Retiree med plan angst
Ex-city workers watch as single-option coverage advances
A key union committee has advanced a highly controversial plan to make Medicare Advantage the only insurance option available for the city’s retired workforce, setting the stage for a final vote next week, according to sources familiar with the matter.
The step, taken Thursday by the Municipal Labor Committee’s steering panel, allows the committee to hold a full vote March 9 to officially push through the proposed Aetna Medicare Advantage Plan — a measure that would make traditional Medicare effectively unavailable for the roughly 250,000 retired city workers as of Sept. 1.
Adams administration officials have for months been pushing for a Medicare Advantage option for retirees, citing hundreds of millions of dollars in potential savings annually from the plan at a time of rising health care costs and fiscal uncertainty for the city government.
Retirees charge that Advantage benefits are inferior to traditional Medicare.
The administration initially wanted to offer retirees both plans, with those opting for traditional Medicare paying a premium. But that plan ran afoul of local law, and was blocked by several judges.
The administration has signaled for months that if the City Council did not change that underlying law to make its two-tiered coverage system legal, it would move ahead with the more drastic measure of eliminating all other options besides Mayor Adams’ preferred Advantage plan.
The City Council has resisted Adams’ demand for a law amendment, and Marianne Pizzitola, president of the NYC Organization of Public Service Retirees, said she’s been on pins and needles for weeks waiting on this development.
“I had a bad feeling this was going to happen,” said Pizzitola, a retired FDNY EMS whose group was behind the lawsuit that got the city’s first Medicare Advantage Plan blocked.
Pizzitola’s grassroots group is likely to challenge the latest iteration of the proposal in court, she said.
“We need to wait and see how they will do this,” she said. “Once the official statement comes out, we go into motion.”
Retired teachers, EMTs and other municipal workers have argued that the change would dismantle their coverage, pointing to federal studies showing that Advantage plans administered by private health insurance providers can deny “medically necessary” care for beneficiaries.
“It is critical that the unions — who represent the workers and the families
who will use any health plan — be involved in choosing a health insurance provider,” said United Federation of Teachers President Michael Mulgrew in a statement to the Daily News on Friday. “We can’t leave decisions like this to the bosses and the insurance companies.”
“As part of that process, the UFT had a list of demands that would make sure our retirees got all the services they need. We were clear that we couldn’t agree to any plan that didn’t meet those needs. We are now going through the proposal line by line to make sure that our concerns have been met,” he added.
State courts blocked the administration twice from implementing an original plan that allowed for multiple insurance options but slapped $191 monthly premiums on retirees who remain on traditional Medicare, saying it violated local law that ensures no-premium coverage for life.
That led Adams to press the Council to rewrite the law, Section 12-126, to make the fee legal — a step overwhelmingly unfavored by Council members.
Officials maintained that removing all other options complies with court rulings, given that such a proposal does not involve financial penalties. An independent arbitrator confirmed as much at the end of last year.
“The administration has never wavered in its commitment to offering quality and sustainable care for our retirees,” Adams spokesman Jonah Allon said Friday.
He pointed to benefits for retirees in the new plan, including a lower deductible, an out-of-pocket maximum and new benefits from transportation to fitness programs, and said Aetna addressed concerns about the number of services requiring prior authorization under the proposal.
“We believe this plan is in the best interests of retirees and taxpayers, and look forward to the full MLC vote on the contract,” he added.