Tillow: Retirees are winning battles against Medicare Advantage


Kay Tillow is the coordinator of the All Unions Committee for Single Payer Health Care, which builds union support for national single-payer health care. She lives in Louisville, Kentucky. This was first published by Common Dreams. The commentary has been edited for length and can be found in full at baytobaynews.com/opinion.

An egg whip sounds like a festive, holiday drink or a meringue dessert. However, it is anything but a delightful treat.

“Egg whip” is the health care industry’s name for employer group waiver plans, a provision for privatization of employer-based, retiree Medicare benefits that was written into the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA).

That law, which House of Representatives Energy & 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.

This other provision in the act, 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.

These private employer-based egg whip Medicare Advantage plans are exempt from requirements that individual Medicare Advantage plans must meet. The egg whip plans “can set their own enrollment deadlines, send members information without prior (Centers for Medicare & Medicaid Services) approval for accuracy, and follow weaker requirements for provider networks, among other things,” according to Susan Jaffe of Kaiser Family Foundation Health News.

Chris Maikels of Mercer Marketplace, a retiree benefits company, claims that his clients have saved up to 50% by moving retirees into Medicare Advantage 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, UnitedHealth or Aetna, through which their Medicare benefits are now funneled. Physicians’ decisions can be overruled by the moneymen 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 copayments will escalate with the gravity of the illness.

Employers who seek the savings of private Medicare Advantage plans hide these detrimental characteristics of egg whips by touting additional benefits like gym memberships, coverage for dental and eyeglasses, no copays 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 effectively stopped Gov. 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 association knew better.

Steve Howard, executive director of 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 health care services to people when they need it the most.”

The association learned about the threat to their retiree health benefits in September 2022. They organized a massive resistance. By May 2023, they had defeated Medicare Advantage. Howard tells the story at minute marker 30:40 on the 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 Medicare Advantage Aetna plan, despite the fact that these plans, in just one year, imposed prior authorization restrictions on nearly 3 million people and denied the claims of 400,000.

On Aug. 11, 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,” wrote 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. New York City retirees are currently urging 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 2022, Retirees Investing in Social Equity 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 Rep. 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 Medicare Advantage plan.

The organization responded 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 health care benefits will be there for them too. We know that employees are often unaware of how much they will need their health care benefits as they age. We know that high deductible health care plans sound great when you don’t need them. But it is when you can’t outrun the health problems that you need those health care 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 and 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.

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