Showing posts with label Medicare. Show all posts
Showing posts with label Medicare. Show all posts

Tuesday, October 18, 2022

Stop the UFT/MLC Shilling for Corporate Healthcare/Wealthcare/Mulgrewcare Ghouls Attempt to Gut only Public Option

Medicare Advantage communications toolkit:

  • One-page handout: “The Problem with Medicare Advantage”
  • PNHP statement: “CMS Should Terminate the Medicare Advantage Program”
  • PowerPoint slides: Medicare Advantage 2022 update, developed by Dr. Ed Weisbart 
  • Podcast: “More like Medicare Disadvantage, AMIRITE?” featuring Dr. Susan Rogers
 
Today is the first in-person/hybrid UFT Retired Teacher meeting where we will get yet another propaganda feast from UFT Welfare chief Jeff Sorkin with a gaggle of sycophants echoing the Unity Caucus line --- rising healthcare costs not due to profit making corporate ghouls but because retired UFT members go to the emergency room or to doctors too much. 

Below I'm posting the Physicians for a National Healthcare Program.
But first a must read by James Eterno who breaks things down brilliantly:

MLC UNIONS HAVE A FEW OPTIONS NOW ON HEALTHCARE

If you want to see why we are in a fix on healthcare, you have to very closely read the 2019-2021 and recurring thereafter Municipal Labor Committee (umbrella group of city unions) Agreement with the City on healthcare. 

The City and MLC met their targets on savings from this Agreement for the 2019-2021 fiscal years from the last round of collective bargaining. A big part of that was forcing new employees onto HIP HMO for their first year on the job even though this is a huge violation of the UFT Contract that guarantees UFT members a choice of premium-free plans.

The City and MLC were not content to stop there but further agreed to additional healthcare savings (givebacks). Now, we are told we have to replenish the Health Stabilization Fund, a fund started back in 1983 that the City draws from. The City is always going to demand further givebacks on healthcare....Read it all
Also check out Arthur Goldstein who finally turned against the healthcare changes: 
Unity is not thinking ahead. This plan is exactly why they won this year by the lowest percentage ever, and exactly why they could lose the next election. Having dealt extensively with the major opposition party, I don't trust them as far as I can throw them. It's beyond disappointing that this is all we can muster in such a potentially vibrant and effective union. We, the UFT, are poorly informed and not remotely as active as we could be....the entire Medicare Advantage plan was abysmally planned. It lacked vision, and MLC didn't bother at all to prepare for the totally predictable outcry that ensued. Some leaders have their heads planted firmly in the sand, and are still insisting that everything is perfectly fine. However, this is a disaster, no matter how much makeup they paint over it....
The MLC Medicare Advantage Plan --- 


Physicians for a National Health Program
 

October 18, 2022

Dear colleague,

You’ve no doubt seen the ads, so I don’t need to tell you that Medicare’s open enrollment period has officially begun. Every year, commercial health insurers are allowed to chip away at our most important public health program by offering Medicare Advantage (MA) plans to America’s seniors, and this year’s enrollment period comes at an especially crucial time in our fight against the privatization of Medicare.

Projections indicate that by next year, more than half of Medicare beneficiaries will have enrolled in MA, putting the care of millions under the control of profit-seeking corporations and emboldening those who seek to hand our public programs to the private sector entirely. 

At the same time, the Direct Contracting program continues its infiltration of Traditional Medicare, as participating entities have compromised the health plans of nearly 2 million beneficiaries, often without their full knowledge or consent. Starting January 1, 2023, this program will kick into overdrive as an expanded cohort of so-called “REACH entities” is given the opportunity to “manage” seniors’ care … in exchange for hefty profits.

What’s wrong with this picture? Look no further than a recent bombshell New York Times article, which builds on PNHP’s expertise and research to expose the ugly truth: MA insurers are accused of exploiting the program to extract millions of dollars from taxpayers while denying care to their beneficiaries. Shockingly, several of these exact same companies have won approval to participate in the REACH program.

Open enrollment is the perfect opportunity for PNHP members to highlight the greed of commercial health insurers and the danger of allowing them to further infiltrate Medicare. We’re encouraging everybody to write an op-ed or letter to the editor of your local newspaper describing the dangers of Medicare Advantage, the looming threat of REACH, and the urgent need for single-payer Medicare for All.

Here are some resources to help you get started:

Medicare Advantage communications toolkit:

  • One-page handout: “The Problem with Medicare Advantage”
  • PNHP statement: “CMS Should Terminate the Medicare Advantage Program”
  • PowerPoint slides: Medicare Advantage 2022 update, developed by Dr. Ed Weisbart 
  • Podcast: “More like Medicare Disadvantage, AMIRITE?” featuring Dr. Susan Rogers
  • NYT article: “The Cash Monster Was Insatiable: How Insurers Exploited Medicare Advantage for Billions”

Medicare’s open enrollment period only lasts through Dec. 7, so now is the time to write your op-ed or letter to the editor. Consider using the following talking points when writing about this complicated issue:

  • Medicare Advantage is only able to offer low premiums and out-of-pocket caps by delaying or denying care on the back end, and by discouraging the sickest patients from enrolling.
  • Medicare Advantage allows seniors to choose their health plan, but it restricts the much more crucial choice of doctor and hospital by using narrow provider networks.
  • Commercial health insurers will never be satisfied with even their current, outrageous profits. Starting in January, the REACH program will allow many of these same companies to “manage” the care of seniors who have declined to participate in Medicare Advantage. 
  • So long as we allow profit-seekers to control our health, they will deny us care, stick us with exorbitant costs, and keep the lion’s share for themselves. The only true solution to our country’s health care problem is Medicare for All, but if we allow corporations to take over Medicare, we will never see it achieved.

If you have any questions or would like advice on your op-eds and letters, please reach out to our Communications Specialist, Gaurav Kalwani, at gaurav@pnhp.org. If writing isn’t your preferred method of engagement, consider using this toolkit as a basis for a presentation to colleagues, conversation with community members, or relationship-building exercise with local organizations. Any way we can get the message out will help move our cause forward.

At this crucial juncture, we must make our voices heard and stop the capture of Medicare by corporate profiteers. We can only do this if we all speak up, and speak as one.

Sincerely,

Susan Rogers, M.D.
President

Physicians for a National Health Program
29 E Madison St Ste 1412 | Chicago, Illinois 60602
312-782-6006 | info@pnhp.org

 

Monday, October 10, 2022

Rally Wednesday Oct. 12 Protest Changes in NYC Admin Code as NYC Firefighters Union Push New York City Council to Stop Messing with Retirees’ Healthcare

We are asking everyone who cherishes the healthcare benefits they earned to come to City Hall and let the City Council hear and see you!   Urge them NOT TO CHANGE Administrative Code 12-126 and protect us from those urging changes to a law that has protected us since 1967. We then will head down the block to UFT HQ and tell Michael Mulgrew of the UFT to keep his hands off our benefits and stop selling them for his own wages!  ....

The NYC Organization of Public Service Retirees

Here is the RALLY INFO FLYER    AND THE ISSUE FACT SHEET
 
This is a joint rally with CROC- Cross Union Organizing Committee, along with Retiree Advocate, groups that have been leading the way in the battle.
 
The Court stated that the City could not force retirees into paying an extra $191 per month if they wanted to opt out of an inferior privatized Medicare Advantage Plan they were being forced into. Since the victory was based on the NYC Administrative Code, the city is now doing an end run by trying to get the Council to change the law!
 
And our own UFT leadership is leading the way by working with the city to mess with our health plans. 
 

 
The more unions that push back the better.
 

Bravest Push New York City Council to Stop Messing with Retirees’ Healthcare

“We have a lot of retirees that are calling that are confused as to why there is a need for a law change. They are against any of these changes.” — UFA President Andy Ansbro. Photo courtesy of FDNY

By Bob Hennelly

A split within the Municipal Labor Committee over the future of the healthcare coverage for New York City’s 250,000 municipal retirees is playing out behind the scenes at the City Council over a controversial MLC proposal to change the city’s Administrative Code 12-126 that requires the City Council’s  approval. 

The MLC is the umbrella organization for scores of unions that represent over 300,000 municipal workers. The change, which would alter the existing language covering healthcare for retirees, is also supported by the city’s Office of Labor Relations and the Adams administration.

The controversy is an outgrowth of last year’s successful retiree revolt against then-Mayor Bill de Blasio and the Municipal Labor Committee’s proposal to shift retirees to a privatized Medicare Advantage program in hopes of realizing some savings.

City Hall and the MLC said the plan, branded as Retiree Health Alliance, which was going to be run by Anthem and Empire Blue Cross Blue Shield, would produce $600 million in savings with no degradation in coverage. Retired civil servants and the NYC Organization of Public Service Retirees  countered the change threatened retirees’ continuity of care, would cost more and would cover less.

Tens of thousands of city retirees opted out. One key issue was a requirement that city retirees who opted out of the new offering would have to pay a $191 monthly premium for their old plan. Subsequently,  the two health insurance companies fronting the controversial plan withdrew. 

The New York City Organization of Public Service Retirees successfully challenged  the city in court bringing the implementation of the plan to a standstill at the start of the Adam’s administration. That litigation continues. 

In his decision, Judge Lyle Frank, ruled that thanks to the city’s Administrative Code 12-126, on the books since the 1960s, the city was obliged to continue providing retirees with their healthcare without charging them a premium.

Marianne Pizzitola is a retired FDNY EMT and was a member of DC 37’s Local 2507. Pizzitola is also the president of the New York City Organization of Public Service Retirees. In a Sept. 24 op-ed in the Daily News she praised the city’s existing administrative code that guaranteed “the city would pay for a choice of health insurance plans—up to a defined dollar cap. For 55 years, every teacher, firefighter, police officer, nurse and others who served the city knew  they would have access to a health insurance plan that met their families’ needs.”

Last month, the MLC voted to ask the City Council to alter the Administrative Code 12-126 as requested by the city’s Office of Labor Relations to clear the way for the implementation of a Medicare Advantage program.

The vote was not unanimous. 

Though the MLC’s largest unions like District Council 37, the United Federation of Teachers, Teamsters Local 831 (Uniformed Sanitation-men’s Association) support the change, several unions opposed it, including the Uniformed Fire Officers Association and the Uniformed Firefighters Association. 

In a Sept. 9 letter to his members, James Davis, president of the Professional Staff Congress explained why his union opposed the change.

“The proposed change eliminates the HIP-HMO rate as the single standard for determining the City’s obligation to pay for health insurance for city employees, retirees and their dependents,” explained Davis. “Under current law, the city is required to ‘pay the entire cost of health insurance coverage for city employees, city retirees, and their dependents, not to exceed one hundred percent of the full cost of HIP-HMO…’ (NYC Administrative Code, section 12-1260.)

Harry Nespoli, chair of the MLC and the president of Teamsters Local 831 did not return a call seeking comment. 

Retirees who oppose the shift to a Medicare Advantage plan point to a recent study by the Department of Health and Human Services Inspector General  that found the plans run by for profit providers showed that the “plans  sometimes denied or delayed patients’ access to medically necessary services, even though the requests met Medicare coverage rules.”

“We have a lot of retirees that are calling that are confused as to why there is a need for a law change. They are against any of these changes,” UFA President Andy Ansbro said during a phone interview.  “They want to keep their healthcare plan the way it is and they have reached out to us demanding that we get in front of this and we have explained to them that we have been a no vote on this change and at this point it is in the City Council’s hands and if they wish to make their voice heard they have to call their City Council member and speak to them and we ask that they speak with them respectfully but just get your point across you don’t believe this law should, be changed.”

 Ansbro continued. “The down side is we don’t know what the long term consequences are. We understand the short term consequences if they feel they will be able to make their Medicare Advantage Plan legal but if the courts rule that what you are trying to do is illegal, trying to change the law is not the way to go about it. You should go back to the drawing board and come up with a plan that’s actually legal.”

“The UFOA voted no in the MLC Steering committee and again voted NO in the general membership meeting,” wrote FDNY Lieut. James McCarthy in a text. “The fight against the change in the administrative code continues on the the City Council. Our active and retired members will also be expressing their opposition to the City Council.”

“The changes proposed would allow New York City, with the approval of the majority of the MLC, to create different classes of employees in reference to health insurance,” warned a UFOA blast email to all of its members and retirees. “This change would then allow New York City to give different health insurance plans to each class. The proposal will also remove HIP HMO as the benchmark for establishing the rate that the city must pay to maintain premium free healthcare for all active and retired members. This seismic change in language MUST BE STOPPED!”

The UFOA continued. “How did we get here…. Over a year ago NYC rolled out the option of Medicare Advantage and described it as a mirror of the current Senior Care Plan. The reality was our members' benefits and access to healthcare would be diminished. Multiple lawsuits were filed, and the rollout of Medicare Advantage was delayed by the judge’s ruling. The City has appealed, and the case will be heard in October. As a result of this pending decision, the city has chosen to change the Administrative Code.”

State Senator Gustavo Rivera, chair of the Senate Health Committee, is a one of the lead sponsors of the New York Health Act which calls for establishing a single payer healthcare system that would decouple healthcare coverage from employment.

“We are at a moment where we have to take all the realities that are around us and think about how we actually solve the problems that are before us,” Rivera said. “Committing ourselves by doubling down on a system that has insurance companies at its core is exactly the wrong direction to go in. But this is exactly what’s happening with the city shifting retirees' benefits for the sake of ‘saving money’—when what you are really doing is taking away the benefits that were negotiated  for the folks that are retirees. What I am telling these retirees and everybody else, is that healthcare is a right and we should act like it.”

 

Saturday, June 25, 2022

Dems and UFT want everyone in Privatized Medicare Advantage (MulgrewCare)- Machinist Retirees Resist, Threats to Working Member HealthCare


Our leadership is willing to sacrifice our health care needs for their own narrow political ends.
 
 
That may not be such an easy sell as:
...it looks like Mulgrewcare might eventually be coming to active people. Only a judge stopped a healthcare plan that would have denied a choice of free plans for retirees. We called the inferior plan Mulgrewcare.--- James Eterno, ICEUFT Blog
This is not only a local but a national issue as a project of the Dem party since the Clinton days:
A Biden administration official in charge of the program has said they intend to have all the traditional Medicare beneficiaries in such for-profit programs by 2030..... Daily Kos
And the UFT/AFT/NYSUT anti progressive agenda is tied to Dem Center right corporatists where the health care industry pores millions of lobbying dollars.

Saturday, June 25, 2022
 
There's a lot on this plate for you to chew on. Retiree Advocate continues to work toward fighting the attempt by the city and our own beloved union to remove us from Medicare and into a higher expense MedAdv plan to save money. Someone explain how much higher expenses save money unless it comes out of services.   
 
June 30 will be a year since our big march and rally to protest MulgrewCare. Posts from June/July 2021:
Last week we had another rally at city hall. I've been trying to keep up with the story:
And James has an update:
  • ICEUFT Blog ACTIVE CITY WORKERS NEED TO WATCH OUT FOR UNIONS DISCUSSING HEALTHCARE SAVINGS - UFT Chapter Leader Update: Efforts begin to rein in health care costs. The Municipal Labor Committee, the umbrella group of nearly 100 municipal labor unions including the UFT, negotiates the health care benefits of all city workers. The top priority of the MLC and the UFT is to maintain high-quality, premium-free health care for all city workers even as costs increase year after year. The city, with the MLC’s support, issued a request for information on June 16 to let the health care industry know that the city is seeking a 10% decrease in health care costs without sacrificing any of its employees’ existing benefits
This cutout from the article on the Machinists resistance sums up the situation:
the Medicare direct contracting pilot program that Trump initiated where equity firms and insurance companies could come in and basically buy up clinics and medical facilities and move people over to that private system without having to really notify them or explain to Medicare recipients that they were now in a different system,” Lux told the members.....  there is about $1.6 trillion in the Medicare Trust Fund that these private equity firms and insurance companies are just waiting to get at—to make a profit 
While we know it's impossible that we will see Medicare for All nationally, there is the NY Health Act which both the UFT and DC 37 oppose. Why? One answer is they employ many people to handle our healthcare and those, often patronage, jobs would disappear. The other is that they can claim to members that the leadership has delivered health care and once that's out of their hands, what else can they deliver? Bupkus. So our leadership is willing to sacrifice our health care needs for their own narrow political ends.
 
It is important to connect what's happening locally with the national trend which is privatization to save money on the backs of the patients while insuring massive profits to industry. I posted a story from The Lever on how Biden is pushing privatization:
BTW - Biden has appointed a guy who wants to privatize social security too.
Reality check -- 2024 will be a disaster and will have the even more awful Rep a trifecta and a DeSantis will be a smart Trump and give us our own Viktor Orban. For me the only Dem who could have a chance is John Fetterman but given his health etc that is a dim chance. Pete or Harris? OY! We're dead.

Here are two more stories to check out: An update from the lawsuit that has stopped MulgrewCare so far and  -- this union is fighting back:

Saturday, June 18, 2022

Successful anti-MulgrewCare Rally - Politicians support including Jumaane Williams (for Gov) - Cross-union Retiree Organizing Committee (CROC)

Retiree Advocate/UFT is part of CROC --- a really good group of NYC union people -- one of the more successful broad union groups brought together by the attack on our Medicare by our own union leaders.

If you wander what UFT retiree activists do, we have noon rallies, followed by a trip to a bar. We had a great rally on Thursday outside the gates to City Hall - much bigger attendance than I expected. What surprised me the most was how many electeds support us. Jumaane Williams on the way to another event in his run for governor, lent some cheer.

Of course we went to a bar afterwards -- but our old fave on Murray St has closed down permanently but we found another.

Signatories on Open Letter to NY Elected Officials Public Advocate

Jumaane D. Williams

New York City Council Members

Kristin Richardson Jordan Christopher Marte
Sandy Nurse
Charles Barron

Kamillah Hanks Shahana Hanif Alexa Aviles Julie Won Althea Stevens Tiffany Caban Carlina Rivera Lincoln Restler

NYS Assemblymembers

Robert C. Carroll Peter J. Abbate Stacey Pheffer-Amato William Colton Demond Meeks

Jo Anne Simon Gina L. Sillitti Kenneth Zebrowski Harvey Epstein Yuh-Line Niou

NYS State Senators

Jabari Brisport

 

Old ICERs: Pat Dobosz, Sean Ahern, Ellen Fox


Bobby Greenberg on right - New Action and Retiree Advocate



 

For Immediate Release

June 16, 2022


Contact:

Sarah Shapiro, CROC

smshapiro@hotmail.com



Municipal Retirees and NYC Elected Officials Demand Mayor Adams Stop Plan to Privatize Their Medicare


Photos and Video from Rally Here 



NEW YORK- Scores of NYC retirees from diverse municipal unions of teachers, plumbers, sanitation workers, hospital workers, school staff, firefighters and others gathered at City Hall with New York City elected officials to deliver a letter to the mayor telling him to stop the “ bait and switch” with Medicare benefits – by pushing them into a for-profit Medicare Advantage plan that is more costly and more likely to delay and deny them care. 


The former city workers, members of the Cross-union Retirees Organizing Committee (CROC), shared their grave concerns about what the switch to “Medicare DisAdvantage” will have on their health as it cuts the quality of their care as private insurance companies skim off profits from the plan. 


“I have atrial fibrillation, which carries a high risk of stroke or worse. I’ve reached the limits of surgery, and the usual drugs prescribed for afib would probably kill me. I sometimes need cardioversions to stop the afib – nothing else works. My doctor, one of the top doctors in the field, knows all this. With Medicare Advantage, my fear is that decisions about my health would be made by a stranger, someone who is not an expert in the field, who doesn’t know my history, and whose main concern is cutting costs. This is genuinely life-threatening for me," said Martha Cameron, who gets Medicare through her husband, a retired computer programmer for the City for 25 years.


Retirees delivered an open letter to Mayor Adams, signed by two dozen city and state elected officials calling on him to drop his appeal in a lawsuit seeking to force the 250,000 retirees into Medicare Advantage or pay a fee to keep their traditional Medicare. 


City Council members Alexa Avilés, Christopher Marte and Kristin Richardson Jordan and Assembly members Robert C. Carroll, Harvey Epstein and Joanne Simon joined the rally with seniors to demand Mayor Adams end his court battle against the workers who had served the city for decades.


“As Medicare Advantage plans face increased scrutiny over fraudulent billing and coverage denials, now is not the time for New York City to force retirees into these privatized plans,” said Council Member Alexa Avilés. “The City is shirking their responsibility to retirees who have served it honorably and now want to live out with a sense of security and dignity.  Retirees rightfully earned their benefits through years of dedicated service. We should deliver for them, not private companies that we know put profits over people.”


In place of their trusted and excellent traditional Medicare with premium-free supplement, the mayor now wants to force them to pay $2300/year to keep the excellent Medicare they have always had and were always promised.


“Our City’s municipal retirees should not be forced onto private Medicare Advantage plans. It won’t improve their healthcare and won’t save the City money.  New York City should not be undermining Medicare and must keep its promise to City workers that they retire with dignity and security,” said Assemblymember Robert Carroll


“No one should have to choose between affording groceries, rent, other necessities,  or medical care but for thousands of workers, that is exactly the choice the City is forcing as it continues to pursue this bait and switch plan. After serving our City, municipal retirees deserve better,” said Assemblymember Harvey Epstein


“We should be expanding healthcare for New Yorkers, not making it harder to use and more expensive. Municipal retirees devoted their lives to running this city and planned on getting the Medicare plans they earned, not the inadequate substitutes that are being foisted on them,” said Assemblymember Jo Anne Simon. “I stand with the city's retirees and urge the Mayor to reject plans that provide less care but cost taxpayers more than traditional Medicare. Insurance companies siphoning off fees - money that should be used to provide care – to increase their profits is wrong-headed and just plain wrong.”


“Switching to the Medicare Advantage plan would leave our retirees overburdened and under-covered. They have spoken clearly against this change, the courts have supported them, and the Mayor ought to honor their request by dropping the appeal,” said Assemblymember Yuh-Line Niou. “Municipal retirees dedicated their lives to supporting this city, it is our duty to provide them the health care that they were promised.“


The retirees are fighting against the City’s plan to change their health benefits after years of service and dedication to this city. They say their traditional Medicare plan is much better.


“In May-- in ONE MONTH-- I had two emergency room visits and three CAT scans.  I am jumping for joy that all is well, and that I did not have to pay one cent for fantastic, immediate healthcare. WHY?  Because I have Medicare and a great supplement from the City of New York. I needed no prior authorizations and have no debt for incredibly expensive procedures.  I am lucky---but I'm here because I believe everyone should have this kind of care,” said Julie Schwartzberg, a retired staff trainer at the Health Department.

The for-profit Medicare Advantage plan is inferior, requires co-pays and dozens of prior authorizations and has a limited network of quality nationwide providers. It is also unfair to lower paid retirees with lower pensions– primarily women and retirees of color– who cannot afford to pay to keep their traditional Medicare.


Dana Simon, a retired librarian who is also visually and hearing impaired spoke of her nightmarish experience with a managed care insurance company in 2006 when her doctor recommended a 2nd cochlear implant surgery.


"The insurance company denied my surgery for almost 3 months. We had to appeal all the way to the NYS insurance commission, where three doctors finally ruled that my cochlear implant surgery was indeed necessary. But the whole ordeal took a real toll on me going through so many months of stress and heartache fighting for the medical care that I really needed. I'm afraid of the high rates of delays and denials these Medicare Advantage plans have. I don’t want to go through that again!” Simon said. 


Medicare Advantage plans are also a bad deal for taxpayers– as the profits private insurance companies siphon off raise their price tag tens of billions of dollars higher than traditional Medicare. Mayor Adams and Mayor DeBlasio before him have claimed the switch to Medicare Advantage is a cost saving measure for NYC, but the switch to a Medicare for All program like the New York Health Act would save the state billions of dollars, according to a 2018 study by the Rand Corp.

A recent federal study found that Medicare Advantage plans routinely delay or deny medically necessary care.


William Shenton, who retired from the New York City Housing Authority over 20 years ago, spoke of the ordeals he and his wife, Susan, have had with their drug coverage. 


“Susan has an incurable autoimmune disease. She purchased a private Medicare Part D drug plan for medication to treat her condition. This medication costs more than $12,000 for a 30-day supply.  Her monthly premium is about $30 and her copay is about $630 after more than $3,000 in January to get out of the “donut hole”. The NYC Medicare Advantage plan does not allow Susan to purchase a private part D drug plan. We are facing untenable expenses we hadn’t anticipated when I retired.”


The City’s plan, Medicare Advantage Plus, is administered by a consortium called the Alliance. This is made up of GHI, Emblem Blue Cross, and a national company called Anthem. Historically, Medicare Advantage corporations deny about 1 in 5 medical procedures. Anthem’s denial rate is twice the national average. 


Doctors and public health experts have raised serious concerns about the switch.

“This plan will reduce by nearly 25% the amount of money available to provide healthcare for City retirees. The City claims that the federal government will make up for what the City is not spending. That claim is false. Retirees will suffer under the City's Medicare Advantage plan,” said Leonard Rodberg, Research Director of the NY Metro Chapter of Physicians for a National Health Plan.


“Medicare (dis)Advantage places a middleman (a private health insurance company) between Medicare and the patient/doctor, resulting in denying or delaying needed health care through pre-authorization requirements” said Oliver Fein, Board Chair of Physicians for a National Health Program, New York Metro-chapter. “NYC retirees should not be forced into such an inferior plan.” 


The City Hall rally was the latest in the retirees’ campaign to stop the City from forcing them into costly lower-quality Medicare DisAdvantage.


The plan, originally approved by Mayor de Blasio, was scheduled to go into effect in phases starting in October 2021. Retirees from across the City came together to fight back and took the City to court. 


In March, a New York Supreme Court judge ruled that the City could not take away the retirees’ current traditional Medicare benefits.

Mayor Adams has taken over the push from his predecessor and is proceeding with an appeal, scheduled to be heard in the Appellate Court in September. 


###


Organizers: Cross-union Retiree Organizing Committee (CROC)













 


Hi all.
 
Sharing an op-ed from today’s NY Daily News that I authored in support of the tens of thousands of retired NYC municipal workers who are opposing a NYC-mandated effort to downgrade their medical coverage from traditional Medicare to for-profit Medicare Advantage.
 
Written in collaboration with Physicians for a National Health Program, NY Metro Chapter. PNHP is a single-issue organization that advocates for a universal, comprehensive single-payer national health program.
 
Written in memory of my life partner Ellen Bilofsky, to carry on her work.
 
 
 

image001.jpg
 
 

Reject the cruelty of Medicare Advantage, NYC

By David M. Newman
 
New York Daily News, Jun 16, 2022 at 5:00 am
 
When my wife, Ellen Bilofsky, was diagnosed in 2021 with grade 4 glioblastoma, an inoperable form of brain cancer, we understood that our remaining time together was limited. We hoped to spend it with family and friends, sharing joyful memories and making Ellen as comfortable as possible. We did not anticipate that the last six months of her life would be consumed by constant battling with our medical insurer to obtain the care that Ellen needed and deserved. This happened largely because our excellent union-negotiated, employer-provided retiree health care coverage had been downgraded from traditional public Medicare to a for-profit Medicare Advantage plan.
In one instance, Ellen’s hospital-based medical team prescribed in-patient acute rehab, and, although the rehab facility approved her admission, our Medicare Advantage Plan determined these decisions to be “medically unjustified” and denied coverage. The denial was eventually overturned — but only after significant delay and interruption in treatment, and significant effort on our part to overturn the denial.
In a second instance, as Ellen’s life neared its end, her medical and rehab teams jointly determined that therapeutic and rehab treatment were no longer effective and prescribed palliative in-patient acute hospice care. The hospice facility approved her admission, but our Medicare Advantage plan again denied coverage, claiming Ellen was not ill enough to warrant in-patient hospice care and directing that she be discharged to home. We again appealed but this time we lost and Ellen returned home, presumably to die there. Only after direct intervention by a member of Congress did the plan agree to cover in-patient acute care hospice, to which she was clearly entitled per both Medicare and Medicare Advantage guidelines. Ellen passed away a few short weeks later in August 2021, after receiving excellent care at the hospice facility.
I am sharing these examples of the pain and suffering our Medicare Advantage plan caused our family because today 250,000 New York City municipal retirees are in court fighting to protect their quality health care from a similar switch from Medicare to Medicare Advantage. I urge Mayor Adams to withdraw his court appeal and cease efforts to force this switch.
Ellen was a strong and tenacious woman and, ironically, she had been advocating for years for universal single-payer health care as a social and racial justice issue. She was a tireless advocate for Medicare for All and the New York Health Act, which guarantees health care as a human right, and which would have provided the care she needed according to her medical team’s recommendations, without interference from insurance administrators. I remind the mayor that in his previous position as Brooklyn borough president, he hosted an informational forum on the New York Health Act — a forum that, incidentally, Ellen was instrumental in helping to organize and which highlighted many of the harms caused by privatized health care.
In April, an investigation by the Office of the Inspector General of the U.S. Department of Health and Human Services confirmed that Medicare Advantage plans “sometimes delayed or denied…beneficiaries’ access to services, even though the requests met Medicare coverage rules.” It also noted that “denying requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care.”
Given Ellen’s experience and these findings, the city’s municipal retirees are right to be concerned that, under a Medicare Advantage regimen, they may suffer denied and delayed medical care. We were fortunate that a high-ranking elected official was able to secure in-patient acute hospice care for Ellen. However, it should not require congressional intervention for insurers to cover medically necessary treatment to which patients are clearly entitled.
The purported rationale for moving from traditional Medicare to Medicare Advantage is cost savings for the employer. In my case, that was a large telecommunications corporation. With regard to municipal retirees, that is the City of New York. However, recent research indicates that switching seniors to Medicare Advantage plans between 2010 and 2019 has cost Medicare in excess of $100 billion more than keeping them in original Medicare would have been. A better way to cut costs — while actually providing comprehensive coverage — would be to pass and implement the New York Health Act, which, according to one recent analysis, would save New York State $16.8 billion annually.
On Thursday, June 16, retired NYC municipal workers will join with councilmembers at City Hall to urge the mayor and city to protect retirees, retain traditional public Medicare coverage, and cancel the switch to Medicare Advantage.
Mayor Adams should stand up for quality public health care for all, and for the employees who served our city for decades. He should drop the city’s appeal to their lawsuit, restore their access to traditional Medicare, and work with New Yorkers to lower healthcare costs, remove barriers to treatment and raise the standard of care.
Newman is a resident of Flatbush, Brooklyn.