ACA Opens Enrollment for 2019: What Patients Need to Know

Open enrollment in the Affordable Care Act (ACA) marketplace opened today, despite shortened deadlines, repeal of the individual mandate, stopping cost-sharing payments, and reduced outreach and marketing for the law. And with all the noise from political talking points adding to an already complicated process, your patients might be in need of a primer on what to do this year. Here are the basics:

Where to enroll

Some states have their own exchange, and some use the federal government’s. Patients can access www.healthcare.gov, www.cuidadodesalud.gov, find their state’s page here, or call (800) 318-2596 for more info.

When to enroll

Enrollment begins November 1 (except for in California, where it began in October). However, deadlines differ in some states. The deadline for most states this year is December 15. A handful (New York, California, Massachusetts, Minnesota, Colorado) have deadlines in January. Those who wait until January to enroll should be aware that their coverage will not start until February.

What about the individual mandate?

Included in the Republican-backed tax plan signed into law last year was a repeal of the individual mandate penalty for individuals who choose not to get insurance. For the coming year, this repeal will be in effect in almost all states (Massachusetts, New Jersey, and the District of Columbia […]

2018-11-01T13:45:23-04:00November 1st, 2018|Patients, Public health|0 Comments
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A Black Nursing Professor’s Personal Calculus in Choosing a Birth Center

“I knew getting pregnant meant that regardless of my socioeconomic status or education, as a black woman I was more than three times as likely to die during labor or in the weeks afterward compared to my white counterparts.”

Recent news stories have drawn attention the dismaying medical experiences of black women during and after childbirth, with even celebrities like Serena Williams and others finding their concerns about potentially life-threatening symptoms going dangerously unheeded by nurses and physicians. The statistics about maternal death from pregnancy or childbirth complications among black women tell us that such stories aren’t isolated examples but part of a larger pattern.

Illustration by Annelisa Ochoa.

A thoughtful professor weighs her options.

All of which makes the personal story told by Sheria Robinson-Lane, an assistant professor of nursing at the University of Michigan, in this month’s Reflections essay (“Birthing by the Numbers“) particularly timely. And yes, nuanced. She knows the numbers and she knows the stories about communication issues experienced by black women with their providers. However, she’s also affiliated with a respected major medical center.

So when she gets pregnant with her second child at age 39, what’s her best course of action in deciding where to have her child? […]

2018-10-01T08:20:40-04:00October 1st, 2018|Nursing, nursing perspective, patient experience|0 Comments
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Quality of Life? Whatever the Patient Believes It Is

Illustration by Eric Collins / ecol-art.com

“What kind of life is that? That’s not how I would want to live.”

In AJN‘s September Reflections essay, “His Wonderful Life,” nurse Elizabeth Buckley interrogates her own judgmental response to a patient with a bluff, abrasive personality (he calls her ‘Nurse Ratchet during their first encounter) who requires nearly nonstop care to stay alive.

The patient has little hope of a meaningful recovery even if he survives the current hospitalization. The reader is surprised when, after a first grueling night of touch-and-go care, the author decides to take him on as her primary patient because she thinks it might be “a good learning opportunity.” (“I texted my friend who worked the day shift to sign me up; she replied that I was crazy.”)

A good life is in the eye of the beholder.

‘Philip,’ obese and with progressive dyspnea and multiple comorbidities, is sure he’ll soon be able to return to his bedbound existence at home watching old movies and chatting on Facebook; the physicians and other nurses are less hopeful. Gradually, over the course of five nights, the author’s respect and affection for the patient grows. He loves his life, however narrow it may seem to an outside observer.

2018-09-19T08:49:44-04:00September 19th, 2018|Nursing, patient experience, Patients, personal health practices|1 Comment
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Is This Child in Pain?

When the child is nonverbal.

Nurses regularly assess patients’ pain. It’s a much more difficult task when the patient is unable to articulate what they’re feeling or even where they hurt. How much more difficult is it when the patient is a nonverbal child with a complex medical history?

In this month’s AJN, Brenna Quinn and colleagues share their research on pain in these children. They define “children with medical complexity” as “those having a cognitive-chronological age mismatch, profound developmental delays, limited or no verbal abilities, and multisystem diagnoses, and who are completely dependent on others for care.” These kids tend to experience pain more frequently (often, daily or weekly), and are more likely to be hospitalized than are neurotypical children.

A ‘wide range of pain-associated behaviors.’

While it is often harder to assess pain in children than in adults, most children have a narrow range of “pain behaviors” that are easily identifiable. This isn’t true of children with medical complexity; some may even seem, from their expressions, to be laughing when they are in pain.

“More than 40 pain assessment tools have been developed for use in infants and children who cannot provide self-report. Despite the availability of these tools, the evaluation of pain in children with medical complexity remains challenging, […]

2018-08-13T08:09:58-04:00August 13th, 2018|family caregiving, Nursing, Patients, pediatrics|0 Comments
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Holding Space for Integrative Medicine in Oncology Care

When the patient distrusts the treatment.

Explaining why chemotherapy is indicated for their treatment to a newly diagnosed cancer patient is part of a day’s work for oncology nurses and physicians. Oncology nurse navigators are no exception—I am relied upon to reinforce patient education and answer questions.

While many patients come to us with the attitude “I’ll do whatever you say, let’s fight this cancer!” others present with a deep distrust of health care. Some of their distrust is justified, a result of corporate greed, Big Pharma, and federal regulations, coupled with misunderstandings of the treatment approval process of insurance companies. Depending on the intensity of these patient conversations, it sometimes feels as if we, the oncology team, are under attack, when it is our intent to help.

Despite good health habits, a cancer diagnosis.

Held / Julianna Paradisi / colored pencil and ink on watercolor paper 2018 – adapted from image author drew during cancer treatment

I was a pediatric intensive care nurse when I was diagnosed with breast cancer. My oncology experience was limited to monitoring young patients with a high risk of tumor lysis syndrome during induction of chemotherapy. The actual chemotherapy was administered by pediatric oncology–certified nurses who knew how to keep the […]

2018-07-02T13:26:59-04:00July 2nd, 2018|Nursing, nursing roles, patient experience, Patients|3 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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