IN A NUTSHELL: How this all happened?
NYC announces that it will begin negotiations with the second-place bidder, Aetna, to provide an MA plan for Medicare-eligible NYC retirees, because the “Alliance” MA plan which NYC and the MLC had negotiated will not be implemented due to the withdrawal of Anthem, the national sponsor, from participation in the plan in July.
NYC proposes, with the support of the MLC, an amendment to the NYC Administrative Code to permit Medicare-eligible retirees and their dependents to be treated as a separate “class” for the purpose of establishing a benchmark health insurance plan at a cost below the full cost of HIP HMO. PSC and other unions oppose such a change because it could undermine the legal right to future premium-free health care coverage for all NYC employees and retirees. The City Council held a hearing on the change in January 2023 but did not vote on it.
PSC proposes both an alternative approach for funding the NYC Health Insurance Stabilization Fund such that savings from forcing NYC retirees into an MA plan would not be needed and the establishment of a stakeholders’ commission to identify ways to reduce the growth in NYC spending for health care with a focus on hospital pricing
MLC local union leaders vote to accept the Aetna MA plan as the only plan available to Medicare-eligible retirees, other than HIP VIP. PSC voted NO. The full Aetna contract was not made available before the vote, only a summary, and more locals voted No or abstained than in the past.
The full Aetna contract was posted on the NYC OLR website. (See the bottom of the page when you click the link.) The contract contains a provision in Addendum B to permit continuation of access for NYC retirees to traditional Medicare plus a supplemental plan. NYC has not sought to establish a supplemental plan to replace Senior Care.
NYC Office of Labor Relations Commissioner Campion sends a letter to all Medicare-eligible retirees announcing that as of September 1, 2023 all Medicare-eligible retirees and Medicare-eligible dependents will be automatically enrolled in the NYC Aetna Medicare Advantage (MA) PPO Plan, except retirees already enrolled in HIP VIP, a Medicare Advantage HMO. GHI Senior Care and all other retiree health plans except the Aetna MA PPO and HIP VIP will be discontinued as of 9/1/23. (Non-Medicare-eligible dependents will be enrolled in the GHI CBP as of 9/1/23, regardless of their current coverage, except dependents of retirees in HIP VIP who will be enrolled in HIP HMO.)
NYC signs the contract with Aetna, and the OLR Commissioner states to the MLC that the City will exercise the options in Addendum B (see above) “…only in the event a change in circumstances in the future, whether due to litigation, legislative action, or some other event, mandates a different approach….”
Nine Plaintiffs and the NYC organization of Public Service Retirees filed a lawsuit challenging the implementation of the NYC Aetna MA plan and also seeking a temporary restraining order and preliminary injunction from forcing Medicare-eligible NYC retirees and their dependents off their existing health insurance pending a determination on the case. In early June, the parties to the case agreed to extend the deadline for the Special Enrollment/Waiver Form submission to July 10, 2023, to permit preliminary argumentation and the judge’s consideration of the request for a preliminary injunction.
Judge Lyle Frank granted a preliminary injunction such that the Respondents [NYC et al.] “are temporarily enjoined until further order of this Court from requiring any City retirees, and their dependents from being removed from their current health insurance plan(s), and from being required to either enroll in an Aetna Medicare Advantage Plan or seek their own health coverage.” This order is not a final disposition in the case, but the judge ruled that the burden for preliminary injunction was met because of the likelihood of ultimate success of the case on the merits and the prospect of irreparable injury if retirees and dependents were forced to change coverage before the case is decided.
Judge Lyle Frank permanently enjoined NYC from removing NYC Medicare-eligible retirees and their dependents from their current health plan(s) and from requiring those retirees and their dependents to enroll in Aetna Medicare Advantage or seek their own health coverage. The City has expressed its intention to appeal this decision to the NY State Appellate Division.
For a longer term history of how this transpired, going back to June 2018, click here.