Reject the cruelty of Medicare Advantage, NYC
By David M. Newman
New York Daily News, Jun 16, 2022 at 5:00 am
When my wife, Ellen Bilofsky, was diagnosed in 2021 with grade 4 glioblastoma, an inoperable form of brain cancer, we understood that our remaining time together was limited. We hoped to spend it with family and friends, sharing joyful memories and making Ellen as comfortable as possible. We did not anticipate that the last six months of her life would be consumed by constant battling with our medical insurer to obtain the care that Ellen needed and deserved. This happened largely because our excellent union-negotiated, employer-provided retiree health care coverage had been downgraded from traditional public Medicare to a for-profit Medicare Advantage plan.
In one instance, Ellen’s hospital-based medical team prescribed in-patient acute rehab, and, although the rehab facility approved her admission, our Medicare Advantage Plan determined these decisions to be “medically unjustified” and denied coverage. The denial was eventually overturned — but only after significant delay and interruption in treatment, and significant effort on our part to overturn the denial.
In a second instance, as Ellen’s life neared its end, her medical and rehab teams jointly determined that therapeutic and rehab treatment were no longer effective and prescribed palliative in-patient acute hospice care. The hospice facility approved her admission, but our Medicare Advantage plan again denied coverage, claiming Ellen was not ill enough to warrant in-patient hospice care and directing that she be discharged to home. We again appealed but this time we lost and Ellen returned home, presumably to die there. Only after direct intervention by a member of Congress did the plan agree to cover in-patient acute care hospice, to which she was clearly entitled per both Medicare and Medicare Advantage guidelines. Ellen passed away a few short weeks later in August 2021, after receiving excellent care at the hospice facility.
I am sharing these examples of the pain and suffering our Medicare Advantage plan caused our family because today 250,000 New York City municipal retirees are in court fighting to protect their quality health care from a similar switch from Medicare to Medicare Advantage. I urge Mayor Adams to withdraw his court appeal and cease efforts to force this switch.
Ellen was a strong and tenacious woman and, ironically, she had been advocating for years for universal single-payer health care as a social and racial justice issue. She was a tireless advocate for Medicare for All and the New York Health Act, which guarantees health care as a human right, and which would have provided the care she needed according to her medical team’s recommendations, without interference from insurance administrators. I remind the mayor that in his previous position as Brooklyn borough president, he hosted an informational forum on the New York Health Act — a forum that, incidentally, Ellen was instrumental in helping to organize and which highlighted many of the harms caused by privatized health care.
In April, an investigation by the Office of the Inspector General of the U.S. Department of Health and Human Services confirmed that Medicare Advantage plans “sometimes delayed or denied…beneficiaries’ access to services, even though the requests met Medicare coverage rules.” It also noted that “denying requests that meet Medicare coverage rules may prevent or delay beneficiaries from receiving medically necessary care.”
Given Ellen’s experience and these findings, the city’s municipal retirees are right to be concerned that, under a Medicare Advantage regimen, they may suffer denied and delayed medical care. We were fortunate that a high-ranking elected official was able to secure in-patient acute hospice care for Ellen. However, it should not require congressional intervention for insurers to cover medically necessary treatment to which patients are clearly entitled.
The purported rationale for moving from traditional Medicare to Medicare Advantage is cost savings for the employer. In my case, that was a large telecommunications corporation. With regard to municipal retirees, that is the City of New York. However, recent research indicates that switching seniors to Medicare Advantage plans between 2010 and 2019 has cost Medicare in excess of $100 billion more than keeping them in original Medicare would have been. A better way to cut costs — while actually providing comprehensive coverage — would be to pass and implement the New York Health Act, which, according to one recent analysis, would save New York State $16.8 billion annually.
On Thursday, June 16, retired NYC municipal workers will join with councilmembers at City Hall to urge the mayor and city to protect retirees, retain traditional public Medicare coverage, and cancel the switch to Medicare Advantage.
Mayor Adams should stand up for quality public health care for all, and for the employees who served our city for decades. He should drop the city’s appeal to their lawsuit, restore their access to traditional Medicare, and work with New Yorkers to lower healthcare costs, remove barriers to treatment and raise the standard of care.
Newman is a resident of Flatbush, Brooklyn.