Talk:Affordable Care Act: Difference between revisions

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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)

Aug 2019: I started looking at this article and adding to it a few weeks ago, and did just realized that a section of Cost-sharing reductions (under provisions) was needed, and then caught this section here indicating it was found needed two years prior. So I stuck it in today. I think I've matched the intent of the original poster.

(Note that I am using the term "Cost-sharing reductions", which mean the same thing, (according to a link in my section). I find "reductions" clearer, as there may be confusion when "subsidies" are used, since direct Federal payments were stopped by the Trump administration.)

Also, when I did the section, I noticed the omission of the silver-plan loading reaction in many or most states, by many insurers (or all insurers in the state, depending on state government orders). Where it was done, the silver loading more-or-less nullified the problem, as long as people not eligible for cost-sharing can figure out to avoid the silver plans. (In the section, I have a reference to Health Affairs describing this silver loading, if you don't know exactly what I'm talking about. It was started, and reported on by Health Affairs and others, at the time of the Trump action.)

NormSpier (talk) 21:35, 25 August 2019 (UTC)

GAR request

I am going through the Good article reassessment request backlog. This article has outstanding and valid tags so that needs fixing. It is also incredibly long (94KB readable prose), which is almost certainly split territory. Given the narrow scope of the article I would say it fails criterian 3b. I will give a chance for editors to respond before going through a more formal process. @Sb101, Fat&Happy, DrFleischman, Innab, TVC 15, Farcaster, Myownworst, George Orwell III, Lfstevens, Prototime, Hauskalainen, Cybercobra, and Kurykh: all editors with over 100 edits to the article (ping others if you want). Plenty of interested editors so hopefully someone will be willing to work on it. AIRcorn (talk) 06:40, 23 March 2018 (UTC)

• Support fork The article is too long. I nominate the "Implementation history" section for a fork to its own article. This section is 37k and is of the least interest to most current readers. Blue Rasberry (talk) 13:06, 23 March 2018 (UTC)

Looks like your nomination wins by default. Will do the split and see what we are left with. AIRcorn (talk) 00:58, 6 April 2018 (UTC)

Split and trimmed. It was full of off topic and overly detailed information. It was self referential. Can someone double check it. I feel something similar needs to happen to the other sections. I will probably look to delist this if it is not improved in a week r two. AIRcorn (talk) 01:34, 6 April 2018 (UTC)

• This article is not even close to GA. I wouldn't spend more time on an assessment. I support the split, because it may give this article a chance to stabilize. Lfstevens (talk) 00:29, 10 April 2018 (UTC)

GA Reassessment

This discussion is transcluded from Talk:Patient Protection and Affordable Care Act/GA2. The edit link for this section can be used to add comments to the reassessment.

The main issue here is focus (crieria 3b. The article sits at 81KB readable prose and this was after I personally trimmed and split the section on implementation history. This is also slightly misleading as it does not take into account the bulleted lists and tables which make up a large part of the article. There are a few main articles so no reason not to use WP:Summary Style. It is also overloaded with sub and sub-sub headers (twenty two under Provisions). Some f these consist of a single sentence. There are also issues regarding tags that need sorting. AIRcorn (talk) 23:10, 9 April 2018 (UTC)

• Delisting per above. AIRcorn (talk) 10:50, 5 May 2018 (UTC)

I agree. The "Legislative history" section needs to be trimmed. Also, old data needs to be removed from "Implementation" section. 131.252.12.89 (talk) 16:51, 15 May 2018 (UTC)

POV issues

(AUG 2018) Portions of this article read as though they were written by the government and therefore should be questioned as political propaganda. Instead of reading in a more neutral manner, many of the points play out in a consecutively gratuitous manner toward the subject of the article. It reads more like a brochure and less like an objective analysis. There is far more positive POV description of the law than neutral or negative, and much time is spent in this article describing the components of the law AND "why that is good" for you, in a symbiotic relationship. Too much of this feels like it was written by someone who heavily supports the law and it feels strongly as though it is purposefully omitting many studies which have shown to portray the effects of the law in a neutral or even negative light, while selecting studies mostly that show the law as achieving the results the creators proclaimed it would. It does not even take the time to mention in the very least, that for SOME people, many of the included studies do not reflect their experiences, especially concerning deductible increases etc. — Preceding unsigned comment added by Lbredefe010 (talk • contribs) 12:48, 20 August 2018 (UTC)

I User:NormSpier' (Aug 2019) have added a Problems Section (i.e. Problems with the ACA). It has 5 problems listed, including the deductibles. It us under heavy attack over multiple Wikipedia standards issues by User:Newslinger being considered partial, "original research" (applied to my example-case, regerneratable from references, calculations of deductibles and over the cliff premiums as a percent of household's modified adjusted gross income. I think also, on one of the problems, Medicaid estate recovery for a large proportion of ACA recipients, listing of cases of states doing and having rescinded the recovery--the listing of states in each case being considered "original research".

There are other issues being criticized as violating Wikipedia standards.

Over one of the problems, listed in this article, and also Medicaid estate recovery, (the problem is with the interaction of the ACA and Medicaid estate recovery, resulting in many ACA recipients actually having not insurance, but just a loan, needing to be paid back by estates at death, for all medical expenses), User:Newslinger has indicated bias and violation of Wikipedia standards of proportional representation, that is, he wrote: "We try to reflect all major viewpoints covered by reliable sources in proportion to their prominence. If an issue is "underpublicized", it should be featured less prominently in an article." Thus, I have identified this principle as forcing us into the establishment-voice-only representation talked about in Manufacturing consent. As far as I can figure, since the establishment sources pay little attention to the issue now (though they did just a bit in 2013/2014, and they have, just a bit, later, in certain states where bold reporters choose to bring it up, or where there was grassroots activism), and also since there has been no response by any government agency in the press to any issues on the problems side, it seems quite possible that that the one serious problem, the Medicaid estate recovery loan-not-insurance issue will have to be removed from this article, and Medicaid estate recovery as well. (Removed or watered-down so much that its seriousness is not evident.) Anyway, I can't stop Wikipedia policy from having the problem deleted from Wikipedia, but I can suggest that Wikipedia might want to stop bugging everyone every year with requests for a donation on grounds of it preserves neutrality and non-establishment voices, and that it just go ahead an get the money from Pfizer.)

Additionally, I have from User:Newslinger "The Verifiability: Readers should be able to verify every single statement in a Wikipedia article with a reliable source."

I'm finding this stifling, to the point where I can't a useful, well-though-out article, with explanations where the reader will need them, can be constructed. It sounds like every single sentence has to be an idea taken from a reference. No explanation, even of obvious things. I've pointed out that they don't do that in other places, such as Internal Combustion Engine, Calculus, and Banach space, they don't do the reference on every statement. So this also impeding the reporting of the ACA Problems.

People interested in this should see the section of this talk page below called "Noticeboard discussion regarding User:NormSpier's recent edits (started by User:Newslinger), as well as the noticeboard he created, WP:NPOVN § Medicaid estate recovery and User:NormSpier.

NormSpier (talk) 13:32, 3 September 2019 (UTC)

I have done a more careful look at this full article, and have agreement with whomever added the Aug 2018 comment "It reads more like a brochure and less like an objective analysis." Outside of what I have added, there was some legal challenges stuff, and constitutional kinds of challenges, and perhaps compulsion challenges mentioned. But not a thing (correct me if I am wrong), saying the ACA wasn't working perfectly. It was a law working well. Perfectly, except where the Republicans messed it up, from the article's POV. Just amazing how good a law it was.

The sections I added change that. The problems section was entirely mine (8/2019), where 5 real problems are listed, some rather perverse.

Within my separate "outline of coverage mechanism section", there is also a bit on where problems may arise. The section was not primarily added to describe problems. It was designed to describe the mechanism of giving coverage to individuals without other adequate insurance in a clear fashion, so that a person has a clear understanding of how the ACA is supposed to get everyone covered. It's supposed to be clear enough that a person with appropriate skills can see how it works, and can use the power of reasoning to see as to where it will likely work, and where it may fail. A person may also find some understanding of the financing restraints on the program, in that the program is tightly limited in who can get a subsidized on-exchange plan. For example, from this, one might see that the law keeps people on Medicaid when possible, with no option for a (federally paid for) on exchange plan, because states have to pay a good share of cost, and as well, because Medicaid has very low reimbursement rates. Much lower than private insurers. One can see this might result in hidden tax on people privately insured, driving up their rates.

I also added some other stuff for clarity, including on the stopping of the cost-reduction payments to insurers (which had actually, unbeknownst to me at the time, been requested on this page), and the silver loading response. (There is nothing that addition that reflects negatively on the ACA. I'm not out to kill it. I'm out to make it, its mechanisms, and its problems, clearly understood.)

NormSpier (talk) 01:37, 5 September 2019 (UTC)

Texas et al v. United States of America et al

Create Texas et al v. United States of America et al article, due to Fate of Obama's health law set to be decided by supreme court – again (15.Dec.2018) ? See Patient Protection and Affordable Care Act#Texas et al v. United States of America et al here in article. X1\ (talk) 20:04, 15 December 2018 (UTC)

There should be a 48 hour waiting period... Allow a couple of days for WEIGHT and further details to appear. Cheers Markbassett (talk) 04:53, 16 December 2018 (UTC)

Title issues

I know this has been discussed before, but I'd like to give a different perspective on the subject. I know there are probably still some people out there that think this article should be moved to "Affordable Care Act" or "Obamacare" per wp:COMMONNAME. However, I don't think that is the whole story. From my experience, "Obamacare" refers more commonly to the provisions of the act, not the act itself. If this is true, then the common name of the act itself would most certainly be "Affordable Care Act." This exact issue doesn't appear to have come up in past move discussions. Bneu2013 (talk) 03:45, 11 June 2019 (UTC)

Noticeboard discussion regarding User:NormSpier's recent edits (Mainly, "Problems" section of article, that is section on ACA Problems, section created and entirely with contents so far only from User:NormSpier<--this parenthetical added by User:NormSpier)

There is a noticeboard discussion regarding the neutrality of NormSpier's edits to this article (Special:Diff/909824345/912954601) and other articles related to Medicaid estate recovery. If you're interested, please participate at WP:NPOVN § Medicaid estate recovery and User:NormSpier. — Newslinger talk 17:15, 30 August 2019 (UTC)

Please see my comments on the noticeboard.

Essentially, after {u:AnUnnamedUser} made comments a week or two ago, I have attempted to repair, but {u:Newslinger} is finding the same problems.

Thus, on my own, I lack the eye, at this point, to find the problems on my own.

Thus, if you could:

a)point out specific passages that should be removed, reworded, and exactly how, if a rewording. (Or, ask for clarification, where does the reference say that?, etc.)

or b)do the deletion or rewording yourselves, using whatever editor consensus procedures you have to make sure there is sufficient agreement on your end. (Delete whatever you need to, if there is no resource to make to conform.)

Thanks

NormSpier (talk) 14:11, 31 August 2019 (UTC)

Also, note. Of the various articles in question (in the messageboard), probably the most critical for it not to appear to others of bias in favor of the ACA, covering up defects, is the ACA article itself, where the section Problems (which I added) lists 5 problems,

5 Problems 5.1 Subsidy Cliff at 400% FPL 5.2 Sometimes-Unaffordable Out-of-Pocket Maximums 5.3 Family Glitch 5.4 Estate Recovery under 138% FPL 5.5 Coordination of Medicaids with On-Exchange Plans

Note that most of the problems, including estate recovery when it is done by states non-long-term-care-related, are in multiple sources, and in particular this reliable one: https://tcf.org/content/report/key-proposals-to-strengthen-the-aca/ (co-authored by Tim Jost, an academic lawyer who did most of the the Health Affairs "Covering the ACA" posts until a year or two ago.)

Specifically, 4 of the 5 wikipedia ACA section 5 "problems" are within the text of the single "proposal to strengthen" article:

5.1 is within "Increase Credits for Moderate- and Middle-Income Families" 5.2 is within "Reduce Cost-sharing and Out-of-Pocket Limits and Improve Minimum Employer Coverage Requirements." 5.3 is within "Fix the Family Glitch" (you only have to go so far as the title) 5.4 is within "Eliminate Medicaid Estate Recoveries from the Expansion Population" 5.5 is the only one not in "proposal to strengthen". But I have reliable references (last paragraph in the article), including actual continuity of coverage issues found in the GAO report. NormSpier (talk) 15:46, 31 August 2019 (UTC)

I have some prior comments on the noticeboard regarding my contributions, which now remain only on this ACA Wikipedia article, and also Medicaid estate recovery.

Here let me add issues relevant to the ACA article, in reaction to comments by Newslinger which are on the noticeboard. (They also may have relevance to the general ACA article, for future editing and such.)

From the bulletin board, Newslinger has written

(1) "It is fine to include some of the criticism listed at Patient Protection and Affordable Care Act § Problems, although the length of the content should be reduced. For instance, the listed examples for silver/bronze plans are considered original research since they're not covered in reliable sources, and they should be removed."

(2) Verifiability: Readers should be able to verify every single statement in a Wikipedia article with a reliable source.

These two principles, let's call them Newsl1 and Newsl2, seem to be causing problems with the ability of the ACA article here to have information to be useful to certain readers needing more than superficial information. In my opinion.

Thus, on removing the bronze and silver plan examples, which is used in two of the "problems" sections: the example provides useful information that a quantitative mind will seek about the issue. For example: over-the-cliff, total expenses, premium plus out of pocket max will be 41% of MAGI, and 27% under the cliff. Values in dollars are also there. The understand is too muddy and incomplete without an example like this.

Thus, the request of Newslinger (Newsl1) to remove the bronze and silver examples would make this Wikipedia article something that I would find, myself, substantially less useful for any kind of numerate understanding of the issue.

(Unfortunately, I see that the two examples, both silver and bronze, are more than we would like. Ideally, only say silver. But the problem comes up from the states' and insurance companies mixed reactions to the Trump order on the stopping of Federal payments of cost-sharing subsidies, which may or may not have silver loading. Doing silver only is flawed. (See my first explanation of the need to avoid silver only, under "subsidy cliff". Silver only would be a flawed analysis, and note the references to Health Affairs, and as well a spreadsheet on silver loading that I think Health Affairs did. I can't do a flawed analysis. I have to respect the quest for truth. I understand the need to simplify. I cannot, however, oversimplify to the point of making the exposition flawed.)

Questions are raised here as to both what level this Wikipedia article is at, and also to how well it is equipped to give adequate information.

The ACA article looks to me roughly at the level of the NY Times. Higher than USA Today, but lower than a graduate math text, or mathematical economics journal, or say the wikipedia article Banach_space.

But, in trying to be at the NY Times level, it still fails. The examples the NY Times might put in, doing its own work. (They have enough policy people and people skilled at calculation to do it.)

However, here at Wikipedia, I was unable to find a reliable source with the information, so I did the numbers myself. I've been asked to remove it. (The calculations are my own, based on the information on the Federal healthcare.gov site, and are thoroughly traceable (for the duration of 2019). However, Wikipedia would hopefully have enough people around, both able to calculate, and with knowledge of the details, to verify. Then, hopefully they would be able to archive the verification somewhere: maybe with a footnote on the table pointing to the verification. Presumably, the NY Times has a procedure like this.

(Besides my own thought that a reliable, verifiable (with a little math and policy knowledge) table from a contributor should be acceptable, I caught that a table from 2014 apparently missed quality control. This was the original one under "Premium subsidies". The last column was labelled "cost-sharing subsidies", but had numbers like $1000 for income at 350% of the Federal Poverty Level. This was just wrong. Cost sharing subsidies stop at 250% FPL. I also manually checked some of the other numbers, and they were off. (Small amounts only, fortunately, like a few hundred dollars.) (I replaced the table with my own, for 2019. Although it is completely verifiable with minor math, and the references I provided, you probably need to delete it under your policies.)

Otherwise, I'm seeking clarification Newsl2 ("Verifiability: Readers should be able to verify every single statement in a Wikipedia article with a reliable source."), because I'm finding articles where that's not the case. Thus Internal combustion engine, and Calculus, and to a lesser extent, Banach_spaces.

Apparently, in the case of those articles, people writing and editing both have an understanding of the technical details, and are not requiring every sentence to have a reference. However, on the ACA-related articles, I've been told everything needs a reference. (So, for example, the obvious assertion that a Medicaid that has all medical expenses being recovered is a "loan" needs references. So I put them in, but now I'm getting that some of the sources may not be reliable.) (I suspect the different treatment of hard-science articles vs. the ACA may have something to do with that in the hard sciences, only people who know what's going on get involved, but in anything with any political component, everyone gets involved, and so controls, and everything verified in little baby steps becomes needed as a control against chaos. But, as I see it, the current Wikipedia procedures are hindering and perhaps blocking a lot of information needed to keep from a muddy, emptyish presentation.)

As for this, I'm not intending on removing important information myself. I am more than happy to help in finding better ways to organize the material, but I can't myself do a gross removal of most of the important information. I understand that general written and unwritten Wikipedia policies and viewpoints will likely result in a gross removal of much or most useful information I have added by others, and that's O.K. with me. NormSpier (talk) 15:59, 1 September 2019 (UTC) NormSpier (talk) 15:59, 1 September 2019 (UTC)

I need to add another comment on this article in response to a third request of Newslinger. Somewhere (I'll save myself the time of finding), he said "too many references" or maybe it was "far too many references". There may official or unofficial policy on this, and I'm not seeking an exception, but I do see that the general policy, like other policies, is removing lots of useful information for certain people. Thus, I have many references at the point where I introduce the controversy around the ACA and Medicaid estate recovery ("The issue of the negative interaction of the ACA with Medicaid estate recovery was noticed in many places starting from the time of ACA passage.[355][356][357][358][359][360][361][362][363][364][365][366][367][345]") Some people may wish to find the original articles, which are from different sources, to get a complete and richer understanding. In separate places, the estate recovery practices of specific states are documented in references, and people might find them useful, or being necessary backup to my claim that a lot of states stopped non-long-term-care-Medicaid estate recovery timed in reaction to ACA, while at least 10 or so have not. I see there is an issue of visual impediment to reading of so many references, but somewhere I think Newslinger has a workaround to that--a "reference group" or something.

Let me repeat also my issue (originally posted on the bulletin board page https://en.wikipedia.org/wiki/Wikipedia:Neutral_point_of_view/Noticeboard)

Newslinger wrote "Reliability: On Wikipedia, sources are considered reliable if they have a reputation for fact-checking and accuracy, and if they are endorsed by other reliable sources."

This sounded to me (perhaps adding other of his comments) like he was saying referencing opinion is no good, you can reference only facts from reliable sources.

So I checked the reference, and found that opinion references are fine, as long as opinion and fact are clearly separated in the article.

My response was:

"I have looked at https://en.wikipedia.org/wiki/Wikipedia:Reliable_sources#Usage_by_other_sources , as one of the issues. (This is the 5th of your issues: Reliability) it says, under: Statements of opinion "Some sources may be considered reliable for statements as to their author's opinion, but not for statements asserted as fact. For example, an inline qualifier might say "[Author XYZ] says....". A prime example of this is opinion pieces in sources recognized as reliable."

This is coming up here in the ACA article, where I have references (repeating my example) on: ("The issue of the negative interaction of the ACA with Medicaid estate recovery was noticed in many places starting from the time of ACA passage.[355][356][357][358][359][360][361][362][363][364][365][366][367][345]"). My labeling does not say everything is absolute, uncontrovertible fact. There are accepted mainstream references, like Seattle Times and Washington Post and Health Affairs (academic journal) post. There are, as well, opinion pieces, notably one from a Paul Craig Roberts, who, though not a mainstream source, does have a Ph.D. in economics, and as well, served as an Undersecretary of the Treasury. Further, though many of his points are expressed heatedly, and he is to the right of me by a good bit, I see that many of the facts he brings up are important, sharp, and not made elsewhere.

Thus, my opinion is that it may be policy or practice to not have many footnotes, and I can understand that you have a policy or practice, and there may be good reasons for that policy or practice. Just please note that the policy or practice removes information that a person might find very useful to really understand both the economic mechanisms involved, and even the emotional flavor and feelings of the real people involved. For example, the reaction of some people from being compelled to sign up for the ACA under threat of penalty, and then as thanks for that, being forced to be exposed to Medicaid estate recovery both of capitations for services not actually used, as well as large recoveries for all medical expenses paid out (no insurance at all).NormSpier (talk) 17:28, 1 September 2019 (UTC)

ACA Problems (Problems with ACA) Section

(Note the ACA Problems section was the main section at issue in the "noticeboard on" section (the prior section) started by Newslinger. So there is some discussion there. Under attack was both the use of simple calculations and lookups from healthcare.gov in my silver and bronze plans examples, which Newslinger categorized as "original research", as well as the mention of the Medicaid estate recovery issue (on grounds of "original research" and proportional-to-mainstream coverage).

I'm not revisiting that here, but rather focusing on whether each of the 5 problems in the section have sufficient information so that the rough magnitude of the financial strain (or medical strain) on people relying on the ACA from each problem is clear. (Any numerate critical thinker will probably want to know the rough magnitude of the financial strain. Other people should see it, even if they don't immediately realize themselves they need to see it, to get an understanding of the issues.)

For "subsidy cliff" and "sometimes unaffordable out of pocket max", I believe my bronze and silver plan examples do exactly that. (Thus, premium plus oop max, some people are at 41% of Modified Adjusted Gross Income. The dollar amounts are also there, so a person, in their head, might also be able to factor in what a household might also have in savings to make up for what is tight by income alone.) (It would certainly be better, to have taken numbers similar to the example numbers I have calculated from a fact-reliable source: the the NY Times, or Health Affairs, the the Kaiser Family Foundation. Unfortunately, I could not find them on search. Wikipedia is unreliable (Wikipedia itself correctly categorizes itself as an "unreliable" source). A sensible reader will not trust numbers in Wikipedia, and would like to, for numbers he/she finds important, to be able to click on a reference and check that the numbers and labeling are correct in Wikipedia. In lieu of an ability to take numbers from a reliable source, a reviewer with some numbers facility should check every calculation in Wikipedia. I've never seen it done before, but numbers or a table could have an "independently checked", when independent checking was done, to give a reader whatever confidence it would add. (I myself noted numbers in a column being non-trivially in error. It was a table in the "premium subsidy" section. It seems to have been sitting there for 5 years uncorrected. It has been replaced by me by a similar, updated from 2014 to 2019 table, though missing two less important columns.)

For "family glitch", what is the magnitude of the unaffordability? One sees that an individual in the household can get an employer plan for 9.86% MAGI or less for themselves. So if its a couple and kids to be insured, one might guess 2.5x to 3x 9.86% MAGI--up to about 30% MAGI for the only plan they can get (besides unsubsidized on-exchange ACA). The quick reasoning and mental multiplication should be doable by people at the level of those who have interest in a real understanding of the problems. So the needed quantitive impact info is there. (There is some possibility, depending on Federal/State laws, that employers can charge actuarially more for spouses and children than employees. So my 2.5x to 3x may be flawed. Someone could conceivably see if that's an issue. If it is an issue, then posting the level of detail may drive the editors, and possibly some readers, crazy. But I'd certainly like to know, and see it in a Wikipedia-article-for-me.)

For Estate Recovery under 138% FPL, that the recovery from the estate is "of all other Medicaid services for people 55 and older". So a person should be able to figure out, that if they have $900,000 in hospital expenses on expanded Medicaid, while 55 or older, their estates may have to pay that entire $900,000, in the states that do non-long-term-care-related Medicaid estate recovery. So the needed quantitive impact info is there. (In more detail, covered in the Medicaid estate recovery article, the recovery may be a mix of capitations (paid to providers at a blanket rate whether or not the person uses the services) and direct payment of hospitals and providers of all medical expenses, so the person can switch over to that article (at least as it is now) for that more detailed picture. But the bottom line is still that what's at risk for the estate can be all-direct medical expenses, like a million dollars, as if the person had no insurance at all.)

For "Coordination of Medicaids with On-Exchange Plans", one issue (and which was explicitly found in a referenced federal report), is coverage gaps. So it's clear that the person has no insurance for a period of time, and that could be the same $1,000,000 magnitude thing. There is also just repeated switching back and forth between expanded Medicaid and on-exchange plans a few times a year. The reader should be able to figure out that it can be a lot of work switching providers all the time, and bad for health and could kill a sick person (new doc unfamiliar with your body; delays till new provider can see you; can't get needed procedure approved until new insurance is in effect). So the needed quantitive impact info is there. — Preceding unsigned comment added by NormSpier (talk • contribs) 14:34, 4 September 2019 (UTC)

NormSpier, what Wikipedia editors do is to summarize published reliable sources, and personal interpretations and assessments by individual editors are simply not allowed. No original research is a core content policy, and following it is mandatory. Cullen³²⁸ Let's discuss it 22:08, 5 September 2019 (UTC)

Question of Authority of Editors regarding how content issues are to be resolved

Some of the discussion with one of the editors (above and in various places linked to above) had me assuming that editor has some level of official authority in the Wikipedia hierarchy of editors. So I put a question on the teahouse about editor authority, and have gotten back a response:

"@NormSpier: Welcome to Wikipedia. We do not operate with ranks or levels of authority. Wikipedia is built by consensus between editors. If someone makes a change you don't agree with, discuss it on the article's talk page. See WP:BRD and WP:DR for details. RudolfRed (talk) 20:53, 5 September 2019 (UTC)"

Whoops: the answer to my question is growing. Here's the full thing at the TeaHouse: https://en.wikipedia.org/wiki/Wikipedia:Teahouse#Determining_official_Wikipedia_editor_role_and_authority_of_editors_coming_in_commenting_on_a_persons_additions

I haven't seen anyone besides the editor in question coming in with an opinion or suggestions so far in 6 days. Hopefully, other editors, skilled in working with the Wikipedia rules, and who also understand the technical issue under discussion in the ACA and also Medicaid, will be able to come in and produce some sort of procedurally correct final article. NormSpier (talk) 21:51, 5 September 2019 (UTC)

Editors are volunteers who work on what they want to work on. Patience is advised. If an editor makes changes to an article that result in other editors adding tags at the top, it is advised that the editor not remove those tags. David notMD (talk) 11:14, 6 September 2019 (UTC)

RfC: Recent additions

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

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

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

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

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

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

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

Scope of disagreement

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

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

Scope clarification (number of articles)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Survey (restore/retain)

• The added content contains significant violations of Wikipedia's core content policies, and is not fit for article space in its current state. Refer to my analysis for details.

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

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

Otherwise, I would prefer to restore the August 7 version, and move the added content to the article sandbox for future development until it is compliant with our core content policies. — Newslinger talk 12:59, 9 September 2019 (UTC)

Discussion

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

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

Notified: Wikipedia talk:WikiProject Economics, Wikipedia talk:WikiProject Health and fitness, Wikipedia talk:WikiProject Law, Wikipedia talk:WikiProject Medicine, Wikipedia talk:WikiProject United States, Wikipedia talk:WikiProject United States Government, Wikipedia talk:WikiProject United States Public Policy, Wikipedia talk:WikiProject U.S. Congress, Wikipedia talk:WikiProject Taxation — 

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

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

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

Who's we?

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

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

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

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

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

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

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

Newslinger's analysis

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

"Outline of Coverage Mechanism" section

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

Original research in the "Outline of Coverage Mechanism" section

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

• Verifiability: Substantial portions of the section reference unreliable sources, including:
  1. Paying for Senior Care, a blog
  2. healthinsurance.org, a shopping tool for insurance
  3. ElderLawAnswers, a shopping tool for legal aid
  4. a former version of the Wikipedia article for Medicaid estate recovery (see "Wikipedia is not a reliable source")
  5. a former version of the Wikipedia article for National Federation of Independent Business v. Sebelius
• Neutral point of view: All of the content after the "Impediments and Imperfections to Design" label is inappropriate for a section named "Outline of Coverage Mechanism". This content should be merged into appropriate sections (such as "Problems" and "Criticism and opposition").

"Cost-sharing Reductions" section

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

Original research in the "Cost-sharing Reductions" section

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

• Verifiability: Portions of the section reference unreliable sources, including:
  1. Google Docs, a self-published document
  2. healthinsurance.org, a shopping tool for insurance

"Problems" section

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

Original research in the "Problems" section

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

• Verifiability: This section contains many instances of citation overkill, but also cites unreliable sources, including:
  1. eHealth Insurance, a shopping tool for insurance
  2. Google Docs, a self-published document
  3. ElderLawAnswers, a shopping tool for legal aid
  4. a former version of the Wikipedia article for Medicaid estate recovery (see "Wikipedia is not a reliable source")
  5. Marshall, Parker & Weber LLC, a self-published blog post from a private law firm
  6. Daily Kos community post, user-generated ("This content is not subject to review by Daily Kos staff prior to publication")
  7. HuffPost contributor (RSP entry)
  8. Open Minds, a consulting firm
  9. Iowa Legal Aid, a legal aid directory
  10. Idaho Care Line, a blog unaffiliated with the state of Idaho
  11. Policygenius, an insurance broker
  12. healthinsurance.org, a shopping tool for insurance

Comments

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

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

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

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