Dr. Kisha Davis' patient, who is uninsured, was gearing up to deliver a stream of invective about President Barack Obama's health care reform law. "I don't believe our government is doing this!" Davis recalls her saying.
Then Davis, a family physician at the Casey Health Institute in Gaithersburg, Md., broke in. "She was getting ready to go on this rant," said Davis, 34. "Then I said, 'But you're going to get insurance and in six months, all these tests that we're trying to get you, you're going to be able to get. And these medicines you can't afford, you're going to be able to get.' And she just kind of stopped in her tracks, like it had never crossed her mind it would help her."
Conversations between primary care doctors and their patients are likely to be a critical part of getting the word out to uninsured people that Obamacare's health insurance exchanges may be a gateway to coverage that has eluded them. The incident also underscores the scale of the challenge facing the Obama administration, states working to implement the law, pharmacy chains, health insurance companies and others in making sure the public understands what the law does and what patients need to do.
"Patients can hear it from their doctor," said Davis, who works at the Casey Health Institute, a small practice in the Washington suburbs where most of her patients have health insurance. "People really take that to heart and it kind of changes the tone of it. It takes all of the political stuff out of it and just says, 'Oh, this is something that could help me.'"
Family physicians will be key messengers about the health care reform law. As trusted professionals with personal connections to their patients, their words carry a lot of weight. Patients who are anxious will come to their doctors with questions, complaints and requests for assistance, so medical societies, physician offices and individual doctors are scrambling to be ready to help.
So far, patients and families aren't asking many questions and are more likely to express concerns. Some think their job-based health insurance will go away or that their taxes are going up, said Peter Pogacar, 41, who practices at East Greenwich Pediatrics in Rhode Island. "Their understanding of it is very poor. They think that somehow it's going to hurt them." Surveys show doctors aren't raising the issue much, either.
That will change when enrollment starts, said Alice Chen, an internal medicine specialist who practices at the Ronald Reagan University of California Los Angeles Medical Center and the executive director of Doctors for America, a pro-Obamacare organization.
"A lot of people are going to be asking health care providers about what is this new enrollment, what do they do," Chen said. "This is ultimately about whether or not the patients that you see can get the care that they need."
In the doctor's office, patients shouldn't expect to have long discussions about Obamacare. Instead, physicians and their staff aim to be armed with basic information, handouts, websites and referrals to other resources that can offer more extensive information, Chen said.
"I will be happy if they have brochures in their waiting room, they have posters on their wall, they have some handouts," Chen said. "It doesn't make sense for a doctor sit down with a patient and walk them through their insurance choices."
Doctors for America has been planning since the Affordable Care Act passed in 2010 to be ready when the six-month open enrollment period begins on the state-based health insurance exchanges Oct. 1, Chen said. People who don't get health benefits at work, as well as small employers, will use these marketplaces to comparison shop for health insurance and to learn whether they qualify for financial assistance based on their income.
"We've been working in our communities over the past few years educating people about the Affordable Care Act, building connections with our community partners, with local churches and chambers of commerce, and various organizations," Chen said.
Doctors for America is training 500 physicians and medical students to assist people in their local areas, coordinating with education and outreach efforts by medical societies and coalitions like Enroll America and Get Covered America, and creating materials doctors and their staffs can give to patients inside their offices.
Medical societies, including the Leawood, Kansas-based American Academy of Family Physicians and the American Academy of Pediatrics, are preparing educational campaigns similar to Doctors for America's.
The American Medical Association, the largest organization of doctors, also will participate. “We will continue to work with the administration and do whatever we can in our power to make this happen,” Ardis Dee Hoven, the group's president, said on C-Span this month. The Chicago-based American Medical Association refused numerous requests for an interview with The Huffington Post.
Physicians will be part of a massive nationwide campaign to improve woeful public understanding of the health care reform law and to maximize the number of uninsured people who get covered. Supporters of Obamacare's coverage expansion have their work cut out of them: Polls consistently show the Americans are uninformed, anxious, and lukewarm at best about the health care reform law.
Those same polls also illustrate a persistent partisan divide about Obamacare, with Republicans opposed and Democrats more optimistic. Reid Blackwelder, a family doctor, has seen that split among his patients firsthand.
"I'm in northeast Tennessee. I've got a lot of folks who are in that group that don't like the Affordable Care Act," said Blackwelder, director of medical student education in the Department of Family Medicine at East Tennessee State University in Kingsport and president-elect of the American Academy of Family Physicians. "I still have to deal with that when patients come in and say, 'I'm not going to bother getting that coverage, it's all a government plot.'"
Surveys also reveal physicians themselves don't believe they understand how Obamacare will affect them and their patients, so medical societies have to help them, too, said James Perrin, president-elect of the Elk Grove Village, Ill.-based American Academy of Pediatrics and a doctor who practices at Children's Hospital Boston.
"I don't think physicians will know as much as they ought to," Perrin said. "What we'll hope to do is have physicians know enough that they can refer their patients to where they can get more information in a pretty easy and reliable way."
The rancorous politics of Obamacare is reflected in how doctors themselves feel about the law and its goal of creating government programs to cover the uninsured isn't uniformly supported among physicians.
"There are doctors who are against the Affordable Care Act and so will badmouth it to patients, or may not be as willing to promote it or let their patients know about this potential benefit to them," Davis said. Physicians should take care not to abuse their patients' trust and the credibility that comes with being in that position of authority, she said.
"They see that white coat and they think whatever that doctor says is gospel truth, so I think you have to be very careful about that," Davis said.
CORRECTION: An earlier version of this story misidentified the American Academy of Family Physicians as the American Association of Family Physicians. It also mistakenly identified Reid Blackwelder as Reid Blackwater in one instance.