Delaware Warns NYC: ‘Your Healthcare Can Go Off the Rails’

By Joe Maniscalco

The New York City Council — celebrated for being the most progressive in NYC history — is reportedly still searching for “clarity” on the campaign to push municipal retirees into a privatized for-profit Medicare Advantage health plan. Retired Delaware State Senator Karen Peterson has some.

“Your medical care can really go off the rails,” Peterson recently told Work-Bites.

How far off the rails?

Peterson, part of the the group of municipal retirees called RISEDelaware who last month successfully beat back that state’s attempts to push them into a privatized for-profit Medicare Advantage plan — points to studies showing “horrible examples of people who couldn’t get pre-authorizations for procedures — and died.”

Then there are still others “who’ve gotten a medical bill for $300,000 because Medicare Advantage decided after the fact that their hospital stays weren’t medically necessary.”

Indeed, a newly-released report put out just last month from City of Hope and published in the Journal of Clinical Oncology, finds Medicare Advantage cancer patients are more likely to die shortly after undergoing complex surgery than those with traditional Medicare coverage.

Medicare Advantage beneficiaries battling pancreatic cancer, for instance, are twice as likely to die in the first 30 days after surgery than those patients with traditional Medicare, the report finds.

City of Hope is one of only 52 National Cancer Institute-designated comprehensive cancer centers in the country.

“Exactly the Same, Only Better” - Yeah, Right

Peterson, who also worked for the State of Delaware for over four decades before being elected to office, says the Medicare Advantage proponents in her state repeatedly tried to sell the switch as a “wonderful” plan that is “exactly the same as what you have — only better.”

What RISEDelaware found out, however, after reading the Medicare Advantage contract the state hastily signed with a company called Highmark in September — was it was decidedly not the same.  In actuality, it contained 2,030 pre-authorizations — 1,690 pre-authorizations for procedures and 340 pre-authorizations for medications.

“One of the things they kept saying repeatedly and in writing was, ‘Oh, there’ll be some pre-authorizations.’ When the contact was signed and we got hold of it, it contained 2,030 pre-authorizations — 2,030 is not some,” Peterson says.

Peterson and RISEDelaware argue a plan that makes money denying pre-authorizations, charging high deductibles, using cost-sharing and other shenanigans is not only bad for them — it’s bad for the entire county.

“[Medicare Advantage] is just depleting the Medicare Trust Fund to the tune of billions of dollars each year,” she says. “But for the states it’s a good deal because they get to pawn their retirees off and let the feds take care of them. But what kind of loyalty is that? You expect loyalty from the employees but give none in return?”

That’s a sentiment municipal retirees are expressing in both Delaware and New York.

“I worked 42 years knowing the state was going to take care of my medical benefits and provide a good supplemental plan — and then, lo and behold, you make your decision to retire based partly on that and they pull the rug out from under you,” Peterson says.

Still More Evidence Against Medicare Advantage

Last month, Kaiser Health News [KHN] also reported findings from newly-released federal audits showing “widespread overcharges and other errors in payments to Medicare Advantage health plans for seniors.”

Some Medicare Advantage plans, KHN found, over-billed the government on average more than $1,000 per patient annually.

The Center for Public Integrity put out a report way back in 2014 called, “Why Medicare Advantage Costs Taxpayers Billions More Than It Should.”

The evidence against Medicare Advantage has only continued to mount since then.

Many labor leaders in Delaware, according to Peterson, looked favorably on Medicare Advantage — at least initially.

“Our unions were either favorable because hey had all this misinformation, or they were just silent,” she says. “We had to work to turn them around — and we’ve been able to do that. It’s to a point now that some of the education associations have contributed to our legal fund.”

It took Delaware retirees and their supporters less than two weeks to form RiseDelaware and file suit to stop the state’s Medicare Advantage push this past fall.

“It was our only option,” Peterson says. “They weren’t going to back down. They had convinced legislators and everybody else [to support Medicare Advantage]. They had written opinion pieces for the newspaper kind of portraying us as greedy old people who didn’t want to pay a five dollar co-pay.”

Despite the opposition and well-documented case against Medicare-Advantage plans, RISEDelaware knows the fight will continue and the State of Delaware hasn’t given up trying to kick them out of traditional Medicare.

“It’s just been exhausting,” Peterson says. “Nobody wants to believe the state lied to them. We trusted them, they were our employer for years and we had no reason not to trust them. But now, all of a sudden, we do have a reason. It’s been our job to convince people that you need to be onboard with us on this because the state has lied about what this plan is.”