-on-healthcare-grandfathering-clause InterpreDemon (talk) 05:32, 8 November 2013 (UTC)

Maybe you already know this, but Obama commented/apologized for the loss-thing: [4][5] Gråbergs Gråa Sång (talk) 10:04, 8 November 2013 (UTC)

This from Politifact might be of some use as well: [6] Gråbergs Gråa Sång (talk) 12:13, 8 November 2013 (UTC)

"If you're happy with your current plan, you can keep it"

This was a phrase uttered by Obama on countless occasions while attempting to sell the ACA to the public. It turned out not to be true, and the President now seems to have "apologized" for people who aren't able to keep their "sub-par" health plans due to the law. Where does the article talk about this misstatement and the controversy surrounding it?--Jerk of Thrones (talk) 03:50, 8 November 2013 (UTC)

Actually, JOT, if you look at the section immediately above this one you started, you will see that we are attempting to address that topic as well as the roll-out difficulties. I agree with you that it is long overdue, but it is extremely tough to run the gauntlet with the editors on this article. InterpreDemon (talk) 04:37, 8 November 2013 (UTC)

Good luck with that!--Jerk of Thrones (talk) 06:28, 8 November 2013 (UTC)

It seems like the quote is worthy of being a sub-section of what ever section about the rollout is eventually written. - Haymaker (talk) 23:06, 8 November 2013 (UTC)

"The Economist": Good secondary source for problems with rollout

I like The Economist because it is not known for having a particularly right-wing or left-wing slant. They have an excellent and concise summary of what a disaster (the subtitle of the article is "Congress hears tales of baffling ineptitude") the implementation of Obamacare has been so far, in case anyone want to use it as a source: http://www.economist.com/news/united-states/21588951-congress-hears-tales-baffling-ineptitude-debacle

They also have an excellent article on how the problems have damaged Obama's reputation as an executive, but that's less relevant to this article. http://www.economist.com/news/united-states/21588929-barack-obamas-supporters-are-worried-he-terrible-manager-whoops --Jerk of Thrones (talk) 15:52, 8 November 2013 (UTC)

table for the future rollout section

It seems like there is an emerging consensus that there should be some section covering the rollout. Inside that section I was thinking about making at table with two main categories: how many people enrolled in each state inside the first month, and then whether or not that state agreed to be part of the ACA or whether the federal government was running the exchange in their state. Are there any other columns that would be worth including? - Haymaker (talk) 23:08, 8 November 2013 (UTC)

I think you know the answer: we should include data in proportion to the content of independent, reliable sources. What source were you planning to cite for the table you have in mind? MastCell ^Talk 00:09, 9 November 2013 (UTC)

I think this would be a real challenge to do on our own, especially for the first month as the data is so scant. I have attempted to find such a running tally (exclusive of gov't vs state exchanges aspect) and they are all over the map, with cumulative totals anywhere from enough to count all your fingers and toes to a million. Perhaps when we see the data released next week by HHS and the level of detail included (state by state and/or other demographic information) such a tally could begin. This is not unlike the problem with figuring out how many have lost their insurance due to cancellations since Oct 1, an equally important and complementary data set that would be nice to have but not really possible until sometime after the beginning of the year when the policy holders (or portion of them) have been enrolled in something to replace those they lost. Right now all of this is basically impounded within the insurance company and HHS databases, and in the case of the former may never become available due to competition and trade secrets. InterpreDemon (talk) 00:41, 9 November 2013 (UTC)