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Doctors Treat New Condition: Questions About Health Law

Nov 04, 2013

This KHN story was produced in collaboration with mcclatchy

SAN DIEGO - Carolyn Senger, a preventive medicine doctor, regularly treats uninsured patients, coaching them how to stay healthy.

Now she is teaching them one more thing -- how to sign up for insurance under the nation’s Affordable Care Act. “Not only can I help you with your health, but I can also help you get some coverage,” Senger says to her patients.

Despite the ongoing controversy over the website and the rocky rollout of the law, the Obama administration still hopes that millions will sign up for new insurance options before the March 31 deadline. To make that happen, health officials are counting on physicians to shift the conversation from the online problems to the benefits of coverage. They are motivated by a longstanding principle: People trust their doctors.

San Diego physician Carolyn Senger explains the Affordable Care Act to a patient (Photo by Anna Gorman/KHN).

But like everyone else, physicians have differing opinions on the law, with some enthusiastically promoting it and others ardently opposing it. In fact, both sides of the political debate are using healthcare providers to get their message out. 

“There are some doctors who think this is a half-baked and terrible idea,” said Lucien Wulsin, 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 meeting with legislators and speaking out against the law. Hampel said he feels a duty to warn patients they could end up with more expensive care and less access to doctors under what he calls the “unaffordable care act.” 

Hampel 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 health reform since before it passed. “We think it’s a dangerous law and it is an intrusion on the doctor-patient relationship,” said Hal Scherz, a Georgia physician and president of the organization.

Differing Opinions

Doctors have also 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 like the American Medical Association to educate doctors. The state’s insurance marketplace, Covered California, 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 showed that doctors and nurses are the most trusted sources for people seeking information about health reform. Nevertheless, patients get more of their information from the news media, family and friends. (KHN is an editorially independent program of the foundation.)

That is in part because physicians’ knowledge about the Medicaid expansion and insurance marketplaces varies widely. Doctors 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!”

'This Stuff Is Complicated'

The American College of Physicians posted an online state-by-state guide for doctors and a list of questions and answers about health reform. Charles Cutler, a Pennsylvania doctor who heads the organization’s board of regents, said several of his patients have already 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 they can seek regular care and their doctors can get reimbursed, said Alice Chen, executive director of the group and a UCLA assistant professor.

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 may 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 greying hair and a thick accent, nodded and smiled. “Imagine,” she said. “I didn’t know.”

Senger’s outreach didn’t end with the patients. Later, she met with a group of residents and medical students, running through the specifics about the state’s insurance marketplace. Veronica Villareal, a medical resident, said by learning “the nitty, gritty details” about Obamacare, she is more equipped to talk to her patients and direct them toward coverage. 

Obamacare 101

The Service Employees International Union also recently unveiled ads with doctors urging consumers to apply. In the ads, two New York doctors tell people in both Spanish and English they have “exciting news” – that consumers can get new, affordable coverage starting next year.  

With enrollment already 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 Insure the Uninsured Project is doing with a presentation entitled “Obamacare 101.” Just a few days before enrollment began on Oct. 1, doctors, medical assistants and health clinic personnel in Los Angeles spent hours learning about both the Medi-Cal expansion and the insurance marketplace. They repeated questions that they had already gotten from patients – about penalties, co-pays and benefits.

Howard Kahn, chief executive of L.A. Care Health Plan, which organized the session, said there is nobody better to educate patients than the person holding the stethoscope to their heart. “A doctor’s message counts more,” he said.

agorman@kff.org | @annagorman

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