NYC City Council Members Debate Guinea Pigs While Retired Heroes Watch Their Medicare Benefits Vanish
As the contingent of outraged municipal retirees worried about the potential disruption of their healthcare looked on from the packed gallery, the debate on the Guinea pig question raged below in the Council Chamber.
By Bob Hennelly
While close to a thousand New York City retired civil servants rallied outside City Hall to protest Mayor Adams’ deal with Aetna’s Medicare Advantage Plan, inside it was business as usual. On April 11, the City Council passed several bills including legislation to ban the commercial sale of Guinea pigs which had evidently proliferated during the pandemic.
“The bill would still allow them to be available for adoption in animal shelters,” City Council Speaker Adrienne Adams (D-D28) told the chamber. "Prohibiting the sale of guinea pigs in pet shops will bring relief to animal shelters and other rescuers who have experienced a surge in abandon and surrender guinea pigs in the past three years as well as cutting off the pipeline to New York City from inhuman sources.”
As the contingent of outraged municipal retirees worried about the potential disruption of their healthcare looked on from the packed gallery, the debate on the Guinea pig question raged below in the Council Chamber.
Council Minority Leader Joseph C. Borelli (R-D51), rose to explain why members of his conference were voting no on the Guinea pig measure after he volunteered that in South America the furry rodent was a delicacy.
“With this particular bill we are taking bad behavior by customers and the owners of these pets, and we are transferring the punishment onto the pet shops,” Borelli reasoned. “We think it will benefit the pet shops of Nassau, Westchester, and New Jersey.”
Other action items included a bill to restrict idling near city parks, requiring the Parks Department to install diaper changing stations, the DOB to conduct outreach on the benefits of installing solar and green roofs systems, as well expanding the accessibility of telemedicine.
There were also resolutions to call on Albany to create a Housing Access Voucher Program to help New Yorkers facing eviction, more price transparency for live event ticket sales, having the Department of Education create a Jewish Heritage Day, and for directing the Wendy’s fast-food chain to join the Fair Food Program that guarantees fair working conditions for farm workers
The City Council was not entirely oblivious to the gallery full of anxious City retirees worried about their healthcare coverage, however.
A MORAL ISSUE?
Council Member Charles Barron (D-D42) raised the issue of the municipal retirees’ healthcare during a floor speech in which he took Mayor Adams to task for his proposed budget which calls for cuts to libraries, education, social services, and healthcare despite $4 billion in unanticipated new revenue and a $8.3` billion budget reserve. He called for a full restoration not the partial restoration proposed by Speaker Adams last week.
Barron also referenced Aetna’s admitted role in underwriting the trans-Atlantic slave trade.
“The money is there…we should pay the $600 million for retirees so they can have their benefits. That should happen,” said Barron as he was interrupted by loud applause and cheers from the gallery. “The City Council can fix a morally bankrupt decision to give Aetna, who participated in the slave trade, a contract to get billions of dollars for healthcare and have them [retirees] go from SeniorCare to Medicare Advantage….let’s do the right thing. We are the people’s City Council, not the mayor’s and not the corporations.”
“Aetna has long acknowledged that, for several years shortly after its founding in 1853 and prior to the abolition of slavery in the United States, the company provided approximately a dozen policies to owners of enslaved Africans,” Aetna said in a statement. “We continue to express deep remorse over any participation in one of the most deplorable practices in our nation’s history.”
“Today, I had the privilege to join hundreds of municipal retirees, firefighters, teachers, police officers, librarians, EMS technicians and many others who are fighting for their affordable, accessible and long promised healthcare,” said Council Member Ari Kagan (R-D47) from the floor. “It is not a Democratic issue. It is not a Republican issue. It is a moral issue. We need to make it right for the hundreds of thousands of municipal retirees.”
In his statement announcing the signing of the Aetna contract last month, Mayor Adams insisted that this administration, working closely with the Municipal Labor Committee, had addressed the concerns raised by city retirees which echoed extensive reporting by the New York Times and Kaiser Health News which called into question the entire privatized Medicare Advantage business model.
“This plan improves upon retirees’ current plans, including offering a lower deductible, a cap on out-of-pocket expenses, and new benefits, like transportation, fitness programs, and wellness incentives,” Adams wrote. “We also heard the concerns of retirees and worked to significantly limit the number of procedures subject to prior authorization under this plan. This Medicare Advantage plan is in the best interests of both our city’s retirees and its taxpayers.”
The Adams administration has testified that by switching to the Aetna Medicare Advantage Plan the city will be ahead $600 million annually thanks to the federal subsidy that comes with signing up with the for-profit plan.
Retiree groups dispute the veracity of the supposed $600 million savings.
GROUND SWELL
Several groups of retirees, led by the New York City Organization of Public Service Retirees [NYCOPSR] have been protesting the push into Medicare Advantage going back to the de Blasio administration citing a profit-making business model that relies on denying people care through the use of prior authorizations.
“Medicare Advantage is nothing like traditional Medicare, on which retirees have relied for over half a century,” wrote Marianne Pizzitola, retired FDNY EMT and president of NYCOPSR, to the Council. “Whereas virtually all doctors and continued residential care communities accept traditional Medicare (and, by extension, Medigap plans), many do not accept Medicare Advantage plans. If allowed to proceed, the City’s unprecedented action will have catastrophic consequences for hundreds of thousands of elderly and disabled retirees.”
At issue, according to both the New York Times and Kaiser Health News is the Medicare Advantage industry wide practice of so-called ‘up-coding’ when insurers have clinicians reevaluate patients’ charts in paperwork to the federal government so that they appear sicker than they actually are while simultaneously subjecting them to denials and prior authorizations to reduce the insurers’ costs.
“The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients,” the Times reported. “And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.”
The Times continued. “As a result, 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.”
“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. 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.”
AETNA’S DOJ BAGGAGE
The Times also reported that Aetna had also disclosed in its SEC filings it was the subject of a DOJ probe.
"The Company has been involved or is currently involved in numerous legal proceedings, including litigation, arbitration, government investigations, audits, reviews and claims," Aetna disclosed in its SEC filings. "These include routine, regular and special investigations, audits and reviews by the U.S. Centers for Medicare & Medicaid Services (“CMS”), state insurance and health and welfare departments, the U.S. Department of Justice (the “DOJ”), state attorneys general, the U.S. Drug Enforcement Administration (the “DEA”), the Federal Trade Commission (the “FTC”) and other governmental authorities."
Aetna's filings continued. "Legal proceedings, in general, and securities, class action and multidistrict litigation, in particular, and governmental special investigations, audits and reviews can be expensive and disruptive. Some of the litigation matters may purport or be determined to be class actions and/or involve parties seeking large and/or indeterminate amounts, including punitive or exemplary damages, and may remain unresolved for several years. The Company also may be named from time to time in qui tam actions initiated by private third parties that could also be separately pursued by a governmental body. The results of legal proceedings, including government investigations, are often uncertain and difficult to predict, and the costs incurred in these matters can be substantial, regardless of the outcome."
The Aetna contract is subject to a 30-day review by City Comptroller Brad Lander.
During a Jan. 9 City Council oversight hearing into the Aetna contract, Barron asked officials from the city’s Office of Labor Relations if they were aware of the probe. They said they would look into it.
“Are you concerned that the City of New York has turned over the providing of healthcare coverage for retirees to a company that’s subject to a federal probe?” Work-Bites asked Speaker Adams during her April 11 press conference.
“Well as far as the carrier is concerned again, I am going to leave that to those who have negotiated on behalf of the contract—those who have bargained and continue to bargain on behalf of all retirees.” Adams said. Adams added she felt the Council had been responsive to the hundreds of retirees that turned out to the January 9 hearing to protest the changes to the Administrative Code requested that covers how the city covers its retirees that was requested by the Adams administration.
“As far as the Council is concerned, they asked us very adamantly in droves not to touch the Administrative Code to preserve their legal standing which we have not done,” Adams said. “We are continuing to hear from both sides, but as far as intervening with the plan--with the carrier, that’s something the Council is not going to do.”
The retirees that are fighting the switch to the Aetna plan stress they have no representation in those negotiations and that whatever savings or revenues are generated will be used to help fund the contract settlements for the active workforce.
A legislative proposal submitted by NYCOPSR was initially picked up by Council Member Amanda Farias (D-D18), but has yet to be assigned a bill number due to concerns raised by the City Council’s lawyers that it would run afoul of New York State’s Taylor Law which covers public employees.
“The Taylor Law is very clear that public unions can only negotiate on behalf of active members, which leaves 250,000 retirees out of the process entirely,” countered Pizzitola. “Historically, it has been the City Council which has protected retirees and acted as the guarantors of the city's solemn commitment it’s made for generations to its workforce.”
Pizzitola invoked the name of Council Member Mary Pinkett — the first Black woman elected to the Council. Pinkett served from 1974 to 2001 and fought for the Administration Code that protected municipal retirees’ healthcare, resisting “the efforts of three prior Mayors to take away health benefits from retirees.”
At last week’s retiree rally, Public Advocate Jumaane Williams, Council Members Chris Marte (D-D1) and Alexa Aviles (D-D38) were in attendance to show their support.
“The whole thing is crazy-making,” said Aviles in an interview after the rally. “One would think the city wouldn’t get into a contract with any entity with any kind of negative reputation, but I think we have a long history of that. I am dismayed that we are in this situation.”
Aviles said that the process for introducing legislation is onerous with “so many trap doors to make sure nothing moves forward with expediency and transparency.”
“Then there’s this culture that when you get to the floor, everyone has to say yes,” Aviles said. “To me that is such an affront to democracy. Why is there that expectation that everyone has to fall in line?”