Medicare Advantage’s Rx for Retired City & State Workers: Pain, Stress and Heartache…
There was a time when MTA retiree Luis Uribe was healthy and strong—today he’s battling both joint disease and prostate cancer and needs healthcare that actually works for him. Sadly, many retirees like Uribe who devoted their lives to transporting their fellow New Yorkers are finding out that’s too much to expect.
By Joe Maniscalco
As terrible as former New York City Transit worker Lloyd Archer knew profit-driven Medicare Advantage health insurance would be for TWU Local 100 retirees like him, he didn’t think they’d be experiencing the level of pain they’re experiencing now.
“This is horrible,” Archer recently told Work-Bites. “I never would have thought it could get this bad.”
Beginning this year, TWU Local 100 retirees learned that—whether they liked it or not—the traditional Medicare health insurance benefits they had always relied on were being stripped away in favor of a profit-driven Aetna Medicare Advantage health insurance plan.
Like their city counterparts fighting Mayor Eric Adams’ ongoing campaign to force 250,000 municipal retirees into an Aetna Medicare Advantage health insurance plan—retired MTA Transit workers opposed to TWU Local 100’s push for profit-driven Medicare Advantage are in court attempting to stop it.
Earlier this month, they used the start of another Medicare open enrollment period as an opportunity to appeal to both the union leadership and MTA to return traditional Medicare coverage as an option for retired Transit workers.
“We are asking that the MTA/TWU step back from the abyss of auto enrollment and seek a moment of moral clarity by putting Traditional Medicare back as a choice,” Archer and his fellow TWU Local 100R members wrote. “The Aetna Medicare Advantage Plan [AMAP] is inferior to Traditional Medicare. The health care of retirees has been negatively impacted by the [AMAP]. The pre-authorization process and the delay or denial caused by that process has proven to be almost deadly to retirees.”
Just last week, the U.S. Senate Permanent Subcommittee on Investigations [PSI] issued a new report describing how the biggest purveyors of profit-driven Medicare Advantage health insurance plans in the nation—UnitedHealthcare, Humana and CVS— are “intentionally using prior authorization to boost profits by targeting costly yet critical stays in post-acute care facilities.”
CVS merged with Aetna following a 2018 deal valued at $70 billion. The company, as highlighted in the PSI report, wasted no time jacking up the rate of prior authorizations needed for post-acute care by 57.5 percent between 2019 and 2022.
“This is prior authorization,” the report’s authors write. “And for beneficiaries of Medicare Advantage, the alternative to Traditional Medicare in which private companies contract with the government to administer health plans, it has become not just a bureaucratic maze, but a potential threat to their health.”
TWU Local 100R’s appeals for the return of their traditional Medicare coverage, however, have fallen on deaf ears. Work-Bites’ has repeatedly attempted to reach the union for comment on this story—but has yet to receive any kind of response. MTA Spokesperson Kayla Shults simply told Work-Bites, "Health care benefits, including retiree health care options, were negotiated with the unions.”
The courts have repeatedly come down in favor of New York City municipal retirees fighting back against the Medicare Advantage push, insisting it would diminish their existing Medicare health benefits and undermine their well being.
On Wednesday, Council Member Chris Marte [D-1st District] introduced a new bill [Intro. 1096] seeking to further codify the City of New York’s nearly 60-year commitment to supplement the traditional Medicare coverage its municipal retirees were promised so that they can see virtually any doctor at any hospital they want nationwide.
For those who somehow still don’t get it, delaying and denying care is how Aetna and the rest of the profit-driven private health insurance giants make their money. CVS reported “saving” more than $660 million back in 2018 by denying prior authorization requests its Medicare Advantage beneficiaries submitted for inpatient facilities. “A majority of these savings,” the PSI report further says, "came from denied admissions.”
Those staggering “savings,” however, still weren’t good enough for CVS shareholders who forced the recent ouster of former CEO Karen Lynch and replaced her with another company exec named David Joyner.
The price of CVS shares has plummeted nearly 25 percent, and the company has already announced it is laying off 2,900 workers in an effort to reduce costs. Speculation that CVS could ultimately break apart persists, nevertheless.
None of that seems to matter, however, to the elected officials and union leaders still doing their damndest to force profit-driven Medicare Advantage plans on city and state retirees in New York and around the country.
Retired MTA bus driver Luis Uribe and his wife moved to a place near Phoenix, Arizona to be close to their grandkids. He’s now battling both joint disease and prostate cancer—the latter linked to his prolonged exposure to Ground Zero toxins following the 2001 attack on the World Trade Center.
TWU Local 100’s switch to an Aetna Medicare Advantage plan means pain has now become a permanent feature of the 69-year-old military veteran’s life.
“With ten being the worst, I’m usually like a six,” Uribe told Work-Bites this week. “It takes me awhile to get going, but I gotta be mobile. When I’m lying down at night—that’s the worst.”
Uribe had been going to the Mayo Clinic in Arizona to help control his severe joint pain through medication, but since TWU Local 100’s switch over to Medicare Advantage, he says he’s been forced to seek out a whole new set of doctors, interrupting his pain management routine and putting needed hip and shoulder replacement surgery in doubt.
“Medicare Advantage doesn't work for me,” Uribe said. “I think that we should have been given the option that we had before—I should be given the option to stay on Medicare or use Medicare Advantage if I want.”
Former Transit worker Paul Rosenberg drove a bus for more than 25 years before retiring in 2008. His wife suffers from COPD and is being evaluated for lung transplant surgery. He told Work-Bites that he never had a problem with his healthcare until this past year when both Columbia Presbyterian Hospital, and then Hackensack Meridian Health informed him that they might not be able to care for his spouse due to ongoing “negotiations” with Aetna Medicare Advantage.
“Her operation is going to be north of a million dollars—that's not counting the aftercare. So, you're looking at $1.5 to $2 million,” Rosenberg told Work-Bites. “What do I do? Do I go back on traditional Medicare and then when I get the bill just go and claim bankruptcy? You know, I put my house in an irrevocable trust just in case a scenario like this would happen and they can't touch my house.”
Rosenberg says he got lucky because both institutions ultimately settled with Aetna Medicare Advantage, but that doesn’t negate the months of “bullshit” he had to endure worrying about his wife’s care.
“It was all undue stress that I did not need at the time,” he said.
Medicare Advantage providers fully or partially denied 3.4 million prior authorization requests in 2022—that’s 7.4 percent of all claims made according to a recent analysis from the Kaiser Family Foundation [KFF]
“Medicare Advantage companies don’t make money providing health care,” retired New York State Senator Richard Gottfried said at this week’s City Hall rally for Intro. 1096. “They make money by saying no. No to what doctor or hospital you can go to; no to what care they will let you receive.”
Similar legislation aimed at safeguarding the existing Medicare benefits of New York State retirees—including MTA retirees, presumably—is still languishing in the State Legislature.
“Right now, I'm way behind on my shots because I had to start the process all over again,” Uribe added. “I gotta go see a doctor; they gotta look at my record; then they'll let me know if I'm eligible for my shots. It’s crazy.”