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!
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:
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:
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:
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
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.
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 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.
The arbitrator also said that unless the City Council amends the New
York City Administrative Code within 45 days, GHI SeniorCare and all
other current “pay-up” plans will no longer be offered once the
premium‑free Medicare Advantage plan launches.
So here we are ---- either chance the admin code so the wealthier retirees can pay to opt out, thus furthering inequity, or being forced into MedAdv run by Aetna -- note Scheinmann forces them to deal with Aetna. See my opening question.
Let's look at CVS/Aetna as a profit making company:
2017 - Aetna Doubles Dividend, Boosts Stock Buyback Plans- Insurer’s moves come days after walking away from $34 billion merger deal with Humana
Aetna was bought by CVS in 2018. Amazon shark jaws are open:
Here's a fun fact:
CVS Health is the parent company of the health insurer Aetna,
which Amazon has reportedly reached out to, among other insurers. The
move suggests that Amazon is moving along with Amazon Care — its
on-demand health service that has at-home care aspirations — quicker
than what may have been expected.
Will my Walgreen's prescriptions still be allowed?
CVS turned Amazon down - for now -- but when can we look forward to having our healthcare managed by Jeff Bezos?
The American Medical Association (AMA) was disappointed in DOJ’s
decision, standing by its stance that the merger will harm patients. “We
now urge the DOJ and state antitrust enforcers to monitor the
postmerger effects of the Aetna acquisition by CVS Health on highly
concentrated markets in pharmaceutical benefit management services,
health insurance, retail pharmacy and specialty pharmacy,” AMA President
Barbara L. McAneny, M.D., said in a statement.
Karen S. Lynch President and Chief Executive Officer
Total Cash $7,045,167
Total Compensation $20,388,412
Shawn M. Guertin Executive Vice President and Chief Financial Officer
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 thatifan agreementis 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 nationalcrisis.”
“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 negotiatedto
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 toother 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.
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.
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.
This is the scam Mulgrewcare is looking to as a way to "solve" the high costs of healthcare. By raking money out of the only real public option we have. Let's help it go bankrupt so they can justify eliminating it because you know -- private - like charter schools - have to do it better according to the neo-liberal Milton Friedman economic school.
Even if their plan had no personal impact on me, I would be against it for political reasons - the movement of money from the public to the private profit making health insurance industry. I keep getting asked what are they getting for doing this? I throw my hands up.
December 12, 20225:00 AM ET Fred Schulte Holly K. Hacker
How Medicare Advantage plans dodged auditors and overcharged taxpayers by millions
In April 2016, government auditors asked a Blue Cross Medicare
Advantage health plan in Minnesota to turn over medical records of
patients treated by a podiatry practice whose owner had been indicted
for fraud.
Medicare had paid the Blue Cross plan more than
$20,000 to cover the care of 11 patients seen by Aggeus Healthcare, a
chain of podiatry clinics, in 2011.
Blue Cross said it couldn't
locate any records to justify the payments because Aggeus shut down in
the wake of the indictment, which included charges of falsifying patient
medical files. So Blue Cross asked the Centers for Medicare &
Medicaid Services for a "hardship" exemption to a strict requirement
that health plans retain these files in the event of an audit.
CMS
granted the request and auditors removed the 11 patients from a random
sample of 201 Blue Cross plan members whose records were reviewed.
A review of 90 government audits, released exclusively to KHN in response to a Freedom of Information Act lawsuit,
reveals that Blue Cross and a number of other health insurers issuing
Medicare Advantage plans have tried to sidestep regulations requiring
them to document medical conditions the government paid them to treat.
The audits, the most recent ones the agency has completed, sought
to validate payments to Medicare Advantage health plans for 2011 through
2013.
We work for a large employer. We expect our union to resist these moves. Not the health corp loving UFT.
A new Kaiser Family Foundation (KFF) analysis
examines the extent to which large employers that offer retiree health
benefits are turning to Medicare Advantage (MA), the reasons why they
are making this shift, and the implications for retirees and federal
spending.
This shift has important implications for beneficiaries and the Medicare
program. Unlike Original Medicare (OM) enrollees, people with MA are
subject to narrow provider networks and utilization management tools
that may limit or delay access to Medicare-covered services. Funneling more Medicare-eligible retirees into MA will likely drive up costs, as Medicare pays more for MA enrollees (including in group plans), on average, than for a similar beneficiary in OM.
Currently, only 13% of large employers (200 or more workers)
offer retiree health benefits. In 2022, half (50%) contracted with MA
plans to provide that coverage—nearly double the share (26%) who did so
in 2017.
About 44% offered retirees no choice but to receive their health
benefits through MA. As a result, those retirees are unable to choose
Original Medicare (OM), unless they are willing to give up their retiree
health benefits.
A driving reason employers cited for offering retiree health
benefits through MA contracts was to lower their own financial
liability. For some, the adoption of MA “appears to be a strategy to
maintain benefits for their retirees, without terminating coverage or
adopting other changes that more directly shift costs onto retirees.”
This shift has important implications for beneficiaries and the
Medicare program. Unlike OM enrollees, people with MA are subject to
narrow provider networks and utilization management tools that may limit or delay access to Medicare-covered services. Funneling more Medicare-eligible retirees into MA will likely drive up costs, as Medicare pays more for MA enrollees (including in group plans), on average, than for a similar beneficiary in OM.
I hate making calls to politicians, but this time I will do it - even if my local city council rep is one of the few Republicans. But I heard she is getting calls 10-1 against changing the admin code. All those police and firemen in the neighborhood. Mulgrew and the UFT hierarchy wants these changes badly but they now have a plan B if they fail to get the changes --- nuke our health plan altogether. My brian is too simple to wade through all those permutations. You can read more about that on our favorite blogs.
In the meantime, if you are available this Wednesday at 10 AM to join us in Retiree Advocate, Register Here
Calling all “No-Change-To-Our Healthcare" advocates!! Join Retiree Advocate/UFT for some holiday cheer as we celebrate our accomplishments in pushing back against Medicare Advantage. We'll share our stories on-line with Zoom and toast each other with cups of coffee, tea, or perhaps a stronger beverage of your choice on Wednesday, December 14th at 10 AM.3
The meeting will end with a phone-a-thon where we will make calls together to our City Council members. We’ll ask them to oppose any changes to Administrative Code 12-126, the NYC law that protects our current healthcare coverage. Scripts will be provided plus your Councilmember’s phone numbers. In addition, more detailed information will be discussed regarding the preservation of 12-126 as it currently stands.
Holiday attire optional. But we'll be there with bells on!
Leo Gordon: How to support non-union staff at union-busting companies during the holiday season.
Mary Jo G: Chancellor came out with a reimagining special education. None of which addresses systemic staffing issues.
Pillars
- scaling up effective programs. ASD programs: NEST and Horizon,
growing incrementally. PATH program - inclusion model for students at
risk for emotional disturbances - it is in 7 schools. Also expanding the
SEED - sensory exploration program that therapists are doing after
school and Saturdays. Initially 2 in each borough & expanding.
Hopefully paying on time. Establishing an advisory council. Advocates
and parents. Will find more info and share.
Ilona: Next week the UFT will hold a meeting for school librarians next week. Attendees will wear a shirt
Mike
Sill: Thanks to Alex and HS EB because they wrote a resolution but the
other ppl who wanted to participate in motivating were not here, but
Rodney:
Oppose policy re: not allowing gay men to donate blood except for
certain instances of abstinence for a year. Now they want to propose
abstinence for 3 months.
Requesting
completely revoking the policy and take a step in the right direction.
They’re starting it, but still it’s discriminatory, capricious, and
arbitrary. Partner w Natl Black leadership on Health; HRC; GLADD. Please
support resolution
Change of DA. It will be 12/21 instead of 12/14
Motion to adjourn at like 6:22p: unanimous
Mike Sill: Okay, if anyone wants to tell LeRoy, go ahead.
It's been a busy day and it's only half over. I'm heading into the city to go to tonight's UFT Ex Bd meeting. We meet at around 5 to talk about stuff then go up to get some dinner. Oh, then there's a meeting. We hope to have a report later.
Earlier Retiree Advocate had a 2 hour regular zoom meeting plotting our next moves. Read another great post from Arthur praising the work of RA.
I guess Mulgrew’s court of last resort is our membership. And Unity,
faced with losses in every other venue, had no choice. Armed with weak
arguments that few believe, they have been trying to convince our
membership. To convince them of what? For now, to support the change to
12-126. No matter how thick Unity is, they are not trying to sell
members on Medicare Advantage, not today. That blew up in Unity’s faces
when they tried to convince our sharp retirees that “Silver Sneakers”
would make up for prior authorizations (and denials). Yeah, right.
Unity has been facing opposition. Even some in their ranks are
worried about what they are doing to healthcare. And those opposed to
Unity and Mulgrew have been vocal. What do they do?
The giant UFT publicity machine is out there shamelessly trying to
fool us with a seven-bullet flier and a different lengthy
save-the-code-amend-the-code piece filled with disinformation. Marianne
Pizzitola has done another video challenging the UFT claim that the UFT
is trying to preserve choice of medical plans so we need to change
Administrative Code 12-126. In reality, Michael Mulgrew has been trying
to limit choice since 2020 as this new video from Marianne shows.
Below is part of the letter on the Request for Proposal for the
Medicare Advantage Plan for City Medicare-eligible retirees that
Marianne refers to in the video. It is from November 18, 2020.
The
MLC question is in the middle column. The City answer is on the right.
Notice the City answering that they intended to end most options for
Medicare-eligible retirees back on November 18, 2020 and the Municipal
Labor Committee went with this Request for Proposal. It would have been
implemented except it was stopped in court because it violated
Administrative Code 12-126 which protects our healthcare.
Maybe I will get back to you later with further updates. Or not. You all have plenty to read without me.
