Now watch UFT staff start appearing at your schools to sell the program and convicne you to accept a deal where you get a raise but use a chunk of it to pay more for your healthcare.
The Facts Michael Mulgrew, UFT, Doesn’t Want You to Know
1. UFT Claim: Mulgrew stated they did not borrow from the Stabilization Fund causing our current health care crisis.
Truth: The Stabilization Fund has been improperly used. It’s been used as a piggy bank to offset City expenses which had not been budgeted. Two examples: in 2009, an ongoing, annual payment of $112M was agreed to, primarily to reduce layoffs. In 2014, a one-time $1 billion payment was made to NYC from the Stabilization Fund to largely pay for UFT raises.
2. UFT Claim: The UFT “fact sheet” claims that the City is spending $11.8 billion in FY 2023 on health care expenses.
Truth: Facts matter: the City’s adopted budget shows healthcare expenses of $7.8 billion. We are not trying to hide the fact that healthcare is expensive, and no one is against trying to find savings. But we need to start with accurate numbers.
3. UFT Claim: “Mulgrew stated “...not a single health care benefit was either lost or diminished during that three-year period as a result of these cost-saving measures.”
Truth: Benefit changes including deductibles, copays and increased prior authorizations were added to the plan. These are diminished benefits. This year they are removing Montefiore from the preferred network adding co-pays, and narrowing the network for imaging and urgent care. All new City hires are automatically forced into the HIP HMO. That may be a prudent way for the City to save on health insurance costs, but it is a diminution of benefits.
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UFT Claim: Mulgrew stated Medicare Advantage (MA) offers the same benefits as Traditional Medicare.
Truth: Medicare Advantage is nothing like traditional Medicare, while the same medical conditions are covered, Medicare Advantage has two main differences: far fewer doctors participate in Medicare Advantage plans; and doctors and their patients have to endure the bureaucratic hurdles – and proven dangers – of prior authorization. Placing a private insurance company – making medical decisions – between the doctor and her patient is a fundamental difference.
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UFT Claim: Mulgrew states his “custom” MA plan is the only PPO MA plan.
Truth: There are lots of PPO Medicare Advantage plans offered by many different insurance companies. Period.
6. UFT Claim: Mulgrew says, “The New York City Medicare Advantage Plus Plan, negotiated by the MLC, was a totally new, unprecedented version of Medicare Advantage that was ONLY for New York City municipal retirees and their families.”
Truth: It is not a unique plan and it is not even a particularly good Medicare Advantage plan. The only true parts of the statement is that it was negotiated by the MLC; and it was “only for New York City municipal retirees and their families.” DUH.: the MLC is not about to negotiate on behalf of teachers in Dubuque.
7. UFT Claim: Mulgrew says, “This new plan negotiated by the MLC and the city was, in fact, a Medicare program. We were able to access federal funding because it is a public program.”
Truth: Medicare Advantage is a public-private partnership: Federal money that goes to a private insurance company. By forcing people out of their traditional Medicare-and-Supplemental insurance program that retirees have enjoyed and relied upon for more than 50 years, the City was attempting to relieve itself of the cost and shifting it to the Federal government. But you get what you pay for: Medicare Advantage is a fundamentally inferior program compared to traditional Medicare. It is nothing more than a budgetary gimmick on the backs of retirees.
8. UFT Claim: Mulgrew says, “The new plan was a custom, large-group version of Medicare Advantage developed for New York City municipal employees only. It was modeled after GHI SeniorCare and was filled with features that made it the same or better than current GHI SeniorCare but at lower cost to the city.”
Truth: The new Medicare Advantage plan is nothing – absolutely nothing – like traditional Medicare plus SeniorCare. Traditional Medicare does not have prior authorization restrictions; the proposed Medicare Advantage plan had over 100 categories of tests and procedures that will limit retirees’ access to health care. Virtually all doctors accept traditional Medicare. Hundreds of New York area doctors said they were not going to accept this plan. And for retirees living outside of the New York area, their access to participating doctors was going to be even more restricted.
9. UFT Claim: Mulgrew stated, “A state judge’s recent ruling illuminated an issue with a part of the administrative code (Section 12 -126) that allows for a dangerous interpretation. The judge said the administrative code required the city to only offer premium-free plans.”
Truth: The Court said no such thing. The City and unions argued that should be the interpretation of 12-126, and the Court rejected it. The Court said that if the City included a plan in its range of offerings, the City had to pay up to the defined price cap.
10. UFT Claim: Mulgrew said that if the Court accepted the retirees’ (winning) interpretation, such a mandate would eliminate the MLC's and the city's authority to offer multiple health care plans, since the “city and the MLC would be unable to absorb the cost of multiple premium-free plans.”
Truth: That makes no sense. The Court’s order made clear that the City must pay for plans offered by the City up to the statutory cap: the price of the HIP-HMO.
11. UFT Claim: Mulgrew stated, “Without this change in code, the city may choose to save costs by offering only one health care option that isn’t up to our standards.”
Truth: In the 1992 Health Agreement, the City is obligated to negotiate all aspects of health care with the MLC. The City cannot get rid of these choices of plans unless the MLC agrees to it. Retirees live all over the country and require plans that include their local doctors and hospitals. One size does not fit all.
What is prior authorization?
Prior authorization is a health plan cost-control process that requires physicians and other health care professionals to obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.
What experts are saying about prior authorization
In today’s physician practice, the prior authorization process is typically manual and time consuming, diverting valuable resources away from patient care. In addition, prior authorization can delay treatment and impact optimal patient health outcomes.
Fixing prior authorization is a core element of the AMA Recovery Plan for America’s Physicians. The AMA works to right-size prior authorization through advocacy efforts and significant research focused on physician concerns over patient care delays, administrative costs and workflow disruptions.
Prior authorization impacts quality patient care
AMA research shows that prior authorization is a barrier to providing timely, patient-centered care. According to the AMA’s annual prior authorization physician survey (PDF), among physicians surveyed:
- 91% reported that prior authorization can lead to negative clinical outcomes
- 82% said prior authorization can lead to patients abandoning their course of treatment
- 34% said prior authorization has led to a serious adverse event for a patient in their care
In the June 16, 2022, episode of the “AMA Thriving in Private Practice” podcast, prior authorization expert Heather McComas, AMA director of administrative simplification initiatives, notes that from this survey, “An overwhelming majority of physicians, 93%, indicated that prior authorization can delay access to medically necessary care. And this just isn't about making people wait or inconveniencing them. It actually has negative impacts on their health.”
Prior authorization woes can also extend to employers. While health insurers tout prior authorization as a cost-saving measure, the AMA survey also found that it can lead to absenteeism and a less productive workforce.
Prior authorization is an administrative burden
Prior authorization costs valuable time for physicians and health care staff. AMA’s prior authorization physician survey reports that physicians complete an average of 41 prior authorizations per physician per week–this workload translates to almost two business days of physician and staff time.
McComas notes, “it's also disturbing to note that 40% of physicians indicated that they have hired practice staff just to do prior authorization. Again, we're adding a lot of administrative costs to our health care system just to do paperwork.”
AMA offers tips to help physicians reduce the prior authorization burden in their practice (PDF), and strongly advocates for health plans to offer automated, streamlined processes.
Momentum to fix prior authorization is building
AMA continues to fight excessive and unnecessary prior authorization through reform initiatives underway at both the state and federal levels. In addition, the AMA adopts policies to minimize the current impact of prior authorization on practices.
In a June 27, 2022, AMA Moving Medicine video update, Rep. Suzan DelBene (D-WA) discusses a current bipartisan legislative effort, the “Improving Seniors’ Timely Access to Care Act,” that would help reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors.
“The bill would establish an electronic prior authorization process,” says DelBene, “so we can be speedy about getting information exchange. It would require HHS to establish a process for real-time decisions for items and services that are routinely approved. Again, there's no reason for something that's routinely approved to be delayed.”
Prior authorization efforts at the state level
AMA is committed to fix prior authorization by working with state legislators and medical societies to remove insurance company interference in the timely delivery of patient care.
As the demand and need for such reforms continues to grow, the AMA has created a model bill (PDF) and related issue brief (PDF) that medical societies can use to begin efforts to address prior authorization in state legislative processes.
Explore other AMA resources on prior authorization
Learn more about AMA’s grassroots advocacy campaign on prior authorization reform at FixPriorAuth.org. The FixPriorAuth campaign also includes a call to action. Other key AMA prior authorization resources include:
- Prior authorization reform initiatives
- Prior authorization reform resources
- Prior authorization practice resources
- Prior authorization research & reports
- AMA Journal of Ethics: Should Clinicians Be Activists?
- AMA Ed Hub™:
- Administrative Burden and Costs of Prior Authorizations in a Dermatology Department: Interview with Aaron M. Secrest, MD, PhD, author of Administrative Burden and Costs of Prior Authorizations in a Dermatology Department
- “Refocusing Medication Prior Authorization on Its Intended Purpose”
- “Administrative Burden and Costs of Prior Authorizations in a Dermatology Department”
Reviewed by: Heather McComas, director, administrative simplification initiatives, and Emily Carroll, senior legislative attorney, Advocacy Resource Center
Reviewed on: July 12, 2022
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