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

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

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

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

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

 

 

 

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

 

MedicareAdv restictions can kill

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

Preauthorizations – a cautionary tale

October 23, 2022 

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

He follows up with:   

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

Who saves?

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

Who pays?

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

Mulgrew raises copays; Bronx gets hit

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

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

More on the New Emblem (GHI) Copays

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

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

Did the UFT make an announcement about copay increases?

October 27, 2022 

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

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

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

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

 Here is an article covering the pushback by retirees:

 

 

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

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

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

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

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

• By Lindsey Copeland
• October 27, 2022

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

Media Advisory: Halloween Horror Press Conference to Tell City Council Members: DO NOT Amend Administrative Code §12-126

 

Media Advisory For October 27, 2022

Halloween Horror Press Conference

to Tell City Council Members:

DO NOT Amend Administrative Code §12-126

New York City municipal retirees have been fighting for over a year to prevent the City from moving us out of our excellent, traditional Medicare-with-supplemental-insurance plan and into a lesser, privatized Medicare Advantage plan. Last March, a lawsuit found that the City's attempt to financially penalize retirees who refused to switch plans was a violation of city code. In response, the City is now pressuring the City Council to change the law that protects us - NY City Administrative Code §12-126. The City's proposed amendment would not only lift retirees' health benefit protections, but would leave the City's active workforce without protections as well, leaving us all vulnerable to a wholesale diminishment of our current health benefits.

We will greet and educate our City Council members as they enter City Hall on October 27th. Halloween is scary and fun, but there is nothing fun about losing our hard-earned health benefits! We will let the City Council know that amending NY City Administrative Code §12-126 would be a real horror show, for the city, and its workers.

Come to the press conference and hear experts and elected officials talk about the proposed amendment to the city code and explain why Medicare Advantage Plans are bad for our health.

Confirmed Speakers:

Jumaane Williams, Public Advocate for the City of New York

City Council Member Christopher Marte, District 1

City Council Member Alexa Aviles, District 38

Dr. Oli Fein, Physicians for a National Health Program

When: Thursday, October 27th, 2022 at 12:30pm

Where: Broadway & Park Place at entrance to City Hall

Press Contacts: 

Julie Schwartzberg  jschwartzberg@gmail.com      

Sarah Shapiro         sarahmorah@gmail.com         

The Cross-union Retirees Organizing Committee (CROC)

                                        crocnyc22@gmail.com, 

 

Here is the admin code changes the UFT etc want to make - in yellow.

Unity/UFT Ends Decades of Tradition of Open ended questioning at Oct. 24 Ex Bd as Questions Attempt to hold leadership accountable

Opposition doesn't come from a naive place. We have educated opinions that differ from leadership's.... Melissa Williams, CL OT/PT Chapter at Oct. 24 UFT Ex Bd

I'm done with anything Unity does anymore. Not joining the healthcare committee. Probably gonna leave contract. Waste of my time and validates them falsely. Done giving them credibility that they aren't partisan. I'm just sad. I'm sad that unity stooped this low. I really am. I was optimistic about working together to some extent. That died today..... Comment from activist who had intentions of working with Unity

Healthcare savings are nothing but givebacks.... James Eterno

United for Change defeated Unity by 500 votes in the high schools to elect the 7 high school reps to the ex bd. There are 20 thousand high school teachers.  They deserve a voice.

Autocrats threatened with losing control, always react with suppressing democracy which actually energizes the opposition. (See Iran).

If you can't find the time to put in two hours every two weeks at an Ex bd meeting, go find something else to do. 

Links to Oct. 24 Ex Bd meeting notes from Nick and James:

• New Action – UFT Union leadership votes to disenfranchise high school executive board members – Executive Board Minutes – 10/24/2022 -
• ICEUFT Blog LIVE BLOGGING FROM OCTOBER 24, 2022 EXECUTIVE BOARD MEET

Tuesday, October 25, 2022

Something broke last night at the UFT Ex Bd meeting, becoming reminiscent of the divide between Republicans and Democrats. We know who the Republicans are. Fundamentally, the UFT/Unity leadership has the mentality of the Republican party - privatizing, voter suppression and anti-democratic. Mitch Mulgrew.

I heard Amy [Arundell] yelling at the top of her lungs when we brought up the length of the president’s report [at the DA] and asking who makes the agenda "it’s our TRADITION," she yelled. Last night she gutted decades of tradition By cutting the question period •limiting it.... Her oath to loyalty over principle may now mean I’ve lost all respect for her unionism......we lose all respect for your unionism when oath to caucus loyalty comes before a modicum of principle. Limiting & silencing questions by rank and file because they make you uncomfortable... Educators of NYC

I admit I was sort of surprised that Amy, who many oppo people have had respect for in the past, led the way on limiting the question period, but I guess she has to demonstrate what a loyal foot soldier she is as her star has fallen somewhat in the leadership hierarchy. 

We watch positioning in the UFT along the lines people watched the Chinese Communist Party where Xi Jinping kept his back turned while his predecessor was escorted from the room. Unity should televise their next Party Congress. Will we see Mulgrew escorted from the room the same way?

Just watch the faces of the Unity Ex Bd and see either blank stares or frustration that they actually have to put up with questions and resos from those who disagree with them. You see, in Unity you don't question. You just follow orders. So actually seeing people ask questions must cause them some culture shock.

 

Last night a line in the sand of sorts was drawn. I wonder if they are taking this comment from Arthur Goldstein, who has been a Unity supporter for years:

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... The MLC Medicare Advantage Plan

More Democracy is threat to autocrats in Unity Caucus:

If UFC ever really gets it together - which is always problematical -- the retiree vote will move further away from Unity and once the healthcare loses take full effect, the membership will move away too. If I live to see the 2025 election, it should be interesting. If I don't, keep me informed anyway by posting comments on this blog.

 

The standard reaction of autocracies faced with threats to their control (think Lucashencko, Putin, Xi, Mulgrew) is to double down on repression. 

 

Democracy issues were front and center at the EB meeting last night.

Unity puts time limits on EB question period - expect further restrictions on democracy

 

Rally and Zoom to Protect Health Care - Thurs Oct 27 12:30 - Numbers Count, Zoom Tuesday Oct 25 7:30-9PM

 

Educational Panel:

Amendment of City Administrative Code 12-126:
What is it & what can we do to stop it?

Tuesday, October 25, 7:30-9:00 PM via Zoom

Join by phone or computer.
Closed captions in English will be available.

A recording will be distributed to all registrants following the forum.

The City is currently trying to push an amendment to the Administrative Code through the City Council, which would allow the City to save money at workers’ expense by reducing healthcare benefits to ALL workers on NYC’s medical coverage.  

Please RSVP to join us on Tuesday, October 25th for a panel with experts on policy and labor activism to learn how City Administrative Code 12-126 would change the City’s responsibility to provide healthcare benefits to its workers.  We will cover what the code is, why this amendment is being proposed, and how it will impact both active and retired city workers and their dependents. There will be time allotted for a lengthy Q&A session! Most importantly, we will discuss how to actively oppose this change (to take action now, you can call your City Councilmember HERE).  

The code they are looking to change has protected NYC workers for over fifty years, and this amendment is a direct attack to undermine the hard-earned benefits of City employees.  Join us to learn more on October 25th at 7:30 on Zoom!

 

 

 

 

Please come out and join us on Thursday Oct. 27th  at 12:30 pm on Broadway & Park Pl. for a Halloween Horror Press Conference as we greet our City Council members entering City Hall. We are frightened and need to let them know NOT to amend City Administrative Code 12-126 because the results would be very scary for us and for our health.

New York City Municipal retirees have fought for over a year to keep the City from switching our excellent traditional Medicare with supplement to a privatized Medicare Advantage Plan.  We won a lawsuit protecting us, and now the City is doing an "end run" by trying to get the City Council to change the law--Admin. Code 12-126!   This change  will not only affect retirees but could diminish current city workers' health benefits as well.

We are gathering once again when the Council is in session to tell them— VOTE NO!

October DA Reinforces United for Change allegation (Complaint #21) that the UFT/Unity Caucus Shuts UFC Out at DA - Unity Denies DA Plan

Sunday, October 23, 2022

The UFC Committee alleges that the UFT has violated the LMRDA with a range of conduct relating to the conduct of the Delegate Assembly, the UFT’s representative legislative body. These allegations are broadly divided into three categories: (a) alleged violations of Roberts Rules; (b) procedural inadequacy; and (c) procedural changes made in conjunction with the election... UFT Election Complaint #21

For decades some Unity Caucus people have been telling us how Unity and the leadership prepped for Delegate Assemblies through what they call their "Speakers Bureau". People get assigned roles. They even rehearse. They held two rehearsals for a recent DA so Mulgrew could get it right. Mulgrew even has seating plans. People are set up to ask certain questions that allow Mulgrew to expand on his already way too long opening report. They have designated plants to speak on leadership backed resos and people known as "call the question" plants to end debates. One former Unity told me a clue is when Leroy Barr removes his glasses. Which makes this report Leroy gave at the Oct. 3 Ex Bd hilarious:

UFT President Michael Mulgrew does not determine who is called on based on caucus affiliation...Concerning the allegation that no delegate not affiliated with the UC has been permitted to present a resolution and no UFC candidate member has been recognized during the new motion period of the Delegate Assembly, this is false. While the UFT does not track caucus affiliation for attendees or speakers at Delegate Assemblies, UFT rejection of UFC Complaint #21 - LOL

While I don't expect the Department of Labor or the AFT to rule against the UFT on the way they run the Delegate Assembly, we need to keep pointing their behavior. Last year's - a UFT election year - the behavior by Unity was the worst as Mulgrew shut out voices of the opposition at last years' DAs after the opposition had won or came close on some resos. 

Unity shuts out opposition voices by controlling the 10 minute New Motion period by inserting its own motions and making it look like they are random. 

Ex Bd UFC member Nick Bacon exposed the continuing behavior in his report on the Oct. DA:

No time for opposition: 

Mulgrew called on one opposition member all night – H.S. executive board member, Ilona Nanay (MORE), who asked a good question (and got a bad answer) on changes to the city council administrative code. It was no accident that Mulgrew called on a known opposition member during the question period, but not during the new motions period. During a question period, it’s easy for Mulgrew to regain control of the room. He can spend lots of time answering a short question, and making it clear that his perspective is the right perspective. 

During a new motion, opposition has far more space to convince the audience. Mulgrew knows that, so we haven’t been called on since last November, 2021 to raise one (and that’s when I was technically still a member of his Unity caucus). It’s also worth noting how obvious it was that Mulgrew knew who he was picking in advance. One of the people he called on, Maggie Joyce, is someone he calls on frequently to raise new motions. She is a familiar Unity face to him, often present at UFT functions. Another of the people he called on was raising a motion he noted before it was even raised (on migrant children).

Nick points out how Unity prevented UFC from presenting a strong healthcare reso to protect the members (rejected in a strict party vote at the UFT Ex Bd - Oct. 3: 

Our healthcare reso didn’t stand a chance. We didn’t even get to the business of motions on 10/12’s agenda. We lost all that to the most brainwashing filibuster Mulgrew has ever given. I’ll give my same advice again – if you want to see diverse union perspectives, come to executive board meetings where you have any chance of actually seeing them.

Unity put two "message" resos on the agenda - on immigrants and support for Iranian women - and watch them attack us for calling them out on this as an attack on the substance of the resos - not true - they could have been added as special business and not taken away from the normal 10 minute new motions. 

This tactic is intentional and happens time and again when they are threatened with a strong oppo reso and we will raise this tactic with the Department of Labor, though I don't think they will get what we are talking about.

Leadership sponsored resos are presented to the Ex bd and then put on the regular agenda of the DA. The ten minute time had been used by the opposition for decades to raise new motions. So especially since Mulgrew took over the UFT, Unity has coopted this time period to raise "late" resos, often handed out unlabeled as to sponsors. Now I understand that stuff may come up last minute -- so my suggestion is to allow them to do this but not count it against the 10 minutes. And if Mulgrew doesn't filibuster for an hour this would be easy.

Adding to the hilarity are the examples they cite of calling on UFC candidates at times before UFC even existed. The funniest was this:

At the November 17, 2021 Delegate Assembly, eventual UFC Executive Board candidate Nick Bacon made a motion regarding potential health care plan changes, which was voted on and defeated;

Nick, who did not become a candidate for UFC until January 2022, pointed out at the Exec Board meeting he was still in Unity in November 2021. In fact, my guess is that Nick was turned off to Unity due to their behavior at the DA. In fact, over the past 25 years, a number of people who were neutral delegates were pissed off enough at the DA to move toward the opposition.

And on this one from the UFT report:

At the November 17, 2021 Delegate Assembly, eventual UFC Executive Board candidate and member of the Educators of NYC (EONYC) caucus Daniel Alicea had a motion listed on the agenda as a special order of business, regarding the UFT’s position towards mayoral control of New York City public schools, which Mr. Alicea withdrew from consideration;

Daniel, who a year before the election was still fairly neutral about Unity - in fact he voted for Unity in the 2019 election - tried to get a mayoral control reso on the agenda in the spring of 2021 but found himself thwarted at every turn and withdrew his reso after its relevance had expired. That they used this example at a time when UFC did not exist and Daniel was not associated with the opposition - yet - makes their response even more of a farce.

In my opinion the thwarting of his attempt to get a discussion going on mayoral control at the DA was what helped open his eyes. When Daniel raised the point that many of the speakers at DAs are UFT employees on the payroll Unity went ballistic on him - he became public enemy #1.

Below is the complete section of the UFT report:

Complaint #21 – The Allegations Do Not Demonstrate Violations Of The LMRDA

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

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

Now watch UFT staff start appearing at your schools to sell the program and convicne you to accept a deal where you get a raise but use a chunk of it to pay more for your healthcare.

The Facts Michael Mulgrew, UFT, Doesn’t Want You to Know

1. UFT Claim: Mulgrew stated they did not borrow from the Stabilization Fund causing our current health care crisis.

Truth: The Stabilization Fund has been improperly used. It’s been used as a piggy bank to offset City expenses which had not been budgeted. Two examples: in 2009, an ongoing, annual payment of $112M was agreed to, primarily to reduce layoffs. In 2014, a one-time $1 billion payment was made to NYC from the Stabilization Fund to largely pay for UFT raises.

2. UFT Claim: The UFT “fact sheet” claims that the City is spending $11.8 billion in FY 2023 on health care expenses.

Truth: Facts matter: the City’s adopted budget shows healthcare expenses of $7.8 billion. We are not trying to hide the fact that healthcare is expensive, and no one is against trying to find savings. But we need to start with accurate numbers.

3. UFT Claim: “Mulgrew stated “...not a single health care benefit was either lost or diminished during that three-year period as a result of these cost-saving measures.”

Truth: Benefit changes including deductibles, copays and increased prior authorizations were added to the plan. These are diminished benefits. This year they are removing Montefiore from the preferred network adding co-pays, and narrowing the network for imaging and urgent care. All new City hires are automatically forced into the HIP HMO. That may be a prudent way for the City to save on health insurance costs, but it is a diminution of benefits.

4. UFT Claim: Mulgrew stated Medicare Advantage (MA) offers the same benefits as Traditional Medicare.

   Truth: Medicare Advantage is nothing like traditional Medicare, while the same medical conditions are covered, Medicare Advantage has two main differences: far fewer doctors participate in Medicare Advantage plans; and doctors and their patients have to endure the bureaucratic hurdles – and proven dangers – of prior authorization. Placing a private insurance company – making medical decisions – between the doctor and her patient is a fundamental difference.

5. UFT Claim: Mulgrew states his “custom” MA plan is the only PPO MA plan.

   Truth: There are lots of PPO Medicare Advantage plans offered by many different insurance companies. Period.

6. UFT Claim: Mulgrew says, “The New York City Medicare Advantage Plus Plan, negotiated by the MLC, was a totally new, unprecedented version of Medicare Advantage that was ONLY for New York City municipal retirees and their families.”

Truth: It is not a unique plan and it is not even a particularly good Medicare Advantage plan. The only true parts of the statement is that it was negotiated by the MLC; and it was “only for New York City municipal retirees and their families.” DUH.: the MLC is not about to negotiate on behalf of teachers in Dubuque.

7. UFT Claim: Mulgrew says, “This new plan negotiated by the MLC and the city was, in fact, a Medicare program. We were able to access federal funding because it is a public program.”

Truth: Medicare Advantage is a public-private partnership: Federal money that goes to a private insurance company. By forcing people out of their traditional Medicare-and-Supplemental insurance program that retirees have enjoyed and relied upon for more than 50 years, the City was attempting to relieve itself of the cost and shifting it to the Federal government. But you get what you pay for: Medicare Advantage is a fundamentally inferior program compared to traditional Medicare. It is nothing more than a budgetary gimmick on the backs of retirees.

8. UFT Claim: Mulgrew says, “The new plan was a custom, large-group version of Medicare Advantage developed for New York City municipal employees only. It was modeled after GHI SeniorCare and was filled with features that made it the same or better than current GHI SeniorCare but at lower cost to the city.”

Truth: The new Medicare Advantage plan is nothing – absolutely nothing – like traditional Medicare plus SeniorCare. Traditional Medicare does not have prior authorization restrictions; the proposed Medicare Advantage plan had over 100 categories of tests and procedures that will limit retirees’ access to health care. Virtually all doctors accept traditional Medicare. Hundreds of New York area doctors said they were not going to accept this plan. And for retirees living outside of the New York area, their access to participating doctors was going to be even more restricted.

9. UFT Claim: Mulgrew stated, “A state judge’s recent ruling illuminated an issue with a part of the administrative code (Section 12 -126) that allows for a dangerous interpretation. The judge said the administrative code required the city to only offer premium-free plans.”

Truth: The Court said no such thing. The City and unions argued that should be the interpretation of 12-126, and the Court rejected it. The Court said that if the City included a plan in its range of offerings, the City had to pay up to the defined price cap.

10. UFT Claim: Mulgrew said that if the Court accepted the retirees’ (winning) interpretation, such a mandate would eliminate the MLC's and the city's authority to offer multiple health care plans, since the “city and the MLC would be unable to absorb the cost of multiple premium-free plans.”

Truth: That makes no sense. The Court’s order made clear that the City must pay for plans offered by the City up to the statutory cap: the price of the HIP-HMO.

11. UFT Claim: Mulgrew stated, “Without this change in code, the city may choose to save costs by offering only one health care option that isn’t up to our standards.”

Truth: In the 1992 Health Agreement, the City is obligated to negotiate all aspects of health care with the MLC. The City cannot get rid of these choices of plans unless the MLC agrees to it. Retirees live all over the country and require plans that include their local doctors and hospitals. One size does not fit all.

 

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

What is prior authorization?

Prior authorization is a health plan cost-control process that requires physicians and other health care professionals to obtain advance approval from a health plan before a specific service is delivered to the patient to qualify for payment coverage.

What experts are saying about prior authorization

In today’s physician practice, the prior authorization process is typically manual and time consuming, diverting valuable resources away from patient care. In addition, prior authorization can delay treatment and impact optimal patient health outcomes.

Fixing prior authorization is a core element of the AMA Recovery Plan for America’s Physicians. The AMA works to right-size prior authorization through advocacy efforts and significant research focused on physician concerns over patient care delays, administrative costs and workflow disruptions.

Prior authorization impacts quality patient care

AMA research shows that prior authorization is a barrier to providing timely, patient-centered care. According to the AMA’s annual prior authorization physician survey (PDF), among physicians surveyed:

• 91% reported that prior authorization can lead to negative clinical outcomes
• 82% said prior authorization can lead to patients abandoning their course of treatment
• 34% said prior authorization has led to a serious adverse event for a patient in their care

In the June 16, 2022, episode of the “AMA Thriving in Private Practice” podcast, prior authorization expert Heather McComas, AMA director of administrative simplification initiatives, notes that from this survey, “An overwhelming majority of physicians, 93%, indicated that prior authorization can delay access to medically necessary care. And this just isn't about making people wait or inconveniencing them. It actually has negative impacts on their health.”

Prior authorization woes can also extend to employers. While health insurers tout prior authorization as a cost-saving measure, the AMA survey also found that it can lead to absenteeism and a less productive workforce.

Related Coverage

Putting patients first means tackling prior authorization

Prior authorization is an administrative burden

Prior authorization costs valuable time for physicians and health care staff. AMA’s prior authorization physician survey reports that physicians complete an average of 41 prior authorizations per physician per week–this workload translates to almost two business days of physician and staff time. 

McComas notes, “it's also disturbing to note that 40% of physicians indicated that they have hired practice staff just to do prior authorization. Again, we're adding a lot of administrative costs to our health care system just to do paperwork.”

AMA offers tips to help physicians reduce the prior authorization burden in their practice (PDF), and strongly advocates for health plans to offer automated, streamlined processes.

Momentum to fix prior authorization is building

AMA continues to fight excessive and unnecessary prior authorization through reform initiatives underway at both the state and federal levels. In addition, the AMA adopts policies to minimize the current impact of prior authorization on practices.

In a June 27, 2022, AMA Moving Medicine video update, Rep. Suzan DelBene (D-WA) discusses a current bipartisan legislative effort, the “Improving Seniors’ Timely Access to Care Act,” that would help reduce unnecessary delays in care by streamlining and standardizing prior authorization under the Medicare Advantage program, providing much-needed oversight and transparency of health insurance for America’s seniors.

“The bill would establish an electronic prior authorization process,” says DelBene, “so we can be speedy about getting information exchange. It would require HHS to establish a process for real-time decisions for items and services that are routinely approved. Again, there's no reason for something that's routinely approved to be delayed.”

Prior authorization efforts at the state level

AMA is committed to fix prior authorization by working with state legislators and medical societies to remove insurance company interference in the timely delivery of patient care.

As the demand and need for such reforms continues to grow, the AMA has created a model bill (PDF) and related issue brief (PDF) that medical societies can use to begin efforts to address prior authorization in state legislative processes.

Related Coverage

Why prior authorization is bad for patients and bad for business

Explore other AMA resources on prior authorization

Learn more about AMA’s grassroots advocacy campaign on prior authorization reform at FixPriorAuth.org. The FixPriorAuth campaign also includes a call to action. Other key AMA prior authorization resources include:

• Prior authorization reform initiatives
• Prior authorization reform resources
• Prior authorization practice resources
• Prior authorization research & reports
• AMA Journal of Ethics: Should Clinicians Be Activists?
• AMA Ed Hub™:
  • Administrative Burden and Costs of Prior Authorizations in a Dermatology Department: Interview with Aaron M. Secrest, MD, PhD, author of Administrative Burden and Costs of Prior Authorizations in a Dermatology Department
  • “Refocusing Medication Prior Authorization on Its Intended Purpose”
  • “Administrative Burden and Costs of Prior Authorizations in a Dermatology Department”

---

Reviewed by: Heather McComas, director, administrative simplification initiatives, and Emily Carroll, senior legislative attorney, Advocacy Resource Center

Reviewed on: July 12, 2022

 

UFT Ex Bd member Ronnie Almonte Superb Summary - The UFT's Health Care Strategy is a Race to the Bottom

Union officials justified these concessions by invoking talking points you’d expect to hear from the boss: rising medical costs are hurting the employer’s pockets, there are workers who are taking advantage of the more costly benefits (e.g., hospital visits), and besides, others have it worse. These points were repeated by UFT officials at this October’s Delegate Assembly meeting. They serve to defend past—and future—health care givebacks.... Ronnie Almonte

I loved this piece so much I read it 3 times and am sharing it all over the place. It is one of those articles I have wanted to write myself but too many brain cells are not operating at full speed. And he included my favorite comparison to the UFT position on healthcare with the arguments charter schools make.

UFT officials have gone so far as to echo talking points used by ed reformers hellbent on privatizing public education. It’s tragic to witness at Executive Board and Delegate Assembly meetings. The UFT officials consecrate the idea of “choice” (of the city to provide multiple, if unequal, health plans), just as charter school companies invoke parental “choice” to plunder money and space from purposefully underfunded public schools. They insist the amendment will increase our bargaining power, but its decades-long decay is precisely how we got here, grasping at straws. They even deny that Medicare Advantage is private because it’s federally funded, revealing a spectacular obliviousness to both history and logic. School vouchers are government funded; for decades they have covered tuition at private schools for the families who use them. Medicare Advantage, unlike Medicare, is managed by big, for-profit insurance companies.

Choice has become a right wing trope. The UFT is using the same terminology. I asked Mulgrew at the RTC meeting the other day why the UFT is joining Republican attempts to gut Medicare -- well actually so are the Democrats.

The UFT's Health Care Strategy is a Race to the Bottom

The union's new push to privatize Medicare for public sector retirees hurts everyone but insurance companies

Ronnie Almonte Oct 20

 https://www.ronniealmonte.com/p/the-ufts-health-care-strategy-is

Negotiations over a new DOE-UFT contract just started—a month after the old one expired—and already it’s looking bad. The city implied that it would not bargain over salary raises until the public sector unions can come up with additional health care savings, according to an email from UFT President Michael Mulgrew. The unions, who negotiate over health care together through the Municipal Labor Council (MLC), have reduced the city’s liability by $4.5 billion since 2014, when they became junior partners in the de Blasio administration’s efforts to cut costs. But the 2014 health care savings agreement—which was followed by a second in 2018—was a bad move for union members. Not only did it raise costs for NYC’s public sector workers and restrict their access to care. It set a terrible precedent of exchanging health care cuts for meager salary raises, hamstringing our influence over the bargaining process as we’re seeing now.

The 2014 and 2018 agreements imposed new burdens on public sector workers. Co-pays for urgent care and hospital visits tripled in 2016, for example. A form of two-tier health care rolled out in 2018, where new hires were forced into the (still premium-free) HIP-HMO plan without the choice of enrolling in the popular GHI-PPO plan—itself a violation of the UFT contract*. Union officials justified these concessions by invoking talking points you’d expect to hear from the boss: rising medical costs are hurting the employer’s pockets, there are workers who are taking advantage of the more costly benefits (e.g., hospital visits), and besides, others have it worse. These points were repeated by UFT officials at this October’s Delegate Assembly meeting. They serve to defend past—and future—health care givebacks.

The MLC’s newest savings scheme would throw retirees under the bus. It would force them to switch from Medicare and the Medigap insurance (which covers whatever Medicare doesn’t) that the city pays for, to a privately managed but federally-funded Medicare Advantage plan. This would save the city another $600 million a year, and the idea is to funnel that savings into the underfunded Health Stabilization Fund (HSF) to cover health care costs for in-service workers. Retirees have resisted this switch, pointing out that Medicare Advantage companies (many of whom are being investigated for fraud) are for-profit, and maximize their profit margins by withholding care from patients, through strategies such as excessive prior approvals. Retirees would be able to keep their Medicare but pay $191 monthly (double for couples) out their own pockets. This scheme would have gone into effect earlier this year, but a judge blocked its roll out. The city is required by law (Administrative Code 12-126) to offer a premium-free health plan to in-service workers, retirees, and dependents and pay the equivalent of the full cost of the HIP-HMO plan. Most people are on the GHI-PPO plan, which is slightly more expensive, so the city uses the HSF to pay the difference. The city would be breaking the law if it stopped paying Medigap insurance because it’s legally required to pay for a plan, and Medicare Advantage, again, is federally funded. The judge’s decision was a victory for retirees, who for over a year have been protesting the city as well as the union officials whom they rightfully see as complicit.

But this victory was temporary, and the MLC’s steadfast commitment to Medicare Advantage now endangers all union members. In September the MLC’s union presidents (led by UFT’s Mulgrew) voted—without consulting the rank-and-file they’re supposed to represent—to lobby the City Council to amend Administrative Code 12-126, the law that protects quality, premium-free health care. Mulgrew insisted at the October DA meeting that any amendment would preserve premium-free coverage for retirees and in-service workers alike. He and the MLC want the law amended such that the city can legally create different plan options, with different funding benchmarks, to different “classes” of individuals—in this case, in-service workers and retirees. Not only is this a lot of hoops-jumping to save money for an employer who always cries broke. It’s also quite the Pandora’s box to open. In the short-term, the amendment could mean a lower benchmark for the city’s contribution and thus the replacement of GHI with an inferior premium-free plan. Indeed, in June the city and the MLC put out a request for information from different insurance companies. In the long-term, since the amendment would eliminate equal treatment in health coverage, it would establish a precedent for the city to later group in-service workers into classes with unequal coverage.

What a mess. UFT and DC37 officials blame it on rising health care costs, but this train wreck was also caused by years of union inaction. When the 2014 health care savings agreement was made, the UFT allowed the city to use $1 billion from the HSF to pay for retroactive raises. Most public sector employees, including UFT members, had worked years under Mayor Bloomberg without new contracts and raises. The UFT’s strategy, which was no strategy at all, was to wait out Bloomberg. But in the end, Bloomberg won. Not only was he able to get the workers themselves to pay for their meager, overdue raises (unions contribute to the HSF). Bloomberg successfully enlisted the union officials to supervise the slow-motion erosion of their members’ salaries and benefits. The plan to wait out Bloomberg led the MLC, with the UFT and DC37 at its helm, to strike a Faustian bargain with new mayor Bill de Blasio—one where payment for money owed would establish a zero-sum game between raises and health care for now and forever. By not choosing confrontation, the unions got co-optation.

Decades of concessionary bargaining and top-down unionism have truly conservatized the labor officialdom. UFT officials have gone so far as to echo talking points used by ed reformers hellbent on privatizing public education. It’s tragic to witness at Executive Board and Delegate Assembly meetings. The UFT officials consecrate the idea of “choice” (of the city to provide multiple, if unequal, health plans), just as charter school companies invoke parental “choice” to plunder money and space from purposefully underfunded public schools. They insist the amendment will increase our bargaining power, but its decades-long decay is precisely how we got here, grasping at straws. They even deny that Medicare Advantage is private because it’s federally funded, revealing a spectacular obliviousness to both history and logic. School vouchers are government funded; for decades they have covered tuition at private schools for the families who use them. Medicare Advantage, unlike Medicare, is managed by big, for-profit insurance companies. Bloomberg Businessweek states, “Selling private versions of the U.S. government health program for seniors—known as Medicare Advantage plans—is among the fastest-growing and most profitable markets in health care.” UFT officials have claimed to be for federal universal health care. But if they succeed at imposing Medicare Advantage, they will have helped channel money to the greatest opponents to single payer. The UFT has really tied itself in knots, and we’re all paying for it.

We’re up against a mayor so draconian that he had cut school budgets while sitting on billions of dollars of federal COVID relief money. Labor stands a lot to lose, but also win if it can adjust its sails. Reversing the decades-long trend of givebacks would help attract and retain educators, whose growing experience will help improve academic outcomes. Fighting for pro-worker policies would help restore legitimacy that unions have lost for accommodating to pro-rich agendas. The UFT talks a big game about its influence in City Hall and Albany. Instead of robbing Peter to pay Paul, the MLC should demand that new contracts be funded, for example, by the city’s rainy day fund, its federal COVID relief fund, or the State’s stock transfer tax for which Wall Street gets rebated billions each year. The UFT should also support, rather than oppose, the NY Health Act whose implementation would remove a bargaining chip from the city. It’s a challenge, but the future of public education, and of municipal unionism, relies on achieving victories over austerity.

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*Article Three, “Salaries and Benefits of Day School Teachers,” Heading G, “Health Insurance and Welfare Fund Benefits,” Section One, “Choice of Health Plans,” paragraph one of the UFT Teachers Contract reads: “The Board agrees to arrange for, and make available to each day school teacher, a choice of health and hospital insurance coverage from among designated plans and the Board agrees to pay the full cost of such coverage.”