Written and edited by Norm Scott:
EDUCATE! ORGANIZE!! MOBILIZE!!!
Three pillars of The Resistance – providing information on current ed issues, organizing activities around fighting for public education in NYC and beyond and exposing the motives behind the education deformers. We link up with bands of resisters. Nothing will change unless WE ALL GET INVOLVED IN THE STRUGGLE!
BREAKING - ADAMS HAS DROPPED OUT AS I HAVE PREDICTED - HE WAS JUST WAITING FOR THE OFFERS FROM BILLIONAIRES TO KEEP GOING UP! ADAMS VOTERS - SWITCH YOUR VOTES TO CURTIS - I'D LOVE TO SEE HIM FINISH AHEAD OF CUOMO!
According
to the lead consultant pushing this plan, even inside the Downstate 13,
the standards remain UHC’s standards. Emblem may process the paperwork,
but the rules—the criteria, or standards, that decide whether your care
is approved or denied—are UHC’s. This means the entire system, for every member, retiree, and family, is governed by UHC’s standards. That’s the Trojan horse in this plan.
I notice that a batch of retiree delegates who are under 65 will be voting Yes because they think they will be protected if they move away from the metro area. Did they buy a broken used car from Mulgrew? And then there is the issue of AI determining denials.
It is bullshit fear mongering from the leadership to claim turning this down will put an end to negotiations. Remember The Maine - I mean the two rounds of Mulgrew's perfect and then more perfect Medicare Advantage - until they faded to awful.
Trust
in this plan continues to be frayed as union leadership refuses to
share the unredacted contract and related documents. Now, the leading
consultant pushing the plan shares a shocking revelation
The newly proposed NYCEPPO healthcare plan is being sold to active
UFT members and pre-Medicare retirees as a way to improve benefits and
save money at the same time. Union leadership and the city’s negotiating
committee are distributing FAQs to calm legitimate concerns about the
role UnitedHealthcare (UHC) will have in this plan given its
well-documented record of claim denials.
The UFT’s FAQ in particular craftily tells members not to worry:
“EmblemHealth will do all prior authorizations in the Downstate 13 counties in New York State, which represents 90% of claims.”
“UnitedHealthcare,
which will process the remaining 10% of claims, will follow the exact
same standards that EmblemHealth adheres to, ensuring that prior
authorizations are handled uniformly nationwide.”
This
framing makes it sound like most members are protected from UHC—and only
a small fraction of claims (10%) will ever touch them.
But this is deeply misleading.
Thousands
of retirees and their families live outside the Downstate 13. For them,
UnitedHealthcare will be their direct administrator and gatekeeper—not
Emblem.
This is strange, even
morbid, “double speak” because another selling point from the UFT
leadership’s paid operatives is that retirees living out of state will
have more options for doctors and providers. Yet, they seem to think
UHC’s 32% denial rate is somehow not going to be a big deal for most of
us since it’s only going to be experienced by the 10%, mostly retirees,
who don’t live locally.
Some active members
and other city workers also live and work outside these counties—they
too will fall under UHC administration.
According
to the lead consultant pushing this plan, even inside the Downstate 13,
the standards remain UHC’s standards. Emblem may process the paperwork,
but the rules—the criteria, or standards, that decide whether your care
is approved or denied—are UHC’s.
This means the entire system, for every member, retiree, and family, is governed by UHC’s standards.
That’s the Trojan horse in this plan.
The Shocking Revelation
Buried
within this proposal is a devastating emerging reality: if
UnitedHealthcare (UHC) standards for care, prior authorizations, and
denials are applied across the board, every member—active or retired,
teacher or paraprofessional, therapist or counselor—will be subject to
one of the most notorious denial machines in the insurance industry.
In
this meeting, the lead consultant informs those gathered that even in
regions where EmblemHealth is technically the administrator, the
standards being enforced will be UHC’s standards.
In other words: every city worker and retiree will live under UnitedHealthcare’s rules, no matter where they live.
Here is one of the exchanges where Calvert admits to the UHC standard being applied to all:
Chris Calvert
responds by emphasizing that the standards being applied will be
UnitedHealthcare’s standards—so no matter where a member lives, the
rules are the same. But for downstate 13 specifically, the actual
reviews and management of those prior authorizations will be carried out
by Emblem, not directly by UnitedHealthcare.
In short:
Standards = UnitedHealthcare rules (applied to everyone).
Administration in downstate 13 = handled by Emblem (the local entity).
UnitedHealthcare’s Track Record: Profits Over Patients
AI-Driven Denials:
Investigations and lawsuits show UHC uses algorithms to prematurely cut
off rehab, skilled nursing, and home care—even when doctors say
patients need more time.
Ongoing Litigation:
Class actions accuse UHC of violating federal law by systemically
denying medically necessary care. Testimony from insiders revealed
denial quotas built into policy. It also is under multiple
investigations for fraud and overbilling.
A Pattern of Abuse: Reports nationwide show seniors denied cancer drugs, patients forced out of hospitals too soon, and families buried in appeals.
Multiple Federal Investigations:
UnitedHealth Group is currently facing both civil and criminal
investigations by the U.S. Department of Justice (DOJ) for fraud and
overbilling.
UnitedHealthCare is not who we want controlling our care, nor setting the criteria.
What This Means for Members and Retirees
If delegates approve this plan:
Doctors and patients lose authority. UHC’s criteria, not medical judgment, will determine treatment.
Retirees
are exposed. Thousands living outside Downstate 13 will deal directly
with UHC—and face its merciless denial machine without a buffer.
Everyone
potentially faces the same denials. Inside Downstate 13, Emblem is only
administering UHC’s rules. Members will still suffer the same
rejections and delays.
Vulnerable populations are
targeted. Retirees, post-surgical patients, lowest paid city workers and
children with special needs will be most harmed by premature cut-offs
and denials.
Members drown in bureaucracy and red tape.
Appeals, phone calls, and paperwork, stress will replace care. Those
without stamina or know-how will simply go without.
Real Lives, Real Consequences
This isn’t abstract. Imagine:
A
retired teacher recovering from hip replacement is cut off from rehab
after just a week, even though her doctor prescribes three. She either
pays thousands out of pocket or risks lifelong mobility issues.
A child of a UFT paraprofessional loses access to speech therapy because UHC’s standard says “progress plateaued.”
A
city worker battling cancer is forced to switch procedures
mid-treatment because UHC refuses to cover the one that her doctor
believes will work for her.
These are not
“hypotheticals.” They are documented cases from UHC’s history. And they
could be our reality if this plan is approved.
The Bigger Issue: Trust and Transparency
Equally troubling is how this plan is being sold.
Leadership knows UHC’s record.
They know thousands of retirees live outside Downstate 13.
They know even within Downstate 13, UHC’s standards will rule.
And
yet, instead of being upfront, they’ve chosen to spin, minimize, and
mislead. That erodes trust. And it betrays the union’s responsibility to
protect its members’ and their families’ health.
UFT Delegates’ Responsibility
Delegates
are not voting on a simple healthcare plan change. They are voting on
whether to hand the criteria of members’ care to UnitedHealthcare.
It’s one of the most consequential votes they will cast.
They
are voting on whether retirees and families must fight an insurance
giant for every day of rehab, every specialist visit, every procedure,
every medication.
They are voting on whether to let leadership’s spin override the lived reality of denials, lawsuits, and suffering.
This is not about numbers on a spreadsheet or “cost savings”. It is about people’s lives.
It cannot be overstated: being under UHC’s standards is, indeed, A MAJOR CHANGE.
We did not have their standards dictating our city premium-free plan for the last several decades. This is not
keeping things virtually “unchanged” while making improvements and
saving money as the paid operatives for Michael Mulgrew’s Unity
leadership caucus tell us.
A Better Path Forward
Rejecting this plan does not mean rejecting cost savings or efficiency. It means demanding a plan that:
Keeps doctors and patients—not insurers or city bureaucrats —at the center of decision-making.
Provides transparency and honest communication with members.
Protects retirees, especially those outside Downstate 13.
Respects the union’s duty to safeguard both wages and health benefits.
Bottom Line: Vote NO
The
NYCEPPO plan is being presented as a step forward. But it is, in fact, a
step backward—a Trojan horse that hands our care to UnitedHealthcare.
UnitedHealthcare sets the standards for everyone.
Retirees and active members outside Downstate 13 are fully exposed.
Inside Downstate 13, Emblem, the local regional administrator, simply enforces UHC’s rules for care.
The FAQ spin is a distraction, not a protection.
Delegates must see through the misleading promises and protect the membership.
For
the teachers recovering from surgery. For the retirees fighting cancer.
For the families raising children with special needs. For every member
who depends on the union to safeguard their health.
Vote NO on the NYCEPPO plan if UHC’s standards apply. Because our health is not negotiable.
I’ve
spent decades fighting for New York City’s municipal workers, and let
me tell you something every New Yorker should know: the city can’t
function without us.
Municipal
workers are the cops, firefighters, and EMTs who respond in an
emergency. They are the teachers who educate your kids and the social
workers and health professionals who connect people to care. They’re the
sanitation workers who keep streets clean, the crews who maintain our
parks, and the staff who operate our public libraries.
They are New York’s most vital organ. And right now, City Hall is trying to gut our health care.
For
decades, nearly 750,000 city employees, retirees, and their families
have depended on the comprehensive health care plan New York City
provides.
But the city wants to dramatically change the health care coverage
we rely on and push everyone into a new “self-insured” plan with zero
input from the people who will live with the consequences of these
changes.
Officials
claim this change will save $1 billion a year. But here’s the truth:
you can’t cut that much money without cutting care. The math doesn’t add
up.
City
leaders promise workers won’t lose anything. They even claim there will
be a broader network of providers, less out of pocket costs and
improved benefits. Too good to be true? It is. Every retiree who lived
through the recent fight over Medicare Advantage
knows better. When the city tried to force retirees onto private plans,
we saw the potential consequences: smaller doctor networks, higher
copays, more prior authorization hurdles, and fewer hospitals willing to
take the plan.
That’s
not savings, that’s just cost shifting. And it means municipal workers
and their families will pay more for less. They claim that the $1
billion in savings will come from cutting payment to hospitals. Many NYC
hospitals can’t afford reduced reimbursement and those that can are
dealing with dramatic cuts in federal funding. What happens when the
hospitals don’t agree? Do they go out of network? Does the city increase
out of pocket costs?
Even
worse, by “self funding” the coverage the new plan strips away the
protections of New York State law, which guarantee coverage standards,
state oversight and enhanced consumer rights. Under the new plan, if
something goes wrong, workers and retirees won’t have the same appeal
rights or oversight that they have today.
To make matters worse, they have picked UnitedHealthcare,
the poster child for excessive claim denials, delays in payments, and
smaller networks, to take over. Among other atrocities, UnitedHealthcare
is under criminal investigation by the federal government for Medicare
fraud and overbilling. While it is being portrayed as an Emblem-United
partnership, make no mistake, this is a United contract and their goal
will be maximizing their profits.
This new plan will be bad for municipal workers, and the way the city is handling the transition has been even worse.
There
was transparency about how the decision was made and no clear
explanation of how the city expects to save a billion dollars without
gutting benefits. Just a backroom deal and a press release.
This
isn’t the first time City Hall has tried to balance its budget on the
backs of workers. And it’s not the first time New Yorkers have said
“no.”
In
the 1970s, workers fought against dangerous hospital conditions.
Recently, retirees successfully pushed back against the forced switch to
Medicare Advantage. Time and time again, when the city has tried to
chip away at health care, New Yorkers have stood up and stopped it.
Why? Because we know what’s at stake. Health care isn’t just a line in a budget. It’s life and death.
If
the city wants to talk about health care savings, it needs to do so in
the open and with public input. It needs comptroller oversight, input
from the people whose lives will be affected, and above all else, it
needs to stop pretending that slashing $1 billion won’t result in less
access to health care.
Changing
the health care plan for 750,000 people is no small undertaking. The
city plans to implement this change in the next 4 months, a dangerously
tight timeline.
The
city may see numbers on a balance sheet. But I see people: the
sanitation worker clearing snow at 3 a.m., the teacher staying late to
help a student, the EMT racing to save a life. They have earned
comprehensive health care.
The city needs to honor their commitment and maintain the plan that municipal employees rely on.
Williams is a former union leader and a board member of HandsOffNYCare.
