JUDGE RULES CITY CAN'T CHARGE RETIREES A MONTHLY FEE TO AVOID MULGREWCARE (MEDICARE ADVANTAGE PLUS)

City retirees who want to keep traditional Medicare without paying a monthly premium scored a victory in court today. Medicare Advantage Plus is the privatized healthcare plan Michael Mulgrew and other union leaders agreed to with the city. This plan has gatekeepers who must approve many procedures that now in traditional Medicare are approved by a doctor and a patient usually. The city wants Medicare-eligible retirees to be automatically enrolled in the new Medicare Advantage Plus  It is what we call "Mulgrewcare". In addition, the city and unions agreed that Mulgrewcare would be the only free plan available for city retirees 65 and over. 

Tens of thousands have already opted out of Mulgrewcare so they can maintain traditional Medicare and stay in GHI Senior Care for supplemental insurance but the city wants to make them pay $191 per month to keep what they have. A judge didn't agree with the city and its union partners.

This is from the NY Daily News via AOL:

A Manhattan judge ruled Thursday that Mayor Adams’ administration cannot slap a financial penalty on retired municipal workers who opt out of the city’s controversial new Medicare plan, marking a significant win for a group of retirees who fought the health insurance switch in court for months.

The effort by the administration to levy a $191 monthly fee on retirees who want to keep their current coverage instead of enrolling in the new Medicare Advantage Plan runs counter to longstanding local administrative law, Manhattan Supreme Court Justice Lyle Frank wrote in a decision.

The law in question, Frank continued, requires the city to “pay the entire cost of health insurance coverage for city employees, city retirees and their dependents.” Any attempt to impose a premium or other cost for coverage is thereby illegal, he added.

“This Court holds that this is the only reasonable way of interpreting this section,” the judge wrote.

Further down:

Steve Cohen, a lawyer for the NYC Organization of Public Service Retirees, said the judge’s order validates the concerns of his clients and amounts to an “incredible victory” for them.

“The city got greedy, and held a sword over the head of retirees and said, ‘If you don’t accept your new plan, we’re not going to pay for your health care,’” Cohen said. “The judge saw right through that and said, ‘No way, you can’t do that.’”

According to data reviewed by the Daily News, more than 45,000 retired city workers had opted out of Medicare Advantage Plan as of mid-February despite the now-rescinded financial penalty they would face.

Without the $191 monthly fee, how many will now opt out of Mulgrewcare to preserve what they have now?

This is not over yet as the city can appeal but the interpretation of the administrative law is quite clear. The city can also try to take away the option of keeping the current plan since they can no longer charge for that. (See a large portion of the actual decision for details.)

Is Mulgrew going to have the gall to try to spin this as another great UFT victory that he fought for? I hope not. 

 

Here are significant details from the decision:

However, based on this Court’s reading of New York City Administrative Code Section 12-126, so long as the respondent is giving retirees the option of staying in their current program, they may not do so by charging them the $191 the respondent intends to charge. This section states unequivocally that “[t]he City will pay the entire cost of health insurance coverage for city employees, city retirees and their dependents, not to exceed one hundred percent of the full cost of H.I.P.-H.M.O. on a category basis.2” Respondent and nominal respondent aver that the definition of “health insurance coverage”, as defined in Admin. Code§ 12-126 (a), stating “a program” as opposed to “any program” means that the City of New York need only pay for the entire cost of one program. This Court respectfully disagrees. NYC Admin. Code § 12-126(b)(1) is simply unequivocal and does not use terms like “provide” or “offer”; rather it uses the term will pay and it provides parameters of such payment. The definition in NYC Admin. Code§ 12-126 (a)(iv) simply provides what constitutes a program or plan that the City of New York is required by law to pay for, by defining the contents of such a plan. This Court holds that this is the only reasonable way of interpreting this section.

Of course, none of this is to say that the respondent must give retirees an option of plans, nor that if the plan goes above the threshold discussed in NYC Admin. Code § 12-126 (b)(1) that the respondent could not pass along the cost above the threshold to the retiree; only that if there is to be an option of more than one plan, that the respondent may not pass any cost of the prior plan to the retirees, as it is the Court’s understanding that the threshold is not crossed by the cost of the retirees’ current health insurance plan. This is buoyed by the fact that the current plan has been paid for by the respondent in full to this point.