Monday, March 6, 2023

MulgrewCare Update: LET US VOTE, Aetna Doesn't Live up to Promises, the one time "Provider Pass", Contract Tied to Healthcare savings

I'm about to leave for today's UFT retiree chapter meeting which has been sold out for attendance in person - I hear 300 for a room that holds 750 --so yes I'm suspicious that Unity has packed the meeting with its people as some of ours got shut out. Last we heard there were 7000 registered online. Retiree Advocate will be there with our LET US VOTE leaflet and other materials, including a nice RA button you can wear. And join us in a zoom on March 26:

Retiree Advocate/UFT Zoom General Meeting

Sunday, March 26th at 7pm Open to all RA members Open to all interested UFT Retirees Info:


Mulgrew keeps saying that healthcare isn’t a part of the current contract negotiations. As I pointed out last week, this is nonsense. ‘Settling healthcare’ was the only way the City would sit down with labor unions to negotiate contracts. Not only is Medicare Advantage clearly a consequence of and prerequisite to collective bargaining, it is part of a larger deal which includes sub-inflation wage increases below the mostly non-unionized U.S. average. Healthcare for in-service members is also due for worrisome changes in cost savings, which could include service changes or increased costs borne by employees. This is all unacceptable. As rank-and-file members are threatened with lawsuits by their own UFT leadership for having the audacity to organize for more, our union officers merely manage decline.... Nick Bacon, New Action blog
Mulgrew lies. And it shows his desperation to get this Aetna deal done because he know no Aetna, no contract. Which explains his meltdown at the MLC steering committee meeting on Thursday when his opposition to tabling a March 9 final vote lost by one vote and he had to call in a non-attendee to call in a vote, creating a tie that was broken by the chair. Pretty desperate. James has the story on the ICE blog:
Mulgrew brags about improvements in preauthorizations and other improvements with the Aetna plan vs the original Emblem. Aetna doesn't have a reputation for always living up to what they promise. I received this from a contact:
Hi.  I am apprehensive about this Aetna plan as described by Mulgrew.  Putnam- Westchester school union accepted Aetna Medicare Advantage about 5 years ago.  We were assured that there would be minimal changes and that all decisions were open to appeal.  Slowly, requirements for prior authorization were installed. Medications were placed on tiers with only the generic accepted automatically.  Medications one had taken for years now had large payment requirements.  Just THIS YEAR they ceased allowing 90 day prescriptions.  Now only 1 month are allowed which means if one gets a 90 prescription, the charge us tripled.  Doctors who not accept Medicare are not required to inform patients and so if you get a new doctor, then YOU have to ask the question.  Otherwise, you will have to make up the 20 percent payment.  There is no benefit to Medicare Advantage!
 ---- a long-time Medicare counselor.
Sure, let's trust Aetna on their promises. I imagine they will live up to most of them for the first few years to help protect Mulgrew and Unity Caucus in upcoming elections (Retiree chapter in spring of 2024 and general election in spring of 2025.)
I will be 80 then and looking forward to increasing pre-authorizations. 
Then there is the one-time provider pass - we call it the get out of jail card.

Provider Pass What happens if you are taken by surprise at a doctor’s office and your doctor accepts Medicare but refuses to accept the Aetna Medicare Advantage PPO plan? You have a one-time opportunity to use Provider Pass right then and there. Call Aetna’s special number from your doctor’s office. Aetna will get on the phone with the provider and make a one-time payment of the bill right then so you can keep your appointment for that day. Your call will also prompt Aetna’s member services team to call the provider's office to educate them about how the plan works and how they can join the network or bill Aetna directly. Aetna will then reach out to you and tell you how that conversation went. If the doctor continues to refuse to bill Aetna directly, Aetna will either help you find another provider or you can continue to see the doctor but you will have to pay the doctor’s bill upfront and then submit the bill to Aetna for reimbursement.

Can you imagine standing in the doctor's office calling the special number and no one picks up? And one time only. Should I use it for a broken finger or wait for my one time only chance when I get cancer? Can we sell our one time only pass on E-Bay? Can we buy multiple passes from others?

The other day I called a new doctor who took the place of my ENT doc who retired and they told me she wasn't in the medicare system yet - I'd have to pay up front and go to collect from my own insurance. I want the seamless system I've had for the past 13 years. So I went elsewhere. So here is what Mulgrew claims on docs:

Let’s talk… doctors Making sure you can continue to see the doctors you know and trust is extremely important to us. The proposed Aetna plan is a Preferred Provider Organization (PPO) plan that is custom-built to give our Medicare-eligible retirees maximum choice when it comes to selecting their health care providers. Aetna has an extensive network of doctors and hospitals both in New York City and nationwide. Both Memorial Sloan Kettering and the Hospital for Special Surgery are in network. You do not need a referral to see a specialist. Because it is a PPO plan, you can see any doctor or hospital even if they are not in Aetna’s network (as long as they accept Medicare and accept payment from Aetna). An out-of-network provider will be reimbursed at the Medicare allowable rate, just like they are today, if they bill Aetna directly.
Yes we've seen over the past two years just how much trust is important to Mulgrew who tried to force us into an obviously inferior plan and it was only the resistance that made them try to get a better one -- and I'm not convinced they did even with the claims.

Like they say they won't even reach out to doctors until the plan is passed. And of course we don't get to vote since Mulgrew claimed he was elected to make decisions and elections have consequences. 

But did we know that the election of Mulgrew meant possible death panels?

Here are latest excerpts from the key bloggers:

Arthur: Mulgrew Is Doing It Again

[Mulgrew] did it to save money for Eric Adams. His 2018 deal leaves him beholden to Eric Adams. Adams is supposed to be our adversary in negotiations, but the President of our union is out there aggressively representing his interests instead of ours.

At a recent meeting with retirees, Mulgrew claimed the push to repeal 12-126 was not about removing the minimum the city was required to spend on health care. But if you examine what it says, and the proposed change, that is precisely what it was about. Mulgrew claimed it was all about giving us choice--the choice to pay for the care we have expected, cost-free, for all our careers.  

Mulgrew then blamed the activists who blocked this for making things worse. You'll be hearing a lot of that. Activists, in fact, were doing what union is supposed to do, what Mulgrew is paid to do--working to improve the lot of working people.

When Mulgrew presented the 2018 health care deal to the Delegate Assembly, he said it was a smart deal to avoid premiums for in-service members. How smart is it to give something forever and get something for three years?

Mulgrew failed to point out that, to achieve this, we'd need to throw retirees under the bus. He said there would be no additional copays, but we all know copays have risen by as much as 100%, and in the case of urgent care, 200% to almost 700%.  Mulgrew told us there would be no extreme changes, but dumping Medicare for every retiree is pretty extreme.

What does he plan for in-service members? My bet is we don't hear about it until after the next contract.

Michael Mulgrew will tell anyone who will listen that this is a fabulous deal, but he said the same thing last year about the previous deal. He said, in fact, that every doctor who took Medicare would accept the last plan he tried to shove down our throats. He then clarified, saying not every doctor who took Medicare would take it. 

Mulgrew now says they've fixed the issues with the previous deal. Given that he's misrepresented this deal at every turn, how can we believe him? And, as Jonathan points out, these issues were not really the problem. The problem was that nobody wanted this deal to begin with.

 Nick: UFT/MLC to Greenlight MAP Nuclear Option

Medicare Advantage has arrived in New York, handing over eviction papers to traditional Medicare in the process. UFT bureaucrats are already informing retired members that the plan is imminent. By September, 2023, barring a win from opposition, it’s all but certain that UFT retirees will be ripped off of GHI Senior Care and thrown onto Aetna’s privatized MAP plan. Here are the plan details. Here is a somewhat sugar-coated comparison with Senior Care (it doesn’t even mention prior authorizations). And here is the same thing but for the prescription rider.

All that is left is for the papers to be signed. The MLC vote is scheduled for March 9,

Mulgrew has made it clear that neither retirees nor in-service members will have a say in how he votes. Indeed, sources suggest that he is steamrolling the plan through MLC steering, forcing the vote to happen before other union leaders have their questions answered.

Mulgrew will need to do two seemingly contradictory things to retain a semblance of consent from membership as he attempts to obliterate our healthcare: (1) sell MAP as equal to or ‘better’ than traditional Medicare; and (2) blame others for its implementation, particularly as the only available retiree healthcare plan (other than HIP VIP – another MAP plan).

The Sell Job

While the so-called ‘Coney Plan’ is a slight improvement over what we would have seen in the last go-around, it does nothing to address the more major concerns of municipal workers and retirees. There are still prior authorizations, copays, more limited networks, and the nagging problem of participating in the privatization/destruction of a public good for short term gain. To make the pill easier to swallow, some of the costs in the plan (like the deductible) are temporarily waived and some prices (e.g. the prescription drug plan) are cheaper in 2023 than in 2024. Perks galore are also mentioned on page 5 of the comparison chart to sweeten the deal. Some of the perks, like the fitness benefit, I don’t see swaying retirees.

Halabi: The Problem Was the Plan, Not the Details

UFT retirees did not like Mulgrew’s Medicare Advantage plan in the Spring of 2021. Now he is announcing a new Medicare Advantage plan. Details have changed. But it is still Medicare Advantage.

The problem was Medicare Advantage, not the details.

Mulgrew did nibble around the edges. There are many more preauthorizations under his second Medicare Advantage plan than there are today, but fewer than under his first Medicare Advantage plan (which Unity told us was fine). More doctors will take this one, but not as many as today. There’s a workaround for some denials – a workaround that is not necessary today.

Better than his first try. That’s true.

In fact, in the days leading to the announcement, more thoughtful Unity people were advising retirees to wait to see the details. And some of the details, it turned out, were at least somewhat improved.

But we all know what’s wrong. It’s a Medicare Advantage plan. Privatized Health Care. While our current plan is fine. Many retirees, probably most, will not be ok with this.

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