By Bob Hennelly

New York City’s 250,000 municipal retirees recently got a form letter from the Office of Labor Relations announcing Mayor Eric Adams’ administration is no longer abiding by its September 1 deadline for the implementation of its Aetna Medicare Advantage Plan, which the New York City Organization of Public Service Retirees [NYCOPSR] has been successfully fighting in court.

The mass mailing was a reiteration of a July 7 announcement on the OLR’s website posted soon after State Supreme Court Judge Lyle E. Frank issued a preliminary injunction against the city proceeding with its plan. Frank’s ruling also derailed the city’s July 10 deadline for retirees who wanted to keep traditional Medicare to opt out of the profit-driven Aetna Medicare Advantage plan.

Lyle’s injunction prohibited the city from removing retirees or their dependents from their current health-coverage plans until after the lawsuit brought by the New York City Organization of Public Service Retirees is resolved.

The Adams administration is appealing, but in the meantime, has suspended the implementation of the controversial plan. Former Mayor Bill de Blasio’s administration also suffered similar legal defeats which delayed implementation. Ultimately, the city was sent back to the drawing board when the Emblem/Anthem Medicare Advantage plan was withdrawn from the running.

“Petitioners have by clear and convincing evidence met the requisite burden for a preliminary injunction by exhibiting the likelihood of ultimate success on the merits, the prospect of irreparable injury in absence of injunctive relief, and the balance of equities weighing in the petitioners’ favor,” Judge Frank wrote in granting the temporary injunction.

Retired UFT member Paula Rogovin, who taught in city schools for 44 years, was ecstatic when she got her OLR mailing this week. 

“When I received a letter from the Office of Labor Relations Employee Benefits Program stating that ‘All current health plans remain in effect’ and that ‘No retiree will be moved into the new Aetna Medicare Advantage PPO plan,’ I was overjoyed,” Rogovin told Work-Bites. “My first thought was how thankful I am to the retirees and others who fought so hard to protect our Medicare health plan from the Medicare Advantage rip-off.” 

Marianne Pizzitola, a retired FDNY EMT and president of the NYCOPSR cautioned that OLR’s letter doesn’t mean retirees have prevailed, “because the city is actively appealing the court’s ruling and trying to press ahead.”

“The NYC Organization of Public Service Retirees is pleased with the Court granting a preliminary injunction stopping the City from forcing us into the Aetna Medicare Advantage plan, thus diminishing our earned and paid for health benefits and blocking our access to Federal Medicare that we paid for since our first paycheck,” Pizzitola wrote. “Mayor Adams has been spreading the big lie that the plan is better, when it will cost senior citizens and the disabled more money and prevent access to many of their current doctors or specialists like cancer centers and skilled nursing and rehab.” 

Pizzitola continued, “We now push on, while also pushing our City Council Legislation sponsored by Council Member Charles Barron D-Brooklyn), Intro 1099, which requires the city to provide a Medigap plan like we have had since 1967.  Retirees are not a ‘detriment’ to the city as [Mayor Adams] has been quoted.  We built the city, rebuilt it after 9/11, and built our unions.  It is bad actors trying to dismantle labor strength by alienating retirees — that’s the detriment.”

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.

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

This week, Council Member Tiffany Caban (D-Queens) was the latest member of the Council to sign on the NYCOPSR’s legislation to protect and preserve their access to traditional Medicare.

In addition to Barron and Caban, other Council Members include, Christopher Marte (D-Manhattan), Erik Bottcher (D-Manhattan), Kristen Richardson-Jordan (D-Manhattan), Linda Lee (D-Queens), Shekar Krishnan (D-Queens), Lynn Shulman (D-Queens) Ari Kagan (R-Brooklyn), Joann Ariola (R-Queens), Alexa Aviles (D-Brooklyn), Shahana Hanif (D-Brooklyn), Inna Vernikov (R-Brooklyn), Robert Holden (D-Queens).

Last year, in hopes of shoring up its financial position, the city said municipal retirees could opt to keep their current health coverage if they didn’t want to participate in its Emblem/Anthem Medicare Advantage plan — by paying a $191 premium to continue their existing GHI senior plan.

That set off a major backlash with retirees asserting that their premium-free healthcare was a form of deferred compensation that the city could not rescind.  The NYCOPSR mobilized quickly and went on  to win two reounds in state court challenging the city's implementation of its healthcare reset. 

While the city retirees were drawing their battle lines with Mayor Adams and the heads of the MLC — who supported the conversion to Medicare Advantage — the national healthcare program was hitting a dubious milestone with just over half of seniors enrolled in the private for-profit Medicare Advantage plan.

Last month, a delegation of 70 NYCOPSR members went down to a rally on Capitol Hill organized by “Be a Hero,” a national non-profit, that’s fighting the increasing privatization of Medicare. At that event, Congressional leaders, including Sen. Elizabeth Warren (D-Massachusetts) told a large crowd that for-profit Medicare Advantage Plans overcharged the federal government $75 billion a year, while denying and delaying care to 85,000 people.

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.

“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.”  

According to the Lever news website, a “2022 investigation by the Inspector General of the Department of Health and Human Services found that in 2019, 13 percent of the total prior authorization requests denied by Medicare Advantage plans would have been covered under traditional Medicare, leading to an estimated 85,000 additional care denials. That year, Medicare Advantage plans also wrongly denied 18 percent of payment claims — covering an estimated 1.5 million claims — reducing the likelihood that doctors will recommend the costliest yet often most effective care, for fear of not being paid”