Showing posts with label aetna. Show all posts
Showing posts with label aetna. Show all posts

Friday, June 9, 2023

Comptroller Lander Attacks Plans to Reduce Medicare as he Declines to Register Medicare Advantage Contract Pending Litigation

“As a matter of public policy, beyond the scope of our office’s specific Charter responsibility for contract registration, I am seriously concerned about the privatization of Medicare plans, overbilling by insurance companies, and barriers to care under Medicare Advantage.... Recent investigations identified extensive allegations of fraud, abuse, overbilling, and denials of medically necessary care at 9 of the top 10 Medicare Advantage plans, including CVS Health, which owns Aetna.  ... ‘Once corporations privatize every inch of the public provision of health care, we may never get Medicare back... Brad Lander
Wow! Brad Lander goes on my very small list of politicians I still vote for.... NYC Retirees

Friday, June 9, 2023

Good news. With the deadline to opt out (June 30) of MulgrewDisadvantateCare fast approaching, Brad Lander tosses a monkey wrench into the Mayor Adams/MRC/UFT deal to drag city retirees out of Medicare into the privately managed, profit making Aetna plan, due to take effect on Sept. 1. As you can see above, Lander went further than just talking about the specifics but went after the general attack on Medicare by the insurance lobby and its allies - our own union.

Fundamentally, the UFT/Unity backing of this change is anti-union and anti-worker. But with a union leadership that dovetails with the corporate wing of the Dem party, why expect anything else? We've noticed that some of the rhetoric coming from the mouth of Randi Weingarten and crew turn calls for Medicare for all into MedicareAdvantage for all --- meaning the standard neo-liberal attacks on government run programs as Medicare is. 

Last week, the lawsuit was filed by retirees and yesterday a bill was supposed to be introduced by Charles Baron to the city council, with a large demo outside of retirees but that was postponed until next week - most likely June 22 - Thursday. It's important to have big crowds at these rallies -- politicians notice.

With Adams facing an election in two years, I imagine Lander has put himself into the running as retirees will vote heavily to oppose Adams and Lander just gave himself a leg up. Yes, politics do matter. Even it we don't win the medicare case, we can punish Adams in the next election - and Mulgrew too - both in 2025.

But there is some skepticism in that the Mayor can overrule Lander and will probably do so, so don't go crazy. However, Lander went much further than the narrow legal issues and raised crucial points we have been trying to raise at the UFT - that they were helping kill the only public option

Nick has notes at NAC on the story:

Mulgrew: the Comptroller is worried about MAP. Why aren’t you? -

Yes, Mayor Adams may reverse Lander’s decision. But we now have well positioned allies refusing to sign off on retiree healthcare cuts. And that bodes well for the future, even if it does mean our dear beloved Unity-led UFT leaders may need to find their ‘healthcare savings’ elsewhere, as their debt to the City passes its due date. And yes, with the spotlight on retirees, we should expect those cuts to land on in-service teachers, who have been promised the absurd: an ‘equal or better replacement to GHI at 10% cheaper of a cost.’

When will that replacement be announced? You better bet it won’t be until after Mulgrew tries to ram through a mediocre contract—and that process will start as early as next week. So, before we vote on a TA, let’s make sure we ask – what will only 90% of our current health plan look like, and how will we afford it on a pay-cut?

Make no mistake: we can’t win the battle against healthcare cuts solely on the good graces of well-positioned politicians. Ultimately, we need to situate ourselves to be able to stop anti-labor backroom deals. As Mulgrew is keen to remind us at DAs and executive board meetings, health care is a part of our overall compensation. Well, we vote on whether to accept what the City offers us in economic compensation. So, both now and when we’re retired, we deserve a vote on changes to medical coverage too. Since UFT leadership doesn’t see the problems everyone else sees with reducing our coverage and tossing retirees onto MAP, we need a formal and permanent mechanism to keep them from doing so.

I'm hitting all my docs before Sept. 1 - braving the smoke today to keep a cardiology appointment - I do preventive maintenance - like having my car checked regularly. I think today is a stress test which I think will show I have slowed down since the last one -- I'm thinking it's my weight which I can't seem to lose - probably due to the cheese cake at UFT Ex Bd meetings. Or maybe it's the stress of seeing my own union try to reduce my healthcare.

The email below was sent by a large medical group here in Delray Beach regarding their feelings about Aetna.  It's an important read regarding their past dealings with Aetna.  





 

Here is Lander's complete statement:

 

FOR IMMEDIATE RELEASE
June 8, 2023

Chloe Chik, (646) 761-2914
cchik@comptroller.nyc.gov

press@comptroller.nyc.gov

Comptroller Lander Declines to Register Medicare Advantage Contract Pending Litigation 

New York, NY – The Comptroller’s Office declined to register the City’s contract with Aetna to transfer City retirees to a Medicare Advantage program for their health care coverage. A pending lawsuit, brought on behalf of retirees, questions the City’s authority to enter into such an agreement.  

Comptroller Brad Lander issued the following statement: 

“The Comptroller’s Bureau of Contract Administration carefully reviewed the City’s contract with Aetna and returned the contract to the Office of Labor Relations without registering it. Pending litigation calls into question the legality of this procurement and constrains us from fulfilling our Charter mandated responsibility to confirm that procurement rules were followed, sufficient funds are available, and the City has the necessary authority to enter into the contract. 

“As a matter of public policy, beyond the scope of our office’s specific Charter responsibility for contract registration, I am seriously concerned about the privatization of Medicare plans, overbilling by insurance companies, and barriers to care under Medicare Advantage.  

“I appreciate the work of the Municipal Labor Council and the Office of Labor Relations to negotiate improvements to the Aetna contract to address some of the concerns raised by retirees. However, the broader Medicare Advantage trends are worrisome. Recent investigations identified extensive allegations of fraud, abuse, overbilling, and denials of medically necessary care at 9 of the top 10 Medicare Advantage plans, including CVS Health, which owns Aetna.  

As health care activist Ady Barkan wrote last month, noting that half of Medicare enrollees nationwide have been transferred from traditional Medicare to private Medicare Advantage plans: ‘Once corporations privatize every inch of the public provision of health care, we may never get Medicare back.’”

###

 

Wednesday, April 5, 2023

RetireeTeacherChapter Meeting - the Horror of Holding up a sign, Sorkin Is Proud to Sign Non-Disclosure, The @uftnyc #MLC might be coming for Active workers - APRIL 11 RALLY, Sign the Healthcare Referendum Petition

Rally!! April 11th. Noon. City Hall


Wednesday, April 5, 2023 - Happy Passover 

I'm rushing to get this our before my wife wakes up with the list of honey-do's in prep for 30 of her family members coming for tonight's seder. 

Retiree Advocate was out in force before and during yesterday's Aetna screw-you retirees presentation at the monthly chapter meeting and we got loads of people signing our petition for a referendum on healthcare, now approaching 5,000, one quarter of what we need according to the constitution. Entire schools are rolling in, which means active members see the threat to their own healthcare with an RFP (Request for Proposal) out there while Sorkin hides behind his non-disclosure. At the Exec Bd when he said he was so proud of signing that I wanted to ask why sign it? 

Toward the end of the meeting, a few activists stood in the back of the room and held up some signs and RTC CL Tom Murphy went nuts, threatening to end the meeting and yelling for security to remove them. 

LeRoy Barr in the house.


Oh, the horrors. I took this photo in the hall. Note the photo of Albert Shanker looking on.
So, I have a lot to report but not enough time.
 The meeting was a boring Aetna presentation. I learned from one of the ladies attending how Aetna cheats to make even more money out of the Medicare system by changing your healthcare descriptions to upcode you for illnesses you might not even have. Imagine going to a hospital and your record is does not accurately reflect your true health?

Geof Sorkin: I have NDAs. I am proud that I will not reveal who the potential bidders are.

Yes, UFT Welfare Fund head Sorkin is proud to sign Non Disclosure Agreements as an excuse to withhold information from UFT members who pay his high salary. 

The UFT has refused to disclose or publicly discuss the RFP except in the vaguest details (there are apparently four bidders left but bet heavily on Aetna). This is the original RFI (Request for information), which proceeds the RFP:

They will probably try to save money by more creating aggressive levels of hospital and doc networks with higher copays for more expensive hospitals and doctors. The City wrote an article about the RFP:


PSC covers it: “You should also be aware that the City is entering into negotiations for a new Comprehensive Benefits Plan (CBP) to replace GHI, the plan in which most of PSC’s active employees are enrolled, starting in 2024. The intent is to keep the CBP premium-free while saving 10% on the current costs. MLC union representatives have not seen the proposals, but they are under review by the MLC executive committee and health technical committee”

Some MLC minutes were leaked in February with more details:
 

Healthcare, Tucker Carlson, and Maternal Mortality – UFT Executive Board Minutes, 3-27-2023

Tonight was mostly about healthcare. Kate Connors came to the Open Mic to talk about the New York Health Act. Ed Calamia asked about Aetna’s ongoing MAP fraud case, to which leadership answered it would not affect our deal. I asked about what specific ‘cost savings’ were being discussed by the vendors in the new in-service RFP, but didn’t get many details.

Nick: Want to ask a question. We’re hearing about an RFP with four potential providers to potentially replace GHI at a lower cost. Not asking about the four respondents – asked last week and wasn’t answered, though you’re free to tell us. However, we know how some of the cost savings have been realized for retirees – like prior authorizations. We also know about some of the cost savings we’ve already realized for in-service – like forcing first year teachers onto HIP or adding huge copays in GHI for most Urgent Cares – 15 bucks to 100 bucks since 2016. What types of ‘cost savings’ are these four vendors suggesting to make the cost savings? What types of copays? What types of networks – diminished? New prior authorizations?

Geof Sorkin: I have NDAs. I am proud that I will not reveal who the potential bidders are. Benefit design: a number of things: looking to replicate to GHI, but also looking across the country and seeing how we could leverage things. We have not met with any of the bidders. Michael has said we’ve identified 4. One of the complexities is we are looking at the info they’ve provided and it’s not always an apples to apples comparison.


Due to the Moratorium Act, @uftnyc couldn’t screw retirees without doing the same to in service workers or he’d face litigation! We hear this week begins negotiations for the in-service workers healthcare plan and it’s been said they are eliminating all health care plans, except for HiP HMO and replacing the Emblem plan with Aetna. That’s it! First they came for retirees. Now they come for you....NYC Organization of Public Service Retirees Inc

Sunday, March 26, 2023

Is the UFT a company union? UFT/Unity act like Republicans: Anti-Strike, Anti-Public Healthcare; Becoming a Laughing stock of the union movement

There is still time to register for tonight's Retiree Advocate-UFT's meeting at 7pm on Zoom.  Register Here: https://bit.ly/3yr6M8K (Close to 250 people are already registered.)

DONATE TO THE UFT PETITION CAMPAIGN FOR A HEALTHCARE VOTE  - IT IS COSTING MONEY TO MAKE SURE EACH ELECTRONIC SIGNATURE WILL NOT BE TOSSED OUT BY THE UFT LEADERSHIP.

A Tale of 3 city teacher unions - and UFT/Unity are the losers


 

Sunday, March 26, 2023 - This  post is loaded, so sit back or just ignore and go out and get some sun

No matter the liberal blather from the UFT (we support the LA teachers for not crossing picket line but would jump off the roof of 52 Broadway of NYC did the same), we have an ineffective right-center UFT leadership compared to the left wing leadership in Chicago and Los Angeles and the compilation I've gathered below proves it, not only ideologically, but in terms of actual political and economic accomplishments. My comment above about changing the leadership does not mean dumping Mulgrew for another Unity Caucus hack but removing Unity from leadership. Note these articles.

In the UFT we have decreased militancy - actually no militancy. Well, if you  consider "wear certain colors certain days" as militancy. 

The increasingly militant autoworkers had their first direct election of a national president and an insurgent won - barely. He said:

“This is the end of company unionism, where the companies and the union work together in a friendly way, because it hasn’t been good for our members ---- President Is Ousted in United Auto Workers Election --

"Company union" increasingly strikes a chord when talking about the Unity crowd. When Marianne appeared on Brian Lehrer the other day, his first comment was how surprised he was that the UFT was teaming up with the Adams administration against its own members. 

We are not surprised.

A long-time UFT activist asked: What would happen if we had direct elections for presidents of the AFT and NYSUT? Right now only winner take all Unity delegates (750) vote in those elections. 

There is actually a new petition campaign in the UFT to bring a level of democracy with a petition campaign based on the UFT constitution calling for a member vote on healthcare changes (as opposed to Mulgrew backroom deals through the MLC).

Monday, March 6, 2023

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

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

Retiree Advocate/UFT Zoom General Meeting

Sunday, March 26th at 7pm Open to all RA members Open to all interested UFT Retirees Info: retireeadvocate@gmail.com


 
Updates:

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

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

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

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

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

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

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

Here are latest excerpts from the key bloggers:

Arthur: Mulgrew Is Doing It Again

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

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

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

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

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

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

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

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

 Nick: UFT/MLC to Greenlight MAP Nuclear Option

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

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

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

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

The Sell Job

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

Halabi: The Problem Was the Plan, Not the Details

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

The problem was Medicare Advantage, not the details.

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

Better than his first try. That’s true.

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

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

Saturday, March 4, 2023

UPDATED - UFT Retirees Make Your Voices Heard as MulgrewCare Moves forward at Retiree Chapter Meeting - Live or Remote on Monday Mar 6 at 1 PM at 52 Broadway

On Thurs, March 9 there will be an EMERGENCY MOBILIZATION. The Municipal Labor Committee (MLC) and the Mayor are on the verge of taking away our excellent public Medicare and forcing us into a life-threatening for-profit Aetna Medicare Advantage plan. The MLC is voting on March 9th.
JOIN US AT THIS MARCH AND RALLY TO LET THEM KNOW WE STILL SAY NO
 

 

You must register in advance. 7000 have already done so.


Join us as Retiree Advocate challenges the upcoming move to the Aetna plan at UFT Retired Teachers Chapter Meeting this Monday, March 6th at 1pm at UFT headquarters, 52 Broadway. It will be hybrid so you can attend via Zoom if you can’t go in person. Michael Mulgrew will be making a presentation about the NEW Contract just received from Aetna for the privatized Medicare Advantage Plan he wants to throw us all into! We all must be there to ask questions and make our voices heard loudly. RA reps will be outside with a leaflet and sign-up sheet beginning at 12 Noon.

You must Register on the UFT Website:Register Here
https://web.cvent.com/.../30fe4882-68e5-437d-930b.../summary
 

And sign up with RA so we can send you more info. Click here and let us know you're coming
bit.ly/3ERqMFf

 

The Blogs have been active: 

MULGREW NEEDS TO PLAY GAMES TO EXTEND VOTE TO GET MULGREWCARE THROUGH MLC STEERING - We got word from inside the Municipal Labor Committee meeting yesterday that there was a vote of the MLC Steering Committee after the regular meeting.

Jonathan Halabi - JD2718 - We heard you loud and clear

Mulgrew wrote to retirees today about the Aetna Medicare Advantage Plan. Or Mulgrew and Tom Murphy did. Or someone did, and put Murphy and Mulgrew’s names on top.*

Arthur Goldstein:  Mike Mulgrew Writes a Letter to Retirees

 An Overview

It has been a long road of intense, hard-fought negotiations. This is largely due to you goddamn retirees dragging our asses to court all the time. Well, we're gonna steamroll right over you, because we know what's best for your health.  

 

Friday, December 16, 2022

#MulgrewCare Update: COLLUSION as Mulgrew promotes MedAdv, There are Calls To Abolish Private Medicare Advantage Plans as Scandals Mount

It is fairly clear that Mulgrew’s negotiations have been all about protecting the health – not of our members and retirees – but of this [stabilization] fund (p.16):.... Jonathan

Scheinman is basically a scribe for the City-MLC, not an independent arbitrator.... James, ICE Blog

More from Jonathan:

Collusion: I have made the case before: Mulgrew, Nespoli, Garrido, the whole MLC, Scheinman, Adams, and the City’s financial administration, starting with the OLR, plus the insurance companies – they are all working in concert. They are colluding. And they leave the evidence all over the place ...I am absolutely convinced that Scheinman worked with the City and the leadership of the MLC unions, including Mulgrew’s people, in creating his 12/15/22 “Opinion and Award.”  JD271Collusion and Bullying by OLR/UFT/MLC (Mulgrew et al)

UFT Ex Bd member Nick chimes in at New Action on the brewing UFT/MLC/Adams/Scheinman Scandal: 

UFT Members Take Note: Medicare Advantage is a Consequence of Backroom Bargaining -

 Nick homes in on the vote for the 2018 contract which is a factor in this mess: 

this all comes down to the 2018 (and 2014) contract(s). Scheinman only has the right to intervene here, because Mulgrew promised healthcare savings to the City that he couldn’t make happen (and without the informed consent of membership).

And there was not informed consent -  Was 2018 the Worst Bad Deal Ever?

Nick has also been pointing out that Mulgrew and Unity try to paint the thousands of people who opted out and support the battle to preserve our healthcare as the bad guys:

The only ‘villains’ in the official story are a “small group of unaffiliated retirees,” (p. 19), i.e. the retired left-opposition. This substantiates what we’ve been saying all along, that the people who have been fighting for better healthcare will be scapegoated by the people in power who destroyed it. Don’t get me wrong, that ‘small group of retirees’ has said some things I disagree with. Grandfathering is NOT a solution here. We must preserve traditional Medicare both for current AND future retirees. 

And never lose site of MedAdv scandals:

Portside: As Scandals Mount, So Do Calls To Abolish Private Medicare Advantage Plans ...the private health insurance program that a recent Senate report said is "running amok" with "fraudsters and scam artists." "In reality, so-called 'Medicare Advantage' is neither Medicare nor an advantage."... 

 
Scandal ridden healthcare is what Mulgrew, another scam artist, is trying to put us into. And he claims going with Aetna, owned by CVS, will save money.

Nothing like overbilling to save money. And this:


 
I reported on the Scheinman decision at ed notes yesterday:

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 

James has a follow-up: ICEUFT BlogARBITRATOR SCHEINMAN IMPOSESES MULGREWCARE (Medicare Advantage) ON CITY RETIREES

Scheinman is not an independent arbitrator here. He has been chairing the Tripartite City-MLC commission on healthcare. How does he have jurisdiction in this matter as the City and union leaders are basically in agreement here?

Jonathan agrees with James about Scheinman having no jurisdiction:

Scheinman’s decision-making power as the arbitrator for the Tripartite Health Insurance Policy Committee arises in the case of a dispute

(From the 2018 letter referred to within the UFT as Appendix B)

Where is the dispute? Does Scheinman actually have any authority here? There are no positions for the parties, because the parties appear to be not in dispute. Everyone agrees about who needs to get screwed (me, and you).

Scheinman NOT designated arbitrator for Medicare Advantage issue

Oh, and oh no. Scheinman has been named to resolve disputes on items 1-4 in Appendix B. But the current issue, Medicare Advantage, comes from item 5. The agreement doesn’t cover point 5. Maybe that’s why Scheinman does not begin by establishing his authority? Point 5 only calls for recommendations.

 

And here is the full piece on MedAdv Scandals from Portside:

Thursday, December 15, 2022

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 #local731HarryNespoli, the #MLC ??
 

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 OfficerTotal Cash $7,045,167Total Compensation $20,388,412
Shawn M. Guertin Executive Vice President and Chief Financial OfficerTotal Cash $4,323,636Total 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