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Keep the Cook County Health board independent
Toni Preckwinkle's proposed changes would fundamentally weaken the authority, independence and legitimacy of the board.

Sunday, February 16, 2020
Crain's Chicago Business
by Don V. Villar Laurence Msall

Keep the Cook County Health board independent

Toni Preckwinkle's proposed changes would fundamentally weaken the authority, independence and legitimacy of the board.

Don V. Villar

Laurence Msall

Margie Schaps

On Feb. 26, the Cook County Board of Commissioners will consider legislation introduced by County Board President Toni Preckwinkle that would shift significant control of Cook County Health from the health system’s independent Board of Directors back to the County Board of Commissioners and the County Board President.

The Board of Commissioners should reconsider several aspects of the legislation, including the County Board’s final say over the hiring of the next and future CEOs and the County Board President’s ability—rather than the independent health board—to name the health system board’s chair.

For more than a decade, an independent board of knowledgeable and committed volunteers has provided oversight of the health system and has proven to be capable of navigating an increasingly complex system through difficult financial and political times. The health system continues to face major financial difficulties, including unexpected growth in charity care. However, neither of the aforementioned changes would fundamentally address these challenges—and are likely to exacerbate them. Similarly, adding another director to the health system board—a county employee directly appointed by the County Board President—will not lead to better decisions or improved reporting by the system board.

Before the creation of the independent board, the system was plagued with poor management and inadequate oversight by the County Board. Decision-making, including hiring, was dominated by political considerations, and critics said the management structure bred patronage and incompetence.

Due to poor record-keeping, the health system often failed to collect payment from insured patients or those who could afford to pay. In 2007, $130 million in unpaid bills were found stuffed into storage boxes. At the time, U.S. Senator Dick Durbin said the health system would have to make reforms, or else the Illinois delegation would no longer advocate for federal funding.

Under the leadership of the independent board, the health system has significantly modernized and professionalized, leading to improvements in charging and billing patients. The independent board has attracted and hired world-class executives, who have worked to build the largest Medicaid managed care organization in the county.

The proposed governance changes fundamentally strip away the independence of the health system’s board of directors and would render the health system board an advisory board rather than a governance board. In order to maintain independence and legitimacy, the health system board must be able to name its chair and must be able to hire future CEOs.

Recruiting knowledgeable volunteers to spend significant amounts of time overseeing the system will only be more difficult if the health system board has no actual authority. Creating confusion as to which board the new CEO will be accountable to could deter world-class talent and may put the health system’s hard-won financial and governance gains in jeopardy.

We urge the Cook County Board of Commissioners to reconsider those aspects of the proposed legislation that would fundamentally weaken the authority, independence and legitimacy of the Cook County Health Board of Directors.

Don V. Villar is Secretary-Treasurer, Chicago Federation of Labor
Laurence Msall is President, the Civic Federation
Margie Schaps is Executive Director, Health & Medicine Policy Research Group



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