Blue Shield hits resistance over vaccines
Santa Clara, other counties negotiating with state to continue with their own appointment systems
California’s plan to make insurer Blue Shield its main pipeline for the coronavirus vaccine is running into an unexpected, eleventh-hour revolt, with Santa Clara County emerging as one of the fiercest critics of the highly touted new distribution plan.
The bold move has exposed more fissures in the state’s vaccine rollout and raised questions about whether the county’s resistance could cut off its supply of the precious shots.
Late Monday, Santa Clara County Executive Jeff Smith proclaimed his county would not sign a contract to hand over control of vaccine distribution to Blue Shield. On Tuesday, County Counsel James Williams said Santa Clara is still hoping to work out an agreement with the state and is part of a group of counties negotiating to continue receiving vaccines directly and operating their own appointment systems.
Williams said he couldn’t share any details of the negotiations or which counties are in the group, beyond saying that the state has recognized their “serious concerns” and that a firm outcome is expected later this week.
Weeks into California’s sluggish start to its COVID-19
vaccination program, the state tapped Blue Shield to oversee distribution, with top officials promising the health insurance giant would streamline what until then had been a decentralized, locally controlled process. But counties balked, arguing that a lack of supply was the main problem and that the local systems they’d put time and effort into developing were better equipped to distribute the shots quickly and equitably.
Smith said during a meeting of the county’s Board of Supervisors on Tuesday he is concerned adding Blue Shield to the mix would pose a significant risk to the health and welfare of residents. It would mean forcing the county to use a new appointment system without any local control, he said. And, Smith added, he’s concerned about a private company collecting protected health information.
San Joaquin County is also participating in the negotiations. “I found our system to be much more laser-focused,” San Joaquin County Supervisor Tom Patti said during a board meeting on Tuesday.
Officials in Contra Costa County expressed their own concerns Tuesday about how Blue Shield would ensure that the most vulnerable residents are prioritized for vaccines.
“They have not provided us any meaningful detail about how the equity goals will be implemented,” Supervisor John Gioia said during a phone interview.
Gioia also echoed a criticism that Smith and some other officials have made: that it is improper for Blue Shield to oversee a program from which it draws a financial benefit: “I also think it’s a conflict of interest because they are an insurer and they have an interest for billings for the vaccinations,” Gioia said.
State officials and Blue Shield did not respond to a request for comment Tuesday. In a statement Monday, Blue Shield said it is finalizing agreements with counties that will ensure the most at-risk residents will be vaccinated.
The uproar comes as Gov. Gavin Newsom is facing a potential recall campaign and as residents, desperate for access to the vaccine, grow increasingly frustrated with the pace of the rollout. Longtime political strategist Dan Schnur said that allowing counties more control might help Newsom if local officials are in fact faster and better at getting shots into arms.
“It’s really not worth a fight,” Schnur said. “It’s only a political problem if it becomes difficult for people to get their vaccines.”
But William Padula, a professor of pharmaceutical and health economics at USC, thinks Blue Shield, with long-standing relationships across the state, has the ability to speed up the vaccine distribution process and worries that back-and-forth dialogue between the counties and state is only going to slow things down and hurt Californians.
“At this point, sending the state back to the drawing board to rethink this public-private partnership, right now all it’s doing is setting us back further,” he said.
Even as counties have resisted signing up with Blue Shield, dozens of other vaccine providers, including hospitals and pharmacies, have already done so, including Stanford Health Care and El Camino Health in Santa Clara County, Axis Community Health and La Clinica de la Raza in Alameda County, and Albertsons pharmacies in multiple locations.
Padula thinks that’s a good thing.
“I think what we’ve seen in the last year is that depending solely on governance to handle the crisis,” he said, “hasn’t gotten us to the finish line.”
One sticking point in the negotiations is whether counties should be forced to use the state’s My Turn appointment system, which has been mired in glitches and doubles the data entry requirements for vaccine providers — who would have to log information into their own systems as well as the state system.
Ultimately, the dissenting counties may have little choice but to sign up with Blue Shield if they want access to the vaccine. Williams of Santa Clara County said he’d received “mixed messages” about whether the state would cut off vaccine supply if counties failed to get in line. Mark Myles, county counsel for San Joaquin County, said he’d received assurances that the ongoing negotiations would not put limitations or “chokeholds” on the amount of vaccine flowing to his county.
Much of the Central Valley had been expected to switch to the Blue Shield plan earlier this month, with Bay Area counties following by mid-March. But just one county — Kern — had signed a contract with the company by late Monday, leaving it unclear just how much control Blue Shield currently has.
A spokeswoman for San Joaquin’s public health department said it was still receiving vaccine from the state.
Los Angeles County — the largest in the state, home to a quarter of California’s population and one of the places hit hardest by the deadly virus — said in a statement Tuesday it was continuing to “work with the state and Blue Shield to design a partnership that strengthens the existing vast and diverse network of vaccination providers and remains focused on ensuring an equitable distribution of vaccine in our hard hit communities.”