Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas Times and Little Rock Public Radio.

And hello again, everyone.

I'm thanks very much for being with us.

A busy news week it has been, with much of it involving issues that voters will decide or may have a chance to decide come November.

Backers of abortion and Freedom of Information proposals have been cleared to begin gathering signatures.

The governor's signature education package is still in the news, and that Polk County casino issue has never been out of the news.

To try to sort it all out now.

Antoinette Grant of the Arkansas Advocate, Josie Leonora of Little Rock Public Radio and independent journalist Steve Bronner.

Thanks to everybody for coming in.

Abortion as an issue back and forth, back and forth.

Now it's on again and it.

Is on again.

Third time was the charm for Arkansans, for limited government.

That's the group that's supporting this constitutional amendment.

On Tuesday, the attorney general approved the language.

He did make a couple of changes.

He clarified the difference between fetal age and gestational age and how this amendment could impact current laws of here in Arkansas, we have one of the strictest abortion bans in the country.

We had a trigger law that went into place with the overturning of Roe v Wade in 2022.

So no exception for incest or rape, but for a medical emergency.

So what this proposal hopes to do is to allow for abortion up to 18 weeks and for rape, incest and medical emergency of the mother.

They since they got the approval, they now will go to the signature gathering part of the process.

And they need to collect more than 90,000 by July 5th in order to qualify for the ballot.

They planned to kick things off this weekend, Sunday in Fayetteville with a rally.

And the attorney general did note that a note of note of caution that while he did approve the language, he noted that any sort of vague link language within the ballot measure could still face a court challenge and potentially, you know, some challenges there.

Right.

The tweaks, as added by the attorney general as it is written now.

Is it acceptable to those to the advocates of the amendment?

They are good with it.

They said that they are grateful for the attorney general's approval and for the professionalism of his office, and they look forward to moving forward with this.

Yeah.

Sort of an olive branch there.

The tough part, Steve Jose is always getting those signatures.

90,000 is a lot of signatures.

And we talked about this last time we heard that this is a pretty pro-life state.

So it'll be interesting to see what happens.

A lot of these ballot initiatives fall apart at the signature stage.

I covered the initiative to overturn the learned law, and that came down just a couple of hundred signatures and they weren't able to get all of them.

So you have to get in 50 different counties.

So you have to get you have to skip work.

You have to go around to all of these rural areas and try to get people to sign off that they want to legalize abortion in many cases in Arkansas.

And that's a huge order and a pretty pro-life state.

You mentioned the 50 counties.

I will note that that's a new law.

The Constitution provides that you collect signatures in 15 of the state's 75 counties, but a new law last year increased that threshold to 50, so five zero.

But that particular law, particular law is being challenged in the courts as unconstitutional.

Senator Brian King of Green Forest and the the League of Women Voters of Arkansas have filed a lawsuit that's just sitting in the courts and hasn't gone anywhere yet.

Yes.

And of course, a signature recorded is not necessarily a signature excepted.

Steve, we have gone through this over the decades.

We've seen it numerous times.

I mean, if you get the signatures and you would think that with the passions that are involved with this issue, that they will get the signatures.

But at that point, it goes to the Supreme Court and typically looks at things through a very fine tooth comb.

And many things have gotten thrown off the ballot because of a technicality with the with the way they were collected.

You know, then, you know, was was it notarized correctly?

Was it signed correctly?

And so we will see what happens.

But that's that's the big the signature issue.

And then just the language.

I mean, this will face numerous Supreme Court challenges, right?

Do we have a sense at all of where Arkansas opinion is on this?

And I mean, with with the exceptions that are added to the amendment, rape, incest, health of the.

Arkansas poll taken earlier this year, you know, it was it was 38% for it making abortion easier, 25% would make no change in the law and 29% make it harder.

And it's already about as hard as it could possibly be.

So there's 54% who would be opposed to making abortion more easily accessible.

Yet another 8% who didn't know or didn't have an opinion.

So that is an increase.

38% supporting making it more making it easier for.

Last year it was 33%.

So there is has been an increase, but it's still a clear majority would not make it easier.

So that's the uphill climb that they would have to make.

The other issue, though, is what happens with who comes to vote, what would happen with turnout, who would actually show up to vote because in Kansas, you had a humongous voter turnout increase when they had an abortion issue on the ballot and voters there voted against amendment that would have made it and they would have banned abortion in Kansas.

So the abortion rights cause passed in Kansas pretty easily, 59% with a huge turnout.

Yeah, anybody.

And when it.

I just you know, that's what the polls show.

But you really don't know what's going to happen until people actually show up to the polls on voting day.

Yeah.

And in a presidential election year, you can look for, you know, a big turnout, also freedom of information.

What's interesting is it's put for this is the same thing where it's a constitutional amendment that was put forward by two bipartisan attorneys.

We have a Republican and a Democrat attorney, and they want to enshrine the Freedom of Information Act in the state constitution.

It's the same thing.

They got to get 90,000 signatures and it would take the freedom of information Act to back before the special session that slightly weakened it.

We saw then that there really was a huge amount of bipartisan support for keeping the Freedom of Information Act.

But again, when you have 90,000 signatures, you're going to these rural counties, 50 counties across the state.

How many people even know what the Freedom of Information Act is will be really interesting to see what their volunteer infrastructure is or I don't know if they'll have paid employers whose job it is to go collect signatures.

So I don't know exactly how that's going to go for them, but I know that the folks behind it, Arkansas Citizens for Transparency, they say they're going to move for with this.

What's interesting in this particular instance is they got approval on Wednesday, but on Tuesday, they had filed a lawsuit with the Supreme Court against the attorney general for not approving things, you know, asking the court to compel him to approve the ballot titles or to revise them and alleging that he's trying to use, you know, sort their ability to gather signatures, which, as we noted, is going to take some time.

That's a bit of a challenge.

And the supporters, you know, told one of our reporters yesterday they're going to continue with both things.

They're going to go try and get signatures, but also continue with this lawsuit.

So we'll see what happens there.

Well, and you know, Josie mentioned that it was a bipartisan uprising against the bill.

Well, it crossed ideological lines as well.

You had arch conservatives and that was considered to be on the left a rising up in opposition to the city.

Yeah, I mean, it got totally shut down as far as the the how it unfolded.

Eventually it ended up being the governor got the the security protections that she was after in.

But, yes, the more expansive efforts to to limit the law created this uprising not just, you know, centrist left centrist, right, left, right conduit, you know, Democratic Party people who were typically very much on opposite sides or opposed to it.

And so, you know, this comes to this comes to the forefront this election season with a lot of the interesting that supporters now will say how much how much money they'll be able to raise to do what they need to do.

Some of these other amendments which seem to have there be a financial interest in what's happening.

There's no financial interest.

And Freedom of Information Act is no big business.

Who's going to make money off of free information.

So but this will be done through a lot of volunteer work.

That said, you'd think there'd be enough support that they would get this interest also.

But again, then it goes to the Supreme Court and what happens there?

Yeah.

Also, we need to go to the board of Corrections.

And again, the attorney general is is involved in this in an adversarial at least adverse to his position.

A lot happening with the Board of Corrections.

The most recent thing this week was that the the judge has tossed out Griffin's lawsuit against the Board of Corrections, claiming that they violated the Freedom of Information Act and illegally hired outside counsel in their ongoing dispute with the board or with the secretary of corrections and the governor.

And I know, Josie, you've covered a lot of what's happening there with that ongoing conflict.

Yeah, the attorney general is upset that the Board of Corrections was going into executive session and not recording the audio, which he felt like was a violation of the Freedom of Information Act.

But the judge didn't agree.

The lawsuit was dismissed without prejudice, so hypothetically, they could bring it.

The attorney general can bring it again in the future.

And quite possibly will go on to education.

Josie.

There was we had, again, the Learns Act, which is the kind of the governor's really her signature legislative accomplishment, parental Choice week.

This was declared and the governor spoke about the expansion of that learns act during a summit meeting before Christian educators on Monday.

Here's an excerpt.

You know, we're close to about 6000 students that are currently enrolled in education freedom accounts across the state of Arkansas.

More than 100 schools, many of which are represented here in the room today, have students that are part of the EFA program that will open up in year two.

We expect that to expand significantly and then be open to every student in the state by year three.

And we feel confident that a lot of families will take advantage of that and we're excited to see that program continue to grow and more and more students get the opportunity they need to be successful.

And basically the governor is saying, Antoinette, you ain't seen nothing yet.

So this program, as she mentioned, was designed to roll out over three years and eligibility expands and who can participate expand every year.

Darrell Smith from the Department of Education spoke to some folks with the Reform Alliance this week.

There's a nonprofit that supports school choice.

And during this webinar, he noted that they're hoping to open up applications for those that had already participated this year in late March and the new folks in April.

He noted that things are getting pushed back to spring because there's a bidding process for the vendor that's going to manage the program.

Eligibility will expand.

So this year, first year, things were capped at one and a half percent of the student population.

So it was around 7000 students and as she mentioned, around 6000 were there.

Now that will expand to 3000 next year or so.

You think 3% so up to about 14,000.

And then eligibility requirements this year, first time kindergartner students with disabilities in an effort at school.

Next year, they'll add a D rated school as well as students whose parents are veterans, military reservists and first responders.

It also would expand to families that are homeless.

There's a little controversy because last year we know that most of the kids that got the vouchers were already enrolled in a private school.

Arkansas Times did some great reporting on how a lot of the kids that had disabilities were just getting a doctor's note, which isn't the same disability requirement that you need to get services generally in a public school.

So we'll have to see what happens next with the learners and who gets the vouchers.

Yeah, and move on to another issue, which we need to get to, Steve.

Are we ever going to see a resolution to the Pope County casino story?

We will.

I don't know.

I would think so because it's in the Constitution.

And again, somebody can make a lot of money off of this.

So if it's in the Constitution, someone can make money off of it.

That will happen.

But, yes, the Grace Commission yesterday had a meeting.

They said we're going to have a you know, we need to rewrite our rules because at the moment there is actually no qualified African.

There's no applicant for the pope.

Can I casino.

Now there's we got casinos and of course there's clean slate.

Steve We start from scratch.

We start from scratch.

We have you know this all started 2018.

Four voters voted to have four casinos.

We got three of them, Pine Bluff, Oakland and Southland.

What's left?

But there was issues with the applications of basically both of the ones that were awarded the casino in Russellville.

So at this point, we're still not sure right now because of the lawsuits and because of the court cases, there are no applicants.

So we're going to start all over from scratch.

The rules be voted on on Tuesday.

They will most assuredly be voted yes.

And then they'll start the process once again.

This one of the big differences between Pope County and the other ones is that there is opposition to this locally in Pope County.

Pope County.

You know, Oakland was you know, there are you had electronic games of skill in Oakland and South L.A. and Pine Bluff needed the jobs.

Russellville has Oxitec.

It has you know, it has the nuclear plant.

It has filters, water.

Bugger.

It didn't.

There's a group that doesn't want this.

So there will be an effort.

There's already a ballot initiative started to start to stop this.

So in addition to the ongoing saga over who's going to get the application, and that would be Gulf side and Cherokee Nation right now, maybe Cherokee Nation has the inside track.

The mayor wants it, the county judge wants it, the quorum court.

But we're still at this point, still not sure when it's going to actually be resolved.

Yeah.

In past years, actually, you know, we had opposition from different government groups.

There seemed to be a demographic breakdown.

At one point it appeared that there was a generational conflict over this issue.

Well, and then just again, you know, and plus you've got an outside group, Choctaw Nation, which coincidentally, of course, operates casinos in Oklahoma.

Yeah.

That is that their only.

Short drive.

Away?

Just a complete coincidence.

Yeah.

But their support that in 2000, last year, 2012, they supported an effort to try to have a local initiative that would oppose the one in Polk County.

We'll see what happens this time.

But again, based on the reporting by the Democrat-Gazette lobbyists all over the place yesterday.

So again, at the meeting, lots of money involved.

It's in the Constitution.

We probably will have a casino, but I don't know who's going to operate it or when that will happen.

Got to end it there because we're simply out of time.

Guys, thanks for coming in, as always.

Come back soon, all of you.

And we will be right back.

We are back.

It is an underappreciated, less understood aspect of the drive for better health care in Arkansas with the number of medical schools in the state now at three, soon to be four.

We are graduating more aspiring physicians than ever, but after those four years of classroom and lab instruction and before these men and women can begin practicing medicine, they have spent at least three years in a hospital residency on the job training, so to speak.

Those residencies are in short supply.

Traditionally, there have been too few a specialty in Arkansas to accommodate the number of med school graduates in Arkansas, the number of graduates that need a residency.

So forced to go out of state for residencies.

A stunning percentage of those doctors from Arkansas don't return to Arkansas.

Some relief is in store.

The legislature has funded a program to significantly increase the number of residencies.

And joining us now with more on that is the CEO and president of Washington Regional Medicine in Fayetteville, Larry Shackleford.

Welcome.

This is a big deal.

This is a big deal.

Thank you.

Millions of dollars here that the state is investing in this program.

Yes.

So, you know, the as you mentioned, when we have medical students that travel out of state for residency, they're taking young families there.

They're traveling, trying to recruit them back to Arkansas, as is hard.

And so we have have been working with our northwest Arkansas council, trying to come up with a methodology where we can increase those training opportunities here in in Arkansas.

Go ahead.

I'm sorry.

And so we receive some help from the Arkansas Legislative Council and have a plan to put 92 additional residency programs at Washington Regional.

Now, in your quadrant of the state, it's my understanding that's almost double the number of residents.

It is.

There's there's probably around 60 total residencies right now.

So that that's going to be really more than than double that the number.

Yeah.

What is involved in a residency in practical terms?

Okay.

So as you mentioned, this is really a chance for physicians to be able to train in the specialty they're going to practice.

Right.

So one of the first residencies we opened was in in Internal Medicine.

So those residents, we have eight each year there will be 24 total and they spend time in the hospital taking care of patients in the hospital.

They spend time in the clinic taking care of patients in the clinic.

They spend time in the the classroom and in the lab.

But over that three year period, they receive that training and they will be certified as as an internal medicine physician at that time and able to to go fully into practice.

But this is true also of, say, neurology, OBGYN and all of the disciplines.

And it.

Is.

Right.

And we chose internal medicine in part because it is so under supply across Arkansas, but in particularly in northwest Arkansas.

The question wasn't always just money.

So you kind of have to understand what the funding mechanism is.

And most residents, cities in this country, for hospitals, the Medicare cost support is where you're reimbursed for those.

And Congress, in its infinite wisdom in the seventies, put some caps on residents.

So hospitals in Arkansas, like Washington Regional, couldn't expand residencies because we were capped.

So what we particularly worked on was, was a process because Arkansas is a rural state.

We could change what our rural practice index, a rural wage index.

And that gave us a chance to start over to have a new cap moving forward.

So the help that the Legislative Council gave us was some funds to cover that differential of being reimbursed under the rural wage and some startup costs to be able to get those programs going.

Well, a key word here is rural is there hope that the expanded number of residencies can put doctors where they are needed most?

Yes.

So one of the programs that that we have added in partnership with Uams is a rural track family practice.

And those physicians specifically will spend a year in urban northwest Arkansas and then their last two years that they will go out and they'll be in a rural hospital like Berryville and Harrison.

So those physicians are trained in a rural area and they're going to be going back to that.

But but I think what's even more important is somewhere around 80% of physicians, if they receive their medical education and their graduate medical education in Arkansas, they stay in Arkansas.

So that's that's where we're optimistic that the entire state will benefit.

And in terms of retention of trained, skilled physicians, as we noted earlier, if they leave the state for a residency, the odds go up that they decide they may like Springfield, Missouri, or Tulsa.

So, you know, the numbers you see is generally around 60%, sometimes as high as 70% of physicians practice within a 50 mile radius of where that training is.

So if that training is here in Arkansas, really, like the odds are going to stay here in Arkansas.

Yeah, we have talked generally in terms of your quadrant of the state and in Washington regional anyway, is is there the prospect of expanding this program to other hospitals in the state, say, well, do you Ames Baptist System, Saint Vincent.

Yes.

And and so the program that we've done.

Without Nimble is this any way I guess with.

With this rural wage reclassification we were the first in Arkansas to take that step.

But but there are others that are following that path.

And and as I mentioned, the the help was to get the program started.

But the Medicare funding formula allows for those residents to be paid for moving forward.

So it's an upfront investment now that that that clearly has a long term payback.

Is there the maybe an off the wall questionnaire but is there existing now the clinical infrastructure to accommodate a substantial number of of residencies?

Yeah.

I mean your point's good.

You you want training in an area where there's there's good patient volume right.

Where you're seeing a lot of things in in that training.

So we've spent some time in the start up process being sure that infrastructure there, that infrastructure from classrooms, video technology.

But more importantly where will those students rotate?

Who are who are the other physicians that they will be working with?

And that is and and can be duplicated in in other areas of Arkansas.

And you're we're ready to do that.

In terms of statewide, do you think?

I do think and and I really believe the limiting factor has been the cap, the inability to have these new residents sees reimbursement moving forward.

And and so that's what's exciting.

So basically, if with additional money, it's simple as one plus one equal two with additional money, additional doctors in Arkansas, that's it.

And and what's great is it's it's one plus one equals three.

You know, not only are you getting the additional doctors in Arkansas, but there's the economic impact that comes with that, that the data shows for every new physician trained in Arkansas, there are 17 health care related jobs that comes with that.

So there's really a multiplier factor.

We've we've looked at some some economic impact data.

And we think when the 92 programs that we're working with are up and going, it's about a $62 million annual positive economic impact.

So one practicing physician.

Seven, eight, 17.

17 additional jobs.

All right, Larry Shackleford, thanks very much for coming in.

And thanks for explaining this.

Thank you.

All right.

And come back soon.

I'd like that.

And that does it for us for this week.

Thanks, as always, for joining us.

See you next week.

Support for Arkansas Week provided by the Arkansas Democrat-Gazette.

The Arkansas All Times, and Little Rock Public Radio.