On Wednesday, January 22nd, the following testimony by Health & Medicine’s Director of Health Equity Wesley Epplin was presented to the Health and Hospitals Committee of the Cook County Board of Commissioners about Cook County Health CEO, governance, and finances. Epplin urged the Board to choose a CEO committed to social justice and health equity with experience addressing root causes of health inequities, and to increase tax allocation to Cook County Health to ensure its fiscal sustainability and ability to fulfill its mission.

Hello.  I am Wesley Epplin and I serve as the Director of Health Equity at Health & Medicine Policy Research Group, a nonprofit focused on advancing health equity and assuring health care as a human right.

Cook County Health is at a crossroads with several big decisions before it, including choosing the next CEO.

For the CEO position, we need someone committed to social justice and health equity, who has public health experience and a track record of action on root causes of health inequities. Our CEO must be have experience in public health care, Medicaid and managed care, and working with unions.

We have a longer list of qualifications in our written testimony for consideration, but now, I want to address Cook County Health governance.

This section written only – not spoken:

CEO qualification considerations:

• Managing a large public health care system with managed care and Medicaid as central elements
• Managing contracts with a unionized workforce
• Capacity to strengthen internal policies, staff training, culture, and communications for ensuring hospitals and clinics are safe, welcoming, and affirming places to receive health care for all people
• Understanding of the links between root causes and health inequities
• Experience in and dedication to improving public health
• Commitment to social justice and health equity, with experience and a track record of action on root causes of health inequities
• Commitment to health care as a human right and the public sector’s role in ensuring people can access high-quality, affordable, accessible, and culturally responsive care
• Understanding of large managed care finances and operations
• Management of large, multi-site health system with operations that include inpatient, outpatient, public health, and correctional health components
• Demonstrated experience in a teaching medical center environment and commitment to teaching and leading in new practice models
• Demonstrated experience addressing and improving quality in a large multi-sector system

Whatever the qualifications of the new CEO, it is crucial to think about management from a team perspective, and that together, a team can cover the various necessary content expertise, competencies, and experience for successfully managing Cook County Health and CountyCare.

The Independent Board that oversees Cook County Health (Independent Board) needs to be strengthened in terms of its autonomy and ability to hold Cook County Health administrators accountable.

For one, the spirit of the open meetings act must be followed instead of small, private briefing sessions. When Independent Board members ask questions of administrators, they need to be answered, not disregarded.

We need informed public interrogation and debate regarding Cook County Health. Strengthening the power of oversight and accountability requires that the Independent Board be able to hire its own auditor and lawyer.

Of course, you all, as County Commissioners, play important roles in supporting Cook County Health.

Before making any major changes to governance or CountyCare, you need to fully diagnose the problem, and ask questions regarding reasons for the deficit.

These questions written, but not spoken:

• How much money is being lost in the operation of medical care? How much is being lost in managed care?
• Are there billing issues with regard to patients who have insurance other than CountyCare?
• Are there always sufficient cash reserves to cover bills that CountyCare needs to pay? If not, that needs to be prioritized so that other providers are paid on time.

Now, I would be remiss if I did not mention that with ACA Medicaid expansion, the County Board repeatedly and unsustainably cut the taxpayers’ subsidy for Cook County Health.

Many people remain uninsured in Cook County, with an uptick in un-insurance rates in recent years. Also, Cook County Health has large and growing uncompensated care costs.

Yes, the other local public hospital—UI Health—needs to step up, as do our nonprofit hospitals; however, Cook County Health is the public system that provides the safety net beneath the nonprofit safety net.

For more than 180 years, Cook County’s taxpayers have again and again supported our government, providing lifesaving health care for people who could not otherwise afford it and would otherwise go without. Fortunately for all of us, that remains Cook County Health’s mission.

While you consider the CEO, governance, and finances, you need to increase the tax allocation to Cook County Health to ensure its fiscal sustainability and ability to fulfill its mission. That remains a big part of your job.

Health & Medicine is dedicated to remaining a strong advocate for Cook County Health and is ready to support efforts to improve its ability to support health care as a human right.