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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Nurses Concerned About Removal of Key Children’s Health Advocate at EPA

At the end of September, the Environmental Protection Agency (EPA), with no explanation, placed the director of the Office of Children’s Health Protection (OCHP), Dr. Ruth Etzel, on administrative leave. This sidelining of a vocal children’s health advocate as the office was heading into October, Children’s Environmental Health Month, was concerning for all who work in children’s environmental health.

The OCHP’s essential role.

The OCHP was created under an executive order in 1997 as public consciousness was increasing about the special vulnerabilities of children to environmental hazards. It is housed in the Office of the Administrator so as to be able to provide guidance to EPA leadership and ensure that children’s health protection is prioritized throughout the agency’s activities. This is essential because, as many have observed, children are not simply miniature adults—what they eat, drink, and breathe can profoundly affect their physical and mental development, while their hand-to-mouth and on-the-floor activities put them at greater risk for exposures from environmental hazards.

The office provides essential resources for health professionals and the public on environmental health issues such as environmental triggers of asthma and how parents can reduce exposures, reducing exposures to lead, and air quality in schools. The OCHP-produced report, America’s Children […]

2018-10-31T11:54:23-04:00October 31st, 2018|environmental health, health care policy, nursing perspective, Public health|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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What Nurses Need to Know About Antidepressant Medications

Rising rates of major depression and suicide.

A recently published Health of America report from Blue Cross Blue Shield, Major Depression: The Impact on Overall Health, highlights a dramatic rise in major depression diagnoses—up 33%—from 2013 to 2016. According to the report, women were found to have major depression at twice the rate of men.

Perhaps most startlingly, rates of major depression have risen 47% among millennials, while among adolescents the increase has been 47% in boys and 65% in girls.

‘Sorrowing Old Man,’ by Vincent Van Gogh. Photo by Peter Horree/Alamy Stock Photo.

In an equally disturbing trend, the CDC has noted that the rate of suicide in the United States rose more than 25% from 1999 to 2016, with 45,000 people dying by suicide in 2016 alone. Suicide rates are higher among people who have mental illnesses, and suicide is of particular concern among those who have depression. Yet the CDC also points out that more than half of people who died by suicide had not been diagnosed with a mental health condition.

An antidepressants primer for nurses.

Given the rapidly rising rates of depression diagnoses, nurses are increasingly likely to encounter patients […]

2018-09-14T10:19:30-04:00September 14th, 2018|mental illness, Nursing|0 Comments
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Have A Seat—Or Maybe Not

Too much sitting is harmful.

Photo © blue jean images.

In this month’s AJN, author Linda Eanes sounds the alarm about the health risks associated with the way most of us spend much of our waking life: sitting down. Her article, “Too Much Sitting: A Newly Recognized Health Risk,” reviews research on the health effects of prolonged uninterrupted sitting (sitting for 30 minutes or more) and high-volume sitting (sitting for seven hours or more each day).

Studies show an association between high-volume and prolonged uninterrupted sitting and health risks, including cardiovascular disease, diabetes, and all-cause mortality. Sedentary time is also linked to obesity and an increased risk of certain cancers, including ovarian, endometrial, and colon cancer.

Eanes notes:

“Simply put, too much sitting, with its characteristic reduced energy expenditure and absence of whole body movement, may jeopardize health even in the presence of regular exercise.”

Exercise matters, but we’re still sitting too much.

Unfortunately, Eanes’s statement describes my life (see my September editorial) and that of most people I know: sitting at a desk, sitting while commuting, and doing some exercise a few hours a week. (Or what we like to think of […]

2018-09-10T10:06:16-04:00September 6th, 2018|Public health|0 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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