Carolyn Senger, a preventive medicine doctor, regularly treats uninsured patients, coaching them how to stay healthy.
Now she's teaching them something else: how to sign up for insurance under the Affordable Care Act. "Not only can I help you with your health, but I can also help you get some coverage," Senger tells her patients.
In a massive push to get millions signed up for new insurance options over the next several months, health officials are counting on physicians. They're motivated by a long-standing principle: People trust their doctors.
But like everyone else, physicians have differing opinions on the law: Some enthusiastically promote it and others ardently oppose it. In fact, both sides of the political debate are using health care providers to get out their messages.
"There are some doctors who think this is a half-baked and terrible idea," said Lucien Wulsin, the executive director of the Los Angeles-based Insure the Uninsured Project. "But there are a bunch who think this is going to be beneficial to helping their patients get care and afford coverage."
Ori Hampel, a urologist in Houston, is one of a cadre of physician opponents who are meeting with legislators and speaking out against the law. Hampel said he felt a duty to warn patients that they could end up with more expensive care and less access to doctors under what he calls the "unaffordable care act."
He and others are part of an organization called Docs 4 Patient Care, which has a strong presence in Texas, Georgia and Michigan and has challenged the health care overhaul since before it passed in 2010.
"We think it's a dangerous law and it is an intrusion on the doctor-patient relationship," said Hal Scherz, a Georgia physician who's the president of the organization.
Doctors also have become messengers for the conservative group Americans for Prosperity. In one television ad, a Virginia doctor says Obamacare has her worried about having to navigate a complicated system rather than help patients. "Can I still work with parents to decide what's best for their kids or will the government be in the middle of things?" she asks.
Whatever their views, physicians are expected to play a crucial part in patients' understanding of the law and their willingness to enroll. The federal government is partnering with physician groups such as the American Medical Association to educate doctors. Covered California, the state's insurance marketplace, has awarded more than $3 million out of a total of $40 million in outreach grants to medical groups.
A recent Kaiser Family Foundation tracking poll found that doctors and nurses are the most trusted sources for people who are seeking information about the health care law. Nevertheless, patients get more of their information from the news media, family and friends.
That is, in part, because physicians' knowledge about the Medicaid expansion and insurance marketplaces varies widely. Doctors who are unsure about the details of the law may be more reluctant to talk about them.
To help, physician organizations are putting information on their websites and offering training sessions. The AMA prepared a fact sheet for doctors, a brochure for them to give patients and a flier for their waiting rooms: "Need affordable health insurance? New coverage options coming soon!"
The American College of Physicians posted an online state-by-state guide for doctors and a list of questions and answers about the law. Charles Cutler, a Pennsylvania doctor who heads the organization's board of regents, said several of his patients had come to him with questions about insurance, benefits and prescription drugs.
"I don't have all the answers," Cutler said. "This stuff is complicated."
Senger, the San Diego doctor, is the state director of an organization called Doctors for America, which is reaching out to physicians and patients with the motto "Coverage Is Good Medicine."
"Even if you don't like this provision or that provision, getting patients insured is universally helpful" in ensuring that they can seek regular care and their doctors can get reimbursed, said Alice Chen, the executive director of the group and an assistant professor at the University of California at Los Angeles.
At a free health fair last month, Senger explained the changes to several patients, including Apolinar Recendiz, a 55-year-old uninsured housecleaner.
Senger told Recendiz that she might be eligible for insurance in January under the Affordable Care Act, despite having diabetes. "They'll try to find what options will work best for you, and also for your family," she said. "And they'll try to make it affordable for you."
Recendiz, with graying hair and a thick accent, nodded and smiled. "Imagine," she said. "I didn't know."
Senger's outreach didn't end with the patients. She met later with a group of residents and medical students, running through specifics about the state's insurance marketplace. Veronica Villareal, a medical resident, said that by learning "the nitty-gritty details" about Obamacare, she was more equipped to talk to her patients and direct them toward coverage.
The Service Employees International Union recently unveiled ads with doctors urging consumers to apply. In the ads, two New York doctors tell people, in Spanish and English, that they have "exciting news": that consumers can get new, affordable coverage starting next year.
With enrollment underway, doctors need to get up to speed so they know what to tell patients, said Richard Baker, an ophthalmologist in Los Angeles.
"These are the new rules," he said. "Physicians need to be educated."
That's what the Insure the Uninsured Project is doing with a presentation titled "Obamacare 101." A few days before enrollment began Oct. 1, doctors, medical assistants and health clinic personnel in Los Angeles spent hours learning about the expansion of Medi-Cal, the state's Medicaid program, and the insurance marketplace. They repeated questions they'd already gotten from patients about penalties, co-pays and benefits.
Howard Kahn, the chief executive of L.A. Care Health Plan, a nonprofit HMO that organized the session, said there was nobody better to educate patients than the people holding the stethoscopes to their hearts.
"A doctor's message counts more," he said.
By Anna Gorman
Kaiser Health News