Bill Friedheim on Shifting NYC Retirees to Medicare Advantage

New York City’s 250,000 municipal retirees had a good deal on health care. Bill Friedheim…

New York City’s 250,000 municipal retirees had a good deal on health care.

Bill Friedheim
Professional Staff Congress

All were covered by traditional Medicare. And they had a gold plated Medi-gap coverage.

But then in a move that many retirees say lacked transparency, Mayor Bill De Blasio and the leadership of the city’s major labor unions, led by the Municipal Labor Committee, cut a deal that would automatically shift all retirees off traditional Medicare and into a private Medicare Advantage program.

New York City retiree Bill Friedheim says that in doing so, New York City and the leadership of the unions threw retirees under the bus. Friedheim is chair of the retirees’ chapter of the Professional Staff Congress, the union that represents faculty and professional staff at the City University of New York.

“For years, the city provided Medigap insurance, what they called Senior Care,” Friedheim told Corporate Crime Reporter in an interview last month. “That paid for the 20 percent that Medicare did not pay for. From personal experience, it was an excellent deal. I would rather see a comprehensive single payer plan for everybody, but given what we had, I paid very little out of pocket since I have been retired over the last fifteen years. And I had some major surgery ten years ago. I was in a big bike accident seven or eight years ago. I’m fully recovered from all of this now. But given the inflated prices we have in the health care marketplace, and that’s what it is – a marketplace – I’m sure that I incurred probably several hundred thousand dollars worth of expenses. And I paid very little, just minimal out of pocket.”

The city and the Municipal Labor Committee selected an alliance between Empire BlueCross BlueShield and EmblemHealth to run the NYC Medicare Advantage Plus Program.

“The Medicare Advantage deal is like throwing retirees under the bus,” Friedheim said. “You are doing away with a plan that retirees are perfectly happy with, then pushing them into uncertainty with this Medicare Advantage plan. And who knows where that is going to go, what it will cover and what it won’t cover. And most importantly for most members, can they continue to see the doctors they are seeing, the health care specialists they are seeing and can they continue to use the hospitals they are using?”

Under this plan, the retirees would be automatically enrolled in this Medicare Advantage plan and then have a six or eight week period to opt out.

The Mayor’s press release says this:

“A major concern for retirees is whether they can keep their current doctors and hospitals in a NYC Medicare Advantage Plus Program. In the City’s Medicare Advantage Plus Program, a retiree can go to any doctor or hospital that accepts Medicare. It doesn’t make a difference if that provider is in the insurer’s network or not. As long as the provider takes payment from Medicare, they are obligated to accept the NYC Medicare Advantage Plus Program payment. That includes all the hospitals in the NYC area, including those at Memorial Sloan-Kettering and The Hospital for Special Surgery (HSS), and almost all hospitals nationally and 99.5% of all doctors. The program is a national program so it covers retirees in any State in which they work or reside and when they travel.” Friedheim says that while under the new plan retirees can go to any doctor or hospital that accepts Medicare, “that doctor or hospital won’t necessarily accept this insurance.” 

“The vendor says that they will pay regular Medicare rates. They argue that’s an incentive to accept their Medicare Advantage plan. But a lot of doctors and hospitals don’t accept Medicare Advantage plans, not because they pay less, which often they do, but because they have to jump through hoops in order to get paid. They just don’t want to be bothered.”

Your union opposed this deal?

“Yes. We opposed it because we wanted a moratorium on these discussions. The discussions were not transparent. We had virtually no information. And had it not been for some enterprising people in my retirees’ chapter, one person in particular, Bob Nelson, we wouldn’t have known about it as early as we did, which was three or four months ago.”

“Our position was we wanted a moratorium on the vote. Our retirees’ chapter took a vote and overwhelmingly said – we needed to see the details and the contract before our union could vote on any plan.”

“We then took it to the delegate assembly of the union, which is the highest governing body of the union on April 15 and the delegate assembly unanimously, by 115 to 0 vote voted yes on that moratorium.” 

“That was our policy. There had to be transparency in this process. Our members and other municipal retirees had to be informed so that the people affected could have a say as to whether we went to this plan or not. That did not happen.”

Did any other union take similar measures?

“The PSC and four other unions voted against this plan. All of the health care unions voted no.”

When the retirees go to get treatment, often Medicare Advantage has narrow networks and the retirees won’t be able to get into the best hospitals or to see the best doctors.

“The Office of Labor Relations has just put up their FAQs a couple of hours ago. The mayor and the insurance companies are saying that this is a passive PPO. It means there are no networks and you can go to any doctor that accepts Medicare. But we know in the public sector, other PPOs in Wisconsin, Connecticut and Kentucky for example, those plans make clear up front that while you can go to any doctor that accepts Medicare, they don’t necessarily have to accept you. That means that the networks are probably not going to be as narrow as most Medicare Advantage plans. But who knows which doctors and hospitals are going to accept this plan. The people who are most concerned are those who are desperately ill. Can they continue to see their doctors and get treatment at the same hospital?” 

“The history of Medicare Advantage plans might be very good if you are healthy. But that’s not the point of health insurance. You need it when something serious happens to you. There is a whole history of Medicare Advantage plans pushing people out of coverage and off their plans by denying them referrals and denying them assistance for things they need. If you are in a desperate situation and need treatment quickly, who wants to go through a long appeals process to see a specialist you need to see or a hospital where you need to be treated?”

“The Medicare Advantage deal is like throwing retirees under the bus. You are doing away with a plan that retirees are perfectly happy with, then pushing them into uncertainty with this Medicare Advantage plan. And who knows where that is going to go, what it will cover and what it won’t cover. And most importantly for most members, can they continue to see the doctors they are seeing, the health care specialists they are seeing and can they continue to use the hospitals they are using?”

This is going to be a huge windfall for these insurance companies. They are going to gain tens of thousands of new customers. I haven’t seen any mainstream publicity in New York City about this.

“We have tried to reach out to the mainstream press, with no results. There have been a number of stories in some local newspapers. There was a story in Newsweek, but Newsweek no longer has a print edition. There were a couple of others. The New York Times, the Daily News, the New York Post –  have not touched it.”

“We opposed this because the deal wasn’t transparent. One or two unions were responsible for doing the negotiating. Most of the unions didn’t know what was going on. Most of the people on the steering committee didn’t know what was going on. We haven’t seen a contract yet. The PSC never got a copy of the contract. We pulled together a meeting of retirees but we didn’t have much to show them. We didn’t have the contract. We voted no on this.”

“We opposed this because it was taking a public good – Medicare – and accelerating the move to privatize Medicare. This is something we were deeply concerned about. Also the austerity politics. It’s unconscionable that public sector unions, instead of organizing in the richest city in one of the richest states in the richest country in the world, instead of organizing for expanding the tax base and making the pie bigger, they are agreeing to collaborate with management to manage a diminishing health care pie for its members. That’s absurd.”

[For the complete q/a format Interview with Bill Friedheim, see 35 Corporate Crime Reporter 31(13), August 2, 2021, print edition only.]