In this second of a two-part interview with Cindy Jackson, the administrator of the Clark County Charitable Health Service, our conversation focused on two subjects: First, how to continue providing health care to patients at a time when many medical clinics throughout the nation—including Arkadelphia— are no longer accepting Medicare and Medicaid patients; and second, what is the future of the CCCHS?  
• What’s the problem? For the past few years, there has been a sharp decrease in the number of students at UAMS and other medical schools across the nation, who are not choosing  ‘family practice’ as their medical specialty. This is having a particularly harmful effect on attracting physicians to rural areas such as Clark County.  
“Broadly speaking,” Jackson continued, “the majority of family practitioners prefer to spend more time with their patients. There is also the question of whether their investment in time and money would be greater had they chosen a different specialty. Then combine this with the problem that local clinics in Arkadelphia are no longer accepting new Medicare and Medicaid patients. At the same time, however, 230,000 Arkansans who are now without health insurance are going to be seeking coverage when the Affordable Health Care Act goes into effect in 2014.
“I think this affects [the problem] in a positive way,” Jackson said, “in that nurse practitioners have been around for a long time. So have physician assistants. And now we see the opportunity to use them to the fullest scope of their practice. They fit the new health care system well just as they fit our current system.”
• How can they help? Nurse practitioners and physician assistants can take our normal patients and even take a medium-level of care to an advanced level of care with the physicians’ guidance. This frees up the physician to take on the more serious problems.
• What may nurse practitioners do?  “They can provide a full scope of care to patients, such as order labs, order medications, and within certain guidelines they work independently from the physician. They, as well as the physicians’ assistants, have stipulations on their practice, that they must have a physician within a defined mileage range with whom they can consult.
• Will nurse practitioners have offices in local medical clinics? Yes. In fact, a nurse practitioner has been hired to join the Arkadelphia Medical Clinic on July 1. Nurse practitioners are also working in the Baptist Family Clinics in Arkadelphia and Gurdon as well as in the Arkadelphia Clinic for Children and Young Adults.
• Meanwhile, what is the role of the CCCHS? “ The Health Service provides a high level continuity of care,” Jackson said. “We followed through with our health service to make sure the patients understood their plan of care—if they purchased their medications, if they understood what their medications were for. If they cannot afford their medications, we sign them up for available drug grants from major companies, or at least find the lowest vendor for the medication and then we will check the nature of the medication.
• Education programs are mandatory for patients. “We bring our patients in for education and we insist on it. If they miss an education appointment, they need to come back. Some think it is not a priority. But with our diabetic patients, they must come in. We have their testing strips for free, their glucometors for free. If the patients continue to miss classes,  we’ll tell the doctor or the nurse practitioner  that these patients have not come in for education and that they are not caring for themselves as well.”
• How will the AHCA affect charitable clinics such as this one?  “Very personally, I hope the AHCA will close us down because that is why we are here—we provide affordable care. About 78% of our patients will qualify for the new Medicaid 100% premium. That leaves us with about 33 patients. To tell you the truth, I am very happy that they will be able to have health insurance. What they will not have is the same level of “managed care,” meaning “Do you understand your doctor? What you are supposed to do?” Our clients won’t have the same access to education, the same guides through the healthcare maze.
• We may morph into something like a guide agency. “I’m not really sure. And like I said, we are not sure how this new Affordable Health Care Act will impact the nation. It’s wait and see. One thing we will not do is to let our folks just go. What we will do is follow them  for about three months to make sure that they have what they need. And when they get a job, we’ll wait for their healthcare insurance to activate. But if they don’t understand their health-care package, they can call and ask questions.
• What’s your advice to the 230,000 Arkansans who are without insurance? “To start slow and easy, to apply, to accept it, and do your best to follow a healthy regimen. Now that you have your insurance, find a healthcare provider and become a responsible, healthy citizen.”