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[1] 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[2] working to implement the law, pharmacy chains[3] , health insurance companies[4] 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[5] , 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[6] 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[7] , 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[8] and referrals to other resources that can offer more extensive information[9] , 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[10] to be ready when the six-month open enrollment period begins on the state-based health insurance exchanges[11] 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[12] .


"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 Association 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[13] 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[14] 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[15] 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 Blackwater, 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[16] 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[17] 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.





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  • 1912


    Former President Theodore Roosevelt champions national health insurance as he unsuccessfully tries to ride his progressive Bull Moose Party back to the White House. (Photo by Topical Press Agency/Getty Images)




  • 1935


    President Franklin D. Roosevelt favors creating national health insurance amid the Great Depression but decides to push for Social Security first. (Photo by Keystone/Getty Images)




  • 1942


    Roosevelt establishes wage and price controls during World War II. Businesses can't attract workers with higher pay so they compete through added benefits, including health insurance, which grows into a workplace perk. (Photo by Hulton Archive/Getty Images)




  • 1945


    President Harry Truman calls on Congress to create a national insurance program for those who pay voluntary fees. The American Medical Association denounces the idea as "socialized medicine" and it goes nowhere. (Photo by Keystone/Getty Images)




  • 1960


    John F. Kennedy makes health care a major campaign issue but as president can't get a plan for the elderly through Congress. (Photo by Keystone/Getty Images)




  • 1965


    President Lyndon B. Johnson's legendary arm-twisting and a Congress dominated by his fellow Democrats lead to creation of two landmark government health programs: Medicare for the elderly and Medicaid for the poor. (AFP/AFP/Getty Images)




  • 1974


    President Richard Nixon wants to require employers to cover their workers and create federal subsidies to help everyone else buy private insurance. The Watergate scandal intervenes. (Photo by Keystone/Getty Images)




  • 1976


    President Jimmy Carter pushes a mandatory national health plan, but economic recession helps push it aside. (Photo by Central Press/Getty Images)




  • 1986


    President Ronald Reagan signs COBRA, a requirement that employers let former workers stay on the company health plan for 18 months after leaving a job, with workers bearing the cost. (MIKE SARGENT/AFP/Getty Images)




  • 1988


    Congress expands Medicare by adding a prescription drug benefit and catastrophic care coverage. It doesn't last long. Barraged by protests from older Americans upset about paying a tax to finance the additional coverage, Congress repeals the law the next year. (TIM SLOAN/AFP/Getty Images)




  • 1993


    President Bill Clinton puts first lady Hillary Rodham Clinton in charge of developing what becomes a 1,300-page plan for universal coverage. It requires businesses to cover their workers and mandates that everyone have health insurance. The plan meets Republican opposition, divides Democrats and comes under a firestorm of lobbying from businesses and the health care industry. It dies in the Senate. (PAUL J. RICHARDS/AFP/Getty Images)




  • 1997


    Clinton signs bipartisan legislation creating a state-federal program to provide coverage for millions of children in families of modest means whose incomes are too high to qualify for Medicaid. (JAMAL A. WILSON/AFP/Getty Images)




  • 2003


    President George W. Bush persuades Congress to add prescription drug coverage to Medicare in a major expansion of the program for older people. (STEPHEN JAFFE/AFP/Getty Images)




  • 2008


    Hillary Rodham Clinton promotes a sweeping health care plan in her bid for the Democratic presidential nomination. She loses to Obama, who has a less comprehensive plan. (PAUL RICHARDS/AFP/Getty Images)




  • 2009


    President Barack Obama and the Democratic-controlled Congress spend an intense year ironing out legislation to require most companies to cover their workers; mandate that everyone have coverage or pay a fine; require insurance companies to accept all comers, regardless of any pre-existing conditions; and assist people who can't afford insurance. (Alex Wong/Getty Images)




  • 2010


    With no Republican support, Congress passes the measure, designed to extend health care coverage to more than 30 million uninsured people. Republican opponents scorned the law as "Obamacare." (Mark Wilson/Getty Images)




  • 2012


    On a campaign tour in the Midwest, Obama himself embraces the term "Obamacare" and says the law shows "I do care." (BRENDAN SMIALOWSKI/AFP/Getty Images)