Many of us who either grew up in, or have lived in, Orange County for many decades remember the old county hospital just off the Santa Ana Freeway in Orange. When I served as mayor of Orange, it was always a surprise to some constituents when they learned that in the mid-1970s the county hospital was sold to the University of California, Irvine and was now the UCI Medical Center. Orange County, unlike other California counties, does not have a county hospital, and it relies on private physicians and hospitals to step up and care for patients in need. The county of Orange has been out of the business of caring for these patients for decades.
CalOptima was developed in the early 1990s, when the federal government awarded waivers for the set up of "county organized health systems," nonprofit, independent public agencies, to contract with the federal government and the state of California and administer Medi-Cal benefits.
Fast forward to 2017, and CalOptima now has a total membership of approximately 800,000 members and an annual budget of $3.4 billion. It is the state's largest COHS, and its funding is a mix of state and federal funds that come solely through the state of California. The county of Orange does not provide any funding. In fact, county documents state that the enacting ordinance in 1993 establishes that "The county is not responsible for CalOptima financial, legal and program obligations."
Due to the large amount of tax dollars being spent, the Orange County Taxpayers Association has been following CalOptima for years.
The Orange County Board of Supervisors has two responsibilities in dealing with CalOptima. Supervisors are permitted representation on, and they appoint the members of, the CalOptima Board of Directors, and this is where the trouble starts.
The Board of Supervisors has changed the composition of the CalOptima Board four times over the last six years - an unprecedented amount for a COHS. The current seated board composition was enacted less than 12 months ago, and the most recent change was voted on last week. OCTax is supportive of the current board composition that was brought forward last year by Supervisors Andre Do and Lisa Bartlett, and received unanimous support from their colleagues. This board offers stable oversight and local control, with designated seats that allow for representation from Orange County CalOptima consumer advocates, Orange County residents, Orange County medical provider representatives and Orange County supervisors. The county's own report states that this board composition "allows for more appropriate and beneficial categorical seat designations. The designations ensure an independent and well-qualified Board of Directors with the expertise, experience and skills necessary to oversee a quality health care delivery system." In layman's terms, CalOptima is a complex agency dealing with issues of great magnitude, and the board of directors needs to know what the heck they are doing. I agree.
So why is OCTax sponsoring Senate Bill 4, which would codify the current make up of the CalOptima board for five years?
It all comes down to political posturing that is risking the stability of this complex organization - and $3.4 billion of taxpayer monies.
Orange County Supervisor Andrew Do, who serves on the CalOptima board, lost his bid to become chairman of the board in early 2017. Do claimed his "ethnicity" had a role in his loss.
The Voice of OC reported: "Sources close to the situation said Do was furious when the current CalOptima board refused to name him chairman in March, and privately has been pressing other supervisors to support remaking the board." At the July 11 Orange County Board of Supervisors meeting, he introduced an ordinance to do just that. This serves as a confirmation of why the taxpayers and residents of Orange County need Senate Bill 4 to pass.
Without SB 4, county supervisors can eliminate the entire CalOptima board any time they want with a 30-day notice. SB 4 does not take away local control. Sacramento will not be the final arbitrator on who sits on the board; county supervisors will still appoint board members. In fact, SB 4 actually confirms what the supervisors themselves put into place.
The agency's $3.4 billion budget - and 800,000 lives - depend on stable, knowledgeable oversight, not political theatrics.
This Op-Ed appeared in The Orange County Register on July 22, 2017.