NYC's call to move retirees to a Medicare Advantage plan is being opposed by a 9/11 hero. She's backed by hundreds of retirees.
Marianne Pizzitola didn’t intend to become a leading expert in the finer details of municipal health plans.
True, the retired New York City EMT had a front-row seat for decades into the kind of suffering so many go through. But like so many others, it wasn’t until 9/11 that her life really began to change.
“I remember being in our headquarters in downtown Brooklyn, and in the waiting room there were TVs where we watched the planes hit the towers,” she recalls with evident pain and horror that has not receded two decades later. “Suddenly, the waiting room cleared out, and we walked across the bridge and commandeered city buses to join our coworkers at the towers.”
Wendell Potter NOW is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
“I got there later that day. We ended up staying at work for four days,” she recalls. “We never went home. My neighbors watched my dog. I was in the same clothes. Even our food was covered in dust. I remember finally walking back to headquarters and seeing dust footprints on the carpet.”
Since that unspeakable tragedy, Marianne and her colleagues have continued to pay a price in the form of their health. “All epidemiologists told us we’d see more cancer after 20 years, and they were right,” she says now. Marianne adds that her team, to this day, still loses members due to 9/11-related illnesses. And it’s not limited to the EMTs she served with. “Between our teachers, students in the area, first responders, cleaners, laborers, mechanics, and people affected by the air,” she explains, “we lost more than the number who actually died on 9/11.”
Marianne Pizzitola discusses the issue with Medicare Advantage’s prior authorization requirements
Sadly, Marianne must now fight an additional battle for the health of her brethren. Thanks to a controversial new scheme by the City of New York, Marianne and the army of retirees she leads, called the NYC Organization of Public Service Retirees, must now fight to get the quality health care they earned over decades of hard work.
A new fight—this time against corporate greed
The issue at hand is a scheme called “Medicare Advantage,” which is neither Medicare nor an advantage for millions of people lured or forced into those privately operated Medicare replacement plans. Instead of continuing to provide retired public workers with traditional Medicare and financial support for a Medicare supplement plan to cover out-of-pocket expenses, the city is instead proposing to herd them into a Medicare replacement plan that would be operated by Aetna, part of the CVS corporation.
Mayor Eric Adams’ plan to move all 250,000 municipal retirees into a commercial insurance company’s Medicare replacement plan is not only cruel and unfair but possibly also unlawful.
While Adams recently got an arbitrator to rule that he could move forward with the plan, Marianne and her team question its validity. For his part, Adams maintains that the city would save $600 million a year if he’s allowed to move forward – but only if all retirees agree to be switched out of the traditional Medicare program and into a private insurer’s plan. Those that don’t agree would have to pay a penalty of $192 a month–or $2,304 a year–for the privilege of remaining in the traditional Medicare program.
I don’t have to tell you that this is an expense that is out of reach for many retirees living on fixed incomes, or worse.
Teachers, EMTs, firefighters and cops join the battle
The NYC Organization of Public Service Retirees is a grassroots organization comprising retired EMTs, firefighters, cops, teachers and other city workers. They worry that a Medicare Advantage plan would result in a reduction in their health coverage.
And sadly, I can attest first-hand from my years in the corporate insurance business that they are right. Many studies have shown that Medicare Advantage plans can and do keep enrollees from getting medically necessary care.
Let me be even more blunt: Medicare Advantage is a money-making scam. I should know because I helped to sell it. As most of you know, I’m a former healthcare executive who used to come up with PR and marketing schemes to sell these private insurance plans. To this day, the industry churns out studies that omit or obscure facts the insurance industry wants to hide about Medicare Advantage plans and other policies with sky-high deductibles. The result? Millions of middle-class families are now buried under a mountain of medical debt while insurers are posting record profits.
The good news is that Marianne and her colleagues are not alone in the fight. “It’s kind of an insanity that the city would give away what little protection a retiree has,” explains John Mudd, of the Midtown South Community Council, a group active in the hunger and homelessness crisis, that is supporting the retirees’ fight. “They use the word Medicare in ‘Medicare Advantage’ to fool us. They should not even be using that word.”
When I asked Mudd why he was getting involved in this fight, he explained, “You’ve got extreme cost when it comes to health care, and it drags a lot of people broke. It’s one of those issues where you have all these other countries taking care of their people with a health care system that isn’t out for profits and doesn’t cause a person to go broke.”
“That’s a big cost in people’s lives,” he added. “If you have an accident, you can be in serious trouble. You can lose your home.”
That might sound like hyperbole, but the sad reality is that such a fate can happen to anyone. Which may be why Marianne’s group is very diverse politically.
“I stay out of the fray of political bias,” she explains. “I watched it in my family, and around the country in 2016. We have a large number of members on the left and right. But we are aligned on a mutual message. Medicare Advantage was supposed to be an option, and not just imposed on us. Despite any differences we may have, we can all unite behind that.”
What specifically worries them about Medicare Advantage plans? Marianne and her group have compiled a multipage chart listing the problems with the city’s new plan, among them a potential reduction in benefits (including Medicare B benefits and widow benefits, sadly very relevant for retirees), loss of equality and protection, the potential for additional copays and premiums, and, critically the need for “prior authorization” before tests and procedures.
Preserving the doctor-patient relationship
Prior authorization is another concept I know a lot about. Unlike traditional Medicare, private insurers use this feature of managed care to “approve” major surgeries or treatments in advance. They often decline to pay for what a doctor says a patient needs by claiming they are not actually necessary. It may seem insane that it’s not your doctor, but instead, an insurance company that decides your course of treatment – but this is the harsh reality facing millions of Americans. And it’s what’s at stake for New York City retirees.
So why would unions go along with this? Marianne explains that retirees can no longer vote for the leadership of the unions, so their opposition to the plan does not have any bearing on whether union presidents get reelected. And as for current union members, she believes they are understandably more focused on the kinds of negotiations — like current benefits and wages – that affect them today.
“Active union members don’t understand. We’ve struggled with how to get the message out to them,” she said. “When you’re 20, 30, or 40, you’re not thinking about when you’re 60. You don’t know what Medicare is or how different it is from your current plan. You don’t know what Medicare Advantage is and how it’s different from Medicare. Or how your health needs change as you get older. Or your life circumstances change.”
“You’re not thinking about when you’re older, and you’re all alone and widowed. You’re aging, becoming more frail.”
But unfortunately, this is what happens to all of us, if we’re lucky enough to live a nice, long life. And without quality health care, New York City’s retirees won’t be able to live their golden years in peace, or health.
They deserve so much better.
Such a scam. My lord. Is there any judgment call mayor Adams will get right?!
The scam here is by Wendell Potter. 911 and Medicare Advantage have nothing to do with each other. Medicare Advantage is a popular and successful program in which nearly 50% of all Medicare recipients are enrolled. It provides more benefits and lower out of pocket costs than traditional Medicare for the same cost. 48 peer reviewed studies have concluded that Medicare Advantage provides better quality care than traditional Medicare where doctors are paid by the volume of services they provide, thereby incentivizing them to provide more care rather than better care. Visit BHCPG.ORG for more on this.