By Joe Maniscalco

To no one’s surprise, but to the absolute horror of many — Mayor Eric Adams’ administration and the heads of the Municipal Labor Committee [MLC] have gone ahead and thrown back the blast doors on the nukes pointed at traditional Medicare health insurance in New York City and started the countdown to launch.

“It is the nuclear option,” Dr. Leonard Rodberg, professor emeritus of Urban Studies at Queens College/CUNY, tells Work-Bites. “If you don’t want Medicare Advantage you have to waive all of your city health benefits — the city has told Aetna that it won’t have any competition; they can count on a very large amount of warm bodies to insure.”

This is the way municipal retirees — former first-responders, educators, administrative staffers and others who spent their entire working lives helping to run this city — are reacting to the newly-released “summary agreement” between the MLC and Aetna — a pact aimed at foisting a privatized, profit-driven health insurance plan on hundreds of thousands of workers and their families.

Outright disgust.

“I’m just at my wit’s end,” NYC DOHMH retiree and cancer survivor Roberta Gonzalez tells Work-Bites. “The way these powerful men [in the MLC] have dug in their heels to make sure that the inconsequential retirees would not get their way — I feel like it’s a push-pull situation with these big babies not wanting to hear anything but what they deem is the right thing. The conversation’s closed — it’s very infuriating.”

Despite lots of talk to the contrary, the five-year contract the newly-released “summary agreement” supposedly represents, is chock full of the same types of stipulations, conditions and prior authorizations that have delayed and denied care to Medicare Advantage subscribers throughout the nation.

Many active city workers find the summary agreement between the MLC and Aetna appalling as well.

NYC Public Education teacher and @EducatorsofNYC organizer Dan Alicea calls the newly-released summary agreement “unconscionable and immoral.”

“Clearly, the union bosses of the two leading unions in the MLC continue their reckless agenda to not listen to members and retirees and to pursue their designs to achieve ‘savings’ by partnering with the City to privatize public healthcare,” Alicea told Work-Bites in an email. "This new Medicare Advantage plan iteration is really not any different from what has been proposed in the beginning."

On the contrary, Alicea says it is based on “a scarcity model that plays the ‘Hunger Games’ with the lives of retirees with many of its pre-authorizations (much more than traditional), limited networks, ever-increasing co-pays, and threats to continuity of care with our existing doctors. All while undermining the original labor goals of traditional Medicare.”

Gonzalez finds the following section contained in the summary agreement particularly alarming:

“Non-contracted providers are not required to seek prior authorization for services from Aetna; however, Aetna reserves the right to retrospectively review claims submitted by non-contracted providers and may deny coverage if the services are not medically necessary and/or not covered under the MA plan.”

“May deny coverage” — what does that mean exactly?

”I’m not really feeling confident about it because of the arrogance and almost unprofessional attitudes these union leaders and higher-ups in government are taking towards a group of retirees,” Gonzalez says. “Who’s the most vulnerable part of the population? The sick, disabled, and elderly. They are not considering what’s best for us — they’re considering what’s best for them.”

Before retiring in 2017, Dr. Rodberg, 90, taught public health policy and other topics for more than 20 years. He estimates anyone attempting to escape the Medicare Advantage plan can expect a “$5,000 to $6,000 hit per person” because “it means you not only have to buy your own supplemental Medigap [Medicare Supplemental Insurance] policy, but you don’t get reimbursed for your Part B premiums  — and you lose your drug benefit, and your other hearing and vision benefits a lot of us get through our welfare funds.”

“Basically,” Dr. Rodberg says, “you’re on your own if you want to stay in Medicare.”

According to Marianne Pizzitola, president of the NYC Organization of Public Service Retirees and head of the FDNY EMS Retirees Association, the only thing that will be available to retirees are Aetna’s Medicare Advantage plan, “and if you live in the five boroughs — you have the option of using HIP/VIP” — which is also Medicare Advantage plan.

“They told a couple of our retirees in writing and emails if they don’t choose one of those two plans, HIP/VIP or Aetna MA — they will have to waive their city healthcare benefits and good luck out on the marketplace,” Pizzitola tells Work-Bites. “Claire Levitt [deputy commissioner at the Office of Labor Relations] even acknowledges retirees will have a problem getting Medigap coverage on the outside because if you’re not in one of four states — New York, Connecticut, Massachusetts or Maine — you are subject to enrolling in a Medigap only during open enrollment periods.”

And it gets worse.

“If you have a preexisting condition, you can be denied a Medigap or you can be charged an exorbitant premium,” Pizzitola says. “If they do purchase on the outside and waive city healthcare benefits, they also lose their Medicare B reimbursements or IRMAA [Medicare Income-Related Monthly Adjustment Amount], if they qualify.”

The whole point, Pizzitola continues, “is to get as many people off the health care obligation by the city as possible — by making it as unpalatable as possible.”

Dr. Rodberg further argues that the federal subsidies city officials are so hot to get their hands on are evaporating fast — down from the 20 percent Adams and the MLC heads have claimed — to just 2 percent. 

“Then there are doctors who don’t accept Medicare Advantage,” Dr. Rodberg says. “The city is forcing you to give up your doctor or spend money you don’t have. Eric Adams, when he was running as a candidate, said this was all a ‘bait and switch’ — and now he’s switched.”

An MLC steering committee has reportedly already fast-tracked a vote on the Aetna contract based solely on the newly-released "summary agreement” alone. The larger membership is expected to endorse it as soon as Thursday, March 9 — despite all the ongoing opposition, and not having reviewed the actual contract in its final form. 

“They keep wanting to say, ‘we’ll give you out of network benefits’ — but they’re not explaining what that means — what burden that puts on the retirees,” Pizzitola adds. “You’re older, and you’re sick, and you have to go through this appeals process? Where we don’t have appeals processes to go through now — you have networks to use — prior-authorizations. They’re saying all these things will be wonderful and they’ll fix it; Aetna will assign you a liaison ‘specifically for your union to help you with any issues.’ We don’t have any issues right now — we don’t need liaisons!”

Opponents of privatization are now anticipating a very well-financed media blitz across all social media platforms touting the glories of Medicare Advantage.

“There are many people who do believe anything they’re told by [UFT President Michael] Mulgrew and company — and then there’s a small contingent who maybe don’t but want to keep their positions of power and jobs,” retired teacher and Cross-Union Retirees Organizing Committee [CROC] member Gloria Brandman tells Work-Bites.

New York City municipal retirees are being denied a seat at the table, but they are pumping out lots of challenging questions nonetheless. Why, for example, doesn’t the newly-released “summary agreement” between the MLC and Aetna say anything about prior approval for drugs?

As Work-Bites previously reported, Municipal retirees in Delaware wondered about prescription drugs too, and when they finally got hold of the Medicare Advantage contract being forced on them they discovered it contained 340 pre-authorizations for medications.

Other nagging questions revolve around medical procedures — which ones, specifically, will require pre-authorization? What is the appeal process? How long will it take? What happens if things don’t work out?

On January 8, a day ahead of a marathon public hearing on the future of retiree healthcare, a 79-year-old DC37 retiree living in Florida wrote a letter that was emailed to members of the New York City Council. It reads as follows:

Like many other retirees I have some medical problems, Gout, Crohns disease and STAGE 4 PROSTATE CANCER. Yes I am dying. Not one, yes not one of my doctors or any other doctors here will accept the [Medicare] Advantage plans you want to force me to take. That is the same as having no insurance at all. There is a good chance that one of you reading this knows someone who has died of this terrible disease.  Maybe you yourself has been lucky enough to survive a bout with cancer. I will not be that lucky. All I am asking is to please let me keep my Medicare and Ghi medical coverage and not force me into a plan no one will accept. Let me at least die with dignity. Years ago we, the union members bargained to have Medicare and Ghi senior care when we retired. It was to be paid for by the union reimbursing us. Now to save some money you feel it is ok to take this choice away from us. Again I am asking to let me keep Medicare and Ghi senior  care  and not force me into an Advantage plan that no doctor will accept.”

Work-Bites’ reached out to the MLC for comment, but was unsuccessful.

Editor’s Note: Retirees and active workers opposing the drive towards Medicare Advantage will rally on the steps of the Smithsonian Museum, just across from Battery Park in Manhattan, beginning at 11:30 a.m on Thursday, March 9. They will then march along Broadway before rallying again at City Hall Park at 1 p.m. For more information, contact crocnyc22@gmail.com.