Open enrollment for people who buy their own health insurance starts Wednesday and ends Dec. 15. That means there are only 45 days to shop for coverage. The shorter enrollment period this year is just one of the changes to the process for buying insurance under the Affordable Care Act.

Here are five important factors to keep in mind if you plan to sign up for ACA coverage for 2018.

1) The health law has not been repealed.

Despite the efforts of President Trump and the Republican-led Congress, the Affordable Care Act remains the law of the land.

That means if you don’t get insurance through your job or a government program, you will still be able to get coverage for a set of comprehensive benefits regardless of whether you have pre-existing conditions. It also means that if you meet income eligibility requirements, you will be able to get help from the federal government to afford your premiums, and, possibly, deductibles and other out-of-pocket costs.

Those cost-sharing reduction subsidies help hold down out-of-pocket costs for people with incomes under 250 percent of poverty (a little more than $30,000 a year for an individual). They will be available despite Trump’s decision to stop the federal government from reimbursing insurers for the required discounts. Most insurers are making up the difference by raising premiums.

Meanwhile, if you get premium assistance in the form of tax credits, how much you pay for coverage is not likely to be much higher, either. That’s because as premiums go up, so do federal premium subsidies. (More about this below.)

2) The requirement for most people to have insurance — and most employers to offer it — is also still in effect.

Under the law, most households that earn enough to owe federal income tax are required either to have health insurance or pay a fine due with their taxes. The fine for not having insurance in 2017 (and 2018) is the greater of $695 or 2.5 percent of the taxpayer’s income. You can claim an exemption from the fine if you demonstrate that you cannot afford insurance offered in your area.

The IRS has said it will start rejecting returns filed in 2018 that don’t indicate whether the taxpayer had health insurance.

Larger employers (those with 50 or more full-time workers) are also mostly required to offer coverage to their workers or pay a penalty. That coverage must be comprehensive and affordable.

3) Like your mama said, you better shop around.

While it’s always been important to compare options, this year it’s more crucial than ever.

For starters, you want to shop and pick a plan yourself so that the marketplace doesn’t automatically enroll you for 2018 coverage. That’s because the auto-renewal date this year is expected to be Dec. 16, the day after the open-enrollment period ends. So, if you are assigned a plan you don’t like, you won’t be able to change it until the 2019 open-enrollment season.

Shopping allows you to compare plans, including which doctors and hospitals are in-network, as well as premiums and copayments, which can vary.

4) Cost will be a factor.

This year, premiums are going up, in some areas by double digits, due in part to the Trump administration’s mid-October decision to cut off cost-sharing subsidies to insurers.

But the premium increases may not affect all plans and “metal levels,” which is why you should compare prices.

Some states, for example, instructed insurers to load those additional costs only onto the silver-level plans, which are midlevel plans that cover about 70 percent of an average person’s medical costs. The policyholder picks up the rest of the cost in deductibles and copayments. As a result of the state’s pricing decisions, though, gold-level plans, which cover an average of 80 percent of costs, might in some cases have lower premiums than silver plans.

Of course, if you get a cost-sharing reduction — meaning lower copayments and deductibles — because your individual income is below $30,150, you will need to stay in a silver plan.

Another factor to consider, however, is that the increased prices for silver plans may drive up a different subsidy — the tax credits that help people pay premiums. Those remain in place for people earning up to 400 percent of the federal poverty level. They could rise because they are tied to the cost of a benchmark silver plan in each region.

In some cases, the tax credit increase could be enough to make a “bronze” or gold plan have a very low or even zero monthly premium, according to a Congressional Budget Office analysis done before the administration took action. But, of course, consumers not getting either subsidies could be looking at higher costs. That gives them all the more reason to comparison-shop.

Some experts suggest looking beyond the official federal and state marketplaces — whether directly checking out an insurer’s website, working through a broker or consulting a private online website — because some states ordered insurers to load additional costs resulting from the Trump order only onto marketplace plans. Therefore, plans off the marketplace might cost less.

5) Buyers should also beware.

Outside of the official marketplaces there may be more insurers selling lower-cost, short-term policies.

Sabrina Corlette, who studies the marketplace for Georgetown University’s Health Policy Institute, said that such plans, while less expensive, may not cover all benefits and might exclude coverage of pre-existing conditions.

Those plans also don’t meet ACA requirements for “minimum essential coverage,” so policyholders would still be liable for paying a tax penalty. “There are going to be some folks out there taking advantage of consumer confusion,” warned Corlette, adding that shoppers who buy outside of state or federal marketplaces “should go to a reputable broker.”

Kaiser Health News, a nonprofit health newsroom whose stories appear in news outlets nationwide, is an editorially independent part of the Kaiser Family Foundation.

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Most people can acknowledge that discrimination has an insidious effect on the lives of minorities, even when it’s unintentional. Those effects can include being passed over for jobs for which they are qualified or shut out of housing they can afford. And most people are painfully aware of the tensions between African-Americans and police.

But discrimination can also lead to a less obvious result: tangible, measurable negative effects on health. A new survey conducted by NPR, the Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health asked members of different ethnic and racial groups about their experiences with discrimination. Ninety-two percent of African-American respondents said they felt discrimination against African-Americans exists in the United States today, and at least half said they have experienced it themselves at work or when interacting with police.

All of this discrimination can literally be deadly, according to Harvard professor David Williams, who has spent years studying the health effects of discrimination.

He tells NPR’s Michel Martin: “Basically what we have found is that discrimination is a type of stressful life experience that has negative effects on health similar to other kinds of stressful experiences.”

Interview Highlights

On the health problems caused by day-to-day discrimination

The research indicates it is not just the big experiences of discrimination, like being passed over for a job or not getting a promotion that someone felt they might have been entitled to. But the day-to-day little indignities affect health: being treated with less courtesy than others, being treated with less respect than others, receiving poorer service at restaurants or stores. Research finds that persons who score high on those kinds of experiences, if you follow them over time, you see more rapid development of coronary heart disease. Research finds that pregnant women who report high levels of discrimination give birth to babies who are lower in birth weight.

On discrimination at the doctor’s office

Across virtually every medical intervention, from the most simple medical treatments to the most complicated treatments, blacks and other minorities receive poorer-quality care than whites. African-Americans who are college-educated do more poorly in terms of health than whites who are college-educated. And these racial differences in the quality and intensity of care persist for African-Americans irrespective of the quality of insurance that they have, irrespective of their education level, irrespective of their job status, irrespective of the severity of disease.

On how to start combating discrimination

Much of this discrimination that occurs in the health care context, and in other contexts of society, may not even be intentional. There is intentional discrimination, but we think the majority of the discrimination that occurs in the health care context is driven by what we call “implicit bias” or “unconscious unthinking discrimination.”

If I am a normal human being, I am most likely to be prejudiced. Why? Because every society, every culture, every community has in groups and out groups. And if there are some groups that you have been taught — just subtly, as you were raised — to think of negatively, you will treat that person differently when you encounter someone from that group, without any negative intention on your part, even if you possess egalitarian beliefs. That’s why you have to acknowledge that I and everyone else is a part of the human family, and these are normal human processes that occur, and the first step to addressing it is to acknowledge: “It could be me.”

NPR’s digital news intern Jose Olivares produced this story for digital.

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Starting next week, Americans will again be able to shop for health plans on the Affordable Care Act marketplaces. Open enrollment in most states runs from Nov. 1 through Dec. 15. But a lot of people don’t know that because the Trump administration slashed the marketing budget for Affordable Care Act, also known as Obamacare. So states, municipalities, community groups, insurers and others are strengthening their outreach efforts.

In Texas, some cities and local governments are doing their best to get the word out, but it will be hard to reach the more rural communities.

In California, the state’s marketplace plans to aggressively advertise and will focus on Latino consumers. And that will be difficult this year, says Christopher Graves, president and founder of the Ogilvy Center for Behavioral Science.

He says the way human brains are wired, it just doesn’t make sense to us to buy something now that we may not need for years. “Health insurance has to be the toughest thing on earth to sell,” he says, “Especially if you’re trying to sell it to somebody who’s young, healthy, and has not had some catastrophe, health-wise.”

That could describe most Latinos in California. That is why they’re a primary target of the state’s marketing and outreach strategy. Latinos represent 38 percent of the marketplace’s potential customer base but only 30 percent of people who actually enroll. The more healthy Latinos sign up for insurance, the more their premiums help balance the costs of older, sicker Californians.

By cutting the advertising budget, the Trump administration has made the already difficult task of selling a product people don’t want to think about even harder. And the Republican drumbeat of “Obamcare is imploding” has been all over the news during the battles to replace the law this past year, causing confusion over whether the ACA still exists.

So California plans to invest $111 million to counteract the negative press. And it will spend 30 percent of its media buy on Spanish language ads.

California is on the defensive, says Lizelda Lopez, deputy director of communications at Covered California, the state’s health insurance marketplace. “Even if they’re hearing, ‘The Affordable Care Act is going away,’ we’re saying, ‘No, no, not yet, not yet.’ “

Carlos Santiago is president and chief strategist at Santiago Solutions Group, a research consulting firm. He fears that message could be too simple.

“To convince someone that was uninsured to get it for the first time, obviously that message is not going to work, especially not this year,” he says. Plus, Santiago continues, the belief that illness won’t happen to you is entrenched in Latino culture.

“Latinos are extremely, extremely positive and overly optimistic,” he explains. That is one reason, he says, they are more likely to be uninsured than other groups.

The mindset is: ” ‘We don’t need to worry so much about today. Things will be OK.’ And obviously when it comes to insurance, that’s not exactly what it’s all about,” Santiago says.

Covered California does have some more dramatic ads. In one, a young Latina woman shows pictures from her wedding day and talks about suddenly finding out she needed a heart transplant. She says that without her health plan from Covered California, the surgery would have cost $1.5 million.

Santiago says hearing the personal story of someone whom Latinas can relate to is good. But he and Graves agree that if the message is too scary, it could backfire.

“That trade-off is people stop taking action. They basically become paralyzed by how overwhelming it is,” Graves says.

In Texas, some groups are taking another tack — a direct one.

Victoria Ortega of Foundation Communities, an advocacy group that provides housing and other services for low-income people in Austin, Texas, sits at a desk with a laptop open to a spreadsheet. Her screen is full of names, and her cellphone is in her hand.

“So far I’ve had about 15, maybe 18 calls,” she says.

Foundation Communities is among the groups working hard this year to get the word out about open enrollment. Texas has been far more dependent on the federal government for signing people up than California has been. But this year, that work is falling to local governments and activists.

Ortega has been calling people who currently have an insurance plan they bought on Healthcare.Gov. She is letting these folks know it’s time to sign up again. She stresses that people they have less time to sign up this year. In 2016, people had three months to sign up for 2017 insurance. This year, in most states, they only have six weeks.

“A lot of the people were not aware of the short time. And they are very interested. They really are wanting to renew,” she says.

Maggie Jo Buchanan works with a national group called Young Invincibles, which encourages young adults to sign up for health insurance.

“All of us nonprofits on the ground really feel that urgency and that need,” she says. “In past open enrollment periods, officials from HHS would be on the ground and announcing the start of open enrollment and getting media outreach. We are just not going to see that.”

In Texas’ bigger cities, local taxpayers are also filling in the gap. Austin is spending a lot more money this year on outreach efforts. Michelle Tijerina works for Central Health, which provides health care for low-income people in Travis County and is funded by local property taxes.

“We will have ads on radio — English and Spanish. We will be on Facebook. We will have Google ads and banners. We will be out in the community, talking to schools,” she says.

Tijerina says Central Health is also hiring twice as many people this year to help folks sign up once enrollment starts. They’re called navigators. The Trump administration cut Texas’ navigator budget by a third. She says folks in Austin likely won’t notice, but rural areas don’t have the same kind of health care infrastructure. That worries Foundation Communities’ Elizabeth Colvin.

“Because those programs have lost funding and there is no one in those communities to step up and replace the navigators,” she says.

Texas also declined to expand Medicaid to more low-income people under the Affordable Care Act, so the marketplace has been the main driver for lowering uninsured rates in the state in the past several years.

Still, Texas has the highest number and rate of uninsured people in the country.

This story is part of a reporting partnership with NPR, KQED, KUT and Kaiser Health News.

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As deaths from opioid overdoses rise around the country, the city of Baltimore feels the weight of the epidemic.

“I see the impact every single day,” says Leana Wen, the city health commissioner. “We have two people in our city dying from overdose every day.”

As part of Baltimore’s strategy to tackle the problem, Wen issued a blanket prescription for the opioid overdose drug naloxone, which often comes in a nasal spray, to all city residents in 2015.

She says many deaths have been prevented by getting the drug into the hands of more people. But now, there’s a problem:

“We’re out of money for purchasing Narcan [a brand of naloxone]. We’re having to ration this medication,” Wen says.

People can purchase Narcan at pharmacies on their own. As we’ve reported, it’s now sold at all Walgreens. But at a cost of about $125 a pop, many people can’t afford it.

Thursday, the Trump administration declared the opioid crisis a public health emergency, but many critics say it doesn’t go far enough when it comes to funding.

Wen says she would like a commitment from the administration to help pay for this drug. She says the administration could also negotiate directly with manufacturers to lower the price of naloxone. “We know treatment works, but we don’t have [the] money,” Wen says.

Paying for rapid reversal drugs is certainly not the only challenge health officials face in tackling the opioid epidemic.

A recent nationwide study published in the Annals of the American Thoracic Society points toa significant increase in the cost of treating overdose patients who are admitted to hospital intensive care units.

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An overdose rescue kit handed out at an overdose prevention class this summer in New York City includes an injectable form of the drug naloxone.

Spencer Platt/Getty Images

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“These are patients who have survived admission [to the hospital] and have significant complications from an overdose,” says study author Jennifer Stevens, a critical care doctor at Beth Israel Deaconess Medical Center. She says complications can include kidney failure and infection. Some patients require a ventilator during hospitalization to support breathing.

Researchers analyzed billing data from more than 150 hospitals in 44 states, and they evaluated all the opioid-associated overdose admissions to ICUs between 2009 and 2015.

The study found a 34 percent increase in overdose-related ICU admissions during that period. And costs rose by almost 60 percent. In 2009, the average cost of care per admission was about $58,000. By 2015, the cost had risen to about $92,000.

In addition, the study points to almost a doubling of deaths among opioid overdose patients in hospital ICUs during the study period.

“It’s a call to arms that everything we’re doing is not enough,” Stevens says.

Stevens says she thinks a lot about the services patients may need once they’re released from the hospital. “They need long-term support,” she says.

Many experts say this must include expanded access to addiction treatment.

“The key to unlocking the opioid crisis is the availability of quality treatment beds,” Gil Kerlikowske, a former drug policy adviser to President Obama, tells us in an email. “We know treatment works and is far less expensive than jail or hospitalization.”

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Tobacco companies put a lot of effort into giving cigarettes sex appeal, but the more sensual smoke might actually belong to marijuana.

Some users have said pot is a natural aphrodisiac, despite scientific literature turning up mixed results on the subject.

At the very least, a study published Friday in the Journal of Sexual Medicine suggests that people who smoke more weed are having more sex than those who smoke less or abstain. But whether it’s cause or effect, isn’t clear.

The researchers pulled together data from roughly 50,000 people who participated in an annual Centers for Disease Control and Prevention survey during various years between 2002 and 2015. “We reported how often they smoke – monthly, weekly or daily – and how many times they’ve had sex in the last month,” says Dr. Michael Eisenberg, a urologist at Stanford University Medical Center and the senior author on the study. “What we found was compared to never-users, those who reported daily use had about 20 percent more sex. So over the course of a year, they’re having sex maybe 20 more times.”

People who consumed marijuana daily had sex 7.1 times a month, on average, for women and 6.9 times for men. Women who didn’t use marijuana at all had sex 6 times a month, on average, while men who didn’t use marijuana had sex an average of 5.6 times a month.

When the researchers considered other potentially confounding factors, such as alcohol or cocaine use, age, religion, having children, the association between more marijuana and more sex held, Eisenberg says. “It was pretty much every group we studied, this pattern persisted,” he says. The more marijuana people smoked, the more they seemed to be having sex.

Now, that association doesn’t necessarily mean the weed is responsible for the heightened sex drive, says Mitch Earleywine, a psychologist at the University at Albany who has studied cannabis and sex but wasn’t involved in this work. “In some surveys, we saw that people [who used cannabis] did have sex more, but it seemed to be mediated by this personality type that’s willing to try new things or look for thrills,” he says. In other words, it seems that people who like to smoke weed may have other character traits that lead them to be lustier.

Or maybe it really is the weed. “It’s possible it makes men or women more interested in sex,” Eisenberg says. In one study, researchers found they were able to induce sexual behavior by injecting a cannabinoid, the class of psychoactive compounds in marijuana, into rats. But people aren’t rats, of course.

Another study published in 2012 found that women became more aroused when watching erotic films when they had cannabinoids in their system. But that might just be because weed seems to heighten sensory experiences overall. “It gets people to appreciate the moment more anyway,” psychologist Earleywine says. “They like food more, find humor in things more easily, so it wouldn’t be stunning to think they would enjoy sex more.”

Whatever the connection, Eisenberg says his results leads him to think that pot, unlike tobacco which can depress libido and performance , isn’t going to take the steam out of one’s sex drive. “One question my patients always have is will smoking marijuana frequently negatively impact my sexual function?” Eisenberg says. “We don’t want people to smoke to improve sexual function, but it probably doesn’t hurt things.”

Not everyone agrees with that conclusion. “It’s a lot of stretch here,” says Dr. Rany Shamloul, a researcher at Ottawa Hospital in Canada who focuses on sexual health and function. He didn’t work on the latest study. In an odd Catch-22, Shamloul says that recent research suggests cannabis might actually make it harder for a man’s penis to become erect, even if weed might turn people on. “Recent studies have shown cannabinoid receptors in the penis itself, and experiments in the lab show an inhibitory response,” he says. “There was basically a mixed result. Cannabis might increase [sexual arousal] frequency in the brain, but also decrease erectile function in the penis.”

There’s another issue that may throw cold water on cannabis’ potential as a love enabler. A frequent side effect of marijuana is a dry mouth, and University at Albany’s Earleywine points out that one’s mouth might not be the only thing turning arid. “Drying of the mucus membranes is a pretty consistent effect of the plant. Women should keep that in mind when considering cannabis as a sexual aid. I know that some products have THC or cannabinoids in a lubricant, but I haven’t seen any actual data on that,” he says.

Stanford’s Eisenberg says his study doesn’t prove the idea that marijuana is getting people into the sack, though he says that’s a possibility. There’s really only one conclusion he can safely draw from the work: cannabis users are doing it more.

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