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Medicare Dis-Advantage: Overpayments And Inequity

Medicare Advantage—the privatized Medicare plans run by insurance firms but funded by the federal government—rips off taxpayers. On this there is little controversy. In March, MedPAC, Congress’s nonpartisan advisory board on Medicare policy, estimated that this year alone taxpayers will overpay Medicare Advantage plans by $83 billion—the savings to Medicare if all of those plans’ enrollees were instead covered by the traditional, fully public Medicare program. A 2022 New York Times exposé, “’The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions,” lays out the gory mechanisms—like fraudulent schemes (known as “upcoding”) to make patients look sicker on paper, which ups payouts from the government.

Insurgent Slate Wins UFT Retiree Chapter Election

In a significant setback to the union’s leadership, former educators with the Retiree Advocate caucus of the United Federation of Teachers have ousted the incumbent Unity slate. In balloting for leadership of the union’s Retired Teachers chapter, the Retiree Advocate slate received 17,226 votes, or 63 percent of the total, while Unity, which is aligned with UFT President Michael Mulgrew, got 10,114 votes, according to unofficial results. Members of the Retiree Advocate had campaigned in opposition to the city’s efforts to switch retired city workers to a Medicare Advantage plan from their traditional Medicare. The plan is backed by the Municipal Labor Committee, of which Mulgrew is the executive vice-chair.

Mayor Adams Keeps Pushing Medicare Advantage Despite Latest Court Defeat

The City of New York’s decision to keep trying to push 250,000 municipal retirees into a profit-driven Medicare Advantage health insurance plan after yet another crushing court defeat on Tuesday has convinced many in the fight that Mayor Eric Adams and his privatization allies must be crazy. “Yesterday was a great day. Retirees won our case again,” retired public school teacher and Cross-Union Retirees Organizing Committee [CROC] member Sarah Shapiro told Work-Bites. “After spending two months deliberating, the court came down with a ruling in our favor. Yet, the city still vows to appeal again. Will the mayor and our union misleaders in the Municipal Labor Committee [MLC] ever learn? Insanity is doing the same thing over and over again and expecting a different outcome—these guys are insane! We vow to keep fighting!”

Retired New York City Teachers Rise And Run

They’ve really stepped in it. The incumbent Unity Caucus that runs the huge teachers union in New York City is facing a challenge from the Retiree Advocate slate who hope to take leadership of the powerful 70,000-person retiree chapter within the union. Ballots were mailed May 10 and will be counted June 14. The rallying issue has been the United Federation of Teachers’ collusion with the city to put municipal retirees, including retired teachers, into a for-profit Medicare Advantage plan run by Aetna. The plan would replace their traditional Medicare, which is provided premium-free along with a cost-free wraparound.

Work Longer, Die Sooner! The Dire Need To Expand Social Security And Medicare

Shameful fact: the plight of U.S. retirees is a global exception. In their pursuit of lower taxes, America’s wealthiest individuals support policies that make it extremely difficult for seniors to manage the increasing costs of healthcare, housing, and basic necessities. Not so in other rich countries like Germany, France, and Canada, where robust public pensions and healthcare systems offer retirees stability and dignity. After a lifetime of hard work, older citizens in the U.S. find their reward is merely scraping by, as savings diminish under the weight of soaring medical costs in the most expensive healthcare system in the developed world.

Progressives Must Put Medicare For All Back On The Agenda

In May 2009, Dr. Margaret Flowers, renowned single payer activist and humanist, was one of 13 single payer activists, doctors, and nurses arrested at one of the Senate Finance Committee meetings, chaired by then-Senator Max Baucus (D-Mont.), charged with reforming the U.S. health care system. The committee heard from 28 witnesses over two days representing major health care stakeholders. Missing from the lineup was even one witness in support of the obvious solution, single payer health care. As activists were hauled out of the hearing by police, one of them could be heard saying, “Why aren’t single payer activists at the table?”

Half Of Rural Hospitals Are Operating At A Loss

In a little more than two years as CEO of a small hospital in Wyoming, Dave Ryerse has witnessed firsthand the worsening financial problems eroding rural hospitals nationwide. In 2022, Ryerse’s South Lincoln Medical Center was forced to shutter its operating room because it didn’t have the staff to run it 24 hours a day. Soon after, the obstetrics unit closed. Ryerse said the publicly owned facility’s revenue from providing care has fallen short of operating expenses for at least the past eight years, driving tough decisions to cut services in hopes of keeping the facility open in Kemmerer, a town of about 2,400 in southwestern Wyoming.

The UAW’s 2028 National Strike Should Center Medicare For All

The United Auto Workers (UAW) are laying the groundwork for workers across multiple sectors to join them in a general strike on International Workers Day, May 1, 2028. UAW president Shawn Fain’s call to utilize labor power — four hundred thousand working members and six hundred thousand retirees make up the UAW alone — for the “good of the entire working class” is a major departure from business-as-usual unionism and represents a potential game changer for social movements to secure public goods, including Medicare for All, that extend beyond the shop floor.

How Medicare Advantage Care Denials Affect Patients

In 2023, insurance behemoth UnitedHealth spent $8 billion buying back its stock to juice its stock price—and its executive compensation, which is tied to the company’s stock price. It spent 39% more on stock buybacks in 2023 than in 2022. In 2023, it also spent $6.7 billion on dividend payments—a 10% jump from the prior year. The company’s CEO, Sir Andrew Witty, pulled in nearly $21 million in 2022—a 13% hike from 2021. (His compensation for 2023 hasn’t been disclosed yet.) Also in 2023, UnitedHealth spent $10.76 million lobbying Congress.

Baltimore Joins Over 100 US Cities In Endorsement Of Medicare For All

Baltimore has officially joined the growing list of over 100 U.S. municipalities advocating for a nationwide Medicare for All healthcare system. This significant endorsement, led by Democratic City Councilmembers Kristerfer Burnett and Odette Ramos, aligns Baltimore with major cities like Philadelphia, San Francisco, and Los Angeles in supporting a federally funded universal healthcare program. Burnett expressed gratitude to advocates who have been instrumental in advancing these resolutions nationwide, highlighting the importance of accessible healthcare for thriving communities. Rev. Alvin C. Hathaway Sr., a local pastor, emphasized the critical need for healthcare as a right, especially for those facing tough choices like affording insulin or groceries.

Why Maximus Workers Are Walking Off The Job

As a federal customer service representative, I help seniors access the healthcare they need through Medicare, often handling hundreds of calls per day to sign people up, answer their questions, help them navigate billing, and more. I am an expert on these programs, but the hard truth is that despite working for the largest federal call center contractor, Maximus, I don’t have access to affordable health coverage for myself and my three children and my pay is so low I’m struggling to stay afloat. This is why I’m going on strike today with hundreds of my co-workers who are experiencing similar struggles.

New Report: Insurers Are Gaming Medicare To The Tune Of $140 Billion

The federal government is losing as much as $140 billion per year by subsidizing private Medicare Advantage plans, according to a bombshell new report. In the groundbreaking investigation, health care researchers identified the four major ways that private insurers systematically exploit the taxpayer-funded national health insurance program while denying care to the nation’s most vulnerable patients. The researchers additionally found that seniors could save over $1,800 in annual fees taken from their Social Security checks if the government redirected what it spends subsidizing Medicare Advantage plans to instead reduce premium costs. Under the current arrangement, “traditional” Medicare pays about $12,000 a year to private Medicare Advantage insurers for every patient whose care they “manage.”

NYC Transit Retirees Join Fight Against Medicare Advantage

TWU Local 100 retiree Patricia Jewett put more than 30 years into the MTA New York City Transit. Now at 67, her knees are shot and bronchial asthma makes it hard to breathe. But Jewett says she remains proud of being the first woman to ever work in the East New York Bus Depot’s Maintenance Division — and she doesn’t understand why she and her fellow retirees are now being stripped of their traditional Medicare coverage and pushed into a profit-driven Medicare Advantage plan. “I spent years being the only woman in an all male atmosphere,” Jewett told Work-Bites this past Friday outside the Downtown Marriott in Brooklyn. “It wasn't easy, but I stuck it out."

Two Large Medical Groups Shun Medicare Advantage Plans

Signaling what may be an emerging national trend, two influential medical groups with San Diego-based Scripps Health are cancelling their Medicare Advantage contracts for 2024 because of low reimbursement and prior authorization hassles, leaving 30,000 enrolled seniors to look for new doctors, or different coverage. "Negotiations with the payers for MA with our medical foundation groups and Scripps Health were unsuccessful and we have been forced to withdraw from those plans due to annual losses that exceeded $75 million," Scripps CEO Chris Van Gorder told MedPage Today in an early morning email.

Whipping Egg-Whips: Retirees Win Battles Against Medicare Advantage

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.
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