6 PREDICTIONS ON HEALTHCARE
An in-service New Action-UFT caucus member shares informed predictions about the new citywide healthcare benefits plan being cooked up by The City, Mulgrew and the MLC. - Repost from: newaction.org
Most UFT members are aware that major changes are coming to our healthcare. The MLC and Michael Mulgrew requested proposals from insurance companies that would cost the City less money. Essentially, healthcare cuts for all City workers.
The reason Mulgrew and the MLC are looking to save the City money is the calamitous 2014/18 UFT/MLC agreements in which they guaranteed the City endless billions in healthcare savings in exchange for mediocre raises. Mulgrew has never explained this decision, and membership deserves a full explanation. We can only guess that Mulgrew felt extreme pressure to deliver raises after failing to come to terms with the Bloomberg administration for years. Reasoning aside, we owe the City money because of Mulgrew, and after failing to force retirees into Medicare Advantage Plans, Mulgrew left us in the position of being on the hook for it.
We know that EmblemHealth (partnered with United Healthcare) and Aetna are the two front-runners for our new plans. What will our new healthcare plans look like?
Here are 6 predictions:
Good news up front, I predict our healthcare will remain premium free. This is not because Michael Mulgrew and the MLC love us or have a solicitous relationship towards us. Simply put, the political calculus disfavors premiums. Being the UFT president who lost premium free healthcare would be a mark of disgrace on Mulgrew’s legacy and would put in danger the Unity caucus’s stranglehold on the UFT. Mulgrew and the MLC will work to find more camouflaged ways to save the City money and will tout the premium free nature of their new plan despite it being a diminution of our healthcare and compensation. This is after Mulgrew used premiums as a scare tactic. In November 2022, Mulgrew and the Unity caucus leadership drummed up fear that if their plan to foist Medicare Advantage Plans onto retirees was unrealized, premiums would be necessary for in-service members. Either Michael Mulgrew has figured out how to avoid this (unlikely) or this was him misleading and manipulating his constituents. Currently, the retirees’ plan to fight their former union has worked, and the Advantage Plans have been enjoined by a judge. Those promised savings haven’t been realized, and Mike is in big trouble.
The Plan will remain a PPO, in name only. Political calculus will again force Mulgrew and the MLC’s decision. They would be happy to force us all into a traditional HMO like they have done to new members, but fully understand this would be poisonous to their future electoral prospects and unacceptable to their constituents. To solve this, they will create a new PPO that will operate similarly to an HMO.
An HMO or Health Management Organization, like HIP, requires participants to see in-network doctors exclusively, except in emergencies. HMOs are far more restrictive and often require prior authorizations before procedures and referrals before seeing specialists. A Preferred Provider Organization or PPO, like our current plan GHI-CBP, allows participants to see in-network healthcare providers or receive reimbursement for some of the cost of out-of-network providers. They do not require prior authorizations or referrals to see specialists. PPOs generally give participants more freedom, but cost more.
3. We will need a Primary Care Physician or PCP to make referrals in order to see a specialist or pay for a larger fee. Any added layer of complexity or hardship in receiving healthcare saves the City money. Participants are less likely to see a specialist if they must first see their Primary Care Physicians or pay a fee to skip their PCP. Therefore, members will be more likely to be treated by less expensive non-specialists. You have allergies, a skin condition, stomach issues, etc., you can no longer go directly to your specialists of choice without getting a referral or paying more. The choice will be to pay with your hard-earned money or pay with your time, but you will pay a price.
4. The plan will feature added prior authorizations. Prior authorization saves the healthcare companies money by allowing them to decide how medically necessary a procedure or medicine is. If they deem it unnecessary, they can deny coverage. You and your doctor no longer get to make decisions about what treatments are appropriate or necessary for you, now the insurance company gets to decide. This also comes with the added responsibility of gaining prior authorization on your own if your doctor is not in-network, which is a hardship few members will wish to deal with.
5. The plan will feature prohibitive out-of-network costs and bureaucratic hardships to force us to use in-network providers. While the plan will technically allow you to see out-of-network providers, making it a PPO and not an HMO, it will be expensive and difficult in practice to see out-of-network providers. This will essentially force the vast majority of us to use only participating providers. If the cost doesn’t force us to use their preferred providers, having to secure prior authorization and submit onerous paperwork for ourselves will.
6. We will see increased co-pays. Mulgrew and the MLC fear premiums. It would be unprecedented for there to be no premium free option for New York City public employees. Co-pays can accomplish the same thing while allowing them to brag about maintaining premium free healthcare. Tiered co-pays, which Mulgrew and the MLC have already used to help shape our decision around which urgent cares we use, could help them do the same for more medical providers and hospitals. Co-pays will eat into our recent sub-inflationary raises, and Mulgrew and the MLC will shape your choices in medical treatment by hitting you in the wallet for choosing providers they didn’t select for you.
Let’s review Michael Mulgrew, Unity caucus, and the MLC’s record on healthcare. Previously, healthcare was one of the primary reasons people joined public service. Currently, our healthcare is mediocre at best, with GHI-CBP freezing their pay rates for doctors for years and adequate mental health care services nearly impossible to acquire. I have personally lost doctors as a result of this, and I know many members who have as well. Our welfare fund is also greatly diminished, and it has become difficult to find dentists that will accept these paltry rates. Mulgrew blames rising healthcare costs, which are admittedly out of control, but then agreed in the 2014/18 agreements to find the City 600 million dollars in savings every year in perpetuity. Costs are rising, as are our debts as a direct result of Mulgrew and company. We elected Mulgrew and Unity to make decisions about our union, not our health.
We deserve full transparency and a vote on any changes to our healthcare. Our lives could be at stake.
The author of this article is an anonymous in-service New Action-UFT caucus member.