Why UFT Delegates Must Vote 'No' on the NYCEPPO Plan if UnitedHealthcare Standards Are Applied To All
Trust in this plan continues to be frayed as union leadership refuses to share the unredacted contract and related documents. Now, the leading consultant pushing the plan shares a shocking revelation
A Trojan Horse in Our Healthcare?
The newly proposed NYCEPPO healthcare plan is being sold to active UFT members and pre-Medicare retirees as a way to improve benefits and save money at the same time. Union leadership and the city’s negotiating committee are distributing FAQs to calm legitimate concerns about the role UnitedHealthcare (UHC) will have in this plan given its well-documented record of claim denials.
The UFT’s FAQ in particular craftily tells members not to worry:
“EmblemHealth will do all prior authorizations in the Downstate 13 counties in New York State, which represents 90% of claims.”
“UnitedHealthcare, which will process the remaining 10% of claims, will follow the exact same standards that EmblemHealth adheres to, ensuring that prior authorizations are handled uniformly nationwide.”
This framing makes it sound like most members are protected from UHC—and only a small fraction of claims (10%) will ever touch them.
But this is deeply misleading.
Thousands of retirees and their families live outside the Downstate 13. For them, UnitedHealthcare will be their direct administrator and gatekeeper—not Emblem.
This is strange, even morbid, “double speak” because another selling point from the UFT leadership’s paid operatives is that retirees living out of state will have more options for doctors and providers. Yet, they seem to think UHC’s 32% denial rate is somehow not going to be a big deal for most of us since it’s only going to be experienced by the 10%, mostly retirees, who don’t live locally.
Some active members and other city workers also live and work outside these counties—they too will fall under UHC administration.
According to the lead consultant pushing this plan, even inside the Downstate 13, the standards remain UHC’s standards. Emblem may process the paperwork, but the rules—the criteria, or standards, that decide whether your care is approved or denied—are UHC’s.
This means the entire system, for every member, retiree, and family, is governed by UHC’s standards.
That’s the Trojan horse in this plan.
The Shocking Revelation
Buried within this proposal is a devastating emerging reality: if UnitedHealthcare (UHC) standards for care, prior authorizations, and denials are applied across the board, every member—active or retired, teacher or paraprofessional, therapist or counselor—will be subject to one of the most notorious denial machines in the insurance industry.
Is this speculation? No!
It’s written plainly in the leaked transcript from September 10th MLC healthcare presentation meeting. There we read and hear testimony and a Q&A between MLC leaders, the paid “independent” lead healthcare consultant from Segal, Chris Calvert, and other union leaders.
In this meeting, the lead consultant informs those gathered that even in regions where EmblemHealth is technically the administrator, the standards being enforced will be UHC’s standards.
In other words: every city worker and retiree will live under UnitedHealthcare’s rules, no matter where they live.
Here is one of the exchanges where Calvert admits to the UHC standard being applied to all:
Here’s what’s being said:
Alan Klinger, the MLC and UFT lawyer, who also is the MLC’s appointee to the joint tripartite committee with the City, interrupts Calvert seeking to clarify that in the downstate 13 region, prior authorizations (the approvals you need before certain care or procedures are covered) will go through Emblem. He goes on to say, that if a union local’s administrators have concerns, they go through Emblem, which manages this process locally.
Chris Calvert responds by emphasizing that the standards being applied will be UnitedHealthcare’s standards—so no matter where a member lives, the rules are the same. But for downstate 13 specifically, the actual reviews and management of those prior authorizations will be carried out by Emblem, not directly by UnitedHealthcare.
In short:
Standards = UnitedHealthcare rules (applied to everyone).
Administration in downstate 13 = handled by Emblem (the local entity).
UnitedHealthcare’s Track Record: Profits Over Patients
UnitedHealthcare is not a neutral player or some benevolent caretaker. It is the largest corporate health insurer in the United States and has a documented, checkered history of putting profits above people. It leads private insurers with a 32% denial rate. According to an American Medical Association survey, doctors have ranked UHC as the insurer with the most prior authorization hassles, with 72% of physicians giving UHC a “high” or “extremely high” burden rating.
AI-Driven Denials: Investigations and lawsuits show UHC uses algorithms to prematurely cut off rehab, skilled nursing, and home care—even when doctors say patients need more time.
The same MLC meeting revealed that AI is very much part of this new agreement.
Ongoing Litigation: Class actions accuse UHC of violating federal law by systemically denying medically necessary care. Testimony from insiders revealed denial quotas built into policy. It also is under multiple investigations for fraud and overbilling.
A Pattern of Abuse: Reports nationwide show seniors denied cancer drugs, patients forced out of hospitals too soon, and families buried in appeals.
Multiple Federal Investigations: UnitedHealth Group is currently facing both civil and criminal investigations by the U.S. Department of Justice (DOJ) for fraud and overbilling.
UnitedHealthCare is not who we want controlling our care, nor setting the criteria.
What This Means for Members and Retirees
If delegates approve this plan:
Doctors and patients lose authority. UHC’s criteria, not medical judgment, will determine treatment.
Retirees are exposed. Thousands living outside Downstate 13 will deal directly with UHC—and face its merciless denial machine without a buffer.
Everyone potentially faces the same denials. Inside Downstate 13, Emblem is only administering UHC’s rules. Members will still suffer the same rejections and delays.
Vulnerable populations are targeted. Retirees, post-surgical patients, lowest paid city workers and children with special needs will be most harmed by premature cut-offs and denials.
Members drown in bureaucracy and red tape. Appeals, phone calls, and paperwork, stress will replace care. Those without stamina or know-how will simply go without.
Real Lives, Real Consequences
This isn’t abstract. Imagine:
A retired teacher recovering from hip replacement is cut off from rehab after just a week, even though her doctor prescribes three. She either pays thousands out of pocket or risks lifelong mobility issues.
A child of a UFT paraprofessional loses access to speech therapy because UHC’s standard says “progress plateaued.”
A city worker battling cancer is forced to switch procedures mid-treatment because UHC refuses to cover the one that her doctor believes will work for her.
These are not “hypotheticals.” They are documented cases from UHC’s history. And they could be our reality if this plan is approved.
The Bigger Issue: Trust and Transparency
Equally troubling is how this plan is being sold.
Leadership knows UHC’s record.
They know thousands of retirees live outside Downstate 13.
They know even within Downstate 13, UHC’s standards will rule.
And yet, instead of being upfront, they’ve chosen to spin, minimize, and mislead. That erodes trust. And it betrays the union’s responsibility to protect its members’ and their families’ health.
UFT Delegates’ Responsibility
Delegates are not voting on a simple healthcare plan change. They are voting on whether to hand the criteria of members’ care to UnitedHealthcare.
It’s one of the most consequential votes they will cast.
They are voting on whether retirees and families must fight an insurance giant for every day of rehab, every specialist visit, every procedure, every medication.
They are voting on whether to let leadership’s spin override the lived reality of denials, lawsuits, and suffering.
This is not about numbers on a spreadsheet or “cost savings”. It is about people’s lives.
It cannot be overstated: being under UHC’s standards is, indeed, A MAJOR CHANGE.
We did not have their standards dictating our city premium-free plan for the last several decades. This is not keeping things virtually “unchanged” while making improvements and saving money as the paid operatives for Michael Mulgrew’s Unity leadership caucus tell us.
A Better Path Forward
Rejecting this plan does not mean rejecting cost savings or efficiency. It means demanding a plan that:
Keeps doctors and patients—not insurers or city bureaucrats —at the center of decision-making.
Provides transparency and honest communication with members.
Protects retirees, especially those outside Downstate 13.
Respects the union’s duty to safeguard both wages and health benefits.
Bottom Line: Vote NO
The NYCEPPO plan is being presented as a step forward. But it is, in fact, a step backward—a Trojan horse that hands our care to UnitedHealthcare.
UnitedHealthcare sets the standards for everyone.
Retirees and active members outside Downstate 13 are fully exposed.
Inside Downstate 13, Emblem, the local regional administrator, simply enforces UHC’s rules for care.
The FAQ spin is a distraction, not a protection.
Delegates must see through the misleading promises and protect the membership.
For the teachers recovering from surgery. For the retirees fighting cancer. For the families raising children with special needs. For every member who depends on the union to safeguard their health.
Vote NO on the NYCEPPO plan if UHC’s standards apply. Because our health is not negotiable.
Vote NO unless UHC’s AI clauses are stripped out or heavily amended with strong protections.
Vote NO because this all points to one unavoidable conclusion: this plan cannot be trusted — including, their refusal to show all of us the unredacted contracts, the many risks of a reckless self-funded gamble, and Mulgrew’s record of betrayal with his failed Medicare Advantage plan.
Learn more:
Why UFT Chapter Leaders and Delegates Must Vote “NO” on the NYC Employees PPO Plan
Healthcare is not an abstract policy issue or some political football. It is not a bargaining chip. It is not a spreadsheet of “savings.”
AI Denials in The Newly Proposed NYCEPPO Healthcare Plan
On September 8th, the Municipal Labor Committee gave city union leaders only a handful of hours that day to examine a redacted version of the newly proposed NYCEPPO healthcare plan.