Leaders of Cook County’s health system on Wednesday sought to downplay a blistering report that alleges their Medicaid health insurance business called CountyCare owes vendors, including medical providers, $701 million.

Cook County Health’s chief financial officer told county commissioners during their regular finance committee meeting that the total is actually less — around $500 million. Ekerete Akpan said the health system has $372 million in cash to pay down the backlog, and that it does indeed pay its bills.

Commissioners weren’t satisfied with Akpan’s answers.

“Well, we know that’s not the case,” Republican Commissioner Sean Morrison said. “You have vendors that haven’t been paid in 12, 16, 18 months. You have hospital systems that haven’t been paid in 12,16,18 months. So that’s not the case. The larger problem with this as well … we are oftentimes given improper or short answers that do not address the issue.”

It’s still not clear how much CountyCare actually owes vendors because some bills could be undergoing an appeal process, while other bills might never be paid. It’s also not clear how CountyCare will pay down the rest of the backlog.

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The tense back and forth at the county building downtown came on the heels of a report Cook County Inspector General Patrick Blanchard released on June 21.

Besides CountyCare’s giant IOU to doctors, hospitals and other vendors, Blanchard’s latest investigation found that the county-run health system and its CountyCare Medicaid business shift money around. Yet this isn’t fully disclosed or explained to the health system’s own independent board or to county commissioners.

Health system CEO Dr. Jay Shannon is out of town and did not attend the meeting. Akpan, the health system’s CFO, took most of the heat.

Commissioners questioned the sustainability of CountyCare and whether the health system should even be running an insurance business. They want another audit of the health system’s books. And they suggested the health system keeps them in the dark about their finances.

“This is just more, and I love this term, kabuki math,” Democratic Commissioner Jeffrey Tobolski said. “Been on the hospital since I got here eight years, saying the day is going to come when it’s going to bankrupt itself.”

He insisted that taxpayers would not bail out the health system to pay down the IOU to vendors. (The health system has not asked for that). Tobolski nodded to the short-lived county soda tax on sugary beverages that angered taxpayers so much, commissioners repealed it.

Democratic Commissioner Bridget Gainer questioned if CountyCare is sustainable.

“Not just the model, but the whole idea that the county runs an insurance program that pays for people to get care at places other than the county,” Gainer said.

Only 15% of people who have CountyCare insurance get medical care within the county health system. The rest see other doctors and hospitals that are part of the large CountyCare insurance network. That’s important, because it means the county pays other providers more than it pays itself for treating patients.

Democratic Commissioner John Daley, who runs the county board finance committee, asked county CFO Ammar Rizki how quickly an auditor could look at the health system’s books again, even though the health system just wrapped up an audit.

“The sooner the better,” Daley told Rizki. “Whatever it takes.”

The health system launched CountyCare in 2013 after the Affordable Care Act expanded who qualified for Medicaid. CountyCare insured around 317,000 people as of May, the most recent state records show.

The insurance plan, like others, is struggling with enrollment. That’s partly because of the state’s slow and burdensome Medicaid application process, health system and county leaders said.

Having lots of members is key, because the state Medicaid program pays CountyCare and other insurance companies based on enrollment.

County commissioners plan to hold a public hearing in late July to give health system leaders more time to prepare more thorough responses to Blanchard’s investigative report.

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