by Penny Mintz

New York City’s 250,000 retired workers —teachers, crossing guards, firefighters, plumbers, elected officials, office workers, and so on and so forth – are embroiled in an ongoing confrontation over the medical benefits that they have been enjoying under Administrative Code §12-126, which was enacted in the 1960s. On January 9, 2023, the City Council Committee on Civil Service and Labor held a hearing on whether to break that deal by changing that law. Section 12-126 requires the City to provide retirees and their partners with the full cost of health insurance up to the price of HIP, which is currently $991/month. The cost to the city of providing Medicare with HIP/Senior Care (Emblem Health) as a secondary is only $191/month per person. So, under §12-126, the city must provide retirees with cost-free Medicare and Senior Care.

Mayor deBlasio tried to change the agreement and force retirees to accept a Medicare “Advantage” plan, which is private insurance and is known to demand preapprovals that result in dangerous delays and denials. Under the deBlasio plan, retirees had to take action to opt out of the private insurance if they wanted to stay on Medicare, after which they would start paying $191/month for each beneficiary and dependent. That’s nearly $400/couple, which is unaffordable for retirees who worked in low-paying city jobs. Nevertheless, 65,000 retires opted out when the plan was first advanced.

The retirees, led by former paramedic Marianne Pizzitola, formed the NYC Organization of Public Service Retirees and sued the city on the grounds that, under §12-126, all plans below the $991 benchmark plan must be free for retirees. While the case was winding its way through the courts, Eric Adams was running for mayor on the promise of trashing the deBlasio plan. The retirees ultimately won their lawsuit, and Mayor Adams immediately reneged on his campaign promise. He is now threatening to take away even the option of paying $191/month for Medicare/Senior Care unless the City Council changes the law on which the retirees’ successful lawsuit was grounded and which, by the way, protects the health benefits of in-service workers as well.

That brings us to January 9th, when perhaps 750 retirees descended on City Hall to attend and to testify at the committee hearing. About 200 retirees were admitted into the hearing chamber. Two spill-over rooms were also filled. By 9:15 a.m., there were about 100 people at the east gate to City Hall and another 200-300 people waiting at the west gate who wanted to be admitted. By 10:15 a.m., cold and futility caused the number at the west gate to dwindle to about 75, at which time they were shepherded across the street to wait on yet another line to get into two more overflow rooms inside 250 Broadway.

By 10:30 a.m., when I was among those finally able to observe the hearing, Committee Chair Carmen de la Rosa was reading from a list of questions that enabled three representatives of the Adams administration to extoll the benefits of the Aetna Medicare Advantage plan and the crisis of the city’s finances. They were Daniel Pollack and Clare Levitt, deputy commissioners from the Office of Labor Relations, and Kenneth Godiner, deputy commissioner from the Office of Management and Budget. I did not hear those administration representatives mention that $1 billion had been “borrowed” from the Healthcare Stabilization Fund, originally set up to pay the difference between health plans like GHI and less costly HMO options. It was used to pay for admittedly well-deserved teacher raises on condition that the Municipal Labor Committee (MLC) would repay the fund from healthcare savings.

In all fairness, perhaps mayor’s representatives did discuss that MLC debt while I was standing outside the west gate yelling “We’re old and we’re cold!”

The MLC represents all union employees in the city and must have the support of 2/3 of its members to make negotiation decisions. More than 2/3 of all city workers are members of the United Federation of Teachers (UFT) and DC-37. Thus, the UFT and DC-37 control the MLC. The MLC never paid back the $1 billion that it borrowed from the stabilization fund. Because that money is gone, the mayor is able to assert that there is no money to pay for continuing the retirees’ current healthcare benefits.

The deputy commissioners made it clear that, without the City Council’s vote to change §12-126 before January 30th, Senior Care and all other retiree healthcare choices would be eliminated. The Aetna plan would be the only option offered. Once eliminated, mayor’s representatives asserted, Senior Care could never again be resuscitated.

At this point, it wasn’t looking good for the retirees. Then the council members began to ask their questions.

Charles Baron challenged the claim of impending fiscal disaster. He pointed out that the city has $8.3 billion in its reserve fund, which is the highest level in history. Baron also demanded that the city should never enter into any contract with Aetna, because Aetna insured slaveholders during antebellum times. He promised to vote “no” on the code change.

Eric Bottcher, from our local Council District 3, asserted that money for healthcare coverage can be found by eliminating price gauging by hospitals. He was particularly incensed by $1,000 charges that city insurance plans paid for COVID tests for some active city employees. On January 11th, Bottcher announced that he, too, would be voting against changing §12-126.

Christopher Marte thanked the retirees who had come to the hearing. He pointed out that private insurers, like Aetna, care more about profit than people.

Shekar Krishnan asked the mayor’s team for their response to the New York Times expose of Medicare advantage plans. The deputy commissioners promised that they had negotiated a better plan that provides oversight and performance guarantees.

Alexa Avilés pointed out that the mayor was demanding a vote from the council to change §١٢-١٢٦ based on a contract that the council had not been permitted to see. They were being asked, she said, “to put retirees at great risk without being able to see the agreement that was being made.”

The mayor’s team claimed that there was a legal impediment to permitting the council to see a contract that had not been finalized. They also said, misleadingly, that the judge in the retirees’ lawsuit had ruled that the city could only offer one plan. Thus, they said, the only way that the retirees could have the choice of paying to remain with Medicare/Senior Care was if §12-126 were changed.

That was patently untrue. Without the change in the law, the city cannot charge some retirees more than others. The problem is the spiraling cost of healthcare. If the cost of healthcare were managed in the public interest rather than by the corporate interest in maximizing profits, choices could still be offered. If the $1 billion that the MLC “borrowed” from the Healthcare Stabilization Fund were returned, choices could still be offered. If money were taken from the $8.3 billion reserve fund, choices could still be offered. If a blue-ribbon commission were formed to explore savings suggested by the NYC Organization of Public Service Retirees, choices could still be offered.

The last council member who spoke before I left was Julie Won. She answered a question that many of us were wondering as we stood outside the gates to City Hall. Do they know that we are out here?

The answer was, “Yes.” Won thanked the retirees in the chamber, in the overflow rooms, and still waiting outside. She mentioned the thousands of emails and telephone calls that the committee members had received. She said that a Medicare advantage plan should be the last option.

The mayor’s team said that they had already done everything that could possibly be done. The city was making sure that no ineligible dependent was being covered. That translates into denying coverage for many spouses of retirees and children of active employees until they prove their entitlement. The city had also imposed copays to change behavior. Copays are designed to discourage people from seeking care by forcing them to pay more for that care. Deputy Commissioner Clare Levitt asserted that copays saved money by discouraging people from having procedures like colonoscopies in hospitals rather than off-site facilities. But the fact is that people actually forego care like physical therapy and Xrays and blood tests and preventive care in general.

Interestingly, the copays imposed on retirees were halted by a judge’s temporary injunction on January 10th, one day after the §12-126 hearing.

One more point made by Levitt was particularly galling: As an answer to the problem that private insurers deny many procedures that Medicare covers, she extolled Aetna’s procedure for appealing denials. After the initial denial, the decision can be appealed to a doctor in the same specialty area. After that denial, there were two more onerous-sounding levels of appeal. All of these appeals have to be argued by a patient’s doctor who, by the way, is not paid for the hours and hours that this takes away from the provision of actual health care.

More than 100 retirees testified after the committee members. According to Susan Herzog, a former city teacher who stayed to the bitter end, their testimony went on until almost 9 p.m., which was long after most of the committee members had left the chamber. Herzog says that every one of the retirees who testified asked the council not to amend §12-126 except for five UFT-associated retirees who wanted the law amended so that they could keep their traditional Medicare and pay $200/month for Senior Care.

“I was amazed at the stunning hypocrisy of [UFT President Michael] Mulgrew, to send these people in to plead to keep their traditional Medicare, when he had just spent 20 minutes telling us how his Aetna plan was so much better than traditional Medicare plus Senior Care,” says Herzog.

At this time, not a single member of the Council has come out in support of the proposed amendment of §12-126. The Committee on Civil Service and Labor failed to approve the bill and move it to the full council. According to committee chair Carmen de la Rosa, there is “no appetite” for it in the Council.

In a press conference on January 18th, Council Speaker Adrienne Adams said that the City Council is unlikely to be voting on it before the Council’s final meeting on Thursday, January 26th.

The mayor might still try to limit retirees to a Medicare advantage plan and eliminate the option of keeping Medicare and Senior Care with a $191 monthly premium, but he lacks the power to act unilaterally. He needs either an action by City Council, which is not forthcoming, or he needs the support of the MLC. So far, the MLC has refused to take the blame for snatching healthcare from elderly retirees.

Penny Mintz, retired attorney, active member of New York Progressive Action Network, mother of 2, grandmother of 3, has only lived in the West Village for 56 years!