Orange County supervisors on Tuesday began their public debate about a proposed remaking of the governing board of CalOptima, the health insurance agency for low income and disabled residents, including nearly half of the county’s children.
The changes – which were put forward by supervisors Andrew Do and Lisa Bartlett – include, among other things, a guarantee that Do would have a seat on the board because his First District has the highest number of CalOptima members.
This provision brought the most pushback from Do’s colleagues on Tuesday, with supervisors Todd Spitzer and Shawn Nelson – and, later on, Bartlett – openly opposing such a guarantee.
”We don’t create mandatory positions in our board appointments,” Spitzer said, noting that the eccentric former school board member Steve Rocco has filed to run this year for Do’s First District seat. “I would never, ever, ever want” Rocco to be a representative on CalOptima.
Nelson pointed out that a future board of supervisors could include a former physician or social worker not from the First District who they’d want to appoint. “I’m concerned with sort of the mandatory language,” Nelson said.
Do, who currently serves on the CalOptima board with Bartlett, was firm that his district deserves a seat.
“Right now the First District has almost half of all of the members of CalOptima,” he said, noting that a majority of supervisors could still reverse the appointment under his proposal.
That didn’t appease Spitzer, who launched into a hypothetical scenario in which someone he doesn’t trust, like Rocco, would get elected for the First District and thereby put him in the controversial position of removing the new supervisor from CalOptima.
“I then exacerbate a situation I didn’t want to create,” Spitzer said. “I don’t want to explain to people why” I’m taking away the person they voted for.”
Do shot back that Spitzer and Nelson’s position was “anti-democracy.”
He noted that in 2007, then-Supervisor Janet Nguyen was “rejected out of hand” from serving on CalOptima, even though she represented more CalOptima members than any other supervisor.
“I think it is really, to me, anti-democracy to say that someone being elected from a district, being a majority of the people” in CalOptima “…to say that we in other districts would presumptively know best for that district,” Do said.
Bartlett then jumped in to support Spitzer and Nelson’s position, saying she wouldn’t want a guaranteed seat on the Orange County Fire Authority for her Fifth District just because it has the most cities that contract with the authority.
“I think a guarantee would not be appropriate,” Bartlett said, asking that Do’s proposed First District guarantee be deleted from the proposal.
CalOptima, which has a $3 billion budget, serves about 770,000 patients, roughly one fourth of the county’s 3.1 million residents. It’s officially a non-profit, independent public body that is funded through federal and state tax funds, with its board appointed by the county Board of Supervisors.
Other proposed changes would allow spending requests and other issues to be approved by less than a majority of the full board, something good government experts have raised concerns about. Both the current and proposed boards have a number of members with financial conflicts of interest that force them to recuse themselves on a regular basis.
Supervisors also debated a change that Bartlett introduced Tuesday, to narrow one of the board positions that was proposed to be for either a current or former hospital administrator. She wanted to take away the ability of former administrators to serve, citing “phone calls” from unspecified people conveying industry concerns.
Health care laws have changed dramatically, Bartlett said, so the concern in the industry is that CalOptima could have a former hospital executive who doesn’t know the current law. So she proposed the deletion of former hospital administrators from those who can serve on the seat.
Do countered by saying that narrowing it to just current hospital administrators increases the potential for conflicts of interest.
Bartlett’s proposal, he said, would limit the position to people “who are self interested by the virtue of their positions.” How can supervisors increase diversity when “we limit the pool of people that can serve without such conflict?” Do asked.
While other supervisors were interested in moving forward Tuesday with the first approval of the board changes, Do successfully argued for a delay. They ultimately voted to bring the issue back on Feb. 9 for more discussion and a potential first approval.
In the meantime, Do and Bartlett are slated to discuss the changes in secret through an ad-hoc committee.
One public commenter weighed in on the issue during Tuesday’s meeting. A nurses’ representative told supervisors that nurses were looking forward to the opportunity to serve on the board under the proposed changes, but have concerns about efforts to appoint “industry insiders” to the public board seat.
This was an apparent reference to recent efforts by supervisors to fill CalOptima’s “public” seat with either a newly retired lobbyist for one of the county’s largest hospital chains or a Bartlett campaign donor who recently served as the top lawyer for an Orange County hospital chain. The seat hasn’t yet been filled, amid pushback from nurses.
“We’re hoping that with this change you will continue to find people who are community members and CalOptima members” to fill that seat, said Andrew Porter of the Calfornia Nurses Association.
Supervisors also made conflicting statements about how much the board changes would affect CalOptima’s operations.
Bartlett made a point of saying the changes won’t affect the agency’s day-to-day operations. But moments later, Do said that he and Bartlett “want a more engaged board. We want a board that is independent and is involved in the day to day workings of CalOptima.”
Tracy Wood contributed reporting to this story.
Nick Gerda covers county government for Voice of OC. You can contact him at ngerda@voiceofoc.org.