Wednesday, July 26, 2023

Retiree Advoate Newsletter - UFC Statement of Support for OTs/PTs, Nurses, and Audiologists: UFT Must Return Back to the Negotiating Table


                                                       July 27, 2023

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We are participating in the " Be A Hero Day of Action" along with hundreds of others around the country. We will tell the NY Senators to protect our public Medicare from Medicare Advantage millionaire CEOs whose focus is on profits over patient health. 

For generations, Medicare has been the rock solid guarantee of healthcare for seniors and people with disabilities. But now, for-profit insurance companies have used Medicare (dis)Advantage plans to line their pockets with BILLIONS of dollars by preventing patients from getting the care they need.

According to the National Bureau of Economic Research, 10,000 Medicare Advantage patients die every year because their insurance providers delay them in getting the care their doctor ordered. Recent studies have also suggested that insurance companies offering Medicare Advantage plans are overbilling the U.S. Government by 75 Billion dollars every year.

Join us on July 28th to celebrate Medicare’s 58th Birthday and encourage our NY Senators, Schumer and Gillibrand, #ReclaimMedicare from CORPORATE GREED.

List of Sponsors
CROC- Cross Union Retirees Organizing Committee
Metro NY Healthcare for All
NYPL Retirees Association
JFREJ-Jews For Racial & Economic Justice
PNHP-New York Metro Chapter 
New York Senior Action Council
Professional Staff Congress- PSC
Bring signs and water. It will be hot!

UFC Statement of Support for OTs/PTs, Nurses, and Audiologists: UFT Must Return Back to the Negotiating Table

July 25, 2023
On July 10, 2023, the American Arbitration Association (AAA) certified ratification results for the 2022-2027 UFT-DOE contracts. While most bargaining units approved their tentative agreements, one did not. Occupational and physical therapists, nurses, audiologists, nurse supervisors, and therapist supervisors, who were grouped together as one bargaining unit, voted down their contract 1,129 to 782. This bargaining unit also voted down their contract in 2018. In that case, the UFT went back to the bargaining table and came back with a new contract that included some improvements – standard procedure when a contract is voted down.

This time around, OT/PTs in particular voted down their contract in higher numbers than in 2018. However, instead of forcing the City back to the bargaining table, UFT leadership appears to be mocking the democratic process by orchestrating an unprecedented ‘revote’ campaign. This revote campaign is problematic for several reasons: (1) it denies the roughly ⅔ majority their chance to go back to the table; (2) it sets a dangerous precedent to do revotes for unpopular contracts in general (rather than organize for improvements); (3) in order to garner support for a revote, UFT leadership seems to be weaponizing their own unwillingness or inability to renegotiate with the City. For all of these reasons, our union leadership must take ‘no’ for an answer (from their members) and go back to the table. That’s how it works – plain and simple.

United for Change, a coalition of caucuses/groups including New Action, MORE, Solidarity, ICE-UFT, Retiree Advocate, and Educators of NYC, is calling on UFT leadership to cease abdicating its duty to represent the affected bargaining unit in good faith. Instead, we demand that UFT leadership work forcefully and expeditiously to pressure the city back to the bargaining table and achieve all necessary improvements to the contract in question. Our union siblings deserve better than a revote to make up for poor union leadership. They deserve better than UFT negotiators capitulating to the city by dragging their feet. 

Finally, UFC urges that all UFT members send a message to President Mulgrew and leadership that now is the time for them to do the work they were elected to do— represent the rank and file.

 Built right into the Federal Center for Medicare and Medicaid Innovation (CMMI or Innovation Center) is a system for permitting Fraud and Abuse.

July 10, 2023
Health care corporations in a Medicare privatization program set up by the Center for Medicare and Medicaid Services (CMS) are being granted fraud and abuse waivers.

The program is called the Center for Medicare and Medicaid Innovation (CMMI or Innovation Center).

Kay Tillow, who is with the group National Single Payer, came across a CMS page titled Fraud and Abuse Waivers that lists the programs that are entitled to the waivers.

Tillow says that the Affordable Care Act of 2010, among its many provisions, set up the Innovation Center within CMS to promote experimental models in Medicare that would save money while maintaining or improving quality, or that would cost the same while improving the quality of care. 

Models approved by CMS can be automatically implemented into Medicare without congressional approval.

Tillow says that the Innovation Center models are not working to accomplish the stated purposes of quality and cost savings. 
“The majority have not saved money, and several are on pace to lose billions of dollars,” reports Bill Frist, former senator and an owner of the giant hospital chain HCA. 

The majority of models do not show significant improvements in quality, says Brad Smith, former Innovation Center director.  The models are neither saving money nor improving care, but the Innovation Center has $10 billion dollars to spend each decade and keeps churning out new models.

How did you come across the fraud and abuse waivers page?

“For a period of time a number of us have been working on the privatization of Medicare,” Tillow told Corporate Crime Reporter in an interview last month. “We are concerned about that. And we are concerned about people who chose traditional Medicare being placed into Direct Contracting Entities. They were renamed ACO Reach. We were looking into the extent to which the Centers for Medicare and Medicaid Services (CMS) is actually handing over this public program to private equity, private venture capital, and big insurance companies.”

“I’ve been wandering around, exploring it, working to explain it to senior groups and other organizations to try and get a movement against this privatization. Medicare Advantage is being overpaid and is gouging the Medicare Trust Fund.” 

“I read what I can about it. And I came across a CMS web page called Fraud and Abuse Waivers. It’s an official government CMS website that lists all of these programs that are given the green light to commit fraud and abuse.”

How many programs like this are there?

“Dozens I think. I don’t know the exact number. They are part of the Center for Medicare and Medicaid Innovation (CMMI). It was born as part of the Accountable Care Act of 2010 when it was created. All of these programs are within the CMMI.” 

“That is the privatizing machine to turn over healthcare to private industry, to recreate a kind of managed care organization with middle men who make money. I don’t know if it’s all of the programs created by CMMI, but it certainly is many of them.”

What percentage of Medicare enrollees are enrolled in these programs?

“Just barely over 50 percent are in Medicare Advantage programs. Then there is another 2.2 million in ACO Reach. I think it’s probably two-thirds or so that are now in one of the privatized programs under CMS.”

But not all Medicare enrollees are in programs eligible for fraud and abuse waivers.

“No. But there is a program called Value Based Insurance Design (VBID). It’s a model under the CMMI. That program seems to have something like over nine million people in it. That program is eligible for Medicare fraud and abuse waivers.” 

“They offer so many dollars a month for groceries, which can be meaningful for someone who has a very modest income. That’s $70 or so a month. But that’s peanuts compared to the amount of money the company will make by getting you into their plan. They can make a lot of money off of each person who goes in.”

If they weren’t exempt, those companies would be liable under federal criminal laws?

“There are several laws they are exempt from. One is the anti-kickback law. One provides a monetary penalty for offering beneficiaries inducements. And then there is a self-referral law. There are several of these laws that they are being exempted from in order to proceed with their models.” 

Don’t Medicare Advantage do this all the time – offer inducements for seniors to get out of traditional Medicare and sign up with Medicare Advantage?

“The major inducement is a lower monthly payment. You can get away with a low or no premium. Because we have millions of seniors on inadequate fixed incomes, that’s all that is needed to get people to switch to Medicare Advantage.”

Is Congress taking a close look at these waivers?

“As far as I know, no one in Congress has said a word about them. I didn’t know about them until I stumbled on the waiver web page.”

“The insurance companies have a history of violation of law and paying fines and then going ahead with what they do. Those companies are being given contracts within the ACO Reach program. They are never kicked out of the CMS programs.”

The overriding drive behind all of these programs is to privatize Medicare. What portion of Medicare has been privatized?

“It’s over half. Medicare Advantage is 50 percent or so. Then all of these programs under the ACO Reach program. I would say the overall number in privatized Medicare is now probably about two-thirds. The Innovation Center has an announced objective of having all seniors into these programs, which are privatized, by 2030.”

If you were to ask the average person on the street, they would say that Republicans are into privatizing Medicare while Democrats are into defending Medicare, keeping it public. 

But here you have the Biden administration saying explicitly, if I’m understanding you correctly, that they want to privatize Medicare by 2030. 

“Yes. Elizabeth Fowler, the head of CMMI, served in the Obama administration. She was the advisor to Senator Max Baucus and she wrote the Affordable Care Act. In the Affordable Care Act, she created this Innovation Center through which the privatization is occurring. And now she is the director of it. She comes from the insurance industry. She was with Wellpoint. And then she worked on the Affordable Care Act. And then she went to Johnson & Johnson. She is an industry person and government official. And now they are the same people. That’s the problem.”

“Whether it’s Trump appointees or whether it’s Democratic appointees they are all doing the same thing, which is privatization through that Innovation Center.”

Wouldn’t most liberals be shocked to learn that Biden has someone in his administration whose explicit goal is to privatize Medicare?

“People in general don’t know or understand it. This gets complex and that’s why it becomes difficult for people within the movement to build an understanding. They never go under the names that admit what they are doing. They don’t call it privatization. They call it moving people into value based payment models. They say they are moving away from fee for service and into value based payment, that they are going to pay for quality rather than volume. And that’s their plan for how they are going to cut back on the cost.”



Why do we need a petition to request a member-wide referendum to vote on healthcare changes?  

According to the UFT Constitution, members can demand a member-wide referendum vote on any issue other than a constitutional amendment or actions on the status of an individual member.  First, ten percent of the membership must petition the UFT executive board for a referendum, and then the executive board must bring the matter to the entire body for a member-wide vote.  Given the serious nature of the healthcare changes that have been made without member input or democratic decision-making, we must take this matter into our own hands.

So sign this petition today. We deserve a say on healthcare.

Quick Facts
  • Mulgrew voted in the Municipal Labor Committee (MLC) to force retired City workers off of traditional Medicare and onto an Aetna-managed Medicare Advantage Plan (MAP). Despite knowing full well that there was significant opposition, Mulgrew denied membership the right to vote directly. 
  • Major changes to our healthcare were made as part of our citywide contracts in 2014, and again in 2018.  Mulgrew was instrumental in negotiating both. In the last healthcare agreement, in 2018, he agreed to $600 million dollars in healthcare savings for the City for every year, in perpetuity. These changes and agreements were negotiated behind closed doors without member input. UFT chapter leaders and delegates were not given Appendix A to read beforehand which delineated the healthcare concessions when they voted in support of our 2018 contract.  
  • UFT Leadership is currently working on a mysterious new health plan for in-service members that would replace GHI with something cheaper. As of now, membership will not have a say in this decision either, or given meaningful details about our potential options.
  • Even without switching us off of GHI, UFT leadership has greenlit various new, significant healthcare expenses for in-service members without a membership vote. 
For instance:
  • ER visits now cost us triple digit copays, which are waived only if a patient is admitted, even if they are deemed to need emergency care. 
  • Copays for most urgent care centers (including CityMD) have also risen to triple digits, from $15 to $100, since 2016.
  • Major providers, such as CityMD, Montefiore, and almost all radiology centers, are no longer ‘preferred,’ leading to higher copays.
  • Despite many healthcare expenses more than doubling, UFT leadership has not fought for fair increases in pay. Because we did not even attempt to stop DC37 from accepting a sub-inflation wage increase, UFT members will not only be seeing higher health costs – they’ll be taking a pay cut
Want More Answers?

From the PSC.  A very thorough list of questions and answers
Medicare Rights- Medicare Interactive
Choosing a Medigap Policy - 2023 Medicare

Consumer reports choosing a drug plan
UFT Retiree Health Care Update May 16
Advocacy and phone counselors from Medicare Rights

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