Cook County commissioners took the first step Wednesday to give themselves more control over the board of the financially struggling, county-run health system.

The health system, known as Cook County Health, is an anchor for uninsured patients. It’s on track to provide nearly $600 million in medical care this year that it won’t get paid for, and that’s giving county leaders heartburn.

During a downtown board meeting Wednesday, commissioners unanimously approved changes to the existing ordinance that established the health system, despite pushback from some Chicago non-profit organizations that help nominate members to the health system board.

“This ordinance removes what small fig leaves may still exist that allows us to pretend that we have an independent board,” said Dr. Linda Rae Murray with the nonprofit Health & Medicine Policy Research Group.

A former physician at Cook County Heath, Murray called for a blue ribbon committee to help save a system she said is “in danger of collapsing and dying.” She said that could impact other hospitals the county owes money to.

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Democrat Alma Anaya was the lone commissioner to vote “present.” Two commissioners were absent. The remaining 14 commissioners approved the proposed ordinance changes.

Anaya said she supported the spirit of the changes, but that they don’t get to the root cause of problems at Cook County Health, including its finances.

Commissioners are scheduled to cast a final vote on Thursday.

The changes include giving commissioners – not the health system’s own board – the final say on who becomes the system’s CEO and how much that person is paid. Cook County Board President Toni Preckwinkle would gain the right to directly appoint an additional person to the health system board, increasing the number of board members to 12. The ordinance changes also would require the health system to share proposed budget figures with county financial leaders before presenting them to their own board.

How a plan for more power gained steam

Preckwinkle first pitched her plan in January to have more sweeping power over the health system board. The health system is one of the largest public health systems in the nation, and is the biggest medical safety net for the poor and uninsured in Cook County. The system has two hospitals, a network of clinics and a Medicaid health insurance plan that covers more than 300,000 low-income and disabled people.

Preckwinkle sought more control because she said she wanted more transparency, accountability and communication from health system leaders.

It’s been a rocky year. The system board ousted CEO Dr. Jay Shannon a few months ago. Now the board is conducting a national search to replace him.

Among the biggest hurdles is how to address the rising amount of medical care Cook County Health provides without getting paid for it. The tab is expected to reach nearly $600 million this year.

Preckwinkle has said that amount of so-called uncompensated care is what scares her the most about the 2020 budget. The health system is a critical part of the county’s financial stability, making up nearly half of its $6.2 billion budget.

To cut costs, Dr. Shannon eliminated hundreds of vacant jobs heading into 2020. The health system also is putting projects on hold, including building a new Provident Hospital on the South Side.

A health system roiling

Since Preckwinkle unveiled her proposed changes last month, Cook County Health has lost its top financial officer, too, and the health system has hired a company to help come up with financial strategies.

The changes are watered down a bit since Preckwinkle first pitched them. Among those no longer on the table, she sought to pick the health system board chairman every year, instead of having the health system board members pick their own leader.

The health system board has pushed back on these proposed changes, saying they weaken the board’s power and effectively make them an advisory body.

Commissioners created the health system board in 2008 to get away from too much downtown political influence and to turn around the system’s precarious finances.

Before they voted Wednesday, commissioners said it was a good time to review an ordinance created more than a decade ago. They hoped the changes would increase transparency from the health system board, especially regarding Cook County Health’s finances.

Democratic Commissioner Larry Suffredin, who helped create the health system board, said the changes were “not a takeover. It is a consultation. It is understanding so that this board and our taxpayers, who are the guarantors, will have a better understanding on a daily basis what is happening in the hospital system.”

Still, not everyone was swayed. Laurence Msall is president of the Civic Federation, a nonprofit that watchdogs local government finances, including Cook County’s. He said the organization supported the creation of the health system board. But he said the proposed changes go too far, particularly giving the county board final say over who becomes Cook County Health’s CEO.

“This provision goes to the heart of the authority of an independent board and would make it more difficult to attract a top-notch CEO,” Msall said.

He added that the changes do not solve the health system’s problems, such as its financial woes.

Several health system board members attended the meeting Wednesday, including board chairman Hill Hammock. But none testified about the changes.

After the commissioners voted, Hammock issued a statement.

“We look forward to working with the President’s Office and the County Board to strengthen the health system and protect its mission to care for all regardless of income, insurance or immigration status,” Hammock wrote.

Kristen Schorsch covers Cook County politics for WBEZ. Follow her @kschorsch.