Talk:Medicaid estate recovery

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"Written like a personal reflection" template -- guidance sought as to whether the issue persists after edits[edit]

Over the last few weeks, I have expanded the article from a Stub.

In the process, in the last few days, AnUnnamedUser (who is a real person, actually) added "May Require Copy Editing... template" and "Written like a personal reflection..." templates to the top of the article.

I have attempted to address both issues with editing. And, in particular, I have removed sections which were not widely written about before.

I am seeking feedback here on the issues in both templates, as regards the current status of the page. But particularly the latter, "essay-like".

Thus, if you can point out particular aspects where I may be veering still into personal essay characteristics after my edits and removals, that would be great. My belief is that, as the references in the current article show, the issues (particularly around the interaction of the ACA with Medicaid estate recovery of non-long-term-care-related expenses) have been substantially reported elsewhere, and the issues are real, though the issues are politically tied and therefore may be viewed as controversial.

--NormSpier (talk) 16:30, 21 August 2019 (UTC)

8/26/19: Believing the issue resolved, and with no feedback otherwise in response to talk, and also a note out to the person who placed the tag a few days ago seeking feedback on the current state of the article, I have removed the "essay-like" ("Written like a personal reflection...") tag.

I have left in the tag that means "May Require Copy Editing", as that may attract an additional set or two of eyes. (The building up the article from a stub, that it was for the last few years, was all done by one person, me, and so there may be copy editing needed.)

I believe the essay-like tag issues are out. All issues mentioned have references to external sources, usually multiple, and are not original ideas. The ideas associated with problems of the ACA interacting with Medicaid estate recovery were published, and taken as serious, real issues, in the Washington Post, Seattle Times, Minneapolis Star Tribune, and PBS Newshour, and were as well reported on by the academic journal "Health Affairs" and a report of the Century Foundation, the latter two being by health law expert Timothy Jost, who is a lawyer and scholar on the faculty of George Washington University, and as well who wrote, for many years, the bulk of the posts for the Health Affairs "Following the ACA" section, which were scholarly and detailed. (I had, prior to the placement of the essay-like tag, had some aspects which were not original to me, but which were only based on discussion with others familiar with the estate recovery issue, rather than written sources. These have been removed.) Further, I have adjusted wording throughout the article to reflect reporting on published thoughts of others, as in the citations I have throughout.

If anyone spots essay-like aspects that they believe remain, if they could please point specifically exactly where they exist, that would be helpful.

NormSpier (talk) 19:04, 26 August 2019 (UTC)

Noticeboard discussion regarding User:NormSpier's recent edits[edit]

There is a noticeboard discussion regarding the neutrality of NormSpier's edits to this article (Special:Diff/682619084/912949236) 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 17:13, 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.)


NormSpier (talk) 14:09, 31 August 2019 (UTC)

Posting here discussion of matters in response to editor User:Newslinger broached on the noticeboard page , with expansions as relevant to this Medicaid estate recovery article.

User:Newslinger pointed out the "undue weight" wikipedia editing guidelines, and felt I was in violation. (Which could be true.)

I was motivated to explore this, so I looked up undue weight, and posted it, with comments

'WP:UNDUE "Neutrality requires that each article or other page in the mainspace fairly represents all significant viewpoints that have been published by reliable sources, in proportion to the prominence of each viewpoint in the published, reliable sources. Giving due weight and avoiding giving undue weight means that articles should not give minority views or aspects as much of or as detailed a description as more widely held views or widely supported aspects." Text later on is unclear to me if equal text space is mandated. I hope not. That wouldn't make sense from a pursuit-of-truth point of view. It may be that one argument is more complex than the other.'

I also commented that it might actually be that these standards were forcing Wikipedia to be an establishment voice, like the New York Times. (As in Chomsky /Herman Manufacturing Consent.)

(That could be OK for Wikipedia to have that goal, but I wanted to make sure all readers were aware of that aspect.)

I, myself, detest that standard "in proportion to the prominence of each viewpoint in the published, reliable sources", because we are really in Manufacturing Consent territory. (As I've remarked elsewhere, it might mean Wikipedia should stop wasting everyone's time each year when it asks for donations on the grounds of freedom from special interests, and just the needed money from big corporations. This is a bit of an exaggeration.)

There might also be, in the application of that standard by some, that on multiple sides of any particular issue, all arguments need to be represented with an amount of physical text space proportional to the presence of arguments in mainstream media. That also really irritates me, because the case for one side may be more complex, and need more text. A "proportional text" rule assumes the reader is just too stupid to figure out that amount of text doesn't correspond to importance. (In medicine, if the brain needs more space to describe in adequate detail than the liver because it is more complex, it doesn't mean the brain is more important than the liver. If certain parts of a car, like then engine, need more space to be described, than the wheels, it does't mean the engine is more important than the wheels. Etc., etc.)

However, going with that detestable "in proportion to the prominence of each viewpoint in the published, reliable sources" for the case at hand, the Medicaid estate recovery for non-long-term-care expenses post-ACA (that section only; that issue only), note I did

add a subsection to the article, "Argument for non-LTCR estate recovery post-ACA". It's restricted to post-ACA, because the whole section discusses the controversial non-long-term-care-related Medicaid estate recovery post-ACA. (If you follow the details of the ill-publicized issue explained in the prior sub-section, and think through the details, the issue arises only post-ACA, as Medicaid becomes substantially non-asset-tested in the Medicaid expansion, and as well there is a purported principle post-ACA of guaranteeing everyone affordable insurance, and as well there was a mandate to carry "coverage", and for many people, the only coverage even remotely affordable will be traditional Medicaid or expanded Medicaid) So the whole justification of non-LTCR estate-recovery changes post-ACA. (So, I've put in what I could find on the contra side.)
The obvious fact is that nothing I could find addresses any of the new post-ACA factors. (The first argument is pre-ACA, but threw it in to try and be balanced. The second argument was made post ACA. It ignores all of the roughly 5 identified problems post ACA. So it's really a non-response. But it's all I can find.)
Basically, although 10 or so large states that have expanded Medicaid still do non-LTCR Medicaid estate recovery, I've found nothing anywhere addressing the 5 or so problems with doing the recovery post ACA.
(You can check yourself. If you Google search for "Medicaid estate recovery", besides legal advice on avoiding it (in LTCR cases, mainly--these are irreleveant to our quest), you get a lot of state documents on recovery (with nothing addressing post-ACA considerations), and then a few pages in, you get many of the references I have incorporated in this article, and some others, all pointing out the problems. You get nothing defending against the 5 issues brought up post ACA.

In other words, the "other side" has really been silent, and not making any argument to address the complications post-ACA. (I have generously represented in the "pro" section the same argument twice, given once pre-ACA, and once, post-ACA.)

There is nothing else the "pro" (pro non-long-term-care-related Medicaid estate recovery post-ACA) side has to say on the matter. (Please, anyone, if you find something, point it out, or put it in yourself on the "pro" side!)

(If you understand the Medicaid estate recovery of non-LTCR post ACA issue, the reason no state governments or newspapers or journals can state support of it is that it really can't be supported. The ACA is just too goofy when it is done. These all have be justified: a)Leading people to believe the ACA gives them insurance, when, no: whatever medical bills are paid out have to be paid back the estates when people die; (b)People observe just above 138% FPL, there is similar copay, very-low-cost (real) insurance coverage, with bills paid out not having to be paid back (c)Similar unequal treatment for people over 55 and under 55, (d)similar unequal treatment for people in different states (e)compulsion under the mandate (until the mandate was revoked, and in some states, like MA, now, still), with the compulsion being of recovery of both all bills paid out and/or capitation payments even when no actual medical expenses were consumed; further, many of these people had passed pre-existing-condition screens and had cheap individual insurance pe-ACA. Now they have no affordable options without the recovery. (f)There are questions of notification before applying for ACA. The Federal exchange has no warning at all. (In which case, perhaps the state Medicaid agency issues the warning after approval for expanded Medicaid after the person is enrolled and already exposed to the recoveries; or perhaps the state agency just doesn't notify the recipient. Otherwise, in states with their own exchagnes, the warning is often inconspicuous. Never does the application instructions say what it should to alert the ACA applicant: "If you don't want your estateto possibly be on the line for two million dollars in medical bills, and $80,000 in capitations, you'd better pay more, often unaffordable to you, for non-subsidized on-exchange coverage.")

The impossibilty of states defending their continued non-LTCR recovery post-ACA, 6 reasons described in the last paragraph, is more or less iterated by director of the National Association of Medicaid Directors, “There’s no way any state is going to see it as ... politically sensible to do that.” (The quote is taken here from the Medicaid estate recovery article.)

So, I think the current article is OK exactly as is, on the Wikipedia standard "in proportion to the prominence of each viewpoint in the published, reliable sources" (But I still detest it!)

Also, I had some time ago switched to neutral wording. I always say, in the article, stuff like "the viewpoint is". (This was before User:Newslinger reviewed the article, and in response to User:AnUnnamedUser, who did correctly point out neutrality wording, and other issues, that, due to inexperience with adding to Wikipedia, I had incorrect.

--Otherwise, note, in my new pro section, my middle paragraph has:

"It can be argued that the justifications were written before the ACA main provisions went into effect in 2014, and do not account for the changes in who is affected by the recovery post-ACA, and as well, that the ACA may reflect a changed attitude intended in the law, that affordable health insurance should be, post-ACA, available to all as an expected matter of national policy. Thus, some may consider it important to examine justifications post-ACA, under the assumption of expanded Medicaid." (It separates the pre-ACA argument and the one made post-ACA.)

I have no references, although User:Newslinger has asserting everything needs a reference. I am assuming that the person reading can think, and may have absorbed the issues, and will see that the post-ACA medicaid Expansion condition is necessary for the question post-ACA.

(I have quibbled elsewhere with why do we have to have a reference on every little thing, even things obvious. Thus I have brought up what they've done over on Internal combustion engine, Calculus, an Banach space, and note a paucity of references, with an assumption that readers and editors know about the subject matter, and/or are able to supply intermediate thinking, etc.)

A comment somewhere of User:Newslinger is that I have too many references. Elsewhere, I commented that an abundance of references could help people to really understand this issue. Policy and editorial considerations may wind up having them mostly cut, but I just wanted to point that extensive references are of intellectual value to certain readers. (There is an issue of too many references disrupting a smooth read. If I remember correctly, User:Newslinger has pointed that there is some sort of fix for this: a reference group or something.)

As I've indicated, I think the final action on this article is that the issues on post-ACA non-LTCR recovery will wind up being completely removed, thoroughly watered down, and perhaps muddled in the process, of necessity, because of Wikipedia written standards, or else unwritten practices. That's OK. Though I won't do the removal or muddling myself. (I am of course open to suggestions for maintaining a fully informative article, for compliance or expositional improvement purposes.) I do expect, and won't be mad, if editors remove all the stuff, or otherwise remove the bulk of it, themselves.

NormSpier (talk) 20:42, 1 September 2019 (UTC) (Note I have done substantial rewording to the above since 1 Sept; NormSpier (talk) 18:35, 4 September 2019 (UTC)}

I've added one sentence to a paragraph on the anti-recovery side. Since we have controversy, I'm noting it here to avoid being accused of being sneaky.


"A further aspect raised was that notification of estate recovery, when present in the ACA application process, was inadequately conspicuous, and that ACA navigators, designated to help people enroll in the ACA, were not trained to explain estate recovery, or to alert people to it.[39][5] Further, it was pointed out that the Federal ACA application (used in states which do not have their own exchanges), and which is for both on-exchange-plans and expanded Medicaid, does not contain any warning about Medicaid estate recovery.[14][40]"

The second sentence is new.

That is, to that notification in the application is viewed by some as inadequately conspicuous, I've added that its simply not present in the Federal application process. (Used for ACA in states with no federal exchange.) On the references, I have a Paul Craig Roberts site, which points out the issue. Though Roberts has a Ph.D. in economics, his site is not considered reliable enough to be taken as always being fact, either by me or Wikipedia. So, my second reference the actual Federal ACA application, that everyone can examine, and see that no warning is there. (Here, I am following the principle that facts need to come from highly reliable sources, but less reliability is needed for opinion. To opinion, I would add, naturally, pointing out of things that can be verified from reliable sources. There was an issue that I brought up elsewhere, that I thought the editor, User:Newslinger, was misstating reliability policies it Wikipedia, in that he was insisting on recognized highly reliable sources for everything, but really the policy is only for fact. In the indented text below.)

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 , 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."

(My additions is concerned with the sufficiently detailed description of the approximately 5 problematic aspects that were brought up in various places at the start of the ACA regarding states doing non-Long-term-care-related Medicaid estate recovery in the presence of the ACA. This is so that a thoughtful person can clearly understand the issue. My personal concern is that a reader should be able to get a real, not superficial, muddy, understanding of the issue. I have attempted to use neutral language. I have attempted to place any countering arguments from the other side of the issue, but the other side has apparently chosen to remain mute to counter the multiple problematic aspects that were brought up.)

NormSpier (talk) 18:13, 2 September 2019 (UTC)