TIME Healthcare

10 Nervous Habits That Hurt Your Health

Bad habits harm your health Marili Forastieri—Getty Images

Nervous habits are often more annoying to the people around you than to yourself, but some types of fidgeting and fussing can do real harm. Here, experts reveal the reasons why nail-biting, hair-twirling, and other seemingly harmless habits can be hazardous to your health.

You bite your nails

It’s one thing if you nervously bite your nails only during scary movies, but when it becomes a regular habit, it can damage both your nails and the skin around them, says Michael Shapiro, MD, a New York City-based dermatologist. Germs from the mouth get transferred to the skin, and vice versa. “Bacteria under the nails may also be transferred to mouth, causing infections of the gums and throat,” Dr. Shapiro says. Painting your nails may discourage you from chewing. No dice? Try tape to break the habit.

You twirl and pull your hair

Twisting and twirling a piece of hair around your finger can lead to damage to the root over time, says Ariel Ostad, MD, a dermatologist based in New York City. “This can result in temporary or permanent areas of hair loss as well as infection,” Dr. Ostad says. Obsessive hair pulling may be a sign of a psychiatric impulse control condition called trichotillomania, which requires psychotherapy and medication.

Health.com: 20 Reasons You’re Losing Your Hair

You crack your neck

Twisting your head forcibly to one side releases gases built up in the the joints between vertebrae and creates a popping sound. Although this may feel good, repeatedly cracking your neck can make the surrounding ligaments hypermobile and more susceptible to injury, says Michael Gleiber, MD, a board-certified orthopedic surgeon and affiliate assistant professor at Florida Atlantic University’s Charles E. Schmidt College of Medicine in Boca Raton. In addition, this excessive motion on the facet joints themselves can cause wear within the joints and may result in arthritis over time. In rare cases neck cracking may trigger a stroke, says Dr. Gleiber.

You touch your face

Repeatedly touching your face or picking at acne can damage the top very thin microscopic layers of the skin, says Jessica Krant, MD, board certified dermatologist and founder of Art of Dermatology and assistant clinical professor of dermatology at SUNY Downstate Medical Center in New York City. “If you bleed, you may have just created a permanent scar,” she says. “Do not pick at pimples or itchy areas. Treat them gently with topical creams and plenty of moisturizer.”

Health.com: 20 Things That Can Ruin Your Smile

You grind your teeth

Clenching and grinding your teeth (bruxism) when you’re under stress can wreak havoc with your oral health. Grinding can cause teeth to crack or break, which may require repair with crowns or root canals. It can also result in damage to the jaw joint in the form of temporomandibular joint disorder (TMJ), says Justin Philipp, who has a dental practice in Chandler, Ariz. “People clench or grind their teeth as a response to stress. However, most cases are a result of pathology such as misaligned or missing teeth and a ‘bad bite.'” Treatments include orthodontics to improve the bite and even Botox injections in the muscles, which can reduce the amount of force and, therefore, the potential damage.

You suck on hard candies

Sucking on hard candies bathes your teeth in sugar, which can lead to cavities, says Philipp. Bacteria feed off the sugar, which creates a perfect environment for tooth decay. Chomping down on hard candy can also risk damaging teeth or dental restorations, says Jack Ringer, president of the American Academy of Cosmetic Dentistry. “Sucking on candies in moderation is fine provided the candies are sugarless and low in acidity,” Dr. Ringer says.

Health.com: Best and Worst Foods for Your Teeth

You lick or bite your lip

Nervously licking your lips exposes them to your mouth’s digestive enzymes, says Whitney Bowe, MD, a New York board-certified dermatologist. “These enzymes chew away at the skin and can lead to dermatitis and cheilitis (inflammation), which make lips appear dry and cracked,” she says. Biting your lips when under stress can cause the development of fibromas, firm flesh colored growths, that may require surgical removal, says Coyle S. Connolly, MD, dermatologist and president of Connolly Dermatology in New Jersey. Relax in a healthier way with these expert-approved stress-busting solutions.

You gnaw on the inside of your cheek

Like biting your nails, cheek-chewing can also become a nervous habit. “Often the inside of the cheek gets swollen and it then becomes easier to continue biting the same spot,” says Ringer. “Even after it heals the habit continues.” Over time this can result in chronic inflammation, possible bleeding, and scarring of the area.

You chew gum

All that snapping and popping does more than annoy your coworkers. It may also put you at risk for TMJ from overuse of jaw muscles, says Philipp. Sugarless gum presents a different set of problems, mainly digestive ailments. Sorbitol, an artificial sweetener, produces an unpleasant laxative effect when eaten in excess (18 to 20 sticks a day). Swallowing excess air while chewing also increases risk of a gassy stomach, according to the National Digestive Diseases Information Clearinghouse (NDDIC). “It is usually easier to try to replace the habit with another one than it is to quit, so try something a healthier switch such as drinking water,” says Philipp.

Health.com: 27 Mistakes Healthy People Make

You nibble the ends of pencils and pens

Germs can lurk on the ends of pens so this habit can expose you to nasty pathogens including cold viruses, says Ted Myatt, director of research compliance at the University of Rhode Island. “An infected person likely has the virus on his or her fingers and spreads it through pens as well as computer keyboards and telephones.” And aside from the embarrassment of ink on your mouth from an exploding pen, chewing on writing instruments can damage teeth and dental work as well as injure the soft tissue and gums inside the mouth, says Ringer.

This article originally appeared on Health.com.

TIME Healthcare

We’re One Step Closer to Better Sunscreen

Jeffrey Coolidge—Getty Images

A bill for better sunscreen is on its way to Congress

The approval process by the Food and Drug Administration (FDA) can be woefully slow, and for over a decade, new sunscreen ingredients—some of which are widely used in other countries—have been trapped in an FDA backlog. But on July 15, those ingredients got one step closer to market when the House Energy and Commerce’s Health Subcommittee approved a bill that would speed up the process.

As we reported in May, sunscreen innovation advocates are hopeful that the a bipartisan bill called the Sunscreen Innovation Act—which is currently under review—could pass this summer. There are eight ingredients currently waiting for FDA approval, and the majority have been used in European and Asian countries for years. Some of the ingredients appear to offer better protection from UVA rays than those currently used in U.S. products.

The House Energy and Commerce’s Health Subcommittee approved the bill, which means it’s one step closer to getting passed by the House, something advocates think could happen before Congress’ recess in August. After that the bill heads to Senate. If the bill passes, the FDA is will have to respond to the current pending ingredients within a year, and all new applications will have to be responded to within one and half years.

Since skin cancer is the most common cancer in the U.S., having the most up-to-date products is important to keep people safe. For now, here are some shopping tips.

Read our full coverage of the bill, here.

TIME Healthcare

20 Million Americans Get Insurance Under Obamacare, Report Says

A new report estimates millions of Americans have enrolled in health insurance as of this Spring

About 20 million Americans have gained health insurance or enrolled in new insurance under the health care reform law, according to a new report.

The report from the Commonwealth Fund, published Wednesday in the New England Journal of Medicine, credits President Barack Obama’s health reform law with an estimated 20 million enrollments as of May 1. The report looks at both people who gained coverage through insurance marketplaces, and people who gained coverage due to provisions in the Affordable Care Act (such as those qualifying for Medicaid and those now covered through the Children’s Health Insurance Program).

The authors estimate that 7.8 million people under 26—who are now allowed to be covered as dependents on their parents’ plans—have enrolled. They also report that 8 million people were enrolled in coverage via new health insurance marketplaces and five million purchased coverage directly from insurers.

The authors write that for ACA’s continued expansion to be sustainable, it will rely largely on the ability of the U.S. to control health care costs.

“Developing and spreading innovative approaches to health care delivery that provide greater quality at lower cost is the next great challenge facing the nation,” the report concludes.
The Commonwealth Fund
MONEY Health Care

The Mystery Behind Your Doctor’s Charges, Unveiled

Illustration of man unlocking filing cabinet of doctors
Medicare is providing consumers with a new way to research health care pricing. Paul Blow

A quick peek into some Medicare data can help you reduce your medical bills. Here's how to use the new tool.

Medicare has pulled back the veil on what doctors, physician assistants, physical therapists, and other health care providers charge, letting everyone see the rates for a wide variety of procedures in advance for the first time. “This is a big step forward and will be very enlightening,” says Jean Mitchell, a health economist at Georgetown University.

Health care researchers and fraud investigators are salivating over the data—already it’s revealed that some doctors favor the most expensive in-office intravenous drug treatments, likely because Medicare pays them a percentage of the cost, says ­Gerard Anderson, a professor at Johns Hopkins University.

As a patient, you can use the numbers, which are from 2012, to conduct your own research into prices and practices. Even if you’re under 65, you can glean valuable insights. Head to the Medicare Physician and Other Supplier Look-Up Tool to find your doctor. You’ll see how many times he or she did a particular service and the average charges. Then here’s what to make of the information:

If you’re facing surgery
See how often your doctor operates; for complicated procedures, frequency pays. “Research shows doctors who perform more than 50 hip replacements a year have fewer complications,” says Andrew Fitch of Nerdwallet Health. Yet about half of orthopedic surgeons did fewer than 20 a year on traditional Medicare patients, a Nerdwallet analysis of the data found.

The tally excludes operations on patients with private insurance or a Medicare Advantage Plan. Still, a low number compared to other MDs should prompt you to ask how often your doctor does the job, particularly for hip and knee replacements, says Fitch. If the figure is high, keep in mind that at times every physician in a group practice bills under one name.

If you’re on traditional Medicare
For a price preview, calculate the difference between the “average Medicare allowed amount” and the “average Medicare payment.” That’s your share of the bill before supplemental insurance kicks in. One caveat: What you see in the Medicare database are charges per service. So ask if you’ll face other bills or a facility fee if you’re cared for at a hospital or surgical center.

If you have private insurance
Check out the “average submitted charge,” which is the doctor’s full retail price. If you go outside your network, you’ll owe the difference between this amount and what your insurer deems a “customary and reasonable” rate (get that from your insurer), on top of your co-insurance.

You should negotiate with out-of-network docs, and the Medicare allowed amount is a good starting point. If the provider balks at that, go as high as 35% more, which is the national standard for a reasonable charge, says Anderson.

MONEY working in retirement

Three Retirement Trends to Be Happy About

Marketers are trying to reinvent retirement, but the best choices are the same ones we've always had. And they're getting better.

Just about anyone over the age of 50 has seen the barrage of new labels for today’s post-retirement lifestyle: Retirement 2.0. Encore Careers. Next Act. Third Age. Not Your Parent’s Retirement.

Forget the marketing hype. When it comes to figuring out your retirement plan, here’s the best strategy: take a good look in the mirror. What you’ll see, if you’re really paying attention, is the definition of retirement that matters to you. And the good news is there’s more opportunity today to design the kind of retirement you want than ever before.

The more research I read, and the more experts I talk to, the more I’m convinced that nearly every kind of retirement option has been heavily road-tested by those who came before. There have always been people who continued to work during retirement—the most powerful and successful people, in fact, tend to never retire. They are having too much fun. Bill Gates will never really leave Microsoft. He continues to work longer hours “in retirement” than the rest of us do at our office jobs. Warren Buffett? They will have to pry a can of cherry coke out of his cold, cold, cold hands before he stops working.

You don’t have to be Warren Buffett, either. Plenty of ordinary people have reinvented their lives in their later years. Older people have always made great entrepreneurs as well as creative artists and inspirational leaders. Often, having a lot of money has nothing to do with the levels of engagement and enjoyment that older people derive from being busy. Sunset years? Hardly.

Continued work in your later years will make your lifestyle during whatever-you-want-to-call-retirement easier to afford—and more comfortable and enjoyable as well. Here are three key trends that should put a smile on your face when you look in the mirror:

Living longer. Yes, you need to make realistic allowances for health problems. But most of us should assume we will live two or three decades past age 65. Take a look at this 2011 life expectancy data from the National Center for Vital Statistics. As you can see, someone age 70 can expect to live to nearly 86, on average:

Age Remaining Life Expectancy (Yrs.)
40 40.6
45 36
50 31.5
55 27.2
60 23.1
65 19.2
70 15.5
75 12.1
80 9.1
85 6.5
90 4.6
95 3.2
100 2.3


Of course, average numbers disguise a lot of differences. People with college educations, who tend to earn more money, will live a lot longer than average life expectancy. So run the numbers as if you plan on lasting to age 100, and update your will to bequeath what’s left over if you don’t.

Improved healthcare. The quality of your medical care will be better than ever. Once the wrenching transition to Obamacare has moved into our rearview mirror—and it eventually will—what we’ll see in front of us is a huge shift toward wellness. Not only will our lives be longer but we live more of that time in good health. Yes, there eventually will be a fall-off into frailty. But increasingly that period won’t occur until just before our death. The technical phrase for this doesn’t sound pretty: compressed morbidity. But the trend is terrific. Better healthcare, more effective drugs and physically active lifestyles are a ticket to a higher quality of life in our later years.

Market power. As our society ages, older people are becoming a new mainstream group. Companies are shaping new products and sales pitches for us—they know that older people control the lion’s share of the nation’s wealth. So we’re likely to see a new wave of positive attention to older Americans. Of course, that’s what companies do to sell stuff. What’s important here is the growing visibility of older Americans, which will encourage a celebration of the diverse and interesting paths they have decided to follow in old age. And in turn, more older Americans will be encouraged try and succeed at lots of different things in their later lives. That will benefit all generations.

Philip Moeller is an expert on retirement, aging and health. He is an award-winning business journalist and a research fellow at the Sloan Center on Aging & Work at Boston College. Reach him at moeller.philip@gmail.com or @PhilMoeller on Twitter.

TIME Companies

Apple to Show Off New Health Care App

Apple Inc. CEO Tim Cook addresses the crowd during the Apple Worldwide Developers Conference (WWDC) 2013 in San Francisco
Stephen Lam—Reuters

On Monday, Apple is expected to present Healthbook, a new health-tracking app for mobile devices, which will launch the company into the health market and potentially draw new consumers to the niche fitness-tracking market

Apple is expected to embrace the health market by connecting its smart devices with new fitness-monitoring services.

At its annual developers’ conference on Monday, the California-based tech giant is projected to announce a new health-monitoring app called Healthbook for mobile devices. The app will track nutrition, fitness and weight by monitoring the user’s habits such as food intake, sleep cycle and hydration levels. Data will eventually be accessed by the smart watch, which is expected to launch later this year, replacing the use of third-party fitness apps.

Paul Haddad, the creator of Twitter’s app Tweetbot, told the New York Times that Apple’s push into the health market could increase the popularity of fitness monitoring among consumers. “An Apple-provided health application will bring a lot more attention to the benefits that tracking your health data on a smartphone can provide,” he said.

Although other companies like Samsung have planned to branch into the health market, none are expected to have the success that Apple will have of drawing new consumers to health-monitoring products. “This means that the overall market for health-style apps will grow significantly,” said Haddad.

TIME Healthcare

The Hidden Cliffs in Obamacare

As the Affordable Care Act becomes reality, so do some of its little-known inequities

A hypothetical couple whom we’ll call Barbara and Harry Jones are 52 years old and have two children, and their household income is $94,200. She’s a freelance marketing consultant and he’s a plumber, so neither has health insurance from an employer. They live in Lancaster, Ohio, and they signed up for Obamacare just in time to make the deadline at the end of March.

Great news: based on their income, Barbara and Harry will get an annual $2,904 subsidy from the government to help pay an insurance bill that will be $12,288 a year for moderately good coverage. Obviously, the Joneses are not poor. But health care is now so expensive that President Obama’s law was designed to give even them help buying insurance.

Alice and Bob Smith (another hypothetical couple) and their two children live next door to the Joneses in Ohio. They too work in jobs–day care for her, light construction for him–that don’t provide health insurance. Their income is $94,300–meaning they’re keeping up with the Joneses and, in fact, beating them by $100. The Smiths will get no subsidy at all.

Now that enrollment in Obamacare has ended for the year, some of the quirks–maybe they should be called potholes–embedded in the complicated and heavily lobbied law are going to start to become visible. First among them may be the “cliff” problem that penalizes the Smiths to the tune of $2,904 for making $100 more than the Joneses. I can already see the headline on Fox News: “Obama’s Health Care Bureaucrats Tax Ohio Couple 2,904% for Making $100 More Than Next-Door Neighbors.”

It will be true. That’s because the Smiths’ income is just slightly more than four times $23,550, the amount defined by the government as living in poverty for a family of four. Under the Affordable Care Act, families like the Joneses who earn up to but not more than four times the poverty level get subsidies. After that, there is no subsidy. Sorry, Mr. and Mrs. Smith. Going over $94,200 is like going over a cliff. Unlike the way the federal graduated income tax is calibrated so that the Smiths never lose money by earning more, the subsidy doesn’t decline step by step. It plunges to zero.

Even steeper cliffs are possible. Suppose the Johnsons, each 63 years old, live in Florida and their kids are grown. They make $62,040 (four times the poverty line for a family of two adults) from the charter-boat business they run. They’ll get a subsidy of $9,024 to pay for their insurance. But they will lose it all if in 2014 they sell just one extra charter. If they make a dollar more (or $100 or $1,000 more) the entire $9,024 federal subsidy goes away. If their over-the-ceiling earnings are $100, that’s like a 9,024% tax on that $100.

“For hourly workers or freelancers who cannot predict their income with complete accuracy, this could be an anvil that comes down on them next year,” says Barry Cohen, an insurance broker in Lancaster who helped me model various scenarios. A middle-class couple, Cohen notes, could get a surprise $5,000 or $10,000 tax bill next April because they received a subsidy but then earned just a few dollars more than they estimated, pushing them above the income ceiling. As with much about the 906-page Affordable Care Act, you had to be in the room–actually many rooms, over hundreds of meetings over many months–when the law was written to understand how these startling cliffs came to be.

One of Obama’s goals, shared by many congressional Democrats worried about conservative opposition, was to keep the cost of the subsidies to the Treasury as low as possible. But in dozens of intense meetings, Obama and his staff, along with the congressional committee staffs, also struggled to make the insurance that people would be forced to buy as affordable as possible for as many people as possible.

Obviously, those two goals pulled in opposite directions. Lower federal subsidies meant higher premiums, but it also meant that the new law would cost less and therefore be easier for Congress to pass. So White House and congressional aides worked up two formulas to balance the competing pressures. The first mapped out how much the subsidies would be. The second defined who would qualify for them.

To determine the amount of the subsidies, the staffs adopted a graduated scale, like the income tax. Those earning at the poverty level would not be required to pay more than 2% of their income for the second lowest so-called Silver plan premium. (Those below the poverty level would qualify for Medicaid, a completely free program.) The plans on the insurance exchanges range from Bronze to Silver to Gold to Platinum depending on the amount of expected expenses–from 60% to 90%–you want the insurance company to pay, with you paying the rest.

Let’s assume that you’re a family of four with $24,000 in annual income (just above the poverty line), and the second cheapest Silver plan available to you costs $800 a month. Two percent of your annual income is $40 a month. That means you will get a $760 monthly subsidy ($800 minus $40), or $9,120 a year for health insurance. Those earning 200% of the poverty level (about $47,000), however, would be required to pay up to 6.3% of their income before they would get a subsidy. Those earning 300% to 400% would have to pay 9.5% of their income before the premium subsidy would kick in.

In other words, the more money you make, the less the government subsidizes your premium, which is just like the graduated-plan income tax in reverse.

However, when it came to who would get subsidies and who would not, the people who wrote the law provided for no sliding scale. Once the Smiths or the Johnsons score an extra construction job or boat charter that pushes their earnings over 400% of the poverty line, they get nothing. One way to have chiseled the subsidy cliff into a gentler slope would have been to keep some set of gradually declining premium subsidies for those earning over 400%. But when the staffers calculated the cost of extending the premium to people like the Smiths or the Johnsons, it was intolerably high.

Another way to chip at the cliff would have been to lower premium-subsidy percentages still more, beginning at the 300%-above-poverty level and gradually decreasing the subsidy to zero when 400% above poverty was reached. There would still be no payouts above 400%, but the declining slope of subsidies from 300% to 400% would have eliminated the cliff because those at 400% would be losing little by earning more. That would have pretty much evened up the fortunes of the Jones and Smith families. But as it is, the weakest part of the subsidy formula is that people who make three or four times the poverty level get subsidies that are arguably not enough to make their premiums affordable. In fact, the burden on those at the 300%-above-poverty level is another looming pothole in the details of the subsidy formula.

For example, even with their current $9,024 subsidy, the Johnsons in Florida, whose earnings are $62,040, are still paying about $5,000 a year in premiums (depending on the plan they choose). On top of that, they will also face a deductible and out-of-pocket costs of about $12,000. That means the Johnsons’ total medical costs (premium and amounts paid to meet the deductible) could take $17,000, or 27%, out of their $62,040 in pretax income. That’s better than the $26,000 it could cost them if they earn $63,000 and don’t get any subsidy. But it’s a stretch to call something that diverts 27% of a family’s pretax income the Affordable Care Act. After taxes, that’s probably about 50% of their disposable income.

Does all this mean Obamacare is going to backfire on its designers? Not necessarily. Only 1% or 2% of people signing up for the exchanges will fall off the cliff. They will mostly be older people, like the Johnsons, in expensive-health-care states, whose income is at or near 400% of the poverty level. Younger people, whom insurance companies charge lower rates, or people in lower-health-care-cost states, where all premiums are likely to be lower, probably won’t be affected much, if at all. But in a program that signed up 8 million people, that could still leave tens of thousands on the exchanges who will come close to or fall over a steep cliff. That’s a lot of families–and a lot of ammunition for the President’s opponents.

Complicating things, as a recent report in the Washington Post notes, is a little-known problem with the notorious (but mostly fixed) Obamacare website. The site’s system for verifying the incomes people have claimed in order to get subsidies is so gummed up that it may take months or years for the government to verify who deserves what subsidies. Many Obamacare patients will have to submit additional documents or face demands that their subsidies be returned to the IRS. That won’t be popular either. “I’m already advising some clients who may be at or near the cliff to watch their incomes toward the end of the year,” says Cohen. “Maybe they can stop working overtime or take a month off. If not, they could get hammered with huge tax bills that they never expected.”

Obamacare took a complex new law with complicated formulas involving big dollars moving in and out of peoples’ wallets and grafted it onto a health care system that was already impossible for most people to understand. In the most public-spirited age of bipartisan fellowship, that would not have been easy. So long as the Affordable Care Act is the Republicans’ favorite whipping boy, it’s likely to get just plain ugly.

TIME politics

Obamacare’s Killer Burden on Nurses

Nurse checking patient's pulse in office. Blend Images - Peathegee Inc—Getty Images/Brand X

The Affordable Care Act means more and sicker patients are entering hospitals, and less comprehensive and timely health care.

As the first enrollees in the Affordable Care Act begin seeking care at my hospital, I wonder how my practice as a Registered Nurse will change. We’re told the goal of the new law is to remodel healthcare in the United States into a system that promotes wellness and prevention, rather than just providing care to sick people. This seems like a great objective, but I worry that the switch may compromise the quality of the care our patients receive.

As a bedside RN working at an acute care hospital in Oakland, California, I care for an incredibly diverse patient population. Most of my patients have had health insurance through employer-based programs, private purchase, or Medi-Cal. Most have interacted with the health care system prior to being admitted to my hospital.

Now, I will take care of patients who are new to health care. Some haven’t had care in a long time (or ever). Some may have pre-existing conditions that enabled insurance companies to refuse them coverage. As they enter my care, their needs may be more complicated.

Last year, I cared for a patient who—like many patients covered through the ACA—hadn’t been to the doctor in years. She didn’t seek care until she was quite debilitated by Type 2 Diabetes.

My experience caring for this woman exemplifies the stress that patients who have never had health care may put on my hospital and nurse colleagues. This woman never had an IV in her arm nor had she ever stayed overnight in a hospital. Now, she was told that when she went home, she’d need to check her blood sugar with a glucometer four times a day and inject herself with insulin. I spent a lot of time with her, explaining things to ease her anxiety.

During that shift, one of my other patients said, “You must be busy. I haven’t seen you all night.” My heart sank. He was fine physically, but I could tell he needed someone to talk to for a few minutes. Unfortunately, I had to get back to my diabetic patient. Preventing her blood sugar from dropping took priority over spending time with my lonely patient. Unfortunately, there were no extra nurses to care for my other patients.

In fact, executives at my hospital recently proposed reducing our inpatient nursing staff. They note that the number of patients admitted for overnight stays has decreased in the last few years. They say medical and surgical care has improved, and better primary care has kept patients healthy enough to avoid hospital admissions. The ACA permits hospitals to continue shifting patient care from the expensive inpatient setting to the cheaper—and more profitable—outpatient setting.

The problem with that diagnosis? My patients are not healthier. With the ACA, there are more patients entering hospital infrastructures that have been diminished. Patients visit the emergency room and wait longer before being admitted. When they do get admitted, rather than being sent home and told to follow up with their primary care physician, they are often much sicker and require more care.

This new burden is falling heavy on the hospitals and staff. Nurses are working harder than ever with fewer resources.

It’s a killer combination: hospitals delaying and denying care to patients as the ACA enables more Americans to buy into this deeply flawed system. If the ACA is successful in contributing to keeping patients out of the hospital, inpatient care will be reserved for patients with acute, severe illnesses and the number of hospital nurses will drop dramatically. Meanwhile, other patients will be managed in the outpatient setting and more nurses will move into home health and advice nursing.

But it’s unrealistic to assume all the care I give my patients in the hospital can be done at home by family members, friends and the occasional visit by a home health nurse. In a hospital, patients benefit from a huge team of health care practitioners.

Consider my new diabetic patient. She benefitted from the ongoing support of nurses to teach her about diabetes, visits from the dietitian to help with her menu planning, and the assistance of a social worker who helped her identify additional resources. Her doctor monitored her blood sugar to see how she responded to the treatment. When, after a few days in the hospital, she checked her sugar, determined her insulin dose, drew it up and administered it to herself, I had tears in my eyes. She deserved that care and I was proud she got it. While I hope the ACA will get care to millions of other Americans, I worry that it may make it harder for people to get comprehensive, timely care from trained and compassionate health care practitioners, including nurses like me.

Amy Dertz is a Registered Nurse and has worked at Kaiser Permanente Hospital in Oakland on the Adult Medical/Surgical/Oncology Unit since graduating from California State University, East Bay in 2007. She lives in Richmond, California. This piece originally appeared at Zocalo Public Square.

TIME Healthcare

Obama Hosts Obamacare Enrollment Party

Champagne, but no selfies, for those who helped 8 million Americans enroll in the Affordable Care Act

President Barack Obama and First Lady Michelle Obama feted about 300 people at the White House on Thursday to celebrate the close of the Affordable Care Act’s maiden enrollment period.

Despite a rocky rollout, the Department of Health and Human Services announced Thursday that 8,019,763 people selected health-insurance plans through the marketplaces created under the law through the middle of April, exceeding projections.

The Obamas cracked open the champagne for allies and advocates who helped defend the law against Republican attacks and led a nationwide campaign to get Americans enrolled in the marketplace plans.

Among the attendees were labor leaders, Democratic operatives and health care activists, as well as celebrities who helped the Administration promote the law, including University of North Carolina men’s basketball coach Roy Williams, former NFL player Eddie George, Friday Night Lights and Nashville star Connie Britton, University of Connecticut women’s basketball coach Geno Auriemma, and actor and former White House official Kal Penn.

According to attendees, the President highlighted the success of the initial enrollment period, but said more work needed to be done — both when enrollment reopens later this year and in states that have not accepted federal dollars to expand Medicaid. Obama gave a special shout-out to the “tech team,” which fixed the troubled HealthCare.gov website that threatened to derail the enrollment process. He was followed by the First Lady, who expressed how proud she was of her husband for pushing the health care law through even when it was politically inexpedient.

Attendees said Obama got “pretty emotional” as his wife retold stories of those who have been helped by the law.

After the Obamas spoke, they worked the room greeting attendees, but as the President warned the crowd: “We don’t have time for selfies with everyone.”


Here’s a readout of the event from a White House official:

The White House Office of Public Engagement hosted an event this afternoon with stakeholders and Administration officials who helped with the outreach and enrollment around the Affordable Care Act to thank them for their efforts.

The President and First Lady attended, along with Senior White House Officials, HHS Secretary Kathleen Sebelius, Secretary Anthony Foxx, and Secretary Tom Perez. Guests included the broad and diverse group of stakeholders who helped to enroll Americans in quality affordable health plans, and get information out about their health care options, including consumer groups, techies, pharmacies, hospitals, athletes, celebrities, local elected officials and community leaders.

The President thanked attendees for the tremendous work they did to help 8 million people sign up for private health insurance plans through the Affordable Care Act Market Places. He emphasized that this represents a major step forward for this country and that the real impact is playing out in the lives of men, women, and children all across this country who now have access to health care – many for the first time.

The President also reminded the attendees that, thanks to their tireless efforts, in last six weeks leading up to the March 31st deadline, 300 radio interviews blanketed the airwaves in key markets. Over five-thousand events were held in key communities across the country. About 350 million followers were reached through social media channels, and there were over 33 million views of videos encouraging enrollment between content produced the White House videos, YouTube personalities, Funny or Die, and College Humor.

In addition to the 8 million who enrolled in private plans, over 4.8 million more people have been covered by states through Medicaid and CHIP programs and around 3 million more Americans under 26 are covered under their parents’ plans. And because of the ACA, 100 million Americans have gained free preventive care, like mammograms and contraceptive care, under their existing plans. Nearly 8 million seniors have saved almost $10 billion on their medicine. And a whole lot of families will have the security of health care, because the Affordable Care Act prevents insurers from placing dollar limits on the coverage they provide.

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