Tuesday, April 27, 2021


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."    


Anonymous said...

But the union...

Anonymous said...

The UFT really does think teachers are incredibly stupid. Start screaming.

Anonymous said...

At the last Retired Teachers Chapter Zoom meeting a few weeks ago with Mulgrew, Tom Murphy and his retired healthcare guru—I don’t recall any of them ever ever equating Medicare Advantage—as Medicare Privatization. Although there are negotiations currently in progress with every city labor union —they said ‘don’t worry’ or listen to rumors- as they painted a rosy scenario that any health plan changes—would be better than any current plan along with available plan choices. Mulgrew boasted that the UFT is an excellent health plan shopper/consumer than all the other unions. He also said—that the yearly springtime city Medicare Reimbursements to retired teachers—were untouchable and would never be used as a bargaining chip.
Bottom line—very concerned at the very least.

Anonymous said...

James and the mayor have an excuse for everything. Crime is rising because of a perfect storm. You should love the uft because it could be worse.

Anonymous said...

Retiree healthcare. The Big Decrease has begun followed by a big lie from UFT. Wonder how the retirees are going to vote now? Still with Unity?

Anonymous said...

Medicare is run a lot better than any private plan. Some years before retirement I dumped Aetna. Their rates rose out of control and their executives were the highest paid in the industry. Certain benefits could be used only once in a lifetime even with their premium rates. Had several peaceful,less costly years on GHI, now Emblem. City began gutting the plan shortly after disastrous Bloomberg contract. I was eventually forced out to retirement sooner than planned. GHI stopped covering a pre-existing condition as in-service health benefits were shrinking every July 1. My doctor told me I needed to retire to get proper medical care which would be covered by Medicare. He was right.
I am being stiffed again.
The privatization and monetization of not-for or non-profits is at the core of this mess. Doctors no longer exercise professional choices in consultation with their patients. The corporate accountants decide. Much of the support staff in health care makes less than a fast food worker. I am not a commodity.
Endured the baloney at several RTC meetings. Mulgrew is so vocal on the privatization of education. Funny how he doesn't get it about healthcare. A lot of retirees rallied back in 1976 to make sure NYC stayed in SS and Medicare when the city tried to opt out. We earned it!

Bring your rollators and wheelchairs. Maybe a few hundred retirees in front of 52 Broadway would light a real fire...

Anonymous said...

92 welfare and annuity funds spent $113.5 million in administrative costs in 2018. Comptroller Stringer report from October 2020. Combine welfare funds to save money, protect benefits for union members.

Anonymous said...

Does this mean retirees would lose ghi?

Anonymous said...

If Emblem does not win the contract with the city, bye, bye GHI.

Unknown said...

Wow...ghi has been good to me.doubt we can do anything but I wish we could all together urge ghi to do a great bid so they can win but idk if they are even in this market.when I went for a group atr incentive session at uft, I asked if health benefits could change.they dismissed me like it was a ridiculous question. Well hopefully it wont affect non retirees over 65.i am 60 but worried...

waitingforsupport said...

Ha. Rumor? Welcome to being treated like you're not US citizens.

Anonymous said...

They dismissed you because they do whatever they want and nobody dies anything and James tells people it's good enough.

Anonymous said...

Nice job uft. Scott Stringer accused of sexual harassment. Per press release from the lawyer, a woman who interned on Scott Stringer’s 2001 campaign for public advocate is coming forward tomorrow with an accusation of sexual harassment from the time.

Dues well spent everybody.

Anonymous said...

The City’s and the Uft‘s clarification creates more questions and puts up more red flags. The retirees of yesterday are not the complacent fearful bunch that they are today - they are going to scream bloody murder. And then they’re going to look for revenge. This just tells me that there’s a bigger plan. The fine tuning of a very specific target market that eliminates those who have little to offer and who cost too much. At $25 a head from retirees and the expenses and trouble they entail, Mulgrew et al have already made their decision. The only wrench in the works is the possibility that the retirees would vote against him and his merry band of men. I would assume he would look to change the retiree voting back to what it is for every other union retiree in the country - null and void once you retire. Let the battle begin. Even if you are a current working teacher this will have an effect on you and it would be in your best interest to get involved.

Anonymous said...

Lol. I thought 957 was a joke. It isnt. Wow, the uft is cursed and has cursed us all. I don't see what some of you see when it comes to this sham and scam union. Oh well. Maybe spring break pay is coming soon.

Anonymous said...

Hey 10:26 Lol this is the Boy's Club so it seems.Scott and Muldoo are perfect bedfellows.Remember Muldoo was busted for his sexual shenanigans at work. Although I do not follow city politics, to be fair, it seems like in today's world, someone will always appear to bring down with these sorts of allegations.no idea if it is true nor do I care.Maybe it started with Anita Hill and the coke comment by Clarence Thomas. An inappropriate comment and look at the big deal
I had a nasty coordinator make an inappropriate sexual comment toward me at a staff meeting years ago.i reported it.He was spoken to by the Principal, but I never received an apology...that is doe...
This whole situation is pathetic.May God save us from ourselves.(I mean this as a general comment about society.not referring to any person or group).Laugh and shake my head and hope we are in a bad dream.Good night!

Anonymous said...

So glad democrats are in charge. Surely they would never go after teacher benefits. We made it! Orange man and Republican controlled senate gone. We unionized teachers are on easy street now. Thank God the democrats are here to preserve our health care. Teachers can now breath a big sigh of relief (with masks on of course).

Anonymous said...

I shake my head when I think about all my very liberal angst filled, white retiree friends. They will argue with me till we’re blue in the face over why middle aged white men, like us, are the most evil entities in the universe. Then it’s on to how horrible Trump is. Trump lives on in each and everyone of their heads - he is closer to them than their wives. Then I have to hear about how the Chinese never stood up for Black folks and how they can understand why they’re getting attacked and that Trump really to blame for the attacks, not the people doing them. Then it’s ignoring deBlasio and crime. Then it’s on to how great Biden is and how he’s doing everything correctly. Then it’s on to why Cuomo shouldn’t resign - anyone can accuse anyone of anything- look at all the ATRs, even Chaz, who was wrongly accused. Then it’s on to scream about conspiracy theories, if somebody questions Fauci or Anderson Coopers opinion. The perennial verbalized difference between Republicans and Democrats is one is extremely generous and the other extremely cheap. But, when you scratch the surface they are the same. It’s about money and power. Both parties are repulsive. The hatred and vitriol that I see still going on in this country is not from Donald Trump. He was a product of that hatred, not the cause of it. The real danger is that people have totally shut out any opinion that doesn’t concur with what they believe to be true; and it’s not just shutting them out, it’s the wild anger that cuts a fine line between vitriol and loss of control.
The betrayal of the Uft for many retirees will be a hard slap in the face, as far as internal conflicts go. I’m sort of enjoying it. I’ve been screaming about Mulgrew and Unity for years. It is completely unimaginable to many of them that Mulgrew and Unity would choose saving money over their lives. Working teachers learned that lesson last March.

Prehistoric pedagogue said...

Waiting for support: I wish I were being treated like I wasn’t a citizen. New York State just dedicated more than $2 billion for illegal aliens. What could that 2 billion have done for retiree health care cost?

Anonymous said...

Yes, $15.6k per undocumented immigrant who meets certain criteria, but who's overseeing the checking process?

The YFT is MIA on the MAP issue. Anyone know if the full time UFT employees such as Mulgrew, Roberson, Arundell, Pepper district reps, etc receive aling with their second pensions, lifetime healthcare from NYSUT? Thinking that they may not ultimately be affected by these egregious proposals.

Anonymous said...

Prehistoric pedagogue. It isn't an either/or issue. All people can and should be helped. This money is just like the unemployment boosts and stimulus checks that were given to citizens.

Also, anyone willing to go on a 23 day hunger strike to fight for what is deserved, as these non citizens did? Pretty strong group of people, united. Can we organize and mobilize like that for anything?

Scapegoating will not help us. Pointing and saying look what they got, why not us, also won't help us. Opting out, and not organizing, and not putting up a fight, won't do a damn thing to better our working conditions either. Maybe, if we were more organized, more focused, and showed more solidarity, like that group of non citizens, we could win something too.

Prehistoric pedagogue said...

4:51 PM. Absolutely disagree. Unless you think there are limitless resources, it is definitely an
either/or situation. How can a group whose very presence in our country is a violation of law demand or deserve outright grants of 2.5 billions
Your post’s premise assumes that people here illegally be treated with the same care and discretion as citizens and green card holders. Is this what you really believe?

Anonymous said...

Prehistoric thinker. Yes. People deserve the same. We are not special because of the rock we were born on. And our country is more than capable, especially since we've been robbing the nations many southern immigrants come from for decades. If anything, they are reclaiming what was already theirs.
Besides, it isn't like our collective money goes to much good with more than half dedicated to our war department, and weapons manufacturers. No wonder schools are forever underfunded, and homelessness continues to be a problem. If we put humanity first, and didn't scapegoat our demise upon the other, as we so often do, then helping one another wouldn't be seen as a disagreeable premise. But alas, some would rather people starve because of nationality and citizenship status.

Now cue reactionary backlash, and butthurt "patriots"

Anonymous said...

James, the article in The Chief is behind a paywall. Do you know how to access the complete article? Thank you.

James Eterno said...

I printed the entire article in the blog post.

Anonymous said...

Thank you, didn't realize it is the entire Chief article.

Do you know if the city has an obligation to provide medicare eligible retirees with a supplemental plan? We all paid into Traditional Medicare. Is the city overstepping by proposing to take us out of Traditional Medicare for this all encompassing private umbrella plan?