City Council Healthcare Hearing Update - Links to Video, Exposing UFT Leadership hypocrisy, And Much more

The City Council hearing on Monday went very well.  We filled the Council chamber with about 250 retirees, plus we had about 300 people outside chanting, "Let us in!"  Our government liaisons were able to get the retirees into 250 Broadway so they were warm and could hear the hearing.  As people left the chamber, retirees were permitted to come across the street to the chamber to testify.

We had retirees testifying until 9 pm!  We were heard.    We were also blessed to have Wendell Potter testify with us.  Wendell, is a nationally known whistleblower in the insurance industry.  Here is his newsletter about the hearing.  

The hearing lasted almost 12  hours long.    If you want to watch the full testimony of the day click here.  VIDEO.  ....NY

Monday, Jan. 16, 2022

 

I just checked out the VIDEO of the hearing - it's 12 hours of drama that would make a mint on Netfix. I got to go near the end at 9:54 -9:57 -  But also check out the woman before me - Laura I think her name is - called Mulgrew and crew out and out liars. Her husband has cancer and told her to say don't change the code - fight them. They're trying to privatize like you wouldn't believe and they are watching us - and that code is protecting us and if we let them do it here it opens everything up for them -- truly a wonderful speech. And UFT Ex Bd member Ibeth Mejia who came over from the UFT Exec Bd meeting with us speaks right after me - find other ways to save money. Mulgrew by zoom is around 4:30. Marianne panel follows them at 4:40 and goes on till 5:40 as she is questioned intensely and holds her own. Renowned critic of Medicare Adv Wendell Potter is also part of her panel. If you want a full picture, check out that segment. 

 

I got some pretty good responses to my 2 minutes, plus phone calls and emails from people I hadn't heard from in a while.

I've been trying to write this report of what happened last Monday at the NYC City Council Healthcare issue for a week but kept getting tangled up with the constant flow of information and the report grew and grew until it became totally unwieldy. So I'm starting over.

 

I reported the morning of Jan. 9 as I was watching the hearing from home and writing my testimony:  

• Monday MulgrewCare/RandiCare Update - City Council Hearings ARE ON -- Big crowd outside moved to overflow room - You can live stream.

I left off as I was about to leave to catch the ferry into the hearing and had just sent in my written testimony at around 12:30. I got there around 2:30 and had to go through various checkpoints - the first policeman told me the hearing was over and to go to 250 Broadway -- so I went there and was told they were about to bring down the people from the overflow room so I should go back. I went through 3 different police who all asked me what I was there for: I came to help save yours and my health insurance - and they all laughed and knew exactly what I was talking about and were supportive.

 

So I came in as Marianne was testifying and filled out a form to get on the speaker list. I was told I was at the end and around 5:15 I left to go to the UFT Ex Bd where I had a delicious meal of pork and potatoes --- oh, yeah, some other shit happened worth reporting. I have a few words to say about the Jan.11 UFT ex bd (the good, the bad, the ugly about Unity actions) but will do that in a separate post - you can catch up with James and Nick reports on Jan. 9 EB:

• ICEUFT Blog: MULGREWCARE FALLS FLAT AT CITY COUNCIL HEARING; NURSES STRIKE IN NYC; UNITY HELPS ELECT ICE-SOLIDARITY'S LULI RODRIGUEZ TO VACANT HS EXEC BD SEAT 

• New Action – UFT Who actually needs time to read a contract anyways? – Executive Board Meeting, 1-9-2023 -

As the Ex Bd was ending around 7:15 I received texts from Jonathan and my friend Shelly in San Diego telling me my name had been called, so I went back to the council and pretty much got to speak almost immediately. A bunch of us from Retiree Advocate left together. Some had been there since 8 AM.

James has a weekend update from Marianne who also appeared on Daniel and Leonie's WBAI program Sunday night with an email update:

• The latest email from the New York City Organization of Public Service Retirees:  They are advising us to be patient. The most important paragraph from the email: We have asked you all to NOT call City Council.  We are allowing them to absorb this week quietly, and we will advise you to our strategy next week.   Monday is a holiday, and we will be in meetings on Tuesday.  We will advise you of our next steps soon.   In the meantime, look back on all we accomplished together!   You wanted to be heard, and boy did they hear you!   Things are looking good...  just give us a few days..  Be hopeful!   WE ARE!  
  

• ICEUFT Blog: NYC RETIREE ORGANIZATION ADVISES PATIENCE FOR NOW; MARIANNE ON WBAI WITH DANIEL SUNDAY AT 7:00 PM -

 

Jonathan also has a few words: JD2718 A Healthcare Week - a pretty full healthcare week.

 

Stories kept breaking all week. We are prepping for a Jan, 19 rally if a vote comes up but that is still in flux.

A biggie on Jan. 12 was another loss for the city and Mulgrew with the judge ruling on co-payments:

• More Bad News for Mulgrewcare - An Injunction for Copayments for Senior Care

Even funnier was Mulgrew's attempts to take credit for the ruling after he was instrumental in inserting co-payments and bragging about doing so. Does Mulgrew have a memory issue where he forgets what he says ten minutes before? James has the funny take with Marianne's video mocking Mulgrew:

Even funnier than funnier was Mulgrew's own retirees trashing MedicareAdv and pleading in their testimony arguing they desparately want the option of not being forced in MedAdv by the actions of their own union leadership - arguing both for and against the UFT position. They testify at 6:30 point.

• Republicans, UFT/AFT Hate Medicare - but not always - Unity at City Council Hearings Beg to Keep Medicare as their caucus tries to take it away

 Arthur did a piece on the same issue destroying the leaderhip. 

• NYC Educator - UFT Leadership Wants to Preserve Choice (for Those Who Can Afford It) -

 MORE News and links:

Left/Right Coalition at Council:

Don't discount the significance of right wing Republicans and Democratic Socialists coming together, a story that might stimulate national interest: 

You know your for-profit, privatized Medicare Advantage health insurance plan really sucks when right-wing Republicans and left-wing Democrats actually unite to defeat its imposition on municipal retirees. 

DamnYankee @HowardNybx Jan 10

Medicare Advantage has been exposed as a vehicle to enrich for-profit insurance. You don't hear the truth on corporate MSM. You get the truth, unvarnished on Work-Bites https://www.work-bites.com/view-all/in-nyc-theyre-lining-up-left-amp-right-to-defeat-medicare-advantage

The 9AM press conference  

There will be blood - er Lawsuits - UFT Leadership Joyful as Crooked - er Biased Arbitrator Scheinman Issues 25 day Ultimatum: Sign with Profit making Aetna (owned by CVS) and change Admin code or Medicare Disadvantage here we come

MULGREW EMAIL SHOWS ROUND TWO PUSH FOR MULGREWCARE (PRIVATIZED MEDICARE ADVANTAGE) IS UNDERWAY... ICE Blog

 Initial Analysis from a Retiree Advocate member on today Scheinman ruling

It looks like he's trying to establish the status quo ante, from before the lawsuit. It's a crass ploy to pressure the City Council to amend the Code. 

• He's ordering the City & MLC to reach an agreement with Aetna, within 25 days, to administer the old Alliance plan. 
• He's threatening that if the City Council doesn't amend the Code within 45 days he will end Emblem Senior Care.
• He will allow the City to offer other options to retirees, as long as there is no cost to the City.
• In the above case, retirees would pay the full cost of any other City plan we chose (so we would presumably still receive our Medicare Part B reimbursements if we chose a City plan). Would the City's offerings include a Medigap plan? I don't know.
• Which is exactly where we were before Judge Frank's ruling.

It seems to me that Scheinman is threatening to do some things that he might not have the power to do, which will result in lawsuits. By the way, Scheinman is the one who is threatening our collective bargaining rights, not Judge Frank....

Let's be clear -- Mulgrew et al is moving us out of a publicly managed option into this private corp monster where profits come before our health. 

CVS Plans $10 Billion Share Buyback - Bloomberg.com

CVS Health: Signify As Growth Catalyst, 8% Buyback Yield, And Cheaply Valued

Dec. 08, 2022 4:26 AM ETCVS Health Corporation (CVS)

 CVS Health is a healthcare company known for its CVS Pharmacy. In addition to CVS Pharmacy, CVS Health owns CVS Caremark and Aetna, among others.

Third quarter 2022 results were strong. During the quarter, revenues increased 10%, free cash flow increased 73%, and earnings per share increased 9%.

Analysts on the Seeking Alpha CVS ticker page expect the dividend to grow 5% for fiscal 2023 and fiscal 2024.

Check quick: Does Scheinman own stock in CVS because this can be a $38 billion windfall?

• when Unity was hard-selling this deal, in an unexplained rush, they clearly said there were no health care give backs. And then they did not provide Appendix B.
• Appendix B is about health care cuts.... Jonathan Halabi, Was 2018 the Worst Bad Deal Ever?

Can you tell me how there are no conflicts here when the #arbitrator who is supposed to be #neutral is having dinner poolside with the lawyer for the

@UFT

@TeamstersJC16

#local731HarryNespoli, the #MLC

@EmblemHealth

@HenryGarrido17

??

 

The arbitrator also said that unless the City Council amends the New York City Administrative Code within 45 days, GHI SeniorCare and all other current “pay-up” plans will no longer be offered once the premium‑free Medicare Advantage plan launches.

So here we are ---- either chance the admin code so the wealthier retirees can pay to opt out, thus furthering inequity, or being forced into MedAdv run by Aetna -- note Scheinmann forces them to deal with Aetna. See my opening question.

 

Let's look at CVS/Aetna as a profit making company:

2017 - Aetna Doubles Dividend, Boosts Stock Buyback Plans- Insurer’s moves come days after walking away from $34 billion merger deal with Humana

Aetna was bought by CVS in 2018. Amazon shark jaws are open:

 

Here's a fun fact: 

 

CVS Health is the parent company of the health insurer Aetna, which Amazon has reportedly reached out to, among other insurers. The move suggests that Amazon is moving along with Amazon Care — its on-demand health service that has at-home care aspirations — quicker than what may have been expected.

 

Will my Walgreen's prescriptions still be allowed?

 

CVS turned Amazon down  - for now -- but when can we look forward to having our healthcare managed by Jeff Bezos?

The American Medical Association (AMA) was disappointed in DOJ’s decision, standing by its stance that the merger will harm patients. “We now urge the DOJ and state antitrust enforcers to monitor the postmerger effects of the Aetna acquisition by CVS Health on highly concentrated markets in pharmaceutical benefit management services, health insurance, retail pharmacy and specialty pharmacy,” AMA President Barbara L. McAneny, M.D., said in a statement.

 

Karen S. Lynch President and Chief Executive Officer	Total Cash $7,045,167	Total Compensation $20,388,412
Shawn M. Guertin Executive Vice President and Chief Financial Officer	Total Cash $4,323,636	Total Compensation $14,339,230

 

Average CVS Health Executive Director yearly pay in the United States is approximately $187,259, which is 133% above the national average.   See more https://www1.salary.com/CVS-HEALTH-CORP-Executive-Salaries.html

 

Nice pay - go ask the clerks at your local CVS what they make.

Here's the good news: 

 

 

 

 

 

 

Mulgrew buddy, so-called "impartial" arbitrator Scheinman, should immediately disqualified. The UFT chose him in 2014 and 2018. 

 

The UFT statement below dovetails with the Scheinman decision.

UFT: For Immediate Release – Thursday, December 15, 2022

UFT Statement on Arbitrator’s Decision on new Medicare Advantage program

An independent arbitrator has ordered the city to negotiate a new Medicare Advantage program with the Aetna insurance company in the next 25 days.  He also determined that if an agreement is reached, the city’s unions would have a choice of either approving the deal or facing the necessity of paying premiums for health care.

UFT President Michael Mulgrew said:  “In the last decade the cost of health care has been rising dramatically and over the long term only action by the federal government can solve this national crisis.”

“In the meantime, the municipal unions have been negotiating with the city on how to preserve our health care benefits.  Most importantly, we want to maintain plans that do not require our members to pay the thousands of out-of-pocket dollars that most workers now typically have to pay for health insurance.”

“A new Medicare Advantage plan will be  negotiated to keep that premium-free status, and we will make sure that it meets our retirees’ needs, even while saving hundreds of millions of dollars that will be dedicated to other health care services.”

Arbitrator Martin F. Scheinman issued his findings December 15, 2022.  Scheinman, who played a key role in city/union health agreements in 2014 and 2018, has been appointed by the parties to arbitrate any potential disagreements over interpretation of the pact and to enforce its provisions. Scheinman also chairs the Tripartite Health Insurance Policy Committee, consisting of the city and the MLC, which was formed in 2018 to consider how city health care could be restructured to preserve quality while stemming the rising cost of its delivery.

A copy of the full decision is here: https://www.uft.org/sites/default/files/attachments/Dec15-healthcare-arbitration.pdf

(Scheinman's conclusions start at page 28)

 

More excerpts from Jonathan:

Was 2018 the Worst Bad Deal Ever?

Here’s the link to the MOA: https://www.uft.org/files/attachments/secure/moa-2018.pdf

Appendix B, as you might guess, is not attached.

In fact, when Unity was hard-selling this deal, in an unexplained rush, they clearly said there were no health care give backs. And then they did not provide Appendix B. James found it. But because the leadership hid it, and most members rely on the leadership for their information, there is no way of knowing how many of those who voted yes on the contract knew there were givebacks. Probably very few, in light of Unity’s brazen lies. Arthur provides a good summary of the Unity rush to get the 2018 contract passed without revealing the health care give backs.

Appendix B is a letter. Here’s a link to the whole of Appendix B (4 pages).

So, we already know, agreeing to cutting health care is a bad deal. But worst deal ever? Let’s look at 1.a, and focus on 1.a.iv

First, a reminder: “savings” are savings for the City of New York and the Stabilization Fund. “Savings” for you and me mean less health care, harder to access health care, or more costly health care.

So Appendix B is about health care cuts.

Let’s focus on line iv. $600 million per yer – on a recurring basis. That means, even though that contract is over, the health care cuts need to continue forward. And worse. Any fool knows, health care costs are going up. So whatever cuts were good enough to amount to $600 mil a year ago, they are not enough today. Unity has put us on the hook for never ending cuts in health care. That’s what makes this perhaps the worst negotiated deal, ever.

Our contract is expired. But the health care cuts continue.

The health care cuts are permanent.

And Appendix B promises more cuts every year that health care costs rise.

 

More from Mulgrew:

You have my promise that the UFT will not move forward with the new plan until we have agreed on a high-quality plan our retirees deserve.

Where we go from here

During the next 25 days, we will push Aetna hard on these fronts:

increase the size of its provider network in parts of the United States where large numbers of UFT retirees live with the goal of getting 98% of the doctors that UFT retirees use in Aeta’s network. ensure that out-of-network doctors who provide services to our retirees are reimbursed by Aetna at the traditional Medicare rate without our retirees being billed. create a real accountability system that ensures that Aetna delivers all rights and benefits to retirees as agreed upon in the agreement; and set up a clear, fast process to rectify any issues. ensure there is an expedited appeals process for denial of care where specialists in the particular field/procedure make the final determination. ensure every retiree, regardless of pre-existing conditions, is accepted in the new plan.

Municipal Labor Committee

Outrage Grows at Mulgrew Healthcare Blackmail pitting working members ($1500 a year) against retirees (forced MedAdv) - Beats Putin to Use of Nuclear Option -

We deserve better from our leadership. ...There is no victory in that email. It's the job of leadership to better our lot, not march us off a cliff. MLC and UFT leadership need to work toward a better solution, or stand down for someone who will..... Arthur Goldstein, NYC Educator

These are pretty bold words from Arthur (I post his entire brilliant blog post below), who supported the leadership and ran on the Unity slate in the election last May. Not a good sign for Mulgrew. I also got a call from an active Unity Caucus member who was not happy either. Also not a good sign for Mulgrew as Unity frays a bit at the edges. Some insiders also not happy with the increasing ineptitude.

 

Sunday, October 30, 2022 - Erev Halloween

 

The municipal union healthcare issue blew up Saturday evening as news of Mulgrew's outrageous threats (see below) of an either or: working UFT members will pay a $1500 yearly healthcare premium or retirees will be forced into Medicare advantage like it or not with no opt out choice. A few choice comments:

What a scam this is - the unions and the mayor have come up with this piece of blackmail to get everyone on board to pass the bill before the city council. The UFT has no limit to their perfidy. ... UFT Retiree - Brooklyn 

The nuclear option is invoked! It's retirees versus in-service employees! Tell the City Council to pass the amendment! Let us screw you over so we can all be protected from Mulgrew's criminally negligent incompetence: The shitty deal he agreed to in 2018! It's a dystopian nightmare.... UFT Retiree

The Mulgrew letter reads as an ultimatum from the city, as if the union reps on the MLC have no option to say NO. James points out that it's all bullshit because 1992 MLC CITY AGREEMENT SAYS MLC UNIONS MUST AGREE TO HEALTHCARE GIVEBACKS

Interpret "must" as there can be no changes UNLESS they agree --

It is understood and agreed that the parties will continue to bargain over and determine by mutual agreement the terms and conditions of employee health benefits.

"Determine by mutual agreement" is strong language that prohibits the City from unilaterally changing anything. It looks like Mulgrew's sole motive in changing the Administrative Code is to save the City money on our backs with givebacks on healthcare. Any change would also do away with our contractual right in Article 3G1 to a choice of premium free healthcare plans..... ICEUFT Blog, MULGREW'S LATEST EMAIL ASKS IF WE WANT HEALTHCARE GIVEBACKS FOR RETIREES OR ACTIVE MEMBERS

Unfortunately MLC and the city are partners so expect MLC to agree to something no matter what Mulgrew is saying about resisting. UFT members have no representation at the MLC while Mayor Adams has the key unions on his side. He is putting his eggs inside changing the admin code which would allow the city to offer retirees the opting of spending $5k a year extra per couple to keep what we have.

Mulgrew saves City a Billion on healthcare - out of our pockets, Restrictions on ER visits can cost lives

The escalating cost of health insurance, prescription drugs and medical care across the country has created a national crisis. Hospitals and drug companies are charging increasingly exorbitant amounts... Michael Mulgrew in UFT FAQ. (See it debunked -The Facts Michael Mulgrew, UFT, Doesn’t Want You to know.)

But of course Mulgrew insists we must make up for these high costs out of our pockets not by really using the leverage a quarter million city union retirees hold. Want to see them hold prices in check? Unions instead of opposing the NY Health Act support it which would threaten the very existence of private health insurers.

Another way is to pressure Medicare to be more vigilant - see the article below

Mulgrew says healthcare costs are going up but ignores the reasons (stock buybacks, high ex salaries, advertising (Joe Namath ads), gouging Medicare) and wants us to pay claiming "savings" coming from our co-pays and other charges - the goal is to dis-incentivize us from using services like the ER. You feel sick and would normally go to the ER but maybe not so sure you want to pay $100 so maybe you wait to get a little sicker. Maybe you wait just a little too long.... UFT Death Panels?

 

 

 

Jonathan Halabi has a series of blogs that expose UFT so-called healthcare - or unhealthycare. People running the union view his posts as doing the most harm to them of all the bloggers. Here are some excerpts from each post but go read them all.

 

MedicareAdv restictions can kill

This about a guy who was diagnosed with pancreatic cancer and had to move fast tells the tale of many Medicare Disadvantage programs compared to traditional Medicare.

Preauthorizations – a cautionary tale

October 23, 2022 

... the oncologist frowned. Unfortunately, the scan couldn’t be scheduled for 3 or 4 weeks. “We’re not the problem...We have to get approval from your insurance. We’ll submit it, they’ll reject it. There’s a lot of back and forth.” Barry was puzzled. …“Just to be clear,” he said, “I’m not in Medicare Advantage. I have regular Medicare with a supplemental.” The oncologist’s “whole demeanor changed.” … The frown became a smile. “Well then, we can go a lot faster,” he was told.

He follows up with:   

Prior Authorization: Who saves? Who loses? October 24, 

Who saves?

• The City
• The Stabilization Fund
• Michael Mulgrew
• The Insurance Companies

Who pays?

• Soon? Retirees. (unless we stop them)
• Eventually? All of us.
• (and the federal government)

Mulgrew raises copays; Bronx gets hit

Do you know what health care savings are? They (insurance companies, Michael Mulgrew, the New York Times) call it savings when 1) you think about going to the doctor, and decide not to and 2) when you pay more (and they pay less) for your visits.

So what do they call it when your copay goes from $50 to $100? Or from $0 to $30? That’s right – the MLC and the UFT leadership call that SAVINGS. Doesn’t feel like savings when it costs me more. How about you?

More on the New Emblem (GHI) Copays

We are talking MRIs, CAT scans, PET scans, NMR, and other stuff. Copays in network were $50. But the City and the MLC and Mulgrew and the Insurance companies found a cost savings. (Cost savings mean you get less medical care, or you have a harder time accessing medical care, or you have to pay more out of pocket for medical care. “Cost Savings” is short for “Cost Savings for them, at our expense”)

In any case, the way they are going to charge us more is by declaring everyone to be out of network, with double the copay ($100 instead of $50).

Did the UFT make an announcement about copay increases?

October 27, 2022 

Maybe I missed it? I have been writing about the increase in GHI (now Emblem) copays, for Montefiore, and for MRIs, CTs, and other scans.

I have pointed out that the notice from Emblem came AFTER the changes went into effect. I have also pointed out that the notice from the UFT NEVER CAME. I searched my mail. I searched my email. Could I have missed it? Please readers, tell me if I have. But I don’t think so.

Tuesday at a UFT meeting two UFT officers indicated this was the first they had heard of it, and that they had not seen it in writing. This is a change to copays for the insurance (Emblem, used to be GHI) that most high school teachers have.

Yesterday I got an email over Mulgrew’s name about healthcare – I read carefully to see if they snuck in a mention of the new copays. Nope. Mulgrew and friends just decided not to tell us about the new copays. Let Emblem do it. Or let the members find out when they get a surprise charge at the doctors office. This, by the way, is tried and true Unity strategy. When they have bad news, hide it.

 Here is an article covering the pushback by retirees:

 

 

Aiming to reset the debate over the future of the healthcare provided retired New York City civil servants, the president of the largest municipal union insists he wants the City Council to change the city’s administrative code — not to force retirees into a controversial Medicare Advantage Plan as critics claim — but to preserve all city unions’ collective bargaining rights. 

On an Oct. 20 virtual press call, Michael Mulgrew, president of the 200,000 member United Federation of Teachers, told reporters that New York State Judge Lyle Frank’s ruling last October “undid 40 years of collective bargaining” and that while an appeal is still pending, the City Council needs to revise the administrative code to preserve the unions’ ability to offer a myriad of healthcare plans to the city’s 200,000 retirees.

Complete article: https://portside.org/2022-10-27/uft-prez-doubles-down-medicare-advantage-push-face-fierce-opposition

 And one more. While we support Medicare, we don't support the lax admin when it comes to fraud. People at the top of MC often move back and forth between govt and industry. If we want to save money let's keep an eye on the corrupt ball.

Medicare Rights: CMS to Release Audit Findings on Overpayments to Medicare Advantage Plans 

• By Lindsey Copeland
• October 27, 2022

https://www.medicarerights.org/medicare-watch/2022/10/27/cms-to-release-audit-findings-on-overpayments-to-medicare-advantage-plans

The Facts Michael Mulgrew, UFT, Doesn’t Want You to Know - Marianne - NYC Org of Public Service Retirees

The UFT, showing signs of panic on the healthcare issue, sent out an FAQ to chapter leaders trying to 'splain themselves. Last night I was on a zoom with people from the NYC Organization of Public Service Retirees - the group behind the lawsuit, parsing the Mulgrew FAQ which some have termed pure bullshit. I'm working on my own version of parsing this but here is their response.

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.

4. 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.

5. 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.

 

FROM AMA: https://www.ama-assn.org/practice-management/prior-authorization/what-prior-authorization

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.

Related Coverage

Putting patients first means tackling prior authorization

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.

Related Coverage

Why prior authorization is bad for patients and bad for business

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