By Joe Maniscalco

Retired New York City librarian Dana Simon was in an Aetna managed care plan back in 2007, when the night before she was scheduled to have her cochlear implant replaced — she received a call from the for-profit health insurance company warning her to cancel the surgery because they weren’t covering the operation.

Aetna called it an “experimental” procedure. In reality, the operation had been introduced some 20 years earlier in the 1980s. Simon appealed the denial to the New York State Insurance Commission and ultimately got the denial reversed.

“My doctor was willing to fight for me,” Simon told Work-Bites during the March 9, mobilization against the City of New York’s campaign to push municipal retirees into a Medicare Advantage program run by Aetna. “If I did’t get this implant, I would have lost my job. It was a miracle.”

The Insurance company, Simon said, “didn’t have to pay any penalty or apologize.”

By 2014, Simon did have to retire from her city job, but not because of her hearing. Her eyesight was deteriorating, too. What Simon didn’t know, however, was she had been put into a Medicare Advantage Plan without her knowledge.

“I had to resubmit papers,” and there were “all kinds of fees,” she said. 

Simply replacing the batteries on her cochlear implant now required Simon’s doctor to take an hour out of the day just to plead her case to the insurance company. After three months of that, Simon was able to switch to traditional Medicare through SeniorCare.

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Bronx Retirees Michael Jurvey and his spouse Dee are sharing eyedrops for their glaucoma because Michael, a former health educator at Harlem Hospital, can’t afford the $318 he’s being charged since becoming entangled in a health insurance mess between HIP/Emblem and Medicare.

“They tell me I need a dis-enrollment letter from one agency and they would cancel out the other, which was HIP/Emblem from being an employee of the City of New York,” the DC37 retiree told Work-Bites. “DC37 doesn’t support me either. This is happening now. I just re-enrolled, so all I have is a doctor’s visit — I do not have prescriptions. I can see a doctor, but if I need a medication I can’t get it.”

Michael has undergone a total hip replacement and battled a brain tumor. He uses a walker to get around and faces further surgery to fuse together some vertebrae in his back, that he does not want to endure.

“He’s suffering a lot — he can’t get no type of medication,” Dee said. “He can see doctors but what’s the sense of seeing doctors if you can’t take any pain medication? He hasn’t had eye drops in over two months. He has glaucoma, I have glaucoma — I’m sharing my eyedrops with him. If I run out, then what?”

Taking it to the Streets since 2021

Municipal retirees fighting back against the ongoing campaign to strip them of their traditional Medicare benefits and push them into a profit-driven Medicare Advantage Plan have been taking to the streets in protest since June 30, 2021.

"Still no respect. Still no invitation to the meetings,” Michelle Keller, president of the New York City Coalition of Labor Women, told the retirees marching from Battery Park to City Hall on March 9. “We are not going away. Our SeniorCare has given us choice, flexibility, reliability of service, and no out-of-pocket costs.”

The looming Medicare Advantage contract with Aetna is valued at $200,000,000.

Council Member Christopher Marte [D-District 1] said Mayor Eric Adams and the Municipal Labor Committee [MLC] are “colluding with Aetna to privatize our health care” and called their actions “extremely despicable.”

Privatization means “necessary life-saving procedures will be harder to get,” DC 37 Retiree Neal Frumkin said. “We have worked for the city for 30-35 years,” but the promise of lifetime health care is being broken by “the mayor, the MLC, and, unfortunately, our unions.”

The DC 37 Retiree group reportedly had a page in the union’s Public Employee Press magazine, but according to Frumkin, it got pulled from this month’s issue by “[DC37 Executive Director] Henry Garrido and his henchmen” for criticizing Medicare Advantage.

Breached Contract

John Pinard, 54, is a municipal retiree who served the City of New York as both a subway conductor and sanitation worker.

“I took these jobs for the main reason of a pension and medical care until I expire,” he told Work-Bites. “I sacrificed. I worked weekends because I believed in the medical care for life.”

Now, Pinard said, “I have to fight for and defend what I already earned through my end of the bargain. It should not even be a questionable situation. This is a contract. It’s being breached.”

Although they’ve been fighting since 2021, Cross-Union Retirees Organizing Committee [CROC] member Julie Schwartzberg vowed to keep up the struggle against Medicare Advantage.

“The MLC voted 941-253 to kick us onto their crappy Aetna plan — but we will fight back,” she said.

A public hearing on the Medicare Advantage contract with Aetna will be held on March 21 at 10 a.m.

— Additional Reporting by Steve Wishnia