Hennepin County commissioners were divided Tuesday over whether they needed to take more control over health care lobbying efforts, but agreed HCMC leaders need to diversify the board overseeing its safety-net hospital.

The more controversial part of the action, approved with a 4-3 vote, was the creation of two new county lobbyist positions that will advocate at the State Capitol on health care issues.

Board Chair Irene Fernando said the new positions were needed after lobbyists for the county and HCMC sent mixed signals to lawmakers during the legislative session that ended in May. Commissioners Angela Conley, Debbie Goettel and Jeffrey Lunde joined Fernando in supporting the new positions.

The change comes amid ongoing tension between the County Board and Hennepin Healthcare System, which oversees HCMC and other county clinics, and already has a lobbying staff.

The health system's bylaws say commissioners must approve all lobbying efforts. Fernando would like all hospital lobbying to be done by county employees, but commissioners do not have control over hospital staffing decisions.

This spring, county leaders were pushing the Legislature to extend the 0.15% sales tax that pays for Target Field's construction debt so it could be used for future health care needs. But in the final weeks of session, commissioners found themselves caught up in what they felt was an unnecessary fight over the governance of HCMC.

"It removes any potential for miscommunication," Lunde said of adding county lobbyists dedicated to health care.

Commissioners Kevin Anderson, Heather Edelson and Marion Greene opposed adding the new positions. They argued better communication was needed between hospital leaders and county officials, not more lobbyists.

Edelson noted it was common for safety-net hospitals across the U.S. to have their own lobbying teams because they understand and can advocate for the unique needs of those facilities.

Greene added that HCMC serves the entire state and she worried the change could diminish the hospital's ability to advocate for itself at the Capitol.

In a statement, HCMC leaders said the county and the hospital system have shared goals and they would continue to advocate for "our patients and for the resources to best serve our community as Minnesota's safety net health system and one of the state's premier level one trauma hospitals."

Call for board diversity

The vote came during a special meeting of the County Board, called to ensure commissioners could address the issue before they finalize lobbying priorities for the coming year. They also wanted Hennepin Healthcare leaders to understand commissioners' preference for the next slate of proposed appointees to the health care system's board of directors.

Commissioners unanimously backed the part of the resolution calling for the health care system's board to include representatives from its workforce and patients while better reflecting the community the hospital serves.

The Hennepin Healthcare board of directors has signaled it is open to broadening its membership, but Fernando, who has one of the commissioner seats on the board, said it has moved too slowly to implement changes. The hospital board could have as many as five vacancies that need to be filled for 2025.

Last month, Babette Apland, who led the board for less than a year, resigned after county commissioners said she made racially-charged statements about Somali immigrants and their impact on rising uncompensated care costs.

Apland apologized, saying her comments were misconstrued and she was only drawing attention to the growing needs of the community. The county's 2025 budget includes a $10 million increase in funding for uncompensated care for a total of $38 million.

County officials have been probing HCMC's finances for most of the year, an examination that began after nurses and other unionized workers raised concerns about changes to their benefits, staffing and safety. Nurses have called for the County Board to take back control of the hospital, a move commissioners have not supported.