Medicare Advantage is Such a Threat to Workers, They Wrote a Paper On It
Dr. Donald Moore holds up his Traditional Medicare card during a rally in in City Hall Park last fall advocating for passage of Intro. 1096—Council Member Chris Marte’s bill to protect municipal retiree’s Traditional Medicare benefits from profit-driven Medicare Advantage plans.
By Joe Maniscalco
This past April, labor advocates for single payer health care published a white paper called, “Medicare Advantage: What Labor Leaders Need to Know.”
In it, the authors remind labor leaders—including those in New York City who spent the last four years trying to push 250,000 municipal retirees into Medicare Advantage—that Medicare Advantage is “neither Medicare (the public, universal program without intermediaries between patients and the healthcare they need), nor is it an Advantage, except to profit-driven insurance companies.”
What Medicare Advantage is, the white paper goes on to say is “another Wall Street privatization scheme of raiding public funds for private profit much like the attacks on public schools, water systems, and even parking meters. With support from both the Democratic and Republican parties, Medicare is just the latest target, and the privatization is happening rapidly.”
Earlier this year, the independent health policy research firm KFF found that profit-driven Medicare Advantage plans denied more than 3.2 million prior authorization requests in 2023.
“A federal investigation into these claim denials found that 13 percent, or more than 400,000 requests, of Medicare Advantage enrollees were denied necessary care that should have been covered–and would have been covered by traditional Medicare without prior authorization,” the white paper continues.
You can read the full report from the Labor Campaign for Single Payer Health Care and the Debs-Jones-Douglass Institute here. Work-Bites has made repeated requests to District Council 37 Executive Director Henry Garrido to find out if he read it, too—but we’ve yet to get a response.
Mayor Eric Adams, citing its associated costs, suddenly announced on June 20 that his administration is abandoning the Medicare Advantage push, at least for now. It was a surprising turnaround that came just two days after a New York State Court of Appeals finally delivered the ruling Hizzoner had long sought to help him move ahead with the Medicare Advantage scheme first hatched during the Bill de Blasio administration.
Garrido celebrated the court decision in the Bentkowski or so-called “nuclear option” case saying, “We applaud the Court of Appeals’ unanimous decision allowing the City to move forward with implementing alternative retiree health plans.” Garrido also called the ruling, now heading back to State Supreme Court, an important “precedent" that “keeps health care negotiations where they belong—at the bargaining table between the union and the employer.”
And while he’s sticking to that story, Garrido’s has yet to do anything to help return democratic control of the DC 37 Retirees Association to its 40,000 members after the group was put into receivership last year. AFSCME, District Council 37’s parent union, says the takeover was necessary due to some bungled tax filings—but members insist it was really retribution for effectively helping to oppose the mayor’s original push for Medicare Advantage.
In contrast to all that, the Labor Campaign for Single Payer Health Care is urging trade unionists nationwide to push their union leaders to back resolutions aimed at “leveling the playing field” between Traditional Medicare and Medicare Advantage.
“The best way to stop the privatization of Medicare is by expanding Traditional Medicare and making it easier for people to choose Medicare, rather than be stuck on a Medicare Advantage plan,” the campaign insists.
Central labor councils in Washington, Maine and Minnesota have already backed such resolutions, a copy of which can be found here. But if you’re a public sector retiree living in Alabama, Arizona, Colorado, Connecticut, Georgia, Illinois, Kentucky, Maine, Michigan, Missouri, New Hampshire, Pennsylvania, or West Virginia—you’re already out of luck because Medicare Advantage is the only option you have.
Simply put, the mobilization effort against ever-expanding profit-driven Medicare Advantage plans couldn’t be more urgent for proponents of Traditional Medicare.
New Threat to Traditional Medicare
Late last month, the Centers for Medicare and Medicaid [CMS] announced that in an alleged effort to “root out waste in Original Medicare,” it will soon start implementing something it calls the “Wasteful and Inappropriate Service Reduction,” or “WISeR model,” which will subject Traditional Medicare with more of the same kind of prior authorizations and their ensuing delays and denials of care that are the hallmarks of profit-driven Medicare Advantage plans.
“CMS is committed to crushing fraud, waste, and abuse, and the WISeR Model will help root out waste in Original Medicare,” celebrity doc turned CMS Administrator Dr. Mehmet Oz declared in a statement heralding the new prior authorizations slated to start in New Jersey, Ohio, Oklahoma, Texas, Arizona, and Washington on Jan. 1, 2026.
“Combining the speed of technology and the experienced clinicians, this new model helps bring Medicare into the 21st century by testing a streamlined prior authorization process, while protecting Medicare beneficiaries from being given unnecessary and often costly procedures,” he added.
Those prior authorizations Dr. Oz is so found of, however, do have a long and established track of being being used by profit-driven Medicare Advantage plans to delay and deny the vital necessary care patients need—the same Medicare Advantage plans also engaged in "upcoding” and wildly overcharging the government for services.
PNHP—Physicians for a National Health Program—puts those fraudulent overcharges at anywhere between $88 billion to $140 billion annually.
Rose Roach, national coordinator for the Labor Campaign for Single Payer and chair of Healthcare for All Minnesota, calls the new spate of Medicare Advantage-style prior authorizations slated for Traditional Medicare “horrifying” and “unnecessary.”
“It's important to look at this in the context of what is a prior authorization? Where did the theory and the idea of prior authorization come from? It came from the insurance industry,” Roach recently told Work-Bites. “It came from the people who do everything they can to take more money in, and pay less money out. And that means less care for us because they are looking to profit off of our suffering.”
Indeed, the use of prior authorizations according to Roach, is a business strategy that has nothing to do with patient care. And to those who argue that Traditional Medicare is already subject to some prior authorizations—Roach insists it is a “rarity to have anybody denied the care that they need or the medical device they need based on their medical professional’s actual diagnosis and determination of treatment.”
“Prior authorizations are causing huge harm—not just to patients who can’t then get the care they need—but also to our health care providers who are spending up to 20 million hours a year fighting with insurance companies to get their patients the care they’ve determined they need is absolutely necessary,” she adds. “It is highly disturbing and it's going to be very problematic.”
Work-Bites reached out to CMS for more on WISeR’s rollout, but the agency has yet to respond to those requests.
Mark Dudzic, longtime labor organizer and current member of the Labor Campaign for Single Payer Health Care’s steering committee, concedes that “Medicare Advantage can look like an easy way to address skyrocketing retiree healthcare costs, avoid concessions, and some wage gains.”
“But the concession—and it is a concession—is likely much bigger than we’d like to acknowledge,” he says. “That said, unions are between a rock and a hard place. In some situations, there are no other alternatives.”
On June 18, the Labor Campaign for Single Payer Health Care held a webinar featuring Association of Flight Attendants-CWA President Sarah Nelson and others who talked about Medicare Advantage’s existential threat to Traditional Medicare—as well as labor’s role in combatting that threat.
“This is also an opportunity for all of us to come together and not hunker down and protect what we have so it continues to shrink,” Nelson argued.“We can actually come together and express our power and set an agenda right now in this moment of crisis that finally achieves the vision that FDR, (labor leader) Walter Ruether, and many of us who have dreamed of health care as a human right can achieve together.”