California’s plan to make the Blue Shield insurance company its primary coronavirus vaccine channel is facing an unexpected 11-hour uprising, with Santa Clara County emerging as one of the fiercest critics of the highly praised new distribution scheme.
The bold move exposed more cracks in the vaccine’s launch in the state and raised questions about whether the county’s resistance could cut off the supply of precious vaccines.
Last Monday, Santa Clara County executive Jeff Smith proclaimed that his county would not sign a contract to hand over control of vaccine distribution to Blue Shield. On Tuesday, county counselor James Williams said Santa Clara still hopes to reach an agreement with the state and is part of a group of counties that negotiates to continue receiving vaccines directly and operating their own scheduling systems.
Williams said he would not be able to share any details of the negotiations or which counties are in the group, and said the state acknowledged its “serious concerns” and that a firm result is expected later this week.
Weeks after the slow start of California’s COVID-19 vaccination program, the state hired Blue Shield to oversee distribution, with senior officials promising that the health insurance giant would streamline what had hitherto been a decentralized and locally controlled process . But counties hesitated, arguing that a lack of supply was the main problem and that the local systems that they invested time and effort in development were better equipped to distribute shots quickly and equitably.
Smith said during a meeting of the county council of supervisors on Tuesday that he is concerned that adding Blue Shield to the mix would pose a significant risk to the health and well-being of residents. That would mean forcing the county to use a new nomination system without any local control, he said. And, added Smith, he is concerned about a private company that collects protected health information.
San Joaquin County is also participating in the negotiations. “I thought our system was much more focused on the laser,” said San Joaquin County supervisor Tom Patti, during a council meeting on Tuesday.
Authorities in Contra Costa County expressed their own concerns on Tuesday about how Blue Shield would ensure that the most vulnerable residents were prioritized for vaccines.
“They have not provided us with any significant details on how the equity goals will be implemented,” said supervisor John Gioia during a telephone interview.
Gioia also echoed a criticism that Smith and some other employees made: that it is inappropriate for Blue Shield to oversee a program from which it derives a financial benefit: vaccines, ”said Gioia.
State officials and Blue Shield did not respond to a request for comment on Tuesday. In a statement on Monday, Blue Shield said it is finalizing agreements with counties that will ensure that most at-risk residents are vaccinated.
The uproar comes when Governor Gavin Newsom faces a potential recall campaign and residents, desperate for access to the vaccine, are increasingly frustrated by the pace of the launch. Longtime political strategist Dan Schnur said that allowing counties more control can help Newsom if local officials are indeed quicker and better at firing weapons.
“It really isn’t worth fighting for,” said Schnur. “It is just a political problem if it becomes difficult for people to get the vaccines.”
But William Padula, professor of pharmaceutical economics and health at the University of Southern California, thinks that Blue Shield, with longstanding relationships across the state, has the ability to accelerate the vaccine distribution process and is concerned with dialogue between the counties and state will only slow things down and hurt Californians.
“At this point, sending the state back to the drawing board to rethink this public-private partnership, now all it is doing is delaying us further,” he said.
Even though counties are resisting enrolling in 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 various locations.
Padula thinks this is a good thing.
“I think what we saw last year is that relying solely on governance to deal with the crisis,” he said, “has not taken us to the finish line.”
A difficult point in the negotiations is whether counties should be forced to use the state’s My Turn naming system, which is mired in failures and doubles data entry requirements for vaccine providers – who would have to record information in their own systems , as well as the state system.
Ultimately, dissident counties may have little choice but to sign up for Blue Shield if they want access to the vaccine. Williams, of Santa Clara County, said he received “mixed messages” about whether the state would cut off vaccine supplies if counties were unable to get in line. Mark Myles, a San Joaquin County councilor, said he had received assurances that ongoing negotiations would not place limitations or “bottlenecks” on the amount of vaccine sent to his county.
Much of Central Valley was expected to switch to the Blue Shield plan earlier this month, with Bay Area counties following in mid-March. But only one county – Kern – signed a contract with the company late Monday, making it unclear how much control Blue Shield currently has.
A San Joaquin public health department spokeswoman said she was still receiving the state’s vaccine.
Los Angeles County – the largest in the state, where a quarter of the population of California lives and one of the places most affected by the deadly virus – said in a statement on Tuesday that it continues “working with the state and Blue Shield to create a partnership that strengthens the vast and diverse existing network of vaccination providers and remains focused on ensuring equitable distribution of the vaccine in our hard-hit communities. “
Joseph Geha and Dan Borenstein contributed to the report.