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!
Retiree Advocate is doing a zoom on Sunday Nov. 6 7PM to address questions people may have and to expose the confusion created by the the joint operation of the city and some of the unions, led by Mulgrew in the UFT and DC 37, the largest components who dominate the MLC (Metropolitan Labor Committee) who make deals with the city that control our health care. We may not have all the answers but we have some answers. We are hoping to have Marianne Pizzitola join us but if she can't make it we have some knowledgeable people.
MORE is planning another zoom in the same issue a week later at the same time and Marianne is definitely going to be there.
Exposing the Adams/Mulgrew Threat to Our Healthcare: Untangling the Confusion
This Sunday, Nov 6 at 7PM, Retiree Advocate/UFT is holding a Zoom Info Meeting to share what we know - and what we don't know - regarding the current healthcare crisis in our unions.
Learn what role Mulgrew and other union leaders in the MLC have been playing in partnership with Mayor Adams and the Office of Labor Relations.
New information is coming in constantly and we are trying to stay up to date. This meeting will share info & analysis, and try to answer your questions.
Attendance will be limited to 100. Meeting will be recorded for those who cannot make it.
Here are some comments I gleaned from some of the listserve discussions after a district rep sent out an appeal to chapter leaders to get their staffs to call the city council to change the admin code. As Jonathan says in his current blog: Administrative Code 12-126 – Line by line:
The code today means:
“The City pays an amount equal to the cost of HIP”
The code if the Mulgrew/Nespoli/Adams amendment goes through will say:
The City pays the cost
of HIP, and no more than that, or else some other amount – and that
amount could be different for different groups of city workers, and
there is no limit on how low those amounts might be.
When you call your city council member, please explain this to them
as you urge them to protect workers and retirees, and reject the
amendment.
Comments from RA listserve:
It's
pure pap! All one has to do is read the amendment language. Your DR is
asking you to not believe your own eyes or use your own brain. The
amendment reaffirms nothing because Judge Frank's ruling changed
absolutely nothing. His ruling merely said that retirees are protected
from paying premiums, specifically on the now-dormant Medicare Advantage
Plus plan, because of price protections built into the city code.
It's not hard to understand the amendment. Just look at it. It does two things and two things only: First it strips
healthcare price protections, for ALL current and retired municipal
employees, by yanking those protections out of city law, and placing
them in the hands of OLR lawyers and union bosses. Second, it allows city bureaucrats to classify municipal employees into separate, as yet undefined, categories. That's a prospect that begs the creation of tiered, unequal levels of coverage for past and present city workers.
I bet your DR wouldn't wish that on her mother's health plan!
, or in the alternative,
This means, "What was said before this doesn't count."
in
the case of any class of individuals eligible for coverage by a plan
jointly agreed upon by the city and the municipal labor committee to be a
benchmark plan for such class,
This means,
"For anyone and everyone in city employment, the benchmark price -
formerly established as the cost of the HIP-HMO plan, and until now
protected by this law - can now be chosen by the MLC and OLR. We don't
need no stinkin' law, made by stinkin' elected legislators, to tell us
what to do! And if we want to, we can have multiple plans, and multiple
benchmark prices, for multiple classes of people, and we can change that
any time we like. So there!"
not to exceed the full cost of such benchmark plan as applied to such class.
This means, "When we say your brand new benchmark plan costs only ten bucks, but you want to stay in your old plan; the one that costs five hundred bucks - and that we will still offer because we believe in freedom of choice - no
problem! Just cough up the $490. But hey, if you want, you can have our
super-duper $5 or $8 plan for free! Because, you know, choice!"
And some Media links to articles:
An excellent article below from Work-Bites
Beware of the Mad Dash to Medicare Advantage
By Joe Maniscalco
Commentary
So, some of the most powerful people in town are warning the rest of us that the most pressing — the most urgent — the most vital issue — facing the City of New York right now is the need to immediately privatize healthcare for municipal retirees — or else. I dunno about you, but this kind of thing reminds me of that time working people were told we had to bail out the big banks.
Remember, it wasn’t that long ago when then U.S. Treasury Secretary Henry Paulson put up a scary countdown clock and told everyone in the country we had to cough up $700 billion to bail out the financial sector — right away — no time for talk — no deliberation — or all was lost.
Paulson got his money.
A few years later writing for Rolling Stone, Matt Taibbi called TARP — the Troubled Asset Relief Program — a “lush nightmare of unintended consequences” and “one of the biggest and most elaborate falsehoods ever sold to the American people.”
The City Council must enable budget-cutting new health
insurance options for retirees, warns Eric Adams’s chief labor
negotiator — or City Hall will eliminate existing insurance plans
We're all in the same boat, we've painstakingly carved out a hole in it, and we're sinking fast. Leadership had better wake up some time before we hit bottom... Arthur Goldstein, NYC Educator
Unity probably thinks Mulgrew hit a home run - an LOL moment
Some thinking inside the Unity machine is this was a brilliant move to get the rank and file involved in pushing their case by threatening working teachers with a $1500 healthcare payment each year and urging them to call their city council, a scheme cooked up by both Adams and Mulgrew and a few other union leaders to bully their way through.
Originally, they thought they had an easy path in the city council to getting their way without scaring the membership. The internal lobbying was not effective, while those of us opposed to the reduction in healthcare were having an impact as our rally last Thursday showed.
So Saturday Mulgrew, seeing a loss coming at his attempt to get the council to change the Admin code in ways that would relieve the city obligation to pay up to a rate agreed to in the 60s, in desperation he tried a scare tactic with the working members, claiming Adams will force working UFT members to pay $1500 a year for healthcare.
What his email accomplished was waking the membership up to the healthcare crisis the UFT is facing and created confusion and uncertaintly and opened the door to other voices. Sometimes we have been screaming into the wind. Already there are signs people are not just listening to the UFT line.
What Mulgrew obfuscated about was trying to give the impression Adams can do this unilaterally when in fact Mulgrew must agree to any changes. Again Jame exposes the Mulgrew lie:
James includes links to the MLC agreement with the city that requires both sides to agree and the video above of the increasingly famous Mulgrew critic Marianne Pizzitola.
I was on a zoom with people from MORE last night where Marianne filled in these younger working teachers on the real deal. There will be a town hall on Sunday Nov. 14 at 7PM to spread the word with Marianne answering questions.
Retiree Advocate is also working on a town hall with Marianne this Sunday at 7PM aimed at retirees.
There are so many great bloggers out there exposing the UFT/Unity Caucus/Mulgrew Shakespearean dramedy. Rather than repeat or echo these blogs here are some links.
Mulgrew's savings are our costs
Everytime Mulgrew says "savings" think "out of your pocket"
Quiz: Health care cuts? or Health care savings? : You are experiencing pain, and think about going to the emergency
room, but think about the cost (copay jumped several years ago from $50
to $150) and decide that it’s probably not serious, and take tylenol
instead. Cost or Savings? You are getting less health care than you would have. The cost scared you away. That is a cut, right? Less care? But you might have said that’s a savings: if you are Mulgrew,
Nespoli, Adams, or an Insurance Executive. That’s an emergency room
visit that you might have had to pay for, and now you didn’t. High fives
for jacking up copays! (I was in this situation, but I went to the ER. That triple-digit copay was a cost to me, a savings to Mulgrew.)
Jonathan also points out that more "savings" come out of the need for
Approval for a procedure that should not need approval
Because of a family history of cancer, you need a special diagnostic
procedure every year. But this year a guy who works for an insurance
company calls to say that your procedure has been approved. Cost or
Savings? If you are a regular person, neither. You need the test, you will get it.
But if you are Michael, Harry, Eric or a stockholder in Emblem or
Aetna or Alliance of whatever monster insurance company is involved,
that’s a savings.
When Jonathan blogs, UFT leadership listens - and looks to counter.
Arthur Goldstein, the dean of ed bloggers, comes back with another powerful hit on the UFT leadership: UFT Leadership's Contract Plan
Can you even believe we're battling to change a law so NYC can charge
premiums? If Mulgrew and Adams succeed in making retired couples pay 5K
a year for the health care they were promised for free their entire
careers, who's to say it will stop there? If Adams doesn't get to charge
in-service members $1500 a year for GHI now, who can say he won't
charge them 2500 next year? After all, in service members might be able
to afford it better than retired members. Can't you imagine Adams making
that argument? Can you imagine us supporting it? This,
of course, is all administered by the MLC. We're the largest union in
the city, and the largest voice in the MLC. Meanwhile, the DOE sees us
actively campaigning for worse conditions.
Arthur connects the Mulgrew/Adams partnership on health care to the upcoming contract. Why will we get a contract when Adams can just make outrageous demands and stall/Bloomberg us for years?
More "savings" - for the city - will be coming with further and higher co-pays and for those with chronic illness - a massive healthcare hit.
Oh, and if you are still working and looking at being in Medicare when you turn 65 - the Mulgrew plan will help kill Medicare as a public option - they brag about draining $600 million out of Medicare and into the hands of the private insurers.
What is the way out? There may be no way out especially with Mulgrew in charge. Call me a dreamer but if we had a medicare for all even at the NYS level, that would be a way out. But given the real probability (even I'm sick of Democrats) Hochul will lose, look for bad times ahead.
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
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.
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.
... 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.
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?
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).
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.
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
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.
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.
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.
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 continues tofight 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.
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:
PNHP statement: “CMS Should Terminate the Medicare Advantage Program”
PowerPoint slides: Medicare Advantage 2022 update, developed by Dr. Ed Weisbart
Podcast: “More like Medicare Disadvantage, AMIRITE?” featuringDr. Susan Rogers
Today is the first in-person/hybrid UFT Retired Teacher meeting where we will get yet another propaganda feast from UFT Welfare chief Jeff Sorkin with a gaggle of sycophants echoing the Unity Caucus line --- rising healthcare costs not due to profit making corporate ghouls but because retired UFT members go to the emergency room or to doctors too much.
Below I'm posting the Physicians for a National Healthcare Program.
But first a must read by James Eterno who breaks things down brilliantly:
The
City and MLC met their targets on savings from this Agreement for the
2019-2021 fiscal years from the last round of collective bargaining. A
big part of that was forcing new employees onto HIP HMO for their first
year on the job even though this is a huge violation of the UFT Contract
that guarantees UFT members a choice of premium-free plans.
The
City and MLC were not content to stop there but further agreed to
additional healthcare savings (givebacks). Now, we are told we have to
replenish the Health Stabilization Fund, a fund started back in 1983
that the City draws from. The City is always going to demand further
givebacks on healthcare....Read it all
Also check out Arthur Goldstein who finally turned against the healthcare changes:
Unity is not thinking ahead. This plan is exactly why they won this year
by the lowest percentage ever, and exactly why they could lose the next
election. Having dealt extensively with the major opposition party, I
don't trust them as far as I can throw them. It's beyond disappointing
that this is all we can muster in such a potentially vibrant and
effective union. We, the UFT, are poorly informed and not remotely as
active as we could be....the entire Medicare Advantage plan was abysmally planned. It lacked
vision, and MLC didn't bother at all to prepare for the totally
predictable outcry that ensued. Some leaders have their heads planted
firmly in the sand, and are still insisting that everything is perfectly
fine. However, this is a disaster, no matter how much makeup they paint
over it....
You’ve no doubt seen the ads, so I don’t need to tell you that Medicare’s open enrollment period has officially begun. Every year, commercial health insurers are allowed to chip away at our most important public health program by offering Medicare Advantage (MA) plans to America’s seniors, and this year’s enrollment period comes at an especially crucial time in our fight against the privatization of Medicare.
Projections indicate that by next year, more than half of Medicare beneficiaries will have enrolled in MA, putting the care of millions under the control of profit-seeking corporations and emboldening those who seek to hand our public programs to the private sector entirely.
At the same time, the Direct Contracting program continues its infiltration of Traditional Medicare, as participating entities have compromised the health plans of nearly 2 million beneficiaries, often without their full knowledge or consent. Starting January 1, 2023, this program will kick into overdrive as an expanded cohort of so-called “REACH entities” is given the opportunity to “manage” seniors’ care … in exchange for hefty profits.
What’s wrong with this picture? Look no further than a recent bombshell New York Timesarticle, which builds on PNHP’s expertise and research to expose the ugly truth: MA insurers are accused of exploiting the program to extract millions of dollars from taxpayers while denying care to their beneficiaries. Shockingly, several of these exact same companies have won approval to participate in the REACH program.
Open enrollment is the perfect opportunity for PNHP members to highlight the greed of commercial health insurers and the danger of allowing them to further infiltrate Medicare. We’re encouraging everybody to write an op-ed or letter to the editor of your local newspaper describing the dangers of Medicare Advantage, the looming threat of REACH, and the urgent need for single-payer Medicare for All.
PNHP statement: “CMS Should Terminate the Medicare Advantage Program”
PowerPoint slides: Medicare Advantage 2022 update, developed by Dr. Ed Weisbart
Podcast: “More like Medicare Disadvantage, AMIRITE?” featuringDr. Susan Rogers
NYT article: “The Cash Monster Was Insatiable: How Insurers Exploited Medicare Advantage for Billions”
Medicare’s open enrollment period only lasts through Dec. 7, so now is the time to write your op-ed or letter to the editor. Consider using the following talking points when writing about this complicated issue:
Medicare Advantage is only able to offer low premiums and out-of-pocket caps by delaying or denying care on the back end, and by discouraging the sickest patients from enrolling.
Medicare Advantage allows seniors to choose their health plan, but it restricts the much more crucial choice of doctor and hospital by using narrow provider networks.
Commercial health insurers will never be satisfied with even their current, outrageous profits. Starting in January, the REACH program will allow many of these same companies to “manage” the care of seniors who have declined to participate in Medicare Advantage.
So long as we allow profit-seekers to control our health, they will deny us care, stick us with exorbitant costs, and keep the lion’s share for themselves. The only true solution to our country’s health care problem is Medicare for All, but if we allow corporations to take over Medicare, we will never see it achieved.
If you have any questions or would like advice on your op-eds and letters, please reach out to our Communications Specialist, Gaurav Kalwani, at gaurav@pnhp.org. If writing isn’t your preferred method of engagement, consider using this toolkit as a basis for a presentation to colleagues, conversation with community members, or relationship-building exercise with local organizations. Any way we can get the message out will help move our cause forward.
At this crucial juncture, we must make our voices heard and stop the capture of Medicare by corporate profiteers. We can only do this if we all speak up, and speak as one.
Sincerely,
Susan Rogers, M.D. President
Physicians for a National Health Program 29 E Madison St Ste 1412 | Chicago, Illinois 60602 312-782-6006 | info@pnhp.org
