Talk:Patient Protection and Affordable Care Act

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Video Talk:Patient Protection and Affordable Care Act

Actions to hinder implementation

I am seriously concerned about this section as it reads as non-neutral. It may be factually accurate, but it's poorly sourced, it includes weasely language (saying that unspecified "prominent Republican politicians") have done of these misdeeds, and non-neutral language ("then insisting," "among others," "Ongoing insistence, despite CBO assertions to the contrary"). This really reads as a little pro-ACA diatribe. Not only does it need to be cleaned up and cite checked, but appropriate contrary views need to be added, as I know some Republicans have tried to justify various actions. If these steps aren't taken then we should delete this subsection. --Dr. Fleischman (talk) 21:24, 3 August 2017 (UTC)

Maps Talk:Patient Protection and Affordable Care Act

Off-exchange enrollment

Doc F reverted me, saying "this is not what the source says - and what the source says is highly misleading". That's not good enough. What is wrong with the edit? Lfstevens (talk) 08:30, 6 August 2017 (UTC)

For starters, your edit said, the number of individual policy holders declined by an estimated 29% from 2016 to 2017. That is not what the source said. The source said that off-exchange individual enrollment declined by 29%. The key word being "off -exchange"--this is the number of people who enrolled directly with their insurers not through the ACA exchanges (a comparatively small number in both 2016 and 2017). HUGE difference. I don't even need to get into the ridiculousness of the source's analysis, and its unreliablity. --Dr. Fleischman (talk) 09:17, 6 August 2017 (UTC)

My edit said:

As of July 10, 141 plans had filed initial applications to offer 2018 coverage, a 38 percent reduction from 227 in 2016, while the number of individual policy holders declined by an estimated 29% from 2016 to 2017.

I happily accept your correction adding "off-exchange" to the text. But otherwise, the edit is accurate. Lfstevens (talk) 18:20, 6 August 2017 (UTC)

Verifiability issues aside, what is the benefit of discussing off-exchange enrollment numbers? Not to mention that we'd need to explain what off-exchange means. --Dr. Fleischman (talk) 03:16, 7 August 2017 (UTC)

The article is not about the exchanges. It's about the Act. Off-exchange enrollment is an essential part of the overall insured/uninsured metric. Lfstevens (talk) 00:34, 10 August 2017 (UTC)

Sure, but why give the off-exchange enrollment figures for a single year, and not the on-exchange figures for the same year, or either for other years? --Dr. Fleischman (talk) 04:14, 10 August 2017 (UTC)

This section is about 2017...If you want to add stuff beyond what I did, go for it. Lfstevens (talk) 06:12, 15 August 2017 (UTC)

You didn't answer my question. It seems to me you're cherry-picking to support a particular POV. --Dr. Fleischman (talk) 07:49, 15 August 2017 (UTC)

How is it cherry-picking to present properly-sourced facts? They were what the source reported. I can think of lots of other things to add to this article. I may get to some of them. Lfstevens (talk) 23:24, 15 August 2017 (UTC)

The source itself cherry-picks and its analysis is bogus. Although its numbers are accurate, it is not a reliable source for its analysis or conclusions. --Dr. Fleischman (talk) 17:16, 17 August 2017 (UTC)

It's a reliable source for its facts. That's all I used. I made no conclusions. Lfstevens (talk) 23:30, 19 August 2017 (UTC)

Right. The facts are reliable; it also cherry-picked those facts to advance a faulty analysis. I oppose the use of them in isolation. If you're going to insist on using them then I suggest WP:DR. --Dr. Fleischman (talk) 17:22, 20 August 2017 (UTC)

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Request split (September 2017)

I propose most of the content in this article be WP:SPLIT into a new, more general article about Obama's health laws. I have two reasons:

• Less importantly: This article is very long. Its readable prose size is 89 kB; far into "probably should be divided" and approaching "almost certainly should be divided" in WP:SIZERULE.

• More importantly: This article should be specifically about the Patient Protection and Affordable Care Act, but sections 2 through 7 (most of the article) make almost no attempt to distinguish between this law and its sister law the Health Care and Education Reconciliation Act of 2010. What's more, this is irreparable: the second law modified the first, so any discussion of the impacts, public opinion, implementation, etc. of the laws can only take the two of them together. If anyone thinks this is trivial because the first act was bigger, HCERA made major changes to PPACA, such as overhauling the tax credit schedule (which is one of the three legs of the law's individual market design), overhauling the Medicaid expansion federal matching, and replacing a third of the law's revenue. Keeping the effects of a two-part health reform under only the article for one part is very misleading to the reader. There is a reason the CBO always refers to the "Affordable Care Act" and specifies that it comprises the PPACA and the HCERA.

Because of these two reasons, I think all content that refers to the subsequent effects of the law (the impact, public opinion, political aspects, opposition, and implementation history) should be split off into a new article covering the two-part Obama-era health reform. It should also get most of the legislative history, though a condensed version of the legislative history should remain on this article. The new article should get a concise version of the still-law provisions of PPACA and HCERA.

The obvious names for the new, broader article would be "Obamacare" or "Affordable Care Act". Obamacare is used slightly more often by news sources, according to google's news searches (8,270,000 to 6,260,000), and much more often in searches by the public. Affordable Care Act is still preferred by some official bodies like the CBO, and was probably used more often by the Obama White House. Madshurtie (talk) 17:04, 23 September 2017 (UTC)

While I can see where you're coming from, I disagree with your analysis and proposed solution. HCERA was a significant amendment to PPACA/the ACA/Obamacare/whatever you want to call it, but that's all it was, an amendment. Obamacare was still created by PPACA, and PPACA was by far the dominant piece of legislation. I don't think it would make sense to split the two because of HCERA. That said, I do think this article should be moved to Obamacare. --Dr. Fleischman (talk) 03:48, 24 September 2017 (UTC)

I guess it depends how significant a significant amendment it's considered to be. One problem with the article at the moment is its very easy to forget this act had a major amendment. The page generally uses "the law" rather than "the laws" when referring to the effects, and refers to "ACA" without specifying whether this is a term for PPACA or PPACA+HCERA (many sources, such as the CBO, use it as a handy way of referring to the two). Madshurtie (talk) 11:51, 24 September 2017 (UTC)

I'd also add it's not an amendment of the same law in the sense the American Health Care Act of 2017 has been having amendments. PPACA and HCERA both have separate public law records. Madshurtie (talk) 11:56, 24 September 2017 (UTC)

I agree that more should be added to this article about HCERA's legislative/enactment history. --Dr. Fleischman (talk) 16:33, 24 September 2017 (UTC)

src: www.healthinsurance.org

Semi-protected edit request on 30 September 2017

All specific bills were defeated, however. The revised BCRA failed on a vote of 43-57. A subsequent "Obamacare Repeal and Reconciliation Act" abandoned the "repeal and replace" approach in favor of a straight repeal, but failed on a vote of 45-55. Finally, the "Health Care Freedom Act", nicknamed "skinny repeal" because it would have made the least change to the ACA, failed by 49-51, with Collins, Murkowski, and Senator John McCain joining all the Democrats and independents in voting against it.

In early September 2017, Senators Lindsey Graham and Bill Cassidy constructed a bill to try and repeal Obamacare once again; however, by September 28, 2017, it was evident that the measure did not have enough votes either and therefore no vote would be held. https://www.self.com/story/twiwh-graham-cassidy-failed 107.144.71.246 (talk) 22:46, 30 September 2017 (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. SparklingPessimist ^{Scream at me!} 22:49, 30 September 2017 (UTC)

src: i1.wp.com

Trump's executive orders in October 2017

Why is there nothing about these?

This is one source.-- Vchimpanzee o talk o contributions o 21:07, 16 October 2017 (UTC)

Because no one has taken the initiative to add them. Go for it! --Dr. Fleischman (talk) 22:17, 16 October 2017 (UTC)

I was hoping someone could tell me where to add the information, but I guess they'll find a way once I've added it.-- Vchimpanzee o talk o contributions o 15:12, 18 October 2017 (UTC)

I think where you put it was the right place. --Dr. Fleischman (talk) 18:49, 18 October 2017 (UTC)

src: wp.patheos.com.s3.amazonaws.com

Origin of term Obamacare

I was the author and originator of the term ObamaCare - so there is incorrect information saying that the first to use the term ObamaCare were political opponents - Fox News picked up the term after seeing me use it on twitter and many began to use it after that - Scott A. LaFata : Wikipedia user ID Firstclasscool - ### -- Preceding unsigned comment added by Firstclasscool (talk o contribs) 19:25, 17 October 2017 (UTC)

Scott, do you have links to back that up? To your tweets and to early Fox News reports? --Dr. Fleischman (talk) 19:42, 17 October 2017 (UTC)

Actually, no need. The term emerged in 2007, per the sources. Your Twitter account was opened in 2011. --Dr. Fleischman (talk) 19:48, 17 October 2017 (UTC)

Like many such appellations, many folk came up with it at the same time. We would need a reliable source for the origination. Which doesn't look likely. O3000 (talk) 21:34, 17 October 2017 (UTC)

As with many memes, there is the original coining, and then there is the earliest usage that seems to've put it into the general public consciousness. Presently, the early-2007 references appear to accurately (if not precisely) represent the latter.
Weeb Dingle (talk) 19:22, 21 January 2018 (UTC)

src: artassocialinquiry.org

Cost-sharing subsidies

In the interests of clarity and neutrality I think we should create a new section or subsection specifically on the insurer cost-sharing subsidies. It would cover the problem in the original act, Obama's executive order, the lawsuit, Trump's executive order, the Murray-Alexander bill, and any subsequent developments. This would make things so much easier to understand than our current structure in which we have this content scattered among "Legal challenges," "Actions to hinder implementation," and "Murray--Alexander Individual Market Stabilization Bill." If it gets too long (likely) it could be spun off into a separate article. --Dr. Fleischman (talk) 16:40, 19 October 2017 (UTC)

Agree, I'll pitch in.Farcaster (talk) 21:47, 19 October 2017 (UTC)

Ask and ye shall receive. Initial draft done.Farcaster (talk) 23:13, 19 October 2017 (UTC)

Nice, thanks. Actually though, this isn't quite what I meant. You framed the section solely around the Trump administration's efforts to undermine Obamacare by not paying the subsidies starting in October 2017. But the subsidies story began way before this month, at least as far back as 2014. This 2015 opinion piece provides some good back story, even if it isn't reliable. Some of the story and sources can be found in House v. Price. --Dr. Fleischman (talk) 23:41, 19 October 2017 (UTC)

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Premature deaths

Farcaster, I don't understand the link between the map you added and Obamacare. The source doesn't say anything about Medicaid, insurance coverage, or Obamacare. As a secondary matter I also question the source's reliability, since it's a blog and there's no indication that it's been fact-checked. --Dr. Fleischman (talk) 00:38, 8 November 2017 (UTC)

Regarding credibility, it's the FRED (Federal Reserve Economic Database) blog run by the Federal Reserve Bank of St. Louis. So you won't get a more credible source of information. The map shows counties where we have higher mortality, and the section in the article where I've attached the image explains how Medicaid affects mortality (e.g., not having health insurance is a killer that impacts mortality). You booted my first attempt to tie the map to Medicaid expansion, so I just left the map citation. If it helps, I'll take the citation from right next to the map and include that.Farcaster (talk) 01:45, 8 November 2017 (UTC)

I added some text in the article to clarify the linkage: 1) Coverage reduces mortality; 2) Medicaid expansion expands coverage; 3) Therefore Medicaid expansion reduces mortality. The map covers mortality. Hopefully that helps.Farcaster (talk) 02:07, 8 November 2017 (UTC)

The problem with the content as currently written is that it's classic original research. Why not just cite the Kaiser source for its summary of the mortality impact of Medicaid expansion, and drop the chart that isn't about Medicaid or Obamacare? The article is long enough as it is, no benefit of adding a big chart of only tangential relevance. Plus, the content you added overstates the Kaiser source, which said that one study found that Medicaid expansion did not affect in-hospital mortality, and another study only found that a decrease is preoperative mortality for cardiac surgery patients. --Dr. Fleischman (talk) 06:36, 8 November 2017 (UTC)

Granted, this article is long enough already. I've got the map in some other places. But sources indicate that lack of coverage increases mortality, and this map is about mortality, so I disagree on OR. You're the resident guardian of this article (a role I appreciate, having done so many times on other articles) so I'll leave the decision up to you and won't pester you about the chart.Farcaster (talk) 14:13, 8 November 2017 (UTC)

I fully support saying something about Obamacare-related coverage (Medicaid expansion or otherwise) decreasing mortality. But for starters we need a source that actually says that. Or, we can scale our content back to what the Kaiser source actually says, which is much less impressive. --Dr. Fleischman (talk) 16:44, 8 November 2017 (UTC)

Since Obamacare Medicaid expansion increases coverage (cited), and coverage decreases mortality (cited), therefore Obamacare Medicaid expansion decreases mortality. This is straight up logic (A implies B and B implies C therefore A implies C). It isn't OR, it's deductive logic, no citation linking A to C required. It must be true by definition.Farcaster (talk) 18:21, 8 November 2017 (UTC)

There are two problems with this. one is that it's classic WP:SYNTH, your logic is exactly what that policy forbids. But what I really want to know is which source (or sources) supports the claim that coverage decreases mortality. --Dr. Fleischman (talk) 20:24, 8 November 2017 (UTC)

How can irrefutable logic result in synthesis? The statement is true by definition, whereas synthesis requires some type of opinion. And the sources that support the claim that coverage decreases mortality is already in the article. Look at the first paragraph in the "Health Outcomes" section.Farcaster (talk) 21:40, 8 November 2017 (UTC)

Ohhh I thought you were pointing to the sources you added yesterday. Now I understand. I'll dig into this a little more sometime soon. --Dr. Fleischman (talk) 21:46, 8 November 2017 (UTC)

src: artassocialinquiry.org

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