The Orange County Board of Supervisors is set to vote Tuesday on a plan to expand the size of the CalOptima board of directors and significantly alter its membership.

The plan, which has been proposed by Supervisor Janet Nguyen, a harsh critic of the current CalOptima board, would give the county administration and the healthcare industry significantly more control over the county’s $1.3-billion health program for the poor.

As it stands now, Nguyen’s plan would increase the size of the CalOptima board from its current nine members to 11 and give permanent seats to representatives from hospitals, doctors and someone either from a health network or from an independent doctors group.

In broad terms, Nguyen has criticized the current CalOptima board for lack of transparency and for approving bonuses to high-level executives while hiking copays for the program’s clients.

But she has yet to offer any specific reasons for such significant changes, nor has the county produced any comprehensive studies or reports on the program. For example, the county staff report advocating the changes is only five paragraphs long.

“There’s got to be a reason for it, and the reason has to be somebody is unhappy with the current board and wants to change it,” said longtime California government watchdog Robert Stern. “Obviously it’s important to know where does it come from?”

It is clear that the proposed changes are business friendly.

One permanent seat would go to someone from business, possibly in the health care industry. Another that is designated for a member of the public could be filled by an industry representative, according to the way Nguyen worded her proposed ordinance.

In addition, Nguyen’s plan would give three seats to county government. Currently, a member of the supervisors sits on the board as does the head of the county Health Care Agency. Nguyen would add the director of the Social Services Agency.

The three remaining seats would go to either someone who uses the CalOptima services or a nonprofit or community clinic that serves them.

Health industry lobbyists, including the hospitals, have argued they deserve permanent seats on the board, in part because other health organizations in California have them.

But CalOptima is far larger than most of the state’s other health organizations, and no one has done a comparison study to determine which system is best.

Nguyen created a political firestorm in October with a surprise item on the board agenda to remake the CalOptima board and give herself a permanent seat.

Following a long-standing board policy, supervisors asked Nguyen to do her own study and report back.

Nguyen held a two-hour public meeting in which industry representatives — hospitals, clinics, doctors and networks — all said they deserved a permanent seat on the board.

And last month the Board of Supervisors was given a presentation on how CalOptima works by David Riley, director of the Health Care Agency.

Board Chairman Bill Campbell said Monday it’s the practice of the board to ask the supervisor who raises questions to do his or her own report.

“That’s the way it’s always been done in the nine years I’ve been on the board,” said Campbell.

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