MLC Leader On Medicare Advantage: ‘We’ve Got The Contract Written Up’ - Work-Bites

 A good comprehensive article on the overall situation. Note the comment from the guy from New Jersey, where teachers have been moved from Medicare to MedAdv -- my friend called about one of his friends who was not aware of the change. Her husband has cancer and has paid very little for treatment and then suddenly started getting enormous bills from the hospital where they said she is now on MedAdv and they don't take that insurance. So claims by these officials should be taken with a big grain of salt. Another issue I read about is that our fearless negotiators are trying to get the insurers to cut down on the number or prior authorizations - which means there is resistance.

 

 

 https://www.work-bites.com/view-all/mlc-leader-on-medicare-advantage-weve-got-the-contract-written-up

MLC Leader On Medicare Advantage: ‘We’ve Got The Contract Written Up’

LatestTri-State News

Feb 4

Mayor Eric Adams’ administration and the heads of the MLC continue to push Medicare Advantage against the objections of many retired and active municipal workers. Photo By Joe Maniscalco

By Bob Hennelly

The deadline for the City Council to change its Administrative code that covers how the city provides healthcare insurance for its active-duty workforce and retirees came and went last month without the Council opting to act after a marathon Jan. 9 public hearing where scores of city retirees blasted the proposal.  

Meanwhile, the Adams administration and the Municipal Labor Committee are closing in on a deal with Aetna to provide a Medicare Advantage plan for the city’s 250,000 retirees, according to Harry Nespoli, chairman of the Municipal Labor Committee, and president of Teamsters Local 831, which represents the Department of Sanitation’s rank and file workforce.

“We are still working on it,” Nespoli told Work-Bites. “We got the contract written up and our official people are all looking it over right now — we are just going to continue moving towards it.” Nespoli added that the MLC had made progress on getting Aetna to further reduce the number of procedures that would require a pre-authorization.

“We have eliminated a lot of the pre-authorizations already and we want to continue doing that because that is the biggest gripe with Emblem [the current provider], and from what we are hearing these pre-authorizations take too much time to get the o.k. for something,” Nespoli said. “If you look throughout the country, Medicare Advantage is the way it’s going for a large group of people. It’s just that you have to make sure that you have the right contract, and you justify the needs of your members---who have had good medical coverage and which we don ‘t want see cheapened now.”

An Adams administration source described the negotiations as ongoing, and a United Federation of Teachers source confirmed an earlier Crain’s New York report that UFT was “requesting an independent entity to conduct pre-authorization reviews for medical procedures in addition to Aetna’s reviews.”

The MLC’s controversial embrace of Medicare Advantage is the outgrowth of deals it cut with the de Blasio administration to find billions of dollars in healthcare costs savings as unions settled well over 100 labor contracts that Mayor Bloomberg had left unsettled for years. And multiple union sources confirm Mayor Adams finds himself in a similar fix with union contracts lapsed and the understanding that no progress can be made on any of them without a resolution of the healthcare question.

FRAUD FOR PROFIT?

Thom Hartmann: Why Is the For-Profit Healthcare Industry Like a Blood-Sucking Tick? Via Ravitch

 Surprise, surprise!

Thom Hartmann: Why Is the For-Profit Healthcare Industry Like a Blood-Sucking Tick?

dianeravitch Jan 20

Thom Hartmann provides a brief history of the power of the for-profit healthcare industry, which has successfully blocked a national Medicare-for-All system. Please open the link and read it all. The industry’s current push is to get people transferred from Medicare to for-profit Medicare Advantage plans. Under Medicare, seniors can choose their own doctors and do not have to seek permission for costly procedures. under Medicare Advantages, patients may see only in-network doctors and may be denied permission for treatment. That’s where the profit is: denying treatment. About half of all seniors are on a Medicare Advantage plan, because they were wooed by prescription drug coverage or a free gym membership.

Hartmann begins:

Republicans have taken control of the House of Representatives, and already have their sights set on forcing major cuts to “entitlements” like Social Security, Medicare, and Medicaid.

One of the promises McCarthy made to become speaker was to force a vote on dialing back 2023/2024 spending back to 2021 levels — and there’s been a 7% inflation increase in costs/expenses since then. In other words, they want massive cuts.

His Republican colleagues have already outlined the starting point for their demands, as reportedby Yahoo News:

“The Republican Study Committee proposed a budget for fiscal 2023 that would gradually increase the eligibility ages for Social Security and Medicare, and change the Social Security benefit formula for people 54 and younger…”

In that, they’re going to have a hell of a fight on their hands, as Senator Bernie Sanders is taking over leadership of the Senate Health Committee, which oversees Medicare and Medicaid. He’s already promising “a lot of subpoenas” will be arriving at the offices of healthcare and big pharma CEOs.

Most Americans have no idea that the United States is quite literally the only country in the developed world that doesn’t define healthcare as an absolute right for all of its citizens.

That’s it. We’re the only one left. Were the only country in the developed world where somebody getting sick can leave a family bankrupt, destitute, and homeless.

A half-million American families are wiped out every year so completely that they must lose everything and declare bankruptcy just because somebody got sick. The number of health-expense-related bankruptcies in all the other developed countries in the world combined is zero.

Yet the United States spends more on “healthcare” than any other country in the world: about 17% of GDP.

Switzerland, Germany, France, Sweden and Japan all average around 11%, and Canada, Denmark, Belgium, Austria, Norway, Netherlands, United Kingdom, New Zealand and Australia all come in between 9.3% and 10.5%.

Health insurance premiums right now make up about 22% of all taxable payroll (and don’t even cover all working people), whereas Medicare For All would run an estimated 10% and would cover every man, woman, and child in America.

How and why are Americans being played for such suckers?

We are literally the only developed country in the world with an entire multi-billion-dollar for-profit industry devoted to parasitically extracting money from us to then turn over to healthcare providers on our behalf. The for-profit health insurance industry has attached itself to us like a giant, bloodsucking tick.

And it’s not like we haven’t tried to remove that parasite.

Presidents Theodore Roosevelt, Franklin Roosevelt, Harry Truman, Jack Kennedy and Lyndon Johnson all proposed and tried to bring a national healthcare system to the United States.

Please open the link and read the rest of this important post.

Diane Ravitch's blog