The California legislature and the Orange County Board of Supervisors are embroiled in a tug-of-war over who will oversee the county’s $3.4 billion public healthcare plan for its low-income, disabled and elderly residents, who account for one-quarter of the county’s population.

The county says the battle for authority over who sits on the CalOptima board is about increasing government oversight of the health plan and preventing the state from wresting away local control through a Senate bill.

But the Orange County Medical Association, a nonprofit that advocates for local doctors and their patients, and which is a prominent supporter of the bill, says the fight was started over one supervisor’s desire for revenge against those who recently denied him the role of chair on the healthcare system’s 9-member board.

Both sides advanced their respective positions this week.

The Board of Supervisors voted Tuesday, July 11, to increase their control of CalOptima by adding all five of its members to the health plan’s board, up from the two supervisors who currently serve.

The same day, the state’s bipartisan Assembly Health Committee unanimously approved SB4, which aims to codify the current, unchanged board makeup for CalOptima – one that gives more power to local healthcare providers and less sway to government officials. The bill is now ready to be heard on the Assembly floor. If it becomes a law, it will override the changes in Do’s proposal.

The CalOptima board – which comprises county supervisors, and appointed members of the public and medical industry – wields power by controlling which physician networks patients can use, decisions that steer billions of public dollars in the process. Supervisors who sit on the CalOptima board often receive large campaign contributions from the local medical industry.

The board also is responsible for implementing changes to federal and state healthcare laws – a duty that could present difficult choices in the near future as Congress aims to repeal and replace Obamacare.

Supervisor Andrew Do, who sits on the health plan’s board and proposed Tuesday’s overhaul, said CalOptima has nearly doubled in size to 790,000 members since Obamacare took effect and that the system now has more overlap with county services, requiring increased coordination.

“Even as recent as three years ago, the county and CalOptima functioned autonomously from each other,” Do said. “Those days are gone…. This board (of supervisors), more than ever, needs to have more oversight over one of our biggest agencies.”

Do initially asked his fellow supervisors to remove the board’s entire membership and make them reapply for their posts. But his colleagues said Do’s changes went too far and requested that the supervisors simply join the current board.

The makeup of the health plan’s board has transformed frequently in recent years, some say to the detriment of patients. Sen. Tony Mendoza (D-Artesia) said he introduced SB4 to create more stability for CalOptima and “preserve a system that is working well.”

County supervisors, including Do, last voted to change the construction of CalOptima’s board only 17 months ago.

Prior to that, in 2011, then-supervisor Janet Nguyen convinced supervisors to change the board’s constitution. Over the next few years, 16 top CalOptima executives left, the grand jury said the agency appeared “to be imploding,” the health network failed to pay for some prescriptions and emergency services, and federal agents imposed sanctions against the agency. Afterward, Supervisor Shawn Nelson blamed the trouble on Nguyen’s changes to CalOptima’s oversight. However, Nguyen, a state senator who received large campaign contributions from the medical industry while overseeing CalOptima, disputed the grand jury’s characterization and said the subsequent problems had nothing to do with the changes to the board’s makeup.

Jim Peterson, executive director of the Orange County Medical Association, said the local industry has backed Mendoza’s bill over concerns that Do wanted to shake up the CalOptima board after the supervisor was angered over being denied the role of chair in March. Peterson also said Do’s proposed overhaul of the board didn’t give enough representation to local doctors, “who are really treating patients and know best.”

“A lot of people thought that there was contemplation (by Supervisor Do) of removing some members of the CalOptima board, and that was a big concern to the provider community,” Peterson said. “We thought that was just not a very good way to have people sit on that board and make tough decisions, knowing things could be shaken up by the Board of Supervisors very quickly.”

But Do questioned Peterson’s motives for backing Mendoza’s bill, accusing the Orange County Medical Association of attempting to maintain a “majority on the CalOptima board … to directly impact their pocketbook.”

“Now they are seeking to consolidate their power on the CalOptima Board by proposing legislation in Sacramento to take away local control,” Do said.

Peterson said medical providers routinely recuse themselves from CalOptima board votes in which they have conflicts of interest.

Supervisors Todd Spitzer and Lisa Bartlett have both opposed Do’s plan, which is set for a second vote July 25.