As we draw  closer to the 2014 start-up of President Barack Obama’s Affordable Healthcare Act, I visited with Cindy Jackson to ask her what effect the AHCA will have on the Clark County Charitable Health Services which she administers.
Jackson: The Affordable Health Care Act is really why this clinic was established. What we do is to provide affordable healthcare to adults ages 19 to 64 living at 185% of the federal poverty level with no medical insurance. So when people go on Medicare they no longer qualify for our program.
Downs: Why not?
Jackson: Because of CCCHS guidelines, to be eligible for our service, a family of one, for example, can earn up to $20,036 a year. Or a family of four—let’s say the mother and three children—can earn up to $40,792. But in neither case may the family have health insurance.
Downs: Getting back to those percentages,  if someone is earning, say, $30,000 yearly, do they qualify for free care?
Jackson: According to our guidelines, someone who earns $30,000, if they are single, earns too much to qualify for our free care. Now from how I understand the Affordable Healthcare Act, if their place of employment does not offer insurance, if they are going into the penalty area, these people would be qualified to buy health insurance out of a statewide insurance pool where people can purchase affordable health care.
Downs: What does that tell you about the need for health-care insurance?
Jackson: It tells me three things. First, that 41% of our patient population is working but cannot afford health insurance because it’s either too expensive; second, that the company they are working for doesn’t offer health insurance; and third, that they might be working part-time, so as of right now all these people qualify for our care.
Downs: What services does your care include?  
Jackson: Our care is basic care, the same as what you can receive at a doctor’s office. We have volunteer doctors, dentists, podiatrists, healthcare providers, and chiropractors here in town who provide free visits. We voucher their care, that is, we send a blank form with the patient’s name on it and our title saying that this person is coming from us.
Downs: Do your patients make their own appointments?
Jackson: No, we make their appointments for them, which is why I said we provide them with basic care.  Every once in a while—actually more than once in a while now—we will provide referrals for advanced care —CTs, MRIs, surgery. We had a patient come into the center who had leukemia and we got that person to a Med Center with a higher level of care right away. So we work with our physicians and get these folks into UAMS or whatever tertiary-care center they need to go to.
Downs: What is tertiary care?
Jackson:  We and the doctor’s office are the first level of care. Baptist-Arkadelphia is an example of the secondary level. Hospitals and medical centers, which provide full services from most specialties, are examples of tertiary—third level—care centers.
Downs: Are all three levels regularly used by the CCSHS?
Jackson: Yes, but getting higher-level care is more expensive. Many of our patients cannot afford the minimum fees required for care. At CCCHS we assist the patients in completing discount forms. If the money is available, we also pay half the fee up to $300. The patient is to make payment arrangements for the remainder of the fees.
Downs: What’s the source of your operating funds?
Jackson: First, because we are a charitable organization, every volunteer who works here, including me, works for free. To raise operating funds, we contact churches. This started out of the First United Methodist Church in Arkadelphia. I’m their parish nurse. We joined the Clark County Strategic Plan, so out of this strategic plan we grew.  We fund ourselves yearly through grants, United Way specifically, and the Clark County Community Foundation. Those are regular grants that we write every year, and so far we have been blessed to get them.
Downs: What kind of response do you receive?
Jackson: Each year I send out about 120 letters to all the churches in Clark County, and we have nine that follow through and participate with us. Each church gives at its own level of giving and you know what? The funny thing is that the smaller churches give proportionally more.  They don’t have the same overhead but most of them have a real heart for missions.
Downs: How else may people help?
Jackson: Money is not the only request we make. I would like the community to understand that you do not need experience in the healthcare field to be an office volunteer.  Granted, we do need nurses badly, but we have other valuable work to be done.  For instance, our Drug Assistance Coordinator and helper have no medical background.

Next: As medical schools graduate fewer and fewer family-practice physicians, what about the idea of opening local clinics operated nurse practitioners?