SUBSCRIBE TO OUR FREE NEWSLETTER
Daily news & progressive opinion—funded by the people, not the corporations—delivered straight to your inbox.
5
#000000
#FFFFFF
5
#000000
#FFFFFF
bill de blasio
Whipping Egg-Whips: Retirees Are Winning Battles Against Medicare Advantage
In a country inundated with ads falsely praising the benefits of MA plans, it is amazing that grassroots organizations have cut through the gibberish, exposed the lies, and are fighting to keep their traditional Medicare with promised supplementary coverage.
Aug 25, 2023
An Egg-Whip sounds like a festive, holiday drink or a merengue dessert. It is anything but a delightful treat.
Egg-Whip is the healthcare industry’s name for Employer Group Waiver Plans (EGWP), a provision for privatization of employer-based, retiree Medicare benefits that was written into the Medicare Modernization Act (MMA) of 2003. That law, which House Energy and Commerce Chair Billy Tauzin twisted arms to pass, added a drug plan to Medicare, not by including drugs as covered Medicare benefits, but by compelling seniors to purchase private drug plans. Big Pharma gained a massive influx of government money into its coffers and rewarded Tauzin with a $2-million-a-year job.
That’s what we could see on the surface. Who knew then that hidden in the MMA law was further privatization of Medicare beyond this privatized, publicly-subsidized drug plan known as Medicare Part D.
The Egg-Whip allows employers that have committed to provide health benefits for retirees to force those seniors, without their consent, into private, for-profit Medicare Advantage plans that impose conditions on the promised benefits.
This other provision in the MMA, the Egg-Whip, allows employers that have committed to provide health benefits for retirees to force those seniors, without their consent, into private, for-profit Medicare Advantage (MA) plans that impose conditions on the promised benefits.
These private employer-based Egg-Whip MA plans are exempt from requirements that individual Medicare Advantage plans must meet. The MA Egg-Whip plans “can set their own enrollment deadlines, send members information without prior CMS approval for accuracy, and follow weaker requirements for provider networks, among other things,” according to Susan Jaffe of Kaiser Health News.
Chris Maikels of Mercer Marketplace, a retiree benefits company, claims that his clients have saved up to 50% by moving retirees into MA private plans. “Employers find Medicare Advantage [plans] appealing because they can drive significant savings,” he asserts.
For the retirees who are forced into Egg-Whips, the results are not so appealing. A private for-profit middleman is placed between the beneficiaries and their physicians. Medicare funds are funneled through these plans. The more the plans limit, delay, and deny care, the greater the profits. The beneficiaries’ interest in care is diametrically opposed to the pecuniary interests of the insurance companies, such as Humana, United Health Care, or Aetna, through which their Medicare benefits are now funneled. Physicians’ decisions can be overruled by the money men who demand prior authorization. The best cancer centers and rehab facilities are off-limits. The network of approved providers may be limited to a geographic region. Doctors come and go from the network. The co-payments will escalate with the gravity of the illness.
Employers who seek the savings of private MA plans hide these detrimental characteristics of Egg-Whips by touting additional benefits like gym memberships, coverage for dental and eyeglasses, no co-pays on some procedures, and more. Those extra benefits are icing on the cake—but there’s no cake underneath.
In a country inundated with Medicare Advantage ads falsely praising the benefits of such plans, it is amazing that grassroots organizations of retirees have cut through the gibberish, exposed the lies, and are fighting to keep their traditional Medicare with promised supplementary coverage.
And they’re winning, too!
Retiree organizations in Vermont, New York, and Delaware have put thousands into motion as they rip down the curtains that have hidden Medicare Advantage from the nation’s understanding and righteous anger.
The Vermont State Employees Association (VSEA) effectively stopped Governor Phil Scott from moving state retirees to a private Medicare Advantage plan. State officials asserted that such a change would maintain the same level of coverage for retirees and save them an average of 20% on their premiums while saving money for the state of Vermont.
The Vermont State Employees Association knew better. Steve Howard, Executive Director of the VSEA, asserted that this was an end run around their rights, under the collective bargaining agreement, to have the same health benefits as the active state employees. “We’re gonna fight with everything we have,” Howard said. “If we have to go to court, we’ll go to court.” We refuse to agree to “privatize this benefit out to an industry that is renowned for denying healthcare services to people when they need it the most,” said Howard.
The VSEA learned about the threat to their retiree health benefits in September of 2022. They organized a massive resistance. By May of 2023 they had defeated Medicare Advantage. Howard tells the story at minute marker 30:40 on this radio program, To Heal D.C.
The New York City Organization of Public Service Retirees has been fighting for two years to keep from getting egg-whipped. They too are winning. It’s a David and Goliath story, and David and his slingshot, amazingly, are hanging in there, creating a spirited, fighting camaraderie as they do it.
Former New York City Mayor Bill de Blasio initiated the move to place the New York City retirees into a Medicare Advantage Egg-Whip. That effort was continued by current Mayor Eric Adams, who claims that the city would save $600 million a year and that the retirees would be better off than they are now with their current plan based on traditional Medicare.
Mayor Adams, sadly, in conjunction with some of the unions, signed a deal with Aetna to move the city retirees into an Egg-Whip MA Aetna plan, despite the fact that Aetna’s MA plans, in just one year, imposed prior authorization restrictions on nearly 3 million people and denied the claims of 400,000.
On August 11, 2023, Judge Lyle Frank granted the request of the retirees and ruled that the city could not place the 250,000 retirees into Medicare Advantage against their will.
“This is now the third time in the last two years that courts have had to step in and stop the city from violating retirees’ healthcare rights,” said Marianne Pizzitola, president of the New York City Organization of Public Service Retirees. “We once again call on the city and the Municipal Labor Committee to end their ruthless and unlawful campaign to deprive retired municipal workers of the healthcare benefits they earned.”
Retirees have waged battle through countless demonstrations and actions that have brought the grassroots into motion like never before. NYC retirees are currently urging the City Council to pass legislation that clearly makes permanent their right to their current health benefit plan. They have persuaded 17 council members to sign on to the legislation and are working to get that number to 34 to give them a veto-proof majority. Uphill battles don’t faze them. They continue with a feisty energy as Mayor Adams announces that he will once again appeal the judge’s decision.
A similar battle is unfolding in the state of Delaware. Since August of 2022, Retirees Investing in Social Equity (RISE Delaware) has been organizing to block a proposal to place them in a Medicare Advantage Egg-Whip plan run by Highmark. RISE Delaware, initiated by former State of Delaware Representative John Kowalko and New Castle County Councilwoman Lisa Diller, has generated thousands of emails and letters to officials and brought litigation that has succeeded, so far, in stopping the state from implementing the change to an Egg-Whip MA plan.
In an open letter from RISE Delaware, the organization responds to the barrage of false information. “The fact that we would not accept the move into Medicare Advantage and took the State of Delaware to court to stop it is an indication of how serious we are about keeping the benefits promised to us.”
They go on to state their solidarity with future retirees:
But we also want a commitment to current employees that healthcare benefits will be there for them too. We know that employees are often unaware of how much they will need their healthcare benefits as they age. We know that high deductible healthcare plans sound great when you don’t need them. But it is when you can’t outrun the health problems that you need those healthcare benefits. So, we are watching as you “survey” state employees about the “modernization” of their healthcare benefits. We know that benefits choice is often code for benefits reduction even if employees are not yet aware of that fact.
RISE Delaware retirees are contacting the members of a state benefits committee that advises the legislature asking committee members to vote “to put a stake through the heart of Medicare Advantage so it can never come back to haunt us. If they don’t, MA will be like a dormant venomous snake in winter—it will come back to strike in spring.”
Retiree organizations in Vermont, New York, and Delaware have put thousands into motion as they rip down the curtains that have hidden Medicare Advantage from the nation’s understanding and righteous anger. They are fighting back, clearing the fog, educating their colleagues and the public to the dangers of Egg-Whips and Medicare Advantage, winning battle after battle to the consternation of the Medicare Advantage companies whose cash cow is suddenly exposed and threatened.
Keep ReadingShow Less
NYC to Pay Millions to Police Brutality Protesters Violently Arrested by NYPD
"They dragged me on the ground and beat me with batons," said one protester. "Somewhere in the process of being cuffed, I had a knee on my neck."
Mar 01, 2023
Hundreds of people who were trapped, beaten, and wrongfully arrested by New York City police officers during a nonviolent 2020 racial justice protest in the Bronx will each receive $21,500 if a judge approves the terms of a settlement filed in federal court late Tuesday.
Around 300 people were arrested, many of them brutally, on June 4, 2020 in the Mott Haven neighborhood while peacefully protesting police violence and systemic racism following the May 25 murder of unarmed Black man George Floyd by Minneapolis police.
"We had every right to protest, yet, the city of New York made an explicit statement that day that the people of the Bronx are at will to be terrorized," 31-year-old Samira Sierra of the Bronx, one of the protesters who sued the city, toldThe New York Times.
"We had every right to protest, yet, the city of New York made an explicit statement that day that the people of the Bronx are at will to be terrorized."
Joshua S. Moskovitz, a lawyer representing the plaintiffs, toldBuzzFeed News they hoped the settlement "marks an inflection point for policing in New York City."
"This unprecedented settlement recognizes that the NYPD's actions in Mott Haven were grievously wrong," he said.
\u201cNew York City has agreed to pay $21,500 to each of hundreds of demonstrators who were penned in by NYPD officers in the Bronx during the George Floyd protests in 2020 https://t.co/Y8vWUBZI6G\u201d— Allison McCann (@Allison McCann) 1677691761
In social media posts, organizers of the June 4 "FTP4" protest—Take Back the Bronx and Bronxites for NYPD Accountability—urged participants to "take back the streets." One Instagram post featured a burning New York Police Department (NYPD) van.
The protest was overwhelmingly peaceful. However, less than an hour into the demonstration—and 10 minutes before an 8:00 pm curfew—a phalanx of heavily armored NYPD officers and cops on bikes began "kettling," or trapping, protesters so they could not leave. Attorneys for the arrested protesters—whose cases were ultimately dismissed—called it a "preplanned show of force."
After 8:00 pm, officers began violently attacking and arresting people for violating curfew. They beat demonstrators "packed like sardines" and unable to escape, with some officers standing atop vehicles swinging their batons down at bodies. Some protesters said they saw officers smiling as they swung into the crowd.
"We went there to protest police brutality and we became victims of police brutality," one demonstrator recounted.
\u201c@LegalAidNYC @shaunking @NYSDOCCS https://t.co/huiAa7g0FX\u2026 police brutality on peaceful protesters in the #Bronx no one is reporting on please help this be seen #DefundThePolice #DefundNYPD Mott haven please retweet - no reporting on this nypd violence they kettled the group 7:30 and beat them at 8 #bronxprotest\u201d— The Legal Aid Society (@The Legal Aid Society) 1591904715
Other officers shoved people to the ground or fired pepper spray in their faces and under their clothing. Arrestees' wrists were bound so tightly by zip ties that some of their hands turned purple due to lack of circulation.
"They dragged me on the ground and beat me with batons," one protester told Human Rights Watch after his arrest. "Somewhere in the process of being cuffed, I had a knee on my neck."
According to the demonstrators' lawsuit: "Many protesters were left injured and bleeding. Some protesters fainted, or lost consciousness and went into convulsions."
24 Minutes in Mott Haven: Ikaikawww.youtube.com
Dr. Mike Pappas, a medical volunteer, recalled how "we were blocked off in a sea of cops. I was standing there watching people being carted out on stretchers with head injuries."
Among those arrested—and sometimes brutalized—were medical and legal volunteers, as well as journalists covering the demonstration and even passers-by.
Arrestees were held in "dangerously overcrowded and unsanitary detention conditions with many people who lacked masks, exacerbating health risks during the Covid-19 pandemic," according to Physicians for Human Rights. Many officers wore no masks.
\u201c.@P4HR documented police violence against protesters and medics in this Mott Haven investigation:\n\nhttps://t.co/Zu1WXoB875\u201d— Joanna Naples-Mitchell (@Joanna Naples-Mitchell) 1677685696
Then-New York City Mayor Bill de Blasio, a Democrat, and Police Commissioner Dermot Shea defended NYPD tactics after the arrests, pointing to violence and looting at past protests. Shea said the operation was "executed nearly flawlessly."
NYPD subsequently said its policies for handling large demonstrations have been "re-envisioned."
If a judge approves the settlement filed Tuesday, the $21,500 per-protester payout would be one of the highest ever awarded in a mass arrest case. The agreement could cost city taxpayers as much as $6 million, according to the Times, which said that as many as 90 protesters have already settled their claims in separate complaints.
In 2021, Democratic New York state Attorney General Letitia James sued the NYPD over the Mott Haven arrests and "to end the pervasive use of excessive force and false arrests by the New York City Police Department against New Yorkers in suppressing overwhelmingly peaceful protests."
Last year, 12 legal observers from the New York City chapter of the National Lawyers Guild who were arrested at the protest collectively received a $49,000 settlement in a federal lawsuit against the city.
Keep ReadingShow Less
NYC Officials Denounced for Holding New Year's Celebration Amid Omicron Surge
"This is a potential superspreader event," said one public health expert.
Dec 31, 2021
Public health experts expressed shock Friday as New York City went ahead with its plans to hold a scaled-back--but still large--New Year's Eve celebration in Times Square, with 15,000 people expected to pack the landmark to ring in 2022 as the city sets new records for Covid-19 cases.
Outgoing Democratic Mayor Bill de Blasio announced last week that the traditional New Year's ball drop will go on, prompting epidemiologists to warn that the event will carry risks for attendees and the city's already-strained healthcare facilities--as well as communities across the country, since many of the attendees are likely to be visiting from elsewhere.
"This is a potential superspreader event," said Dr. Oni Blackstock, founder of healthcare consulting group Health Justice, on Tuesday as the city reported more than 27,000 new cases and a positivity rate surpassing 19%.
\u201c.@NYCMayor, please cancel NYE in Times Square.\n\nThis is a potential superspreader event.\u201d— Oni Blackstock (@Oni Blackstock) 1640722844
Blackstock noted that major international cities including Tokyo, Paris, and Rome have canceled their public New Year's celebrations due to the rapid spread of the Omicron variant.
"NYC needs to follow suit," she said.
New York City Council Member Mark D. Levine, the chair of the Council's Health Committee, concurred.
The city is taking some precautions aside from limiting the number of participants at the event--which last year was attended by only frontline workers and their family members but generally draws tens of thousands of in-person viewers.
"If we run out of hospital capacity, then we are in a different world of hurt."
All attendees over the age of five will have to provide proof of vaccination and masks will be required.
Still, New York University epidemiologist Dr. Danielle Ompad told the New York Times Thursday, "given the increase in Covid cases due to Omicron, I would not go to Times Square to watch the ball drop."
Earlier this week, the city was forced to shut down an entire subway line between Queens and Manhattan due to the number of transit workers who called in sick. The New York City Fire Department issued a call to New Yorkers to refrain from calling 911 except in cases of real emergencies, after receiving calls from sick residents who wanted ambulances to take them to hospitals for Covid-19 tests. The department reported that a third of its paramedics were out sick this week.
More than 100,000 people in the city have tested positive since Christmas Day.
Emergency physician Dr. Kelly Doran said while an outdoor celebration is safer than an indoor gathering, the event is likely to send thousands of people into the city's subway.
"How do you think people get to Times Square?" tweeted Doran. "Where do they go afterwards? And how much of our first responder resources will this event consume with [emergency medical services] already struggling?"
The Mt. Sinai Health System in the city announced Wednesday that it was suspending elective surgeries in its hospitals. Although the city's intensive care units are far less full than they were during last winter's surge, before vaccines were widely available, Levine told the Times that illness among healthcare workers is causing a "squeeze."
Doran called the plan to go ahead with the celebration--supported both by de Blasio and incoming Democratic Mayor Eric Adams, who will be sworn in at the event--"pretty unreal" considering the surge in Omicron cases.
\u201cPretty unreal to me that NYC is still holding its big New Year's Eve bash tomorrow when COVID cases are higher than ever, hospitals are having to call in visiting help & cancel elective surgeries, and FDNY is pleading with the public not to call 911. (1/)\u201d— Kelly Doran MD MHS (@Kelly Doran MD MHS) 1640895298
"Right now we're in the public health crisis of our lifetimes," CNN medical analyst Jonathan Reiner told "CNN Newsroom" Thursday. "And although I love a big celebration... all those people have to get to Times Square via some way, they're all going to be on public transportation, they're going to be on the subways. And I think frankly it should have been canceled the way most European cities have done."
"If we run out of hospital capacity," he added, "then we are in a different world of hurt."
Keep ReadingShow Less
Most Popular