Wednesday, May 05, 2021

MEDICARE OR MULGREWCARE?

We predicted how yesterday's UFT Retiree Town Hall would function.

This is what this blog said on Monday:

UFT Town Halls in the age of COVID-19 are basically like call-in radio shows. President Mulgrew gives a lengthy monologue saying whatever the UFT is doing at the present time is the greatest thing ever and then some screened questions are allowed. The questions usually start with something like: "Hi Michael, thank you for the wonderful, amazing job you are doing..." My wife and some friends have tried to get through and have never had a challenging question answered live by Mulgrew

We were almost completely on target. Yesterday at the Town Hall for Retirees, Mulgrew gave a long speech saying how switching from traditional Medicare to the Municipal Labor Committee's Medicare Advantage would be the greatest healthcare system in the country. We're calling the privatized system that could be coming soon "Mulgrewcare" although all Medicare-eligible NYC municipal retirees, not just UFTers, will be part of the program if it goes through. 

The Mulgrewcare pledge: Under Mulgrewcare, retired city employees are being promised the same or better health benefits at the same price as now with the same reimbursements for Part B. Better still, the savings we get from this privatized benefits program would come back to us through the health stabilization fund. Whatever insurance provider that wins the contract will get more money from the federal government only if we consumers are satisfied. Does this sound too good to be true?

After Mulgrew finished selling the program, there were the softball questions coming one after another. I was not entirely correct in my forecast, however, as one rather difficult query did get through that of course Mulgrew could not adequately answer.

Bennett Fisher asked: What is to stop doctors who do currently take traditional Medicare from not accepting this plan at their discretion?

Mulgrew Answer: The fact is most doctors accept Medicare because there are federal and state incentives for them. That would be a problem even if we stay in our same plan. If something like that were ever to occur, if it is on a small scale, we would use all of our abilities and whatever companies we are working with to get that fixed. If it is a large scale, then it becomes a legislative issue at a state or federal level.

Mulgrew offered no guarantee that doctors will take Mulgrewcare.

This is from eHealth:

Medicare Advantage plan networks must include hospitals, dialysis centers, primary care physicians, specialists, and other health-care professionals and suppliers.

However, Medicare Advantage plans don’t have to contract with every Medicare provider in their area. Instead, they contract with Medicare providers who agree to coordinating patient care, improving the quality of patient care, and accepting the Medicare Advantage plan’s reimbursement schedules and administrative rules.

To be fair, my guess is Mulgrew will be right for the majority of NYC retirees since 250,000 city retirees is such a large pool of patients so most doctors would continue to take the city's privatized Mugrewcare. However, if doctors are receiving less of a reimbursement or slower payments from the privatized insurer, who knows? There is no certainty.  

As for the long term, I would still like my two questions from yesterday answered:

Medicare Advantage or part C is privately run healthcare. If 250,000 NYC retirees go from a public into a privatized program, don't we run the risk of weakening traditional Medicare significantly which will make it less likely that we will get Medicare for all in the long run which is what we should be striving for and that is the only way to really control prices?

Also, I may have attempted to sneak this in:

How are we going to be opposed to privatizing schools (charters-vouchers) when we are privatizing our own healthcare?

If 250,000 city retirees are strengthening the current United States privately run healthcare system that Mulgrew conceded is out of control in terms of costs, then Mulgrewcare is bound to fail in the long run. One retiree I spoke to today said he recommends that people buy health insurance company stocks. Insurance companies will be the big winners if 250,000 NYC retirees are pushed into privatized Mulgrewcare.

Tuesday, May 04, 2021

2021-2022 NYC CALENDAR RELEASED WITH CONTROVERSY OVER DELETION OF COLUMBUS DAY

The NYC Department of Education released the new school calendar today for the 2021-2022 school year. It looks like school will be starting almost a week later because Rosh Hashanah starts on the night of Labor Day so teachers need not report until Thursday, September 9, 2021, and school will not start for the kids until Monday, September 13. Snow days are now asynchronous learning days so forget about them.

This is not the controversial part. One million Italian-Americans in NYC were not consulted about the change from Columbus Day to Indigenous Peoples' Day on the calendar. I am not going to go through the entire historical judgement on Columbus here. That is way beyond the scope of this posting. Let's just say if you judge him in the context of the 15th and 16th centuries, he comes out a bit better than if you use today's standards. (This may come as a shock to some of you, but I never taught from the perspective that just about everything the United States and Western culture have done has been for some nefarious purpose.) On the issue of the DOE calendar, the fact is many Italian Americans are not happy that Columbus Day was eliminated as a holiday. It is still recognized as a New York state official holiday.  

From ABC 7:

There are also two changes in the observed holidays this year. First, the non-attendance day on October 11, 2021, will be in observance of Indigenous Peoples' Day, with Columbus Day removed from the calendar.

That decision was quickly blasted by Republican lawmakers.

City Council members Joe Borelli and Steve Matteo and Congresswoman Nicole Malliotakis issued a joint statement demanding the Department of Education restore the name "Columbus Day" to the holiday, claiming it was removed without any public announcement or fanfare.

Further down:

In response, the DOE updated its calendar to celebrate October 11 as Italian Heritage Day/Indigenous People's Day.

"Italian Heritage Day/Indigenous People's Day will celebrate the contributions and legacies of Italian Americans and recognize that Native people are the first inhabitants of the land that became our country," the DOE said in a statement. "By including these holidays on our calendar we are honoring the past, present, and future contributions of Indigenous communities and Italian Americans."

Maybe that will be enough to appease show respect for my fellow Italian-American brothers and sisters.


We'll have more information when we get it. Thanks to the people who sent the links. Note it is still Indigenous People's Day on this version. 


 

From Mulgrew


Dear __________,


I'm happy to report that the city Department of Education finally released the 2021-22 school calendar today. The holidays next school year make the calendar particularly challenging — especially with Labor Day falling immediately before Rosh Hashanah. But the final calendar still includes the minimum number of days to meet collective bargaining requirements and receive aid from New York State.


Here are some of the highlights:

  • Labor Day falls on Monday, Sept. 6, and schools are closed for Rosh Hashanah on Tuesday, Sept. 7, and Wednesday, Sept. 8. As is customary, all school-based staff will report to work without students for two days, on Thursday and Friday. The first day of classes for students is Monday, Sept. 13.
  • Schools will be closed on Yom Kippur on Thursday, Sept. 16.
  • Schools will be closed on Veterans Day on Thursday, Nov. 11.
  • Schools will be closed on Lunar New Year on Tuesday, Feb. 1.
  • The mid-winter recess will be from Monday, Feb. 21 to Friday, Feb. 25.
  • The spring break, which includes Good Friday and Passover, will be from Friday, April 15, to Friday, April 22.
  • Schools will be closed on Eid al-Fitr on Monday, May 2.
  • Schools will be closed for Juneteenth, a new public school holiday, on Monday, June 20.
  • Parent-teacher conferences will take place only in early November and in March.

See the 2021-22 school year calendar for staff »

This morning, we sent a text message linking to the family version of the 2021-22 school calendar. If you'd like to receive UFT text messages in the future, please use this online sign-up form.

New York City schools must, by state law, have 180 “aidable" days. This year’s calendar is at that minimum because of the late start of classes and the number of school holidays. This situation has produced some unusual features in the 2021-22 school year calendar:

  • The last day for students will be Monday, June 27, but the last day of work for classroom teachers, attendance teachers, school nurses, therapists, lab specialists and paraprofessionals will be Tuesday, June 28, as contractually required. It will be a Chancellor’s Conference Day. June 30 is the last day for all other UFT school-based titles.
  • Snow days, if we have any, will be remote instructional days. Otherwise, the DOE would have to convert another scheduled holiday to an instructional day to make up the day to meet the 180-day minimum.
  • Election Day will be a professional development day. Students will have a remote learning day with no synchronous or live instruction. All schools will receive funding to pay per-session to teachers to plan that day’s asynchronous instruction.

I hope this information is helpful as you plan ahead. Thank you for everything you do.


Sincerely,

Michael Mulgrew's Signature

Michael Mulgrew
UFT President


Staff version





LIVE BLOGGGING FROM RETIREE TOWN HALL

President Michael Mulgrew greeted the retirees. Apologizes for not having more information out there as negotiations continue on an RFP. Our lawyers said not to release information but other unions put out more information. Healthcare is 1A with wages. Received emails.

Municipal Labor Committee negotiations on healthcare costs are always ongoing. Our goal is not to diminish benefits. Michael Bloomberg strategy was to let costs spiral out of control and then diminish benefits. We had to hold tight through stabilization fund. PICA drugs which people need in a health crisis are needed by sickest individuals. We want to keep premium free healthcare which almost nobody else has. Under de Blasio, there has been a lot of negotiations but year-to-year costs have been going up even faster than under Bloomberg. Was a HIP baby as my father was sanitation worker. HIP building back and not so worried about bonuses. Forced new workers into HIP and now 95% stay in HIP. We save a lot of money from that. We use money we save into stabilization and to fund and to fund raises.

RFP on PICA, we were very tough negotiating and saved $300,000,000 Healthcare front and center in fight. We want to keep all doctors and everything else. We use our buying power to keep what we have and put more into stabilization fund. 

Some emails are just not true. Have met our obligations for contract we are already in. UFT officers do not have a different medical plan than everyone else. People using things that are factually wrong for their own purposes. How do we get to a better place?

Senior care program when city shut down. Medicare part A and Medicare Part B and Medigap. Costs going way up on senior care. Discussions stopped because of COVID. Question: How do we maintain what we have and use buying power to benefit retirees? We had a major fight with NY Presbyterian. Hypothetically, x-rays being used on the same machine were charging $1400 while others were charging $400. We and the city do healthcare together. There are too many of us. We are not the rest of the United States. We are not going to be lambs to the slaughter. We agreed with the city to get back to the insurance companies to audit the hospitals. We bring large numbers of people. 250,000 in senior care and 1.3 million active members. 

Two things to clear up. I hate the name Medicare Advantage. Medicare risk plans from 1990s and 200s that were bad plans. Individuals going medicare individual plans on their own are what people are complaining about. Any plan that would net accept Medicare, we are not interested in. Preserve premium free and access to doctors. Reduce costs and that money has to go back to healthcare stabilization fund for our benefits. If we pay $100 and it goes down to $80, the money goes back to us for benefits. Medicare Advantage Group plan. The city and the city unions are the group. We don't want the off the shelf plan. We are telling insurance companies we have 250,000 in plan and we want to know what you will do for us.

How do they make money? Part A and Part B, last 20% picked up by the city. City does not get federal reimbursement because it is not covered. We are entitled to some reimbursement in the group that could come back to the stabilization fund. This will stop us from doing something crazy two or three years from now. NYC public employees are the only people with premium free healthcare in the United States. It is not free. What we have we have paid for and we continue to pay for it. At the end of every year, people at the MLC have a list of everything that has been utilized. We then adjust rates. Prices keep going up. That's why we have embarked on this process. If we do nothing, two or three years from now we will be in a bad position. We have fought and paid for too much over the years. If we can now say that by moving to this kind of plan, the process is not done, if we get everything we want in writing so we can continue to have premium-free healthcare with more or the same benefits, we can do it or we can say no. Each union in the MLC gets a vote. Put all of the unions together and trying to figure out how to get things done is tough but it has served us well. We're trying to create more revenue and keep the benefits we have. We saved money on PICA. Using our power, we tell Emblem we need a better process.

Why would someone want this business? How can I be assured they are trying to do the best by our members? Federal government more than happy to give people money to manage it. Group plans, the group gets set up with x number of dollars for every person and then the real money is if the people within the group are satisfied. They get money with a 4-star platform. Reads an email, non politically motivated. If we do this transition, there will be no additional costs. We as a group are telling the insurance company that this is what we want. On Empire for supplemental coverage, will it be impacted? No. Could we go back to senior care plan? No, if we go in this direction. You would have to pick up $170. The process is to wait for the mediator to decide and then the MLC would decide and it would be brought back to this group. We are driving everyone in the industry nuts. We have to make sure everything is in writing and everything is assured to us. Most pick up 365-day hospital rider. We think it should be covered for the year. RX rider should be covered. No cap for out-of-pocket. Some families hit really, really hard. How do we get a cap? We deal with this system personally taking care of my wife and my mothers. Lots of out of pocket costs. You can go to any doctor that takes Medicare. Some hospitals we are not going forward unless we can get full coverage from them. Presentation yesterday at MLC so now free to talk a little more about it.

Fight with NY Presbyterian worked so we should be okay with them. We need a standing committee on healthcare in retiree chapters and with in-service people too. Loves that we are in this fight. We believe everyone should have premium-free healthcare. If we play by their rules, this ends in us losing. We are getting super aggressive. Keep benefits, reduce costs and have savings go back to us. Joint labor-management committee to monitor everything within the system. Fought hard and are proud of it. We can preserve these rights for generations and generations until the federal government does something about drug costs and hospital costs. Our fight is to make sure we keep this benefit. it is the entire MLC that does this. In service healthcare contract is coming up next year. Emails have pushed things into our negotiations. Questions guide us.

Question: Phased in or come at once?

Mulgrew answer: It's not finalized so we can't say now.

Question: What is the MLC?

Answer: Municipal Labor Council is all the unions negotiating as a group on healthcare. That's police, sanitation, CSA, others and us. 

Question: Live in Oakland, California, how would we be affected?

Answer: All Medicare doctors will take it and can go to another Medicare doctor if yours retires. 98% of doctors take Medicare.

Question: Daughter in college on my GHI. What would happen with her coverage?

Answer: Writing it down. Doesn't think there will be a problem with that. Will ask that question. We put that into new plan. Should be fine.

Question: If we switch over, would we still get a part B reimbursement every spring?

Answer: Yes

Question: Part A and Part B gets paid for by the federal government if enrolled (Mulgrew says 6,000 aren't enrolled), government said for big firms and cities to administer plans. Express Scripps, would there be a problem if they moved that?

Answer: That won't be a problem.

Question: Particulars important, committee on healthcare to meet and be strong. Is that different from joint labor-management committee? 

Answer: Retiree chapter should set that up, can't tell chapter what to do. Joint committee of MLC would need a retiree and in-service member. These battles are not stopping. Hospitals ask for 18% increase and only raise it 9% like they did us a favor. Non-profit CEO with $9 million salary and millions in bonuses. Hospitals got billions of dollars from federal government in COVID. 

Question: Parent of developmentally disabled man in his fifties. Accept Medicare. Will we be negotiating with smaller facilities?

Answer: They will have to accept it. Can use a facility outside of Medicare in senior care  and we will make sure they can be used.

Question: In negotiating, have to give like new members in HIP. Instead of having people go into HIP for one year, make it 3-5 years to add to supplemental program?

Answer: Everyone when we negotiated this thought that nobody would want to go into HIP. New CEO said she was doing what she could for to improve it. That will be on the table for the next negotiation.

Question: Retiring this year, will offices be open for a pension consultation?

Answer: They are open now.  

Question: Would be losing UFT welfare fund dental and optical?

Answer: No, but we could lose more if the stabilization fund is depleted. 

Question: When is negotiation going to be over and when will we get a printout of the decision?

Answer: We have still have questions with the mediator from our bid. The mediator makes a decision and then we will bring to you what is in that plan. Decision then on what the UFT vote will be at the MLC.

Question: Live in Florida on west coast, programs for Medicare and Medicare Advantage. Florida Medicare is different that anyplace else?

Answer: Can move into different plans. Many individual plans in Florida. We are not interested in narrowing of networks or facilities. We want the broadest network possible. Institutions, we have a lot of people in Florida. Most hospitals take Medicare. There should be no issues, especially in a state like Florida. 

Question: Thanks Mulgrew, Part B reimbursement, what about IRMA payments?

Answer:  I think that will be fine but not totally certain. Not clear on that at this moment but we will get back to you. Tom Murphy chimes in that IRMA will remain the same. 

Question: Retirees not yet on Medicare?

Answer: They stay where they are at this moment. Let the committee drive what they should be doing. Keep and improve benefits and lower costs. 

Question: If people want to remain on GHI senior care they can do it for an extra $170 a month?

Answer: Can pay more if you like but you can keep the same doctors in the group. Why pay for something you would get without paying?

Question: Is this an HMO or a PPO?

Answer: It's not an HMO it works more like a PPO. You just go and it is covered. They offer more than what is covered because they want to have the good scores to get more money from the government. 

Question on expatriots?

Answer: We are asking about that. 

Question: Bennett Fisher asked: What is to stop doctors who do currently take traditional Medicare from not accepting this plan at their discretion?

Answer: The fact is most doctors accept Medicare because there are federal and state incentives for them. That would be a problem even if we same in our same plan. If something like that were ever to occur, if it is on a small scale, we would use all of our abilities and whatever companies we are working with to get that fixed. If it is a large scale, then it becomes a legislative issue at a state or federal level. 

(Sorry folks, I missed a while as an operator finally picked up to let me ask a question. No surprise but I wasn't put on the call.)

Question: Gym memberships and group classes?

Answer: We are working on that.

Mulgrew thanks people for taking their time. Recommend a standing healthcare committee. We're taking care of each other. The nastiness of politics especially on social media has had a bad effect. That is not us. Take pride in taking care of in-service and retirees. Hope you have a better understanding. Tell people to calm down on Facebook and other social media. We are really good people. There will be another town hall when we make a decision. 

You can listen to the entire Town Hall on Sound Cloud

The question I wanted to ask:

Medicare Advantage or part C is privately run healthcare. If 250,000 NYC retirees go from a public into a privatized program, don't we run the risk of weakening traditional Medicare significantly which will make it less likely that we will get Medicare for all in the long run which is what we should be striving for and that is the only way to really control prices?

Also, I may have attempted to sneak this in:

How are we going to be opposed to privatizing schools (charters-vouchers) when we are privatizing our own healthcare?

Monday, May 03, 2021

ALMOST 500 ATTEND RETIREE ADVOCATE WEBINAR ON MEDICARE PRIVATIZATION; SCHIRTZER ASKS MULGREW FOR A DISCUSSION ON MEDICARE ADVANTAGE

I had the privilege of being one of the speakers on Zoom last night as hundreds of retirees attended the UFT Retiree Advocate webinar in advance of Michael Mulgrew's Town Hall with retirees on Tuesday. An invited medical doctor pretty much laid out the pros and cons of Medicare Advantage and then people associated with New Action, Solidarity, MORE and yours truly were able to speak.

I told the Zoom that UFT Town Halls in the age of COVID-19 are basically like call-in radio shows. President Mulgrew gives a lengthy monologue saying whatever the UFT is doing at the present time is the greatest thing ever and then some screened questions are allowed. The questions usually start with something like: "Hi Michael, thank you for the wonderful, amazing job you are doing..." My wife and some friends have tried to get through and have never had a challenging question answered live by Mulgrew. When the UFT dispatches an unprepared part-timer to call to answer the question that was posed, it is rah, rah, UFT essentially.

Tomorrow, I hope the retirees will have an open question and answer session during the Town Hall at 1:00 P.M. One retiree said we don't want a 90-minute UFT "infomercial" but rather a real dialogue on changes possibly coming for Medicare-eligible retirees. 

We have reported on what we know about the probable changes coming mostly based on information from my other union, the Professional Staff Congress (CUNY teachers) which along with the UFT is part of the 152 union Municipal Labor Committee negotiating with the city. 

Mike Schirtzer, who is pretty much the only independent left on the UFT Executive Board, asked two questions on Medicare and this was his followup from Arthur Goldstein's report (bold added by me):

Retiree town hall--Please take questions on Medicare.

Mulgrew- Not making any decisions yet. If we have to blow it up, we will.  Lots of bad information out there. There are always factions. UFT officers get same health care as everyone else in the UFT. Of course it's very inportant. People are bored when I talk about hospitals, but when we're negotiating, those costs are on the table. The most expensive doctor is usually not the best one. It's an insane industry. They wouldn't allow us to question costs, just pay bills. That's what we're dealing with. We need to avoid high premiums. Retiree chapter has already given me lots of questions.

While I am against privatizing services like education and healthcare, early studies show Medicare Advantage does have many satisfied customers. However, research also reveals that MA does limit access to care. Then there is the question about people who are very sick. 

This is from what I believe is a very objective paper published by HeathAffairs.org that acknowledges the pros and cons of Medicare Advantage (MA):

Another marker of quality is whether Medicare beneficiaries remain in MA plans when their health deteriorates. On this basis, there is reason to question whether MA plans offer higher quality. One paper found that MA members who had been hospitalized at least once had a higher rate of switching back to traditional Medicare than did other MA enrollees. The same was true for users of home care and long-term nursing home care.

We can't forget the profits:

We know that MA is dominated by a few large companies, and that it is a profitable line of business. At the end of 2020, the four largest MA companies accounted for more than 60 percent of total enrollment, and the 15 largest accounted for more than 80 percent. MA has also been very lucrative for many private health insurers. In 2017, according to MedPAC, the average pretax margin of for-profit MA plans was 5.2 percent; in 2018, it was 4 percent.

The HealthAffairs.org summary:

In conclusion, it is not clear that Medicare Advantage for All would help bend society’s cost curve more than Medicare for All or other policy proposals. In fact, the current evidence suggests that MA plans have not saved Medicare any money relative to traditional Medicare. To the extent that they lower costs, the lion’s share of those savings seems to be flowing to insurance companies, partly in the form of profits. Policy makers should consider whether this is the direction in which they want health care financing to go.

Sunday, May 02, 2021

LETTER TO MULGREW-MURPHY ON MEDICARE PRIVATIZATION

In my inbox is a letter to Mulgrew-Murphy that expresses retiree frustration over a possible switch for retired city employees from Medicare to a private Medicare Advantage plan.

Here is the link to register for the Retiree Advocate webinar this evening at 7:00 P.M. that will discuss this issue. My understanding is 200 people have registered.  

Shameless plug: I will be one of the panelists this evening. I will be speaking on how Mulgrew's town halls operate ahead of the Tuesday Mulgrew town hall with the retirees.


After stewing in my anger, fear and frustration over this sellout I needed to put my thoughts on paper.  Here is the copy of my letter to Tom Murphy and Michael Mulgrew.


It’s mind boggling to think that as a growing majority of Americans, on both sides of the political divide, support a national single payer healthcare system the UFT is taking a giant step backward (behind closed doors) and dropping the Medicare Traditional program offered to UFT Retirees and changing it to Medicare Advantage, a private, for profit, medicare [sic] like program.  

Honestly, the UFT is following in the foot steps of the Trump Administration by its privatization of the UFT Retirees medicare program.  This private, for profit program will need to make a profit, unlike government run Medicare Traditional and thus cannot give us the same services at the same cost.  We don’t need smoke and mirrors.  Just do the math.

A few well documented and researched facts. (1) The US ranks 11 among the top10 Industrial Western Countries in quality and delivery in healthcare services.  (2) The top 10 countries all have a universal health care system.  The systems are less costly and provide better health care for all of its citizens.  (3) Private health insurance companies stand between doctors and patients.  Decisions are made based on a business model formula of patient healthcare needs that yield a profit for the company.  Do the math, otherwise they wouldn’t be in business.

UFT THINK OUTSIDE THE BOX! 
 
“The MLC is tasked with finding cost savings for the city to the tune of $1.1 billion during the current negotiation period (2018-2021) —including $600 Million in fiscal year 2021.”

It’s not OK for senior citizens living on a fixed income to bear the onus, look else where to fill the gap.  

UFT MAKE DEMANDS OUTSIDE THE BOX!  

For example, demand that the city end all the sweetheart tax free and tax abatement programs and other lucrative incentives given to both domestic and foreign investors.  That money would be more than enough to bridge the savings the MLC has been tasked with. You just have to scratch the surface.  Seek and you shall find, as the expression goes.  



THINK OUTSIDE THE BOX.

Retirees  live on a fixed income while the big corporations, investors and CEOs pay nothing or a pittance in City taxes. Why are the most vulnerable being ordered to fix the financial gap?

It is not OK for retirees to bear the brunt, carry the burden of bridging the gap because the City says it can’t afford to pay for the Retirees government run Medicare Traditional program. 

It’s not OK to privatize the retiree medicare program that will provide less flexibility, reduced services and cost more. 

It’s not OK for the UFT to use the theatrics of smoke and mirrors to tell us we are getting the same and or better deal in a private, for profit  medicare [sic] like plan.  Health insurance companies are in the business to make a profit.  Profit is the driving force and not healthcare.  Using the business model you cut corners on healthcare but not reduce profits.  And don’t throw tele-doctoring in our face! Anything to make a buck for the health insurance industry. 

THINK OUTSIDE OF THE BOX!

We need a national healthcare system.  Rather than moving towards that end you are beefing up the Trump era model of privatizing government services. SHAME ON YOU.

UFT YOU SHOULD AND CAN DO BETTER!

Healthcare is a human right and not fodder for corporate greed! 
 

A Very Disappointed  UFT Retiree,

Denise Rickles

Friday, April 30, 2021

LANCET RESEARCH SHOWS THAT COVID ELIMINATION IS MORE EFFECTIVE THAN MITIGATION; SHOULD COVID VACCINES EVENTUALLY BE MANDATED IN SCHOOLS?

For people who really want to return to normal pre-COVID living, I highly recommend reading this Lancet research. The authors find that five countries that chose a rapid elimination strategy with full lockdowns (Australia, Iceland, Japan, New Zealand, and South Korea) have fared much better than advanced countries that have attempted mitigation (the United States, Israel, the UK, France, Germany, etc.) They then write about getting this pandemic under control internationally as we move ahead.

From the study on mortality:

COVID-19 deaths per 1 million population in OECD countries that opted for elimination (Australia, Iceland, Japan, New Zealand, and South Korea) have been about 25 times lower than in other OECD countries that favoured mitigation. Mortality is a proxy for a country’s broader disease burden. For example, decision makers should also consider the increasing evidence of long-term morbidities after SARS-CoV-2 infection.

What about economic performance?

There is also increasing consensus that elimination is preferable to mitigation in relation to a country’s economic performance. One study quantified the optimal basic reproduction number so that elimination is achieved at minimal economic cost. To this end, consider weekly GDP growth with respect to 2019 for the OECD countries that opted for elimination or mitigation. Elimination is superior to mitigation for GDP growth on average and at almost all time periods. GDP growth returned to pre-pandemic levels in early 2021 in the five countries that opted for elimination, whereas growth is still negative for the other 32 OECD countries.

Oh and then there is freedom?

Among OECD countries, liberties were most severely impacted in those that chose mitigation, whereas swift lockdown measures—in line with elimination—were less strict and of shorter duration. Importantly, elimination has been framed as a civic solidarity approach that will restore civil liberties the soonest; this focus on common purpose is frequently neglected in the political debate.

The conclusion:

National action alone is insufficient and a clear global plan to exit the pandemic is necessary. Countries that opt to live with the virus will likely pose a threat to other countries, notably those that have less access to COVID-19 vaccines. The uncertainty of lockdown timing, duration, and severity will stifle economic growth as businesses withhold investments and consumer confidence deteriorates. Global trade and travel will continue to be affected. Political indecisiveness and partisan policy decisions reduce trust in government. This does not bode well in those countries that have seen a retraction of democracy. Meanwhile, countries opting for elimination are likely to return to near normal: they can restart their economies, allow travel between green zones, and support other countries in their vaccination campaigns and beyond. The consequences of varying government COVID-19 responses will be long-lasting and extend beyond the end of the pandemic. Early economic and political gains made by countries aiming to eliminate SARS-CoV-2 will probably pay off in the long run.

Green zones and vaccine passports look like they are going to be an issue as we move forward.

NY is definitely trending positive with COVID-19 as more and more of us are vaccinated but we are still in an orange zone with the virus continuing to spread in the community.

Educators of NYC has a survey out that thousands of educators, parents, and community activists have responded to so far.  I am somewhat surprised that preliminary results show overwhelming majorities support mandatory vaccinations for students and educators. This is not a scientific poll but the numbers are fascinating.




You can take the survey by clicking here.



Wednesday, April 28, 2021

PROFESSIONAL STAFF CONGRESS FREQUENTLY ASKED QUESTIONS ON CHANGING TO MEDICARE ADVANTAGE (Privatization)

The PSC put this out for their retirees. The PSC is part of the Municipal Labor Committee as is the UFT. What's missing are questions about if prior approval will be needed for procedures, surgeries or tests. That is where it looks like the changes might be. Norm is likening these union negotiated changes to death panels as the unions would be helping to ration care. Is this too dramatic a description?

Frequently Asked Questions About the Proposed Medicare Advantage (MA) Plan 

What follows are questions sent to the Welfare Fund by participants in the recent PSC Retirees’ Chapter meeting. The answers given by Welfare Fund Executive Director Donna Costa reflect what is presently known. More details will be available when the bidder/vendor of the MA plan is selected. 

Q: Will all doctors accept the new Medicare Advantage Plan? 

A: All physicians who accept Medicare must continue to accept Medicare B coverage under the MA plan. 

Q: Will the coverage be equivalent to GHI SeniorCare? 

A: The table below details the current GHI SeniorCare coverage, deductibles and limits. All of the prospective vendors contractually agreed to offer the same or better coverage.



Q: Will the other Medicare Advantage plans that are currently in force remain or will they be replaced by the new Medicare Advantage plan?

A: The City has not yet determined whether it will offer the Medicare Advantage as the only plan option or offer both a Medicare Advantage and the option to purchase GHI SeniorCare. 

Q: Will there be two MA plan options? 

A: The possibility of two plan options is slim because all of the vendors have said they cannot guarantee the savings if members are allowed to pick from a variety of health care plans. 

Q: What is the cost to the City for the current health insurance program for retirees? 

A: The approximate current medical and hospital projected savings for all New York City ‘s retired Medicare eligible participants and their spouses is approximately $500 to $600 million. We assume a Medicare Advantage plan will reduce the City’s spend materially through efficiencies and moving to a single program. 

Q: Will the new MA plan be accepted anywhere in the US? 

A: Yes, you are covered anywhere in the US or US territories as long as the urgent care physician and/or hospital accepts Medicare. 

Q: I have GHI Emblem health for myself and my husband. My monthly cost is $2.00 for me and $2.25 for my husband. What will the monthly cost for the new MA plan be for me and for my husband?

A: The monthly cost you are referring to is the cost of the optional 365-day hospital rider. There is no cost for current GHI SeniorCare coverage. There will be no cost for any MA plan currently being considered. All plans will include the 365-day hospital coverage at no additional charge. 

Q: My primary care physician does not accept Medicare. I am currently reimbursed according to Medicare rates but pay extra to see him. Will this remain the same or will I not be reimbursed according to the Medicare schedule? 

A: If your primary care provider accepts Medicare but does not accept Medicare Assignment of Benefits (in which Medicare pays physicians directly), you will still be able to see the physician under the MA plans. 

Q: Will the $50 deductible, no-copay feature still be available under the Medicare Advantage plan? 

A: All of the plans being considered must meet the same coverage as the GHI SeniorCare Plan now offered. GHI SeniorCare currently has an annual deductible of $248 per participant, plus a $25 deductible for ambulance, durable medical equipment, and private duty nursing after the Medicare Part B deductible has been reached. 

Q: My wife is under 65, is on the Affordable Care Act, and has supplemental coverage under my Empire Blue Cross plan. Will I know for sure whether she will be covered as well under the Medicare Advantage plan being proposed before I have to decide whether to join city's Medicare Advantage plan?

 A: Spouses over 65 are eligible for coverage under the proposed MA plans. Spouses and/or dependents under 65 will also be covered, but details are pending the selection of the vendor.

Q: If I choose to remain with traditional Medicare, do you have a ballpark figure on how much I would have to pay for me and my wife if I wanted to retain the supplemental plan I have now? 

A: The option of purchasing the current GHI SeniorCare program has not yet been decided and will depend on which vendor is selected.

Q: What will the timing be for the transition from traditional Medicare to Medicare Advantage? 

A: No vendor has been selected yet so the timing of the transition is still being decided. 

Q: Can such a large-scale conversion occur by July 1? 

A: At this point none of the bidders can meet a July 1, 2021, implementation. 

Q: How can continuing participation by Medicare doctors and other providers in the new Advantage plans be demonstrated and assured? 

A: The only requirement is that a doctor must be a participating Medicare provider. Currently 97% of all doctors accept Medicare patients. 

Q: If I remain with regular Medicare next year, can I join the Medicare Advantage plan the following year without penalty?  

A: If you opt out of the proposed Medicare Advantage program you will have to wait until the next Medicare open enrollment period before changing again. The same goes if you take the MA plan and want to switch back. 

Q: My spouse is not eligible for Medicare because he has fewer than 5 years legal residence in the US. He is a dependent on my GHI plan for medical and Empire for hospital. How would this plan affect him? 

A: Since your spouse is not eligible for Medicare, he would not be eligible for the MA plan. Your spouse would be covered under a GHI type plan. Details are still pending the selection of the vendor. 

Q: If my husband and I choose to stay with Traditional Medicare and purchase our own supplemental coverage, will NYC still reimburse us for our Medicare premiums? 

A: I believe so but that is not yet confirmed. 

Q: Is there any way that they would grandfather those already in standard Medicare since that was what we were told we would get at the time of retirement? 

A: Since the new plan is offering the same or better coverage than GHI SeniorCare, I do not think NYC will be open to continue paying for the current plan. 

Q: Will there be a way to pull out if they go through with this and it dosen’t work well? 

A: There are contractual guarantees and penalties that will come into play if the plan does not meet its obligations to provide the same or better coverage than the current plan. 

Q: What kind of coverage does the MA plan provide for when we are out of the US? 

A: You are covered in full from the 1st through 60th day, except for the Medicare deductible amount, and from the 61st through 90th day, except for the Medicare coinsurance amount. 

Q: My husband is a dependent on my health coverage. If we are moved to an Advantage plan, what will happen to his coverage if I die before him? 

A: Whether you move to the MA plan or not, your spouse’s health care will cease on the last day of the month in which you die. Your death is a qualifying event and will trigger a special Medicare open enrollment period that will allow your spouse to select traditional Medicare A & B or another Medicare Advantage program.

Q: Will he have to re-register with Medicare to get the traditional Medicare restored, with the appropriate card, or would this be automatic? And will the procedures for this transition be addressed in detail? 

A: When an MA vendor is selected all the procedures for the transition will be addressed in detail. 

Q: How do Medicare Advantage plans make money? 

Here is Donna’s overview: Medicare Advantage plans act as both Medicare A & B and Medicare Supplemental insurance. Medicare pays the vendor a monthly amount to manage the Medicare A & B claims and pays them an administrative fee to do so. CMS funding to MA’s is based on “Star” rating and “risk” of membership. Higher ratings equal more CMS funding. The star rating also has a direct impact on their Quality Bonus Payment (QBP). In 2018 Health plans with an Overall Star Rating of 4.0 and received up to a 5.0% QBP. Star ratings are also a tool to assist Medicare beneficiaries in selecting high quality plans. See below for a description of the five main star categories: 

• Staying Healthy: Plans are rated on whether members had access to preventive services to keep them healthy. This includes physical examinations, vaccinations like flu shots, and preventive screenings. 

• Chronic conditions management: Plans are rated for care coordination and how frequently members received services for long-term health conditions. 

• Member experience: Plans are rated for overall satisfaction with the health plan. 

• Customer service: Plans are rated for quality of call center services (including TTY and interpreter services) and processing appeals and new enrollments in a timely manner. 

One benefit of the MA plan is that since it is responsible for Medicare A, B and supplemental care issues, our members and/or the welfare funds have a single go-to entity to reach to for help on any issue related to Hospital, physician and/or other covered treatment. 

Another way the MA program is incentivized to help members is to help them better manage their conditions by identifying these members and offering them additional help. This is in no way similar to a managed program which restricts members to certain providers. An example would be in identifying a diabetic and offering them better tools to help manage their condition (more current blood glucose monitor perhaps?). The MA provider is betting that by identifying at risk members early they can help the members to remain healthier longer which means there will be less related hospitalizations thereby recognizing a savings in claims dollars spent and an additional savings in improving the member’s risk score. See the slide below for examples:



MULGREW-MURPHY-SORKIN EMAIL TO RETIREES ON POSSIBLE MEDICARE PRIVATIZATION

The UFT is feeling the pressure from retirees on possible changes to retiree healthcare that the UFT is negotiating as part of the Municipal Labor Committee with the city. Michael Mulgrew will do a town hall for retirees on Tuesday. I wonder if the UFT will try to screen out tough questions as they do with active members at town hall/DAs.

The email:

NY LEADS COUNTRY IN AVERAGE TEACHER SALARIES

For those who think having a union means nothing, I suggest you look very closely at the data below from the National Education Association.

Which state ranks highest for average teacher pay? NY is number one. It is fully unionized. The UFT started that charge for better conditions for teachers in the 1960s and early 70s. Then, the unionized Westchester and Long Island teachers led the way to increase NY teacher wages from the 80s until the Andrew Cuomo years. Do you think NY is number one without unions? The states that round out the top five are all heavily unionized.

Where are teacher wages rising fastest now? You guessed it if you said it was mostly states where teachers were willing to go on strike. Washington is number one followed by Oklahoma. West Virginia is at four. NY is in the middle of the pack here at 22. I think the last teacher strike in NY State (illegal of course) was 1999.

Please note also that Wisconsin, where teachers have to opt into their unions each year and collective bargaining rights were decimated by former Governor Scott Walker, now ranks 45th in terms of rising wages.  I think we can safely conclude that the data shows that in states where unions are weak, the teachers don't do very well.

I am not saying unionization is the only factor that leads to higher wages but following this fairly simple formula that is easier said than achieved will generally succeed:

Educators United + Militancy = Better Wages and Working Conditions.

What are you doing to make this happen?

Tuesday, April 27, 2021

CHIEF LEADER GETS THE CITY TO CLARIFY ON MEDICARE PRIVATIZATION

From the latest edition of the Chief Leader, there is a lengthy piece on privatizing retired NYC government employee health benefits through a Medicare Advantage plan. This looks like it will be happening later this year. For those who do not wish to read the entire article, here are the paragraphs I found most concerning:

"In the Medicare Advantage programs that we're looking at," [Deputy City Labor Commissioner Claire Levett] said, "you can still go to any doctor or hospital that accepts Medicare," noting that "99.5" percent of the nation's doctors participate in Medicare.

She conceded, however, in a subsequent email that a concern raised in the City/New York Focus article that more than half of Medicare Advantage participants were in plans that required prior authorization for some services, including ambulance rides, had validity.

'Some Pre-Authorization'

"Our finalists indicated in their proposals that some services will require pre-authorization,"  Levitt stated. "These include hospital inpatient, behavioral health inpatient, ambulance and step therapy for certain high-cost drugs. Note that all these services and many more require pre-authorization in the City's current plans for active employees, as they help control quality and costs by getting patients to the appropriate care. The retiree should not have to do anything about the pre-authorization; they are typically handled by the provider."

They claim they will get lower administrator costs from private providers. This study from KFF seems to show this does not happen in the real world.

A key part:

Medicare Benefit Payments for Traditional Medicare and Medicare Advantage, 2008-2018

The overall cost of administering benefits for traditional Medicare is relatively low. In 2018, administrative expenses for traditional Medicare (plus CMS administration and oversight of Part D) were 1.3 percent of total program spending; this includes expenses for the contractors that process claims submitted by beneficiaries in traditional Medicare and their providers. This estimate does not include insurers’ costs of administering private Medicare Advantage and Part D drug plans, which are considerably higher. Medicare’s actuaries estimate that insurers’ administrative expenses and profits for Part D plans were 10.7 percent of total plan benefit payments in 2018. The actuaries have not provided a comparable estimate for Medicare Advantage plans; however, according to a recent analysis, simple loss ratios (medical expenses as a share of total premiums collected) averaged 86 percent for Medicare Advantage plans in 2018, which means that administrative expenses, including profits, were 14 percent for Medicare Advantage plans.

1.3% administrative costs for traditional Medicare vs. 14% for Medicare Advantage plans but the city is going to save money by going to Medicare Advantage and retirees are supposed to have the same benefits. Something doesn't seem to add up.

The full Chief-Leader piece:

 Anxiety About Shift to Medicare Advantage Plan, City Clarifies Intent

By RICHARD STEIER Apr 23, 2021 Updated 59 min ago

Discussions between the de Blasio administration and municipal unions meant to produce hundreds of millions of dollars in health-care savings through a move to a Medicare Advantage program have prompted alarm and suspicion among some retiree groups and activists that the savings will be realized either by reducing benefits to them or increasing out-of-pocket costs.

Uneasiness grew after an April 21 article that was a collaboration between the investigative website The City and New York Focus headlined, "Retired City Workers Recoil at Coming Cost-Saving Medicare Shift." 

Among those it quoted was Jane Roeder, a former high-level official in the Office of Labor Relations, the agency that has been spearheading the city's attempt to reach a deal with the unions. Calling the prospect "a little frightening," Ms. Roeder said, "The word on the street is that these Advantage plans are fine as long as you don't get sick, as long as you don't need the chemotherapy that my friend is having right now, or radiation treatment, or infusion treatment, or skilled nursing."

Try to Allay Concerns

OLR officials have been tight-lipped about the discussions, which will eventually lead them to agree with the Municipal Labor Committee, the union coalition that negotiates health-benefit changes, on a single private insurer to run the Medicare Advantage program for 250,000 city retirees and their spouses.

But in the wake of that article, Labor Commissioner Renee Campion and Claire Levitt, OLR's Deputy Commissioner, Labor Strategies, spoke at length during an April 22 phone interview to try to calm those who seem convinced that they are collaborating with the unions to stick retirees with the short end of the eventual agreement.

They were somewhat limited in their ability to discuss specifics, Ms. Campion said, because "we have not selected a vendor yet. We are down to the finalists."

Although the City/New York Focus article said retirees had been told by their unions that the finalists were Aetna and Empire BlueCross BlueShield, Ms. Campion declined to name the finalists, or even to confirm that there were just two of them.

Insists Plan Will Help All

The one aspect she and Ms. Levitt were willing to affirm was that when a vendor was selected, the plan—which they expect to have up and running before the end of the year—would benefit retirees as well as the city and its unions.

Retirees' apprehensions had two roots, Ms. Campion said: "People are afraid, No. 1, that they're not going to be able to see their doctor, and it's going to cost them a ton more money."

While there are a small number of Medicare Advantage programs nationwide in which either or both of those negative aspects exist, Ms. Levitt said that neither will happen under the vendors the city and the unions are considering.

Ms. Campion said, "We are committed to our retirees and making sure any new program will increase quality and benefits while reducing costs to the city."

Medicare Advantage, Ms. Levitt said, is a replacement for the traditional Medicare Part A and Part B. Instead of being administered by Medicare, it will be run by a private insurer, something that is already true for 40 percent of retirees nationally.

The huge amount that the city and unions would be spending on the plan assures them better treatment than might be available through a smaller employer or union.

'Still Go to Any Doctor'

"We're buying a Group Medicare Advantage Program," Ms. Campion said. "It's still going to be a free program for retirees, and they'll still get Medicare Part B" reimbursement from the city.

Ms. Levitt said the fear caused by some Medicare Advantage plans that a smaller network of doctors would be available to retirees would not materialize with the vendor chosen by the city and the MLC.

"In the Medicare Advantage programs that we're looking at," she said, "you can still go to any doctor or hospital that accepts Medicare," noting that "99.5" percent of the nation's doctors participate in Medicare.

She conceded, however, in a subsequent email that a concern raised in the City/New York Focus article that more than half of Medicare Advantage participants were in plans that required prior authorization for some services, including ambulance rides, had validity.

'Some Pre-Authorization'

"Our finalists indicated in their proposals that some services will require pre-authorization," Ms. Levitt stated. "These include hospital inpatient, behavioral health inpatient, ambulance and step therapy for certain high-cost drugs. Note that all these services and many more require pre-authorization in the City's current plans for active employees, as they help control quality and costs by getting patients to the appropriate care. The retiree should not have to do anything about the pre-authorization; they are typically handled by the provider."

And, she added, "Traditional Medicare doesn't technically require pre-authorization, but it does have medical-necessity provisions that apply to the payment of many services. So, for example, Medicare regulations state that 'Medicare covers ambulance services only if they are furnished to a beneficiary whose medical condition is such that use of any other means of transportation is contra-indicated. A beneficiary whose condition permits transport in any type of vehicle other than an ambulance would not qualify for services under Medicare.' " 

Whichever vendor is ultimately chosen, Ms. Campion said, the new program will mean "improvements on the benefits that people have in their Senior Care plan. It will offer both fitness and wellness programs to retirees, and result in lower co-pays and out-of-pocket expenses."

Not Squeezing Every Nickel

"We're not looking to save as much money as possible," she said, which was why the deal could offer improvements for retirees even while providing the city the cost relief it needs.   

Ms. Levitt noted that the many municipal retirees who have moved out of state will have access to the Medicare Advantage program that is chosen, and that in cases in which a retired worker's spouse is not yet Medicare-eligible, he or she will remain in the plan for active employees until they are old enough to qualify.

"The savings come from the fact that the [private] insurers are much more efficient at managing the plan than Medicare is," she said, notwithstanding Medicare's well-earned reputation as among the best-administered government programs. 

And, Ms. Levitt added, the vendor will have a built-in incentive to provide quality services: "the higher the plan is, the more they get from Medicare. We are only tapping into four-star plans."

MLC Chairman Harry Nespoli, who is also president of the Uniformed Sanitationmen's Association, said April 23, "I understand the retirees' concerns—they're on fixed incomes and they want to know exactly what the changes will be."

'Can Keep Their Doctors'

But, he said of some of those who have been deluging their union leaders with calls, "They think it's the old Medicare Advantage. It's not: they can keep their original doctors."

While he echoed Ms. Campion's remarks, saying, "We still have to work out the particulars" of the provider and the plan, Mr. Nespoli said the MLC would meet with union presidents before the end of the month for a progress report, and would not finalize terms before having them vote on the agreement.

One of the early critics of the secrecy surrounding the discussions had been Stu Eber, the former head of the Managerial Employees Association who is now president of the Council of Municipal Retiree Organizations. In an open letter to the Mayor and the MLC that was published in this newspaper's March 12 issue, he stated, "Nowhere in this process have you consulted with the 200,000 people and their families to determine how it will help or harm us...The lack of transparency in your rush to change this program is both insulting and frightening to those of us who have collectively worked millions of years serving the people of New York City. How can we trust our very health to a back-room deal based on a dubious assumption of cost avoidance?"

Reason for No Discussions

When the two OLR officials were asked why there hadn't been education sessions to answer retiree questions and assuage their fears, Ms. Campion replied that this was not feasible at a point when the city and the MLC have not made a decision on the provider.

"You need to know who the vendor is before you can have the conversations," she said, with Ms. Levitt explaining that "the finalists have different benefits that they're offering."

Once the city and the MLC make their choice, she said, "There will be a very extensive outreach program," with a customer-service call center set up solely to answer questions about the program.

Ms. Campion provided a copy of a letter she had sent to Mr. Eber March 31 trying to reassure him that stated, "The selected Medicare Advantage program will continue to be free to retirees. The offerings have been carefully analyzed to ascertain that the program will not harm retirees but actually provide better or equal coverage. The program permits retirees to utilize any provider nationally that accepts Medicare, assuring that provider choices are as broad as they are under the current program. There will be no bureaucratic hurdles to selecting providers or obtaining care. The Medicare Advantage program also offers additional programs for retirees not available under the current program including transportation and food delivery for post-hospitalized patients and coverage for fitness programs."

Lost in the Mail

Mr. Eber, reached by phone that evening, when asked why, after receiving those assurances, he had remained skeptical of the program in his comments for the City/New York Focus article, said he had not seen the letter, which had been sent to him at the offices of the Professional Staff Congress rather than COMRO or his home address.

After a copy was emailed to him, he said he would defer a detailed comment on its contents but supported a resolution approved by the PSC's delegate assembly April 15 asking that the City University of New York instructors union persuade the MLC to place a moratorium on moving to a Medicare Advantage program.

Ms. Campion said the uproar from retirees had not been directed only at her agency. "I think the unions, from what we're hearing, are getting their fair share of incoming," she said, adding that once a vendor has been chosen, the city and the MLC will work jointly to lay out the details of the program for retirees.

She declined to comment on when the choice has to be made in order to have the program operational by the end of the year, except to say, "We need the vendor in place as soon as possible."