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What Nurses Should Know About Post-ACA Health Coverage, with Kiahana Brooks Nu’12 GR’16 RN MPH

When it comes to health care, there’s policy, and then there’s ground truth. Kiahana Brooks has been up close to both.

As a former inpatient nurse who earned her BSN at Penn as well as her Master’s in Public Health and now works within the federal government as an Affordable Care Act data and policy analyst, Brooks has experiential insight to the real time transformation of today’s health care landscape, and what this means for not only patients, but nurses too.

New health coverage has a learning curve

“The ACA expanded coverage to millions of people but one of the challenges that comes with that is understanding the new health care that you have. People are still learning the ins and outs of how their explanation of benefits works, what they need a referral for, what tier their medication is on, and lots more. It’s a process.”

ACA care is usually a question of coverage

“Knowing what’s in-network and what’s covered for each patient under an ACA plan is crucial to helping patients make health care decisions that won’t negatively impact their finances and will get them the best care. This is one of biggest challenges that nurses face.”

It’s all in the book

“A lot of nurses don’t fully understand how their health insurance works. My own nursing job was my first real job that had insurance—I had to read the booklet to educate myself—and I found that the more I dug into the specifics of my own plan, the more I began to understand concepts like bundles, referrals, copays, etc.”

The road to care is paved with surprises

“It can be a shock for patients to show up and find out that they have a copay or any kind of financial share at all in their health care costs. It’s important for patients to ask questions about what’s in-network and how billing works, and it’s also very important for nurses to be able to direct patients to the right people who can offer them answers.”

Following up makes a difference

“One of the most important things that a nurse can do with patients who are learning about how their coverage works is to take the time to follow up and make sure that patients found the information they needed to make fully-informed decisions going forward.”

Sometimes even nurses need help

“Understanding how health insurance works in the ACA landscape is one of many things that new nurses have to learn when they’re also learning how to be a nurse, period! Knowing your limits, knowing what resources you have within your reach, and knowing when to consult with a colleague is essential. Especially when it comes to questions that you or any patient might have about the complexities of an insurance policy.”

Hospital expertise is an asset

“Nurses really understand how hospitals work. They know the nuances of things like discharging or admitting a patient. And today, with the ACA in place, there’s a great need for that insight at nonprofits and in government. As people start to think about the role that health care plays in people’s lives, nurses can offer firsthand knowledge of what it actually looks like.”