Orange County Supervisors unanimously approved an ordinance Tuesday that would change the make-up of the Board of Directors for CalOptima, the county's health insurance plan for low-income and disabled residents.
This is the second time in five years that supervisors have made significant changes to CalOptima's Board, which they say will increase oversight by seeking directors with expertise who can be more engaged in the agency's day-to-day operations.
Major changes include reducing the size of the board from 11 members to nine, removing current Chair Mark Refowitz, head of the county Health Care Agency, as a voting member, and possibly increasing the pool of medical industry professionals who could serve to include pharmacists or nurses.
Noticeably absent, however, was a proposal to guarantee a seat on the board to the supervisorial district with the most CalOptima members -- which would have ensured First District Supervisor Andrew Do, whose district has half of all CalOptima members, would have a seat on the future board.
Do received pushback at the last supervisors' meeting from colleagues who objected to creating a guaranteed seat on boards or commissions for any supervisor.
Do's predecessor and former boss, state Sen. Janet Nguyen, also attempted in 2011 to reserve a seat on the CalOptima board for the First District. Later that year Nguyen worked with a lobbyist for the Hospital Association of Southern California to pass an ordinance that significantly restructured CalOptima's board.
Supervisors approved the ordinance on Tuesday with no discussion. After the meeting, Supervisor Todd Spitzer said the new ordinance would result in a more engaged board.
"I spent six months of my life [at CalOptima] when we were under federal and state sanctions," Spitzer said. "If these changes result in a more proactive board, that's exactly what we want."
Under the new ordinance, existing board members will be replaced when the new rules take effect in August, although current members can reapply.
Other proposed changes include:
- Offering up to $300 per month plus mileage to members for attending meetings. The two Supervisors and non-voting Health Care Agency director who sit on the board would not receive the payments.
- Reducing the number of community clinic seats on the board from two to one.
- Potentially replacing one of the two doctors now on the board with a nurse, pharmacist or other medical professional.
- Allowing a family member of a CalOptima member to hold the board seat reserved for a member. Children make up more than 43 percent of CalOptima patients.
Board Chairwoman Lisa Bartlett and Do, who both currently sit on CalOptima's board and authored the new ordinance as part of a closed-door ad hoc committee, say the changes will attract health industry professionals who can ensure CalOptima is delivering quality care for its nearly 773,000 patients.
Bartlett and Do did not return requests for comment.
But two former CalOptima Board members who left the board 2012 after Nguyen's restructuring are skeptical.
Former board member Jim McAleer said the changes made to CalOptima's board in 2011 tipped the balance of leadership toward the hospital industry and providers.
"I have zero problem with the hospital industry, but the providers have their own interests at heart and the consumer has its own interests," McAleer said. "The last time this ordinance was changed, it took a great deal of decision-making power further away from consumers and placed them in the hand of providers. My fear is this one does not correct that."
He is, however, in favor of a provision in the new ordinance that allows a family member to serve on the board, a change that McAleer, whose son was adopted through the county and was a CalOptima member until he was 18, had advocated for.
"Anyone who gets services should have a say on how their children are managed…there are members who might have mental retardation who might have difficulty accessing government — but whose parents can," McAleer said. "I'm glad they made that change."
Former Board Chairman Ed Kacic agreed with McAleer and believes the board's membership should be one-half consumer advocates and one-half providers. Kacic was not convinced that the ordinance, which expands who is eligible to serve on the board, will greatly affect the board's policy direction unless the county also changes to how members are nominated and selected.
Currently, nominees are reviewed by a panel of five, which includes two supervisors, before going to all five supervisors for approval. The new ordinance broadens authority for the chair of the Board of Supervisors to appoint people to that selection panel.
Kacic noted that many of those who were concerned about the latest changes to CalOptima's board did not publicly oppose the plan or attend supervisors' meetings because they felt it would be politically futile.
"I think people who are against the changes feel they don't have the ability to cause change to happen, anyway," Kacic said.
Although supervisors once shied away from the CalOptima appointment, those seats have attracted campaign donations from healthcare industry special interests.
In the nine months after she began restructuring CalOptima's board in 2011, Nguyen raised about $50,000 in campaign contributions from the medical industry.
Bartlett’s 2014 campaign consultant, Jeff Corless, became the county lobbyist last year for the politically active Integrated Healthcare Holdings Inc. (IHHI) hospital chain, which recently was taken over by a firm owned by one of its largest investors and had its name changed to KPC Group.
Corless said he stopped working for Bartlett in December, 2014, and didn't begin working for KPC until early 2015.
KPC gave Bartlett the maximum $1,900; and its CEO, Suzanne Richards donated another $1,900 to Bartlett. Corless' firm, Venture Strategic Inc., was repaid $40,000 last year that Bartlett's owed him for 2014 campaign work.
Through a spokesman, she said Corless had no involvement with the CalOptima ordinance change.
Do has raised at least $39,000 in 2014 from people and groups in medical industry – including the Monarch HealthCare doctors network, local hospital owner Prime Healthcare, and many doctors and pharmacists.
Correction: A previous version of this story said Corless did campaign work for Bartlett in 2015. Voice of OC regrets the error.
Voice of OC reporters Tracy Wood and Nick Gerda also contributed to this story.
Contact Thy Vo at email@example.com or follow her on Twitter @thyanhvo.