California: Tensions rise as state now insists Blue Shield will oversee vaccine distribution
The battle over who distributes California’s coronavirus vaccine grew even more tense Wednesday when the state insisted health insurer Blue Shield will play a significant role in determining how vaccines would be allocated in communities around the state, regardless of local objections.
A spokesperson for the California Department of Public Health said Wednesday that counties would not retain control over how vaccines are distributed within their borders under the state’s new, centralized vaccination system. Instead, the spokesman said, the state would determine which hospitals, clinics and other groups get vaccine supply, relying on recommendations from Blue Shield. That declaration infuriated Santa Clara County officials, who have balked at Blue Shield’s new role in distributing vac
cines and earlier in the day believed the state was backing away from forcing counties to sign vaccine contracts with Blue Shield.
“That’s a bit of a surprise,” Santa Clara County Executive Jeff Smith said late Wednesday. “But that just proves the problem, that they’re relying upon an insurance company to make recommendations about distribution that are related to populations that we normally take care of. We know where the populations are, we know who the players are, we know who the vaccinators are, and they’re going to ask a private corporation to give them advice? It’s absurd.”
Earlier this week, Smith said the county would not sign a contract to hand over control to Blue Shield, insisting it would add layers of bureaucracy to a system that was already working. Santa Clara is among a group of counties, including Los Angeles, that have rebelled against the Blue Shield plan.
In an email sent to Health Officer Dr. Sara Cody on Wednesday that was shared with other top county officials and reviewed by this news organization, a member of the Blue Shield COVID Vaccine Task Force acknowledged that the state was working on individual “memorandum of understanding” agreements in place of the contract. County officials initially took that as a signal they could maintain their key role in distribution.
“We appreciate your time and consideration, however in light of this development we ask that you please disregard the TPA contract,” the email said, referring to the contract with Blue Shield.
California asked Blue Shield to oversee vaccine distribution last month with the promise that the company would streamline the state’s decentralized process. The new program, meant to replace a patchwork of county systems, was supposed to roll out across the state by the end of March, first in the Central Valley. But counties fought back, arguing that lack of supply was the main problem and that the local systems are better equipped to equitably distribute the vaccine.
Because of supply shortages, Santa Clara County was recently forced to stop scheduling first-dose vaccine appointments and send several thousand Kaiser patients who had booked an appointment through the county back to the health care giant. County officials have expressed frustration with the state for not clearly explaining exactly how its limited supply of vaccine is allocated, leading to confusion around how many appointments they will be able to handle.
Representatives from Blue Shield referred questions about the controversy to the state but said “it remains steadfast” in its goal to help provide residents with equitable access to vaccines.
Smith initially considered the email from Blue Shield a victory for Santa Clara County.
“This means that the state realized that there was no utility in trying to force an agreement between the county and” Blue Shield, Smith said earlier Wednesday. “The county should be able to get a direct allocation from the state and get increased volume consistent with the increased volume coming to the state from the feds. And we don’t need a third-party administrator involved in any of it.”
Contra Costa County Supervisor John Gioia, a member of the Executive Committee for the California State Association of Counties, said counties’ negotiations to opt out of the Blue Shield deal were “close to final” but that it’s likely the state continues working with the insurer in some capacity.
“What the terms of that agreement will look like, I can’t tell you,” Gioia said. “Does it mean that Blue Shield is making recommendations to the state, and then the state is working directly with counties? We’ll have to see.”
Some health experts are worried the dispute could lead to more disjointed bureaucracy.
William Padula, a professor of pharmaceutical and health economics at USC, is concerned that if some counties go with Blue Shield and others stick with the state, it could create a “have and have not” situation.
“Hopefully this doesn’t create disparities between counties in terms of access to the vaccine, but it’s a concern we’ll have to look out for,” he said.
“To me, the governor’s office reaching out to an organization like Blue Shield to ask for help was a likely signal that they couldn’t handle the level of distribution themselves,” Padula added. “So they’re asking for help. I just hope these counties potentially lacking experience in this department know what they are getting into.”
Still, it has remained unclear whether and how the state could force counties to sign a contract with Blue Shield. Santa Clara County Counsel James Williams said Wednesday he had received “mixed messages” as to whether the state could curtail vaccine supply, but Mark Myles, county counsel for San Joaquin County, said he’d received assurances that the ongoing negotiations would not put “chokeholds” on the amount of vaccine flowing to his county.
As of Monday, just one county — Kern — had signed a contract with the company.