Talk:Affordable Care Act

Non-Profit Option?

I thought the Senate bill included a nonprofit health insurance plan administered by the United States Office of Personnel Management (similar to the Federal Employees Health Benefits Program, in lieu of the public option? Why does this article make no mention of it?

Started Article, Notes

The fact that I am starting this article a week after the event, which was on the cover of every newspaper and major news site in the US, is a case in point of the lack of diligence on the current health care debate.

In the intro I mentioned what this bill means in the context of the health care reform effort, which serves as an example of providing context to the reader that is almost totally lacking in most other articles.

Please help expand this article, using the links I listed in the article among others.

There needs to be, among other things:

• an outline of the bill
• a section that compares this with the House bill, which the NY Times does nicely
• claims on all sides, including President Obama
• support and reservations that people had in the initial debate

NittyG (talk) 02:18, 28 November 2009 (UTC)

Text of the Bill

I made an attempt to convert the bill to wiki text. It is here in wikisource:HR 3590 TOC. The final section of the bill (TITLE X) is a series of amendments to HR3590. This makes it impossible to read the bill before unwinding all of the changes in TITLE X. Jeff Carr (talk) 07:35, 28 December 2009 (UTC)

Most bills are impossible to read without reference to the U.S. Code or some original act, so it's not that much different than any other bill. Since I have the opportunity, though, I'll just point out that having to add Title X rather than amending the various sections just proves how idiotic the Senate's rules are. -Rrius (talk) 06:25, 22 March 2010 (UTC)

Downplaying of tax increases

In this article (which I realize is in its infancy of course) there is only a cursory bullet point about the tax hikes. Instead, there is a bold section about the "deficit reduction". Clearly, the only way this bill can cut the deficit is if it increases taxes by about 2 trillion dollars over the next two decades (only makes mathematical sense, given that in the article it also states that the projected costs for each decade are nearly $1 trillion each. More details should be given on what the taxes are, and why they count towards making the bill budget-friendly even though they may or may not have anything to do with the health care issue. —Preceding unsigned comment added by 98.244.78.41 (talk) 06:12, 22 March 2010 (UTC) Tried to sign it but not sure how, sorry.

As you seem to be aware, no one is downplaying the tax increases. You do make one point that is just false, though. A bill can cut the deficit by increasing taxes, directly or indirectly cutting spending. Therefore you would need to provide reliable sources for any discussion of increased tax revenues expected. Finally, leave a note at User talk:Rrius to explain the trouble you're having starting an account; I'll see if I can help. -Rrius (talk) 06:31, 22 March 2010 (UTC)

clarification

I don't understand this line:

HR 3590 is divided into ten titles. The text of the bill cannot be read directly as printed. The tenth title is a list of amendments to the previous nine titles. These amendments must be processed before the bill is read.

This needs clarification. Cannot be read as printed? --Gerrit ^CUTEDH 08:32, 22 March 2010 (UTC)

I think it means that the amendments are not wrote into the bill where they belong, so if you read it straight through, some of the information is obsolete because the amended provisions are still there in their original form. —Charles Edward ^{(Talk | Contribs)} 12:18, 22 March 2010 (UTC)

Semi-Protected

I note the page is currently semi-protected. This is due to all the drive-by vandalism? --Kim Bruning (talk) 12:19, 22 March 2010 (UTC)

A number of anons were positively contributing to this. The history looks like a mess of numbers, but notice what version are being reverted to - many of them anon edits. (not counting anons reverting to their own vandalism) Xavexgoem (talk) 13:47, 22 March 2010 (UTC)

It's surprisingly quiet! --Kim Bruning (talk) 15:28, 22 March 2010 (UTC)

I say we leave it unprotected unless there becomes a rash of vandalism. —Charles Edward ^{(Talk | Contribs)} 15:34, 22 March 2010 (UTC)

I wouldn't be surprised if we don't need it. There's not a helluva lot of vigor on either side of the kill-the-bill argument atm ;-) Xavexgoem (talk) 15:59, 22 March 2010 (UTC)

I wouldn't be so sure of that. As I understand it (and I don't have sources for this offhand, for which I apologize), Michelle Bachmann is introducing legislation to repeal it. You also have statements from Newt Gingrich, and Rush Limbaugh. And then of course, there's the ever lovable Bill Kristol stating that it will be repealed in 2013. For what its worth, you can probably find sources for what i'm talking about on the Fark.com politics tab. Just don't go there if you'd like to retain your faith in humanity ;).Umbralcorax (talk) 16:36, 23 March 2010 (UTC)

Bill vastly expands IRS, both in numbers of employees and powers of enforcement

There is no mention of this - 16,500 new IRS enforcement agents. Nor is there mention of the IRS as the principle enforcement agency.

I can't think of a legitimate argument which would justify excluding this information.

See: http://online.wsj.com/article/BT-CO-20100318-715006.html —Preceding unsigned comment added by 66.207.93.82 (talk) 12:58, 22 March 2010 (UTC)

I can. The US Federal government employees more than 2 Million people. Any attempt to rationalize dramatically overstating the importance of an increase in the employee pool by zero point zero zero eight two five percent is pure folly. —Preceding unsigned comment added by 68.102.36.46 (talk) 19:53, 24 March (UTC) 2010

I don't particularly care either way, but wouldn't the percent increase in the number of IRS agents be a more relevant indicator of the importance of the issue raised than the percent increase in the total number of government employees? Fat&Happy (talk) 20:12, 24 March 2010 (UTC)

The reason why not is because these articles are monitored by people who support the bill. Any reputable news organization would report this. Wait, most of them did. http://www.google.com/search?hl=en&client=firefox-a&tbo=p&rls=org.mozilla%3Aen-US%3Aofficial&tbs=nws%3A1&q=irs+16%2C500&aq=f&aqi=&aql=&oq=&gs_rfai= —Preceding unsigned comment added by 97.126.199.80 (talk) 04:37, 25 March 2010 (UTC)

Table expansion

The table under "Comparison with House version" should be expanded to include a third column for the reconciliation (HCEARA) bill even if some of the rows cannot be filled-in. --RoyGoldsmith (talk) 13:16, 22 March 2010 (UTC)

Legal challenges

There should probably be a section on the threatened legal challenges. [1][2][3][4]. Nine states have formally announced a legal challenge today [5]. Findlaw has a pretty good article discussing case law surrounding the bill [6]. I think at least four states are so far preparing to mount a legal challenge. One of those article says 31 are considering a legal challenge. —Charles Edward ^{(Talk | Contribs)} 13:43, 22 March 2010 (UTC)

I just read the FindLaw article you referenced. It is terrible. Do you really want us to believe that the their are no limits to Federal power expressed in the Constitution? Because the cheap rationalizations and bad case law cited in that article lead to exactly that. 24.11.186.64 (talk) 18:14, 23 March 2010 (UTC)

One of the two "legal" references reads this: "Legal experts say it has little chance of succeeding because, under the Constitution, federal laws trump state laws." If we are to assume this is not simply propaganda, the sheer stupidity of such a statement is difficult to fathom. This would be the sort of answer one might expect from a mediocre high school student. Quite obviously this bill violates the Commerce Clause of the US Constitution and any bone fide "legal expert" knows that the US Constitution explicitly limits what the Federal government can do. 24.11.186.64 (talk) 18:08, 23 March 2010 (UTC)

? I am not sure what you are getting at. The point is to show both sides, hence the conflicting opinions. The findlaw articles is not currently being used in the article though. But if you read through the findlaw article thoroughly, it is just summarizing positions, not pushing one. I think it would make a pretty good source. If you have an issue with the legal challenge as it is in the article please feel free to change it, with references of course. :) Or point out the issues here. I would be glad to address them. —Charles Edward ^{(Talk | Contribs)} 18:19, 23 March 2010 (UTC)

This is to discuss the article itself, not to editorialize about the legislation. --kurykh 18:24, 23 March 2010 (UTC)

I've expanded the section to give an analysis of the case law involved, and venue by which the bill could be ruled unconstitutional or upheld. According to the article, it all hinges on whether the Court thinks the purpose of the fine is - revenue creation or a regulation to effect behavior. If its revenue creation, then the bill stands given current precedent. If it is to effect behavior, it is unconstitutional given current precedent. Dorf concludes that the fine is at its core a revenue creation measure, and upon that basis his opinion that it will be found constitutional by the court. His analysis is the value of the findlaw article, not his conclusion. I can't find anywhere else where that level of analysis has been given. —Charles Edward ^{(Talk | Contribs)} 19:05, 23 March 2010 (UTC)

No protection?

You're kidding, right? I don't want this article to go from none to full because of an edit dispute. It may still want to be advance semi-protected. I doubt vandalism will be the issue for a while. mechamind90 15:26, 22 March 2010 (UTC)

I unprotected it. I'm sitting here doing other things with Huggle notifying me of any revisions. Once I leave, I'll reprotect. Xavexgoem (talk) 15:56, 22 March 2010 (UTC) And never do we ever advance protect, except for things like high-use templates

60-39 vote?

Was this vote pre Scott Brown or did a republican actually vote for it? IF so I think there name is worth mentioning here. I know I could do the edit but I don't the facts yet. 174.96.253.231 (talk) 16:10, 22 March 2010 (UTC)

It was pre Scott Brown. —Charles Edward ^{(Talk | Contribs)} 17:22, 22 March 2010 (UTC)

"most controversial" in lead

This is currently in the lead: "The bill is one of the most controversial measures of the 111th United States Congress." I have fact tagged it. Obviously this is completely true, but none of the given sources state it in this manner. This is also no discussed in the body of the article, where a fuller description of this sentence needs added. —Charles Edward ^{(Talk | Contribs)} 17:59, 22 March 2010 (UTC)

I think calling it "controversial" or a "highly controversial" measure would be accurate and appropriate for the lede. Concur about something in the body. Ravensfire (talk) 18:18, 22 March 2010 (UTC)

Public option

Are states allowed to set up their own public option? 82.124.100.124 (talk) 19:27, 22 March 2010 (UTC)

Yes, there's a waiver program if states want to go further than the federal program. --Cybercobra (talk) 19:40, 22 March 2010 (UTC)

Thanks. Would states have to waive their citizens receiving federal subsidies, or lose other benefits, by going further than the federal government? 82.124.100.124 (talk) 20:12, 22 March 2010 (UTC)

Please discuss the article, not the subject of the article. Thanks. --SarekOfVulcan (talk) 20:17, 22 March 2010 (UTC)

Sorry, I thought this subject might be appropriate for inclusion in the article. 82.124.100.124 (talk) 20:24, 22 March 2010 (UTC)

I see that Section 1332 of the Act provides for a "waiver for state innovation". It would compensate states for opting out if they wanted to go further than the federal government. This appears to me to be a significant aspect of the legislation. 82.124.100.124 (talk) 20:27, 22 March 2010 (UTC)

I'd like to see this detail get implemented in the article.   — C M B J   01:11, 23 March 2010 (UTC)

Biased?

Frankly, I'm reading this and wondering if this article isn't overly biased. While it's certainly factual, virtually all of the facts point to the positive and sunny side of the issue and very little discussion is had as to the controversial side of the issue. A non-biased, encyclopedic article - IMO - should discuss all sides of the issue, not just tell me why it's a good thing.

As has been pointed out, this is a highly controversial piece of legislation. So far, all of the quotes and citations have been glowing, positive ones while any detractors are made to seem like mere dissenting grumblers. Sure, there is a section on "Legal Challenges" but I'm just not feeling that this covers the whole issue. The big story behind this is two-fold. On the one hand is the bill itself and on the other hand is the very contentious and controversial nature of the bill and it's history.

I do, however, understand that this is a new article and also understand that perhaps the debate and controversy itself might belong in a separate article, but at least some of that discussion should be found in more direct form here, no? Kholya (talk) 19:58, 22 March 2010 (UTC)

Wikipedia is an international encyclopedia. The international opinion on this bill is vastly favorable. The criticisms are mostly from Americans who oppose the bill based on their own personal biases. The best measure of any act is to look at it from the outside. The idea that affordable healthcare despite pre-existing conditions is nearly universally accepted outside of the United States. In most nations, the universal single payer system is in use, the general health of these nations is almost always better, and the ratings of their healthcare systems by citizens are almost always better. ReignMan (talk) 13:50, 24 March 2010 (UTC)

Do some research, find some negative opinions, and add them to the article (with citations). This is a wiki, you're openly encouraged to fix stuff you think could be better. --Cybercobra (talk) 20:30, 22 March 2010 (UTC)

For what its worth, I also feel its mostly a positive article. But like Cybercobra said, simply requires someone to edit the article to make it more two-sided. However I myself don't think I have the capacity to do such a thing :D TheFedExPope (talk) 02:29, 23 March 2010 (UTC)

Just an anon comment here, but I think, as often happens in politics, there is an assumption being made here that if the tone is not negative, it's positive. I don't think it's such a simple dichotomy..."for or against". There a million shades of grey relative objectivity in the middle. It's like assuming if I don't say "Pizza is the best food", that I'm saying pizza is a bad food. The fallacy rests in the existence of a middle option, i.e. "pizza is a food". The former statements implied a value judgement, the latter does not. Stating the facts of the health care bill, as dryly and to-the-point as possible is objectivity, not whitewashing for a positive result. Without trying to stir up a hornet's nest, I think some of the claims of bias against the media for coverage of this issue are based on people who want to hear "there is a health care bill, and it is evil" and what they're hearing is "there is a health care bill". That doesn't equate to support, it's a statement of fact, just like the text in this article. Unless we can identify and remediate specific points of supposed bias here, I think one has to honestly consider whether it sounds "positive" to you just because it doesn't have negative rhetoric. The lack of the latter doesn't make the former. —Preceding unsigned comment added by 204.65.34.174 (talk) 13:53, 25 March 2010 (UTC)

A poll here[7] shows that only a mere 78% oppose this bill 68.59.177.3 (talk) —Preceding undated comment added 22:23, 25 March 2010 (UTC).

That is not a reliable source. Opinion polls need to be conducted by taking a sampling of the population and figuring out a margin of error. This is a website with a sidebar poll, which is unreliable. ReignMan (talk) 01:55, 26 March 2010 (UTC)

Who specifically wrote the bill/act ?

I don't see anywhere where it says who the author(s) are. Redtrade (talk) 21:53, 22 March 2010 (UTC)

Not sure if that is even clearly determinable. The act has been in debate and amendment for 6 months between both houses. Grandmartin11 (talk) 04:02, 23 March 2010 (UTC)

Several Democrats asserted Republicans contributed 200+ text amendments to the bill, if that helps track it down at all.   — C M B J   06:54, 23 March 2010 (UTC)

A preliminary print that I have seen for this Act is well over 2,000 pages. I am sure that that the Act has many, many authors. Famspear (talk) 23:25, 23 March 2010 (UTC)

Ted Kennedy

The article should note the significance of Ted Kennedy's indirect contributions to this bill, assuming reliable sources can be located. The bill achieved one of Kennedy's lifelong ambitions--as illustrated by "Kennedy! Kennedy! Kennedy!" cheers during the final House vote.   — C M B J   02:23, 23 March 2010 (UTC)

I think that belongs more in the general health care reform article. Ted Kennedy died before this bill was even created. To add him in this bill would seem like unnecessarily glorification. --kurykh 03:18, 23 March 2010 (UTC)

Kennedy was directly referenced by several speakers in the House, which resulted in at least one congressman being penalized for exceeding the allocated time limit. It seems only appropriate to concisely describe extraordinary house proceedings and circumstances.   — C M B J   06:13, 23 March 2010 (UTC)

LBJ was referenced quite a few times in the context of Medicare, but he's not necessary here. I don't think it's relevant to this article. Parliamentary penalties should not make Kennedy any more needed in this article, or else we might have to talk about Randy Neugebauer's "baby killer" comment in the HR 4872 article. --kurykh 07:01, 23 March 2010 (UTC)

Considering that Neugebauer's remark reached front page status on some news outlets immediately following the event, I'm frankly fascinated that it has not yet resulted in an edit war. But on the subject at hand, we must weigh whether the information is merely rhetoric or if it is indeed something truly noteworthy. In analyzing the Speaker's closing statement, “And now, I want to just close by saying this. It would not be possible to talk about health care without acknowledging the great leadership of Senator Edward Kennedy, who made health care his life’s work. In a letter to President Obama before he passed away — he left the letter to be read after he died. Senator Kennedy wrote that: ‘Access to health care is the great unfinished business of our society.’ That is until today.", as well as her following statement today "I don’t want to sign this bill without mentioning Senator Edward Kennedy, who up until his last days had an influence on this legislation in the most positive way. He said this is ‘the unfinished business of our society.’ He said having health care reform was about ‘the character of our country, not the provisions of any particular bill.’ And in his honor, we all have to be prayerful and feel very blessed that we could all be here for the passage of this legislation.", it can be observed that there is what seems to be more than a casual connection at hand.   — C M B J   07:48, 23 March 2010 (UTC)

Again, it would be a mistake to say he influenced this piece of legislation itself. It would be more proper to put him in the general article, as he made an impact more on the entire reform movement and process rather than this particular bill. At this point in time, the article is still about a single part of the reform process, not about the movement itself. However, if in the future this article starts to take on more of a general health care reform aspect, discussing the entire process instead of just a part of it, then we can probably add Ted Kennedy in. At this time, I would find it improper. --kurykh 18:22, 23 March 2010 (UTC)

I am not proposing that we engage in original research or synthesis about Kennedy, nor do I believe that this article will (or even should) ever begin to incorporate substantive quantities of abstract material. All I originally intended to suggest was that we include a concise and validly sourced citation--perhaps even a one or two liner--which explains that a fair number of politicians explicitly deliberated on Kennedy's connection to this specific bill; some fervently enough to deliberately violate House decorum. Though I may have failed to adequately articulate the original proposal here, there is nothing remotely improper about what I envisioned--rather, its ommission would be unencyclopedic. I do fully agree with you in that we currently lack the proper section to incorporate it into, however.   — C M B J   03:00, 24 March 2010 (UTC)

No, I know what you're saying (perhaps I didn't give that impression). It's just that as of now, I find it more of an unneeded passing reference which seems forcibly incorporated more than something the article needs (right now, at least). --kurykh 03:05, 24 March 2010 (UTC)

Actually, now that I think about it, we're kind of arguing even though we agree pretty much on everything here: that it can be incorporated, but it would seem awkward and gratuitously glorifying to do so right now. If this is true, I would say hold off until such an opportunity arises where it would be useful. --kurykh 03:07, 24 March 2010 (UTC)

Sure, that would be just fine.   — C M B J   04:13, 24 March 2010 (UTC)

Historic narrowness

As the article develops, we may need a bit more mention of the historic narrowness or one-sidedness of the vote. As The New York Times put it, "Never in modern memory has a major piece of legislation passed without a single Republican vote. Even President Lyndon B. Johnson got just shy of half of Republicans in the House to vote for Medicare in 1965...." I haven't surveyed other news accounts to see if this point has been made elsewhere. —Kevin Myers 08:36, 23 March 2010 (UTC)

Private Mandates?

In the section on state lawsuits, you mention that they oppose the government's requirement that individuals purchase healthcare, but I do not see that listed in the provisions. I know that this was a contentious issue leading up to the bill, does the final legislation require individuals in America to purchase healthcare and if so what are the provisions to that extent? Thanks!

It says: "Impose an annual fine on individuals who do not obtain health insurance; exemptions to fine in cases of financial hardship or religious beliefs." —Charles Edward ^{(Talk | Contribs)} 12:06, 23 March 2010 (UTC)

Republican measures used in bill

I would like to see information on what Republican/opposition ideas made it into the final bill. Not to turn it into a partisan issue, but IIRC there are more than 100 Republican amendments in the final legislation, which resulted in 0 Republican votes. This information would help us understand how they shaped this bill and what aspects they have ownership of. - Liontamer (talk) 16:08, 23 March 2010 (UTC)

200 Republican amendments, according to Speaker Pelosi.   — C M B J   16:23, 23 March 2010 (UTC)

Interesting. I'm hoping this article goes much more in depth with the content and effects of the Republican amendments on this legislation. - Liontamer (talk) 16:17, 24 March 2010 (UTC)

Senator Tom Coburn (R-OK)-No viagra for registered sex offenders. Dflav1138 (talk) 22:26, 24 March 2010 (UTC)

That's a proposed amendment to the reconciliation bill, not this. --kurykh 22:27, 24 March 2010 (UTC)

Final count in the House

What was the final vote tally on Sunday? Our article says 219-212, while this says 220-211. -R. fiend (talk) 16:50, 23 March 2010 (UTC)

You're looking at the vote for the Reconciliation Act. This is the vote on this Act. Fat&Happy (talk) 17:14, 23 March 2010 (UTC)

Thanks. -R. fiend (talk) 17:42, 23 March 2010 (UTC)

Deficit impact

A subsection from the article:

Deficit impact

According to the CBO, the legislation will reduce the deficit by $138 billion over the first decade and by $1.2 trillion in the second decade. The CBO has been continually revising their estimates, changing from a savings of $132 billion to $118 billion and then to $143 billion. The CBO estimates the cost of the first decade at $940 billion, $923 billion of which takes place during the final six years (2014–2019) when the benefits kick in.

It doesn't specify which deficit will be reduced. Is it the national debt, the trade deficit, or something completely different? --Lucas Brown 19:21, 23 March 2010 (UTC)

These are not ambiguous within the context of this text. "deficit" here, and in general, means the budget deficit. Each year, the budget results in a surplus or a deficit and this is added to the debt. Bernardd (talk) 13:39, 24 March 2010 (UTC)

Does the CBO actually give an estimate for the second decade? The CBO letter cited does not make a definitive statement on this. On page 15 of the letter, the CBO makes plain that it cannot give a detailed estimate. The closest I could find to a number for the second decade was on page 16, which references a "broad range" around 1/2 percent of GDP. Is this where the $1.2 trillion comes from? If so, it is misleading at best. I see 2010 GDP estimates at 14,532B. Are there growth assumptions in GDP assumed and then 1/2% applied to this set of data? What exactly is a "broad range?" 76.97.217.112 (talk) 05:00, 24 March 2010 (UTC)

Added section on background

I added a section on the background here, which I realize is rather redundant with other sections, and for that matter may be more about legislative history which comes in the next section (I did go back to the primaries, in very summary fashion). If others want to organize it better that's certainly fine with me, or I may try to do so. The section was blank, so I figured something was better than nothing.

As an aside, this article is somewhat difficult to find, though I don't know if there's any way for us to improve that.Mackan79 (talk) 23:08, 23 March 2010 (UTC)

confused about something

I understand that the act requires employers to provide medical insurance, but this statement isn't as straight-forward as it appears; many employers provide insurance, but only to full-time employees. Does the new act require employers to provide insurance only to full-time employees, or to all employees? Minaker (talk) 23:36, 23 March 2010 (UTC)

There is no such requirement; employers can choose to not offer an insurance plan. If they choose not to offer such a plan, they pay an annual fine per employee if they have more than fifty employees. —Charles Edward ^{(Talk | Contribs)} 00:01, 24 March 2010 (UTC)

OK, thanks for your non-answer, I guess. I'll rephrase to make you happy:

I understand that the act requires employers to either provide medical insurance or pay an annual fine, but this statement isn't as straight-forward as it appears; many employers provide insurance, but only to full-time employees. To avoid paying a fine, are employers required to provide insurance only to full-time employees, or to all employees?

Off-subject trivia: Federal tax law doesn't actually require you to pay your taxes; you can choose to go to prison instead. Minaker (talk) 00:53, 24 March 2010 (UTC)

Regarding who must be offered insurance to avoid the fee, section 4980H states that the employer should "offer to its full-time employees (and their dependents) the opportunity to enroll in minimum essential coverage under an eligible employer-sponsored plan" (emphasis mine). The fee amount is also defined in the same section by the number of full-time employees. For some other parts of the bill, the size of the business is counted in terms of "full-time equivalent employees", defined in section 45R (basically, the average number of people employed over a calendar year). It's pretty easy to find this stuff in the bill by doing "find text" in your browser. — Steven G. Johnson (talk) 01:14, 24 March 2010 (UTC)

Sorry you misunderstood me, please assume good faith. :) The bill does not mandate employers provide health insurance, the fine or tax is there as an alternative for employers to choose what is best for them - paying the fine\tax or offering the insurance. Companies would probably continue to operate similarly to how they do now, some just have to pay an additional tax. Its pretty similar to unemployment taxes and workers compensation taxes in that regard; employers participate or pay a fee. I have not heard at what point this fine\tax applies, whether it is part time or full time employees. That is an interesting point. —Charles Edward ^{(Talk | Contribs)} 01:42, 24 March 2010 (UTC)

I understood you just fine. And I would never accuse you of bad faith, that would be against Wikipedia policy. I cannot emphasize how much I am assuming good faith on your part, even despite all evidence to the contrary.  :)

Off-subject trivia: Federal tax law does not mandate you to pay your taxes, the fine or imprisonment is there as an alternative for people to choose what is best for them - paying the fine/ going to prison or offering the taxes they owe. Minaker (talk) 03:44, 24 March 2010 (UTC)

Ok maybe I am misunderstanding you. :) Federal law does mandate people pay taxes. The law says if you max X you must pay Y, and if you do not pay you face legal action - non-payment is a non-legal option. This law does not say you must offer healthcare insurance to your employees or face legal action, it says you can offer it or not offer it, and if you choose to offer there is X financial incentive to do so, but if you choose not to do it there is Y financial penalty for it. Thats all. The bill, and the exact quote you stated says "should", which has an entirely different legal meaning from "must" or "shall". And that "should" is in relation to avoiding the financial penalty. There is no mandate requiring a business to offer health insurance; just the opposite, the fine will allow the government to fund its own insurance option which the employee then can access in lieu of an employer provided option. —Charles Edward ^{(Talk | Contribs)} 12:14, 24 March 2010 (UTC)

At the risk of appearing to beat a dead horse on a slightly off-topic subject, editor Charles Edward is certainly correct that U.S. Federal law does indeed mandate that people pay taxes. And no, fine or imprisonment is not there merely as an "alternative" for people to choose what is best for them. You don't have the "choice" of "prison or payment." You can be tried, convicted, sentenced and imprisoned for Federal tax offenses, and still be required to pay the tax determined to be due -- if necessary by seeing the Internal Revenue Service seize your assets (even without a court order). Similarly, even if you are found not guilty of a Federal tax crime, you may still be legally obligated to pay the related tax, as some people have found out the hard way. Federal criminal tax proceedings (sending you to jail) and Federal civil tax proceedings (determination of tax liability, collection of tax, seizing of your assets, etc.) are separate proceedings. Famspear (talk) 13:37, 24 March 2010 (UTC)

Yes, you are misunderstanding me quite a bit, so I will spell it out more plainly. My point in providing the tax example is to illustrate the folly of editor Charles Edward's distinction between my interpretation of the law -- that you are required to provide insurance -- and his interpretation of the law -- that no, you're not required to provide insurance, you can pay a fine instead. A fine is "a sum of money imposed as a penalty for an offense or dereliction" according to one dictionary definition. In other words, you're paying the fine because you broke the law. Yes, according to Mr. Edward, you can "choose" to pay the fine instead of providing the insurance, just like you can "choose" to pay traffic tickets instead of obeying traffic laws. Similarly, you can choose to no longer pay taxes. You can liquidate all of your assetts and bury the cash somewhere the government will never find it, no one can stop you, that is your "choice," but then you must pay the legal consequences for this action.

Now, just so you don't think I'm ignoring your other point, I will assert that your distinction on the legal significance between the words "must" and "shall" is equally meaningless. I'm no lawyer, so for all I know, you may be right on this point on a purely theoretical level, but on a practical level, the difference in wording is entirely irrelevant. The law requires you to provide insurance. The penalty is the fine. The law requires you to pay your taxes. The penalty is imprisonment. "Provide the insurance or pay a fine." "Obey the traffic laws or pay the traffic ticket." "Pay your taxes or go to jail." It's entirely up to you. Whether this can be considered a "choice" is the question you're both hung up on.

Remember basic reading comprehension in grade school? When you have to read a paragraph and figure out the main point? Mr. Edward was so busy correcting what he erroneously saw as imprecise wording that he somehow missed the obvious main point of the paragraph. I'm honestly sorry if that comes across as a personal attack, but this whole thread is wearing me out. All I wanted to know was how the law affects part-time employees, for cryin' out loud! Minaker (talk) 22:50, 24 March 2010 (UTC)

First of all, if you're asking questions about the legislation, you're in the wrong place. This talk page is to discuss the article, not the legislation.

Second, the section below may give an answer about fines, taxes, or whatever. --kurykh 23:31, 24 March 2010 (UTC)

I don't know what else to say. [8] "Under the health care bill, by 2014 most Americans would be required to have health insurance or pay a fine, with the exception of low-income Americans. Employers would also be required to provide coverage to their workers, or pay a fine of $2,000 per worker. Companies with fewer than 50 employees, however, are exempt from this rule." This is pretty much what the article says now, provide it or pay a fine. It is not at all clear from anything I've read that employers are absolutely forced to provide health insurance benefits. This fine has no criminal implications, unlike tax avoidance. —Charles Edward ^{(Talk | Contribs)} 23:29, 24 March 2010 (UTC)

Mr. Edward, I'm going to just move on and consider attempting to communicate with you to be a lost cause.

In response to Kurykh, if the article leaves the answer to my original question so unclear, then someone should call attention to the ambiguity, no? The next question to ask would have been, "Is the article unclear because of imprecise wording, which can be fixed, or because the legislation itself is unclear?" but I'll admit that the discussion got way too far sidetracked. Thank you, editor Steven Johnson, for finding an answer to the original question, so we can remove the unnecessary ambiguity and thus improve the article. Minaker (talk) 13:11, 25 March 2010 (UTC)

Ok well please just get to your point. The article currently says: "Impose a tax penalty on employers with over 50 employees who do not offer health insurance to their full-time workers. (In 2008, over 95% of employers with at least 50 employees offered health insurance", what do you think it should instead say? That is a fair summary I think. It sounds to me like you are trying to say that the employers are going to be unilaterally required to offer health insurance, which I have found nothing that says that. Could you please provide a source for your position, and clearly state what you would like added to the article? —Charles Edward ^{(Talk | Contribs)} 13:23, 25 March 2010 (UTC)

I already answered your original question above, by quoting directly from the bill text (recap: only full-time employees must be covered). But I guess your filling this thread with pointless carping obscured that. — Steven G. Johnson (talk) 01:31, 26 March 2010 (UTC)

Public Reaction

Please contribute to Public Reaction on the legislation. —Preceding unsigned comment added by 138.16.24.148 (talk) 01:27, 24 March 2010 (UTC)

Who are the 14 million who will remain uninsured?

The article estimates that 45 million who are now uninsured, and quotes Senator Reid to the effect that this bill will extend benefits to 31 million of them. So who are the 14 million who will remain uninsured? I think this question should be answered in the article, as I have not seen the answer anywhere. Dirac66 (talk) 01:45, 24 March 2010 (UTC)

Here is a list and a source

• Undocumented immigrants. About 6 million people.

• People who are eligible for, but don't sign up for Medicaid.

• People who opt out. Some healthy individuals may decide to pay the penalties, which aren't that high, rather than purchase health insurance.

• People who feel insurance is unaffordable. This is similar to the "opt out," except that they may not owe a penalty. If insurance coverage would cost more than 8 percent of household income, people won't face a penalty for going without it. The law would provide subsidies that would assist people up to about four times the poverty level. For a family of four, that means federal assistance will phase out above about $88,000 in income.

Source: Christian Science Monitor 3/23/2010 [9] --Sjsilverman (talk) 02:20, 24 March 2010 (UTC)

This is another source with some relevant discussion, though I don't know if it is extremely authoritative. It says Obama has referred to a lower number of uninsured, and discusses the discrepancy between that number and the figure from the Census Bureau. Mackan79 (talk) 04:55, 24 March 2010 (UTC)

Working on adding a section to the article with this... And, added! --Cybercobra (talk) 05:52, 24 March 2010 (UTC)

How can this take effect in 2010 AND in 2018?

"All existing health insurance plans must cover preventative care and checkups without co-payment." —Preceding unsigned comment added by 68.104.175.130 (talk) 03:41, 24 March 2010 (UTC)

New plans are affected as of 2010. Existing plans are affected by 2018.   — C M B J   05:22, 24 March 2010 (UTC)

Fines for not buying insurance

What if you refuse to pay the fine? Like flat out refuse to buy insurance, pay the fine or anything else. Will they throw you in jail for not being financially responsible —Preceding unsigned comment added by 67.162.95.189 (talk) 13:38, 24 March 2010 (UTC)

Think about it. What do they do if you refuse to pay taxes? We already have the same exact situation on nearly every other social service in the country. You can't just refuse to pay for roads, schools, police, fire department, sewers, military, interest on debt, welfare, social security, food and drug inspections, farm subsidies, airport security, border patrol, foreign aid, and every other thing you pay tax for. You can't just send the government a check with some money missing and say, "I don't like the war, I won't fund it." They'll throw your ass in jail. This is the exact same thing. ReignMan (talk) 14:00, 24 March 2010 (UTC)

There is exemptions for religious reasons and financial hardships, I suspect that people will take advantage of that to avoid the fine. Otherwise it would be treated as an unpaid tax and the government would levy bank accounts, take it out of your tax refund, etc. I can't find any reliable secondary source that discusses this, only the verbage of the bill. It shouldn't be added to the article until such a source exists. —Charles Edward ^{(Talk | Contribs)} 14:02, 24 March 2010 (UTC)

Regarding ReignMan's comments, if you're talking about the possibility of throwing someone in jail for failure to pay the monetary penalty for failure to maintain "minimum essential coverage" as provided in the Act, you should be made aware that subparagraph (A) of paragraph (2) of subsection (g) of Internal Revenue Code section 5000A (as enacted by section 1501(b) of the Act) provides as follows (in part):

"In the case of any failure by a taxpayer to timely pay any penalty imposed by this section, such taxpayer shall not be subject to any criminal prosecution or penalty with respect to such failure."

Hope that answers your concern. Famspear (talk) 14:52, 24 March 2010 (UTC)

Also, editor Charles Edward is correct that there is a long list of exemptions (such as religious, hardship, incarcerated individuals, taxpayers with low income, etc.) in section 5000A of the Internal Revenue Code, as enacted by the Act. Famspear (talk) 14:55, 24 March 2010 (UTC)

Well, that sounds better anyway. I always like the idea of a new program being optional. But, then again, no tax is negotiable. So, what do they do if you refuse to pay? They can't toss you in jail, prosecute, or penalize you, so what's to keep people from refusing? ReignMan (talk) 01:51, 26 March 2010 (UTC)

Facts of the Text

At the summit, the Republicans had stacks of documents which would indicate that the legislation is thousands of pages. Don't see anything reporting on its text structure. Do see reported elsewhere that the reconciliation bill (the one currently in the Senate) is an additional 150 pages. 72.228.177.92 (talk) 15:20, 24 March 2010 (UTC)

It is 2409 pages, [10]. I am not sure that is the best measure for length though. It all depends on how they format the pages, font, etc. A quick word count yeilds: 477,520 words, 2,252,006 characters, 63,691 paragraphs. That is probably the best means of judging its size. Of course all that is Original research using a primary source. We need a secondary source before it can go into the article. —Charles Edward ^{(Talk | Contribs)} 15:34, 24 March 2010 (UTC)

I just ran a word count on it and got 370,000 words; at 500 words per page (typical for single-spaced 12-point Times), this would run to about 750 pages. I'm not sure how you got 500,000 - I just downloaded http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590PP/html/BILLS-111hr3590PP.htm and ran "wc -w" on it. Because of formatting, however, it would print to considerably longer than that, but obviously it will depend a lot on the font size.

In comparison, Harry Potter and the Order of the Pheonix is about 260,000 words.

— Steven G. Johnson (talk) 15:40, 24 March 2010 (UTC)

I copied the text into word from the pdf, something probably was lost in translation. —Charles Edward ^{(Talk | Contribs)} 15:55, 24 March 2010 (UTC)

That is not OR and needs to be in the article. A sourced fact report like that is not OR, or if it is it's the good kind that wiki actually needs and is well within the effective norms (as opposed to the barratry kind). 72.228.177.92 (talk) 15:49, 24 March 2010 (UTC)

I disagree, I think we do need a secondary source on that. Just counting it ourselves isn't ok. There is bound to be one source out there somewhere that gives a count. The reason I say we need a secondary source is because page count depends on how it is formatted. Who knows what the length will en up being once its codified? —Charles Edward ^{(Talk | Contribs)} 15:55, 24 March 2010 (UTC)

OK,let's see how that works out and how different from "approx. 2400" the final page count turns out to be. 72.228.177.92 (talk) 15:57, 24 March 2010 (UTC)

Heres a source that give 2700 pages, [11], 2800 pages [12], 2000 pages [13], our own count was 2400, etc. We need something definitive. Just by google, look slike 2700 and 2800 are the most common numbers. —Charles Edward ^{(Talk | Contribs)} 15:59, 24 March 2010 (UTC)

Actually no one version is "definitive," as there are several official U.S. Government Printing Office versions of each FINAL version of each Act of Congress. I have a PDF copy of the 2,409 page version. The PDF copy of the enrolled bill version, however, is "only" 906 pages. As noted by Charles Edward, it depends in part on how the lines are spaced by the printer, the font, etc. Eventually you will see the version printed as a "slip law" (i.e., the official pamphlet, also published by the U.S. Government Printing Office) format, and then later a printing in what is called "session law" format (United States Statutes at Large, also published by the Government Printing Office). All these official formats can have varying spacing, etc., and therefore varying total pages.

By the way, in a few days the official "public law" number for the Act will become available, as in "Pub. L. No. 111-xxx", as well as the United States Statutes at Large citation, as in "xxx Stat. xxxx." When those citations become available, they should be added to the article. Once the public law number is assigned to an Act of Congress, most legal commentators stop using the "bill number" (the "H.R." or "S." number) in citing to the Act. Bill numbers can repeat every two years, but a public law number, once assigned, is unique for each Act of Congress to which such a number is assigned. There are also such things as "private laws" (with private law numbers) enacted by Congress, but that is beyond the scope of this discussion. Famspear (talk) 16:06, 24 March 2010 (UTC)

Here is a link to the final enrolled bill (this format is 906 pages):

[14]

However, as noted above, there will later be the "slip law" pamphlet version and the "sessions laws" version -- all of which are also officially published. Famspear (talk) 16:09, 24 March 2010 (UTC)

I added the link to the 906 page "enrolled bill" version to the article. Notice that the enrolled bill print, while it is an official print, does not include the "approved" notation on the last page. When the slip law and session law versions are published, the Government Printing Office will include the "approval" notation on the last page. What is the approval notation? It's the notation of the constitutional date of enactment, which of course is the date on which the President signed the bill into law (in this case, March 23, 2010). Official reprints of an Act of Congress by the Government Printing Office generally do not reproduce the President's signature. Instead, they show the word "approved" and the date of the signature.

Each bill or joint resolution passed by either the House or the Senate is said, in one sense, to have been "enacted" by that body. However, for purposes of the Constitution, and for purposes of references to "date of enactment" in a given statute, the date of "enactment" is the date on which the President signs the bill or joint resolution into law (or the date that it becomes law without presidential signature, such as the date on which the Congress completes the override of a veto).

Ain't this stuff fascinating?? Famspear (talk) 16:41, 24 March 2010 (UTC)

How about the bill itself, on the H. of R. website, which includes the nifty page numbers right in the bill. Here[15] shows exactly 1990 pages. It also comes with a certificate by the superintendent of docs at the USGov printing office. 68.59.177.3 (talk) 22:53, 25 March 2010 (UTC)

Children's coverage

Just noting why I removed the info on allowing kids with preexisting conditions to get coverage at the six month mark. Turns out it was not part of the bill and was reported erroneously. Here's the AP story: [16] —Charles Edward ^{(Talk | Contribs)} 16:55, 24 March 2010 (UTC)

high risk pools start within 90 days, June 2010 not Sept

The law states "(a) IN GENERAL.—Not later than 90 days after the date of enactment of this Act, the Secretary shall establish a temporary high risk health insurance pool program to provide health insurance coverage for eligible individuals during the period beginning on the date on which such program is established and ending on January 1, 2014."

If we are looking for secondary sources, this one should suffice: http://www.kff.org/uninsured/upload/8041.pdf which says "This high-risk pool program is scheduled to go into effect 90 days following the enactment of the bill and terminate on January 1, 2014 when the state-based American Health Benefit Exchanges are established." - Chromatikoma (talk) 17:20, 24 March 2010 (UTC)

New England Journal of Medicine survey story

I think the article should make some effort to include the fact that many doctors have stated that they may resign as a result of the passing of the bill, upwards of forty percent according to the New England Journal of Medicine. —Preceding unsigned comment added by 96.237.163.118 (talk) 21:17, 24 March 2010 (UTC)

--kurykh 21:27, 24 March 2010 (UTC)

That seems unusual/improbable given that the AMA supported the bill. --Cybercobra (talk) 22:15, 24 March 2010 (UTC)

Outlandish claims like this one need a strong reference and giving a medical journal without the actual citation isn't citation. Over 40% of doctors threatening to resign would have made front page news for days or weeks on end. That's not the case. Bernardd (talk) 22:38, 24 March 2010 (UTC)

Would you mind providing us with a source to back up this claim? A related NEJM survey says "Respondents — across all demographic subgroups, specialties, practice locations, and practice types — showed majority support (>57.4%) for the inclusion of a public option (see Table 1)." and "Overall, 58.3% of respondents supported an expansion of Medicare to Americans between the ages of 55 and 64 years (see Panel B of graph)."   — C M B J   09:06, 25 March 2010 (UTC)

Those figures do not back the original claim above that upwards of 40% of doctors may resign if the bill passed. Bernardd (talk) 12:04, 25 March 2010 (UTC)

I did some digging. This may be what the original post was refering to: [17], [18], [19], [20]. The CBS story says: "Oddly, NEMJ polled heavily on the public option, which has been out of the ObamaCare proposal since mid-December when the Senate finally killed it. The public option is deeply unpopular among physicians, with only 29% in favor of it. Forty-five percent would either retire or quit if it passed, and 71% believe their income would fall with a public option ? probably from experience with Medicare and Medicaid." —Charles Edward ^{(Talk | Contribs)} 12:20, 25 March 2010 (UTC)

Ok, I digged a bit deeper still from your links and I see what's going on. First, the survey is not from the New England Journal of Medicine but from a firm called Medicus Firm based in Dallas and Atlanta. The survey was included as an advertiser insert in one of the issues of NEJM. NEJM clearly states that it doesn't reflect their opinion [21]. Second, the survey is not scientifically valid. It was conducted by email using a "simple random sampling" and a web based surveying application [22]. Third, the survey says that 21% would leave practice and another 24% would retire early if a bill with a public option is passed. That's where the 40% figure comes from. The public option has been rejected last October by the Senate so this info is irrelevant to the current bill. The percentages fall to 8% leaving and 22% retiring early for the passage of a bill without public option. Also note that this survey was conducted last summer and is of dubious relevance to the bill that was just passed. CBS News has removed mention of the survey altogether. The other couples of openly right leaning sites you list still propagate the info unfortunately. More on the story here [23] with statements from the NEJM editor. Bernardd (talk) 14:15, 25 March 2010 (UTC)

I agree with your conclusion, primarily because of the age of the survey. Its not particularly relevant anymore. —Charles Edward ^{(Talk | Contribs)} 14:17, 25 March 2010 (UTC)

Going back to House

I was reading that the bill is going back to the House. I dont know if it should be added or not.[24] —Preceding unsigned comment added by 199.8.158.21 (talk) 13:46, 25 March 2010 (UTC)

That is not this bill, but the reconciliation bill: Health Care and Education Reconciliation Act of 2010. This article will need update with the amendments from the reconciliation bill when and should it pass. —Charles Edward ^{(Talk | Contribs)} 13:48, 25 March 2010 (UTC)

Threats section

I'm a little iffy on including the "Threats" section here. While it's obviously related to the passage of the bill, it's not part of the bill's results per se.... --SarekOfVulcan (talk) 18:30, 25 March 2010 (UTC)

its not part of the bill, obviously, but what article would this information go in, if not here?--Jojhutton (talk) 18:46, 25 March 2010 (UTC)

Yeah, that's the problem. Should it even go in an article, or does it belong over at WikiNews?--SarekOfVulcan (talk) 18:51, 25 March 2010 (UTC)

I agree the section runs the risk of recentism. Until a member of Congress actually gets hurt or, God forbid, killed because of this, then it would be encyclopedic, but until then... --kurykh 19:02, 25 March 2010 (UTC)

The entire article is recentism, but I do agree that the threats in themselves are not enough to be notable.--Jojhutton (talk) 19:16, 25 March 2010 (UTC)

Obamacare

Obamacare has been set up as a link to this act.

Is that really appropriate? This is an act, not an insurance program. It seems to me that Obamacare is simply a derogatory term used to describe "some vague aspects of this act", often including things that actually aren't in the act, such as the death panels and the socialization of America and Obama eating your babies and such. dougmc (talk) 19:16, 25 March 2010 (UTC)

I don′t consider it inherently pejorative. The term by itself does nothing other than associate this topic with an individual whom the speaker considers a chief proponent, cf. Reaganomics. I suppose if we had a more general Positions of Barack Obama on health-care article it might be a more appropriate target for that redirect, though the goals of this “Patient Protection and Affordable Care Act” would be a significant part of it. To that extent the “health care reform” link in the following template similarly may be over-specific. ―AoV² 20:28, 25 March 2010 (UTC)

I disagree with how pejorative you think the phrase is, but not much. Doing a (very) brief search on words/phrases in a similar vein, "Fundie" has non-Bay of Fundie links at the tail or the article, the much harsher "Republitard" does not exist (not even remotely surprised, nor inclined to approve one), "Little Bush Junior" doesn't exist either. So I guess the point I'm trying to make here is that a redirect is kinda unnecessary, as by the standards of Wikipedia it would seem to be just a pejorative use, but I don't really know if you could claim it's not notable. So, IMHO, tie. I could see sending it to AfD, but I'm unsure if it would pass. Now, if you don't mind, I seem to have some bricks coming in through my window. --Human.v2.0 (talk) 00:05, 26 March 2010 (UTC)