By Bob Hennelly

The New York City Organization of Public Service Retirees [NYCOPSR] was given a hero’s welcome at a ‘Save Medicare’ rally in front of the U.S. Capitol on July 27. Roughly 70 members shared the spotlight with Sen. Elizabeth Warren (D-MA), and several other members of the House of Representatives who blasted for-profit Medicare Advantage insurance companies for delaying and denying health care treatment to seniors which they said resulted in an estimated 10,000 deaths a year.

The drive by the heads of the Municipal Labor Committee [MLC] and the City of New York to push 250,000 municipal retirees out of traditional Medicare and into a profit-driven Medicare Advantage Plan, so the city can realize what it says will be a $600 million annual windfall, goes back to former Mayor Bill de Blasio’s administration. New York City municipal retirees fighting back in the streets, in court and inside the New York City Council, have consistently beaten back the campaign, however. 

Mayor Eric Adams’ administration, like the de Blasio administration before it, along with the MLC, maintain the Aetna Medicare Advantage takeover can be done without any diminishment in healthcare for retirees. In their court filings, NYCOPSR offered sworn affidavits from municipal retirees documenting the switch to Aetna will, in fact, undermine their existing healthcare with catastrophic consequences.

As Work-Bites has consistently pointed out, the debate in New York City that has the leadership of unions like DC 37, the United Federation of Teachers and Teamsters Local 237 aligned with Mayor Adams against retired civil servants, is part of a much larger national debate over the increasing corporatization and takeover of healthcare, including Medicare, by Wall Street. 

Tuesday’s rally to ‘Save Medicare’ was organized by Be a Hero, a non-profit, that according to its website believes that in the “richest country in the world, and everywhere… healthcare should be a human right.”

According to Jamila Headley, the group’s co-executive director, saving Medicare from increased privatization has emerged as a top priority for the non-profit. Headley said that the New York City retirees’ battle against Aetna Medicare Advantage had been an inspiration to other activists across the country concerned about the fate of Medicare.

“Honestly, every news article we saw and every time we talked with the folks organizing on the ground — it gave us hope that there were people willing to fight back,” Headley told Work-Bites. “I think that for so long this has been happening and no one had been organizing or saying anything about it. And even us, as a national organization — we were working on other healthcare issues — sort of sleeping on this — which is really a looming threat. It has really been inspiring seeing folks organized and really fight back at a local level. It gives us hope for what is possible on the national level.”

The Capitol Hill rally included remarks from Meagan Bent, whose father Gary Bent, a retired University of Connecticut physics professor, died in March after his Medicare Advantage insurer, using an algorithm and artificial intelligence, denied him access to skilled nursing and acute therapy that had been prescribed by his neurosurgeon. Bent was 82.

“Our family continues to struggle with the question why are people who are only looking at patients on paper or through the lens of an algorithm making decisions that deny services judged necessary by people’s healthcare providers?” Bent said. “People that have interacted with them [the patients] personally and, sometimes, have known them for years.”  

“This year, for the first time more than half of all beneficiaries are enrolled in Medicare Advantage instead of traditional Medicare,” Sen. Warren told the large crowd in front of the Capitol. “Medicare Advantage substitutes private insurance companies for traditional Medicare and that private coverage is failing with Medicare beneficiaries and taxpayers. It’s all about the money. Private insurers are in Medicare Advantage to play games to extract more money from the government. Experts estimate the Medicare Advantage insurers will receive more than $75 billion in over payments this year alone.”

Last year, the New York Times and Kaiser Health News published extensive investigative pieces which raised alarming questions about the nation’s largest Medicare Advantage insurers including Aetna. The news outlets confirmed that the insurers were on the radar of regulators who had documented a sector wide practice of so-called “upcoding” when insurers would say patients were sicker than they were to secure a higher reimbursement from the government while using prior authorizations as well as outright denials of care to reduce their costs.

“We’ve been fighting the City of New York and unfortunately our former unions who were sold by insurance companies telling them they can give us free insurance and they would benefit from the savings there by forcing us into Medicare Advantage and taking us out of our Medicare and our city supplemental plan,” Marianne Pizzitola, retired FDNY EMT and president of NYCOPSR, told the crowd. “We are here today not only to expose all of the issues with prior authorizations and wrongful delays and denials of care — we are also saying that employees that have served the city or their union — or any employer in whatever city from sea to shining sea — should not be forced into a Medicare Advantage plan. We earned our Medicare, and we want to be in Medicare.”

Pizzitola introduced Rep. Rosa DeLauro (D-CT), who thanked Pizzitola for her “very strong voice” in the national fight against the increasing privatization of Medicare. 

“Access to basic quality health care is one of the most important issues that face our nation today — that’s why it’s time to call out so called Medicare Advantage for what it is. It’s private insurance that profits by denying coverage and using the name of Medicare to trick seniors,” DeLauro told the crowd.

DeLauro referenced the New York Times investigation into the entire Medicare Advantage sector.

“Eight of the 10 biggest Medicare Advantage insurers — representing more than two-thirds of the market — have submitted inflated bills, according to the federal audits,” the Times reported last year. “And four of the five largest players — UnitedHealth, Humana, Elevance and Kaiser — have faced federal lawsuits alleging that efforts to over diagnose their customers crossed the line into fraud.”

“The fifth company, CVS Health, which owns Aetna, told investors its practices were being investigated by the Department of Justice,” according to the newspaper.

“A study from the Kaiser Family Foundation, a research group unaffiliated with the insurer Kaiser, found the companies typically earn twice as much gross profit from their Medicare Advantage plans as from other types of insurance,” the Times reported.

The bottom line, the Times observed, is that Medicare Advantage is “a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.”

Julia Santos, representing National Nurses United, the nation’s largest nurses’ union, told the rally registered nurses “got a front row seat to the devastating consequences patients are faced with when insurance companies overrule the decisions made by healthcare professionals.” In addition to holding insurers accountable for denying and delaying care, Santos said NNU wanted to see Medicare expanded “to every person living in the United States.”

“The insurers are breaking the rules,” Alex Lawson, executive director of Social Security Works, a non-profit, told the crowd of activists. “They are not allowed to delay and deny care. We all know that. In Medicare, if you get sick you get the care that you need. That decision is made by a doctor, a provider, and the patient. The insurer is not allowed to insert themselves and say ‘no’ which is what they are doing, and they are ripping us of for the privilege of denying and delaying care.”

“Americans have fallen victim to slick advertising or to employers who forced them into a Medicare Advantage plan, and they have the disadvantage of finding out that they do not have the care that they thought that they had when they need it,” said Rep. Lloyd Doggett (D-Texas). “They as billed as keeping people healthier and saving money, but they have become a cash cow [for insurers]…for each individual who has suffered from a Medicare disadvantage plan the taxpayers are paying an additional $1,500 a year more than they were for traditional Medicare.”

Rep. Mark Pocan (D-WI) and Ro Khanna (D-CA), who were both in attendance at the rally have introduced the “Save Medicare Act” which would prohibit so-called Medicare Advantage plans from using Medicare in their titles or advertising because they say it amounts to a false claim.

Khanna suggested that rather than shifting tens of billions to private insurance companies, Democrats should revive Sen. Bernie Sanders (I-VT) proposal contained in President Biden’s original Build Back Better proposal to include dental, vison, and hearing coverage into Medicare.

“I don’t understand why Democrats are not fighting for that,” Khanna said. “We’ve got to strengthen Medicare. We’ve got to stand for Medicare for all — this should be a litmus test in the modern Democratic Party.”

“Only Medicare is Medicare — it’s really that simple,” Pocan said. “Six percent of people in 2021 had their claims automatically rejected and then when they went to dispute it 80 percent of those were approved. It shows that they were automatically delaying and disapproving care for people who need it. The top two companies that year had a 12 percent denial rate, nearly one in ten.”

Rep. Katie Porter (D-CA) recounted her firsthand experience with her father, who was a farmer battling cancer linked to his occupational exposure to agricultural pesticides but was “boxed out” of the specialist he needed by his Medicare Advantage plan. “These confusing and complicated networks and purposeful refusal of price transparency make it impossible for patients to choose the best care,” Porter said. “Medicare Advantage takes the problem of private insurance and imports them into Medicare infecting our best and most effective healthcare system with the ills of putting profits before patients.”

“Medicare Advantage is neither Medicare nor an advantage,” said Rep. Barbera Lee (D-CA). “Congress needs to end this deception and that’s what it is.”  

“Medicare Advantage is not only terrible for patients — denying and delaying with narrow networks that are killing Americans everyday — they are costing the taxpayers excess money because the leeches of private insurance are sucking dollars out that should be going to care,” said Dr. Steve Auerbach, a physician with Physicians for A National Health Program. “That’s why Medicare disadvantage is also bad for doctors and hospital groups across the country oppose it.”