6月14日，市劳工委员会以压倒性多数批准了一项从为退休雇员及其受益人提供的医疗保险计划过渡到私人管理计划的计划，预计该计划将提高关键领域的福利，同时每年为该市节省5亿美元的医疗成本. Story from The Chief by Richard Steier. July 14.
That savings will be used to fortify the Health Stabilization Fund, 在牙科和处方药福利等领域为员工福利基金提供补充帮助，但已经接近耗尽.
The new plan, known as the NYC Medicare Advantage Plus Program, mlc在医疗福利问题上为城市工会讨价还价，而白思豪政府也要求他们在两家知名医疗服务提供商之间做出选择. Ultimately, acting on the recommendation of mediator Martin Scheinman, 他们选择了会徽健康(Emblem Health)和帝国蓝十字/蓝盾(Empire Blue Cross/Blue Shield)联盟的提议，而不是安泰保险(Aetna)的提议. It will take over Medicare services as of Jan. 1, 2022.
“I really think it’s a good program: for the city, for the retirees, and for future retirees,MLC主席哈里·内斯波利(Harry Nespoli)在该计划获得90%会员委员会批准一小时后接受电话采访时说, led by the city’s two-largest unions, the United Federation of Teachers and District Council 37.
Labor Commissioner Renee Campion said in a statement, “在每次讨论中，英国正版365网址首先考虑的是为员工提供最高质量的医疗保健, retirees and dependents while at the same time controlling the ever-increasing costs of health care. We have found ways to achieve both, 这个过程的一部分是仔细研究每一个细节，寻找每一个可能实现这两个目标的可能性.”
She continued, “医疗保险优先计划是继续为英国正版365网址的员工提供同样医疗保健的一个例子, while providing necessary cost controls. Finalizing this change has taken much longer than everyone expected, 但是，通过这些改变，英国正版365网址将拥有一个非常强有力的医疗保健计划，为英国正版365网址的退休人员提供更好的福利，并允许他们继续接受他们感到舒服的医生和他们想去的医院的治疗.”
一些退休人员曾表示，他们担心全国各地的其他“医疗保险优先”项目提供的福利比传统的“医疗保险”项目少，或者对那些参与项目的人来说成本更高. They also worried that two major city hospitals, Memorial Sloan Kettering and the Hospital for Special Surgery, had not accepted Medicare Advantage patients.
到春季中期，工会和市政府确保了这两家医院参与纽约市医疗保险优势计划的承诺, regardless of which of the two health-care providers was chosen to run the program.
与目前该市提供的老年护理计划相比，将为退休人员提供一些新的自费项目, among them $15 for specialist visits, diagnostic tests, mental health/substance use disorder, and rehabilitation services. In all those cases, however, according to charts that were provided to union officials prior to the vote, co-pays of that amount were scheduled to be imposed starting next January under the current Medicare plan.
In other areas, however, 保险覆盖方面有了显著的改善，这可能会为退休人员节省数千美元的自付费用.
One example is that retiree costs, which currently have no limit, will be capped at $1,470 a year. A Durable Medical Equipment benefit for employees that is currently capped at $2,500 will no longer have a limit.
A potentially huge savings for long-term hospital stays will be a feature of the new program. Right now, 退休人员在医院住院61至90天，必须支付这30天期间的全部共同保险费用, a 50-percent coinsurance for days 91-201, and full coinsurance for days 302-365. Under NYC Medicare Advantage Plus, there will be no coinsurance charge for any portion of their stays.
Mr. Nespoli said that benefit will mean, “If a person’s sick enough, they can stay long enough [to recover] and not worry about being bankrupt when they come out.”
Ambulance services are currently provided to Medicare retirees with a $25 deductible and a $2,500 annual cap. Under the new city plan, there will be no deductibles or annual limits.
While the new plan will require that an ambulance be deemed “medically necessary” to transport retirees, in cases where that standard isn’t met, for the first time those retirees will be entitled to 24 paid rides annually, up to 30 miles per ride, in other vehicles, including cars.
Other new benefits include 14 free meals following up to four “events,” involving either an inpatient stay or certain weight/health conditions. There will be a hearing-aid allowance of up to $500 a year. And as part of the city’s effort to encourage “wellness” through healthier diet and exercise, retirees will receive up to $200 in gift cards for completing certain activities, and senior citizens with gym memberships will be enrolled at no cost in the Silver Sneakers program, which will provide them with online videos and classes and other related resources.
All terms will remain in effect for the next five years.
Five unions voted against the deal, according to one labor leader who took part in the discussions via Zoom: the 30,000-member Professional Staff Congress, which represents faculty at the City University of New York, the New York State Nurses Association, the Doctors Council, the Committee of Intern and Residents, and the Sergeants Benevolent Association.
All those unions except for the SBA had sought to have the vote delayed to allow for further discussion. A proposal to put it on hold until Aug. 31 was defeated during a meeting of the MLC Steering Committee, 随后提出的将投票推迟到本月底的动议被全体会员委员会否决.
Even before presentations were made to MLC members in two morning sessions June 14, 工会领导人在收到有关提案内容的详细书面描述后，对该提案表达了截然不同的观点.
The PSC two days earlier made its first push for the MLC to delay the vote, with its new president, James Davis, saying in a statement, “五天的时间是不够的，就这样一个重要的决定进行磋商……这次通过退休人员医疗计划寻求储蓄的投票，适逢纽约市完全有能力寻求替代方案。.”
他认为，退休人员个人应该有机会审查该协议，并在投票前向工会提供意见, and concluded, “Whatever its provisions, 将节省成本的负担转移到工会成员和市政雇员身上的计划对未来来说并不是一个好兆头. Higher costs may be demanded of union members down the line. The answer is not privatization. 它将继续工党为单一支付方的公共医疗保健系统和为纽约公平服务市政工人的系统而奋斗.”
Organization of Staff Analysts Chairman Robert J. Croghan took a contrasting view. 他说，美国民主社会党人一直在游说工会坚持单一付款人计划, 在2019年和2020年初的民主党总统初选中，伯尼·桑德斯和伊丽莎白·沃伦都曾支持过这个项目. “The impression we had,” he said in a phone interview, “was that it was not as good as what we had now.”
In fact, much of the momentum Ms. 由于工会不愿放弃其成员从他们协商的雇主项目中享受的一些额外福利，工会抵制了她的健康计划，沃伦在2019年夏天的发展受到了阻碍.
Mr. 克罗根说，在MLC和白思豪政府相互谈判以及与两家医疗服务提供商谈判时，他的退休成员提出了两个特别紧迫的问题.
“The first was, would they be able to keep their doctors? They will,” he said. “The second was, would they keep specialized care—and they will.”
他指出，对现有医疗保险优势项目的一个抱怨是，这些项目的文书工作过多，不仅对参与者，而且对一些医生来说都是一种威慑. But Mr. Croghan said that, “Previously, 英国正版365网址去看医生，会收到两张账单:80%由医疗保险支付，另外20%由英国正版365网址(工会)的健康保险支付.”
Under the new Medicare Advantage Plus program, he continued, “Now you’re only getting one piece of paper: from Medicare.”
Talking to his rank and file, Mr. Croghan said, “The main thing I got from my members over the past few months was they didn’t want much change, and this doesn’t require it.”
Mr. Nespoli voiced a similar sentiment, saying, “Very few people like changes,” especially when they are content with their situations. But he recalled something he was told more than two decades earlier, long before becoming president of the Uniformed Sanitationmen’s Association, by that union’s longtime financial consultant, Jack Bigel—one of the municipal-labor officials who, going back more than 50 years, 强调建立附加福利，如医疗保险，即使这意味着牺牲工资增长.
“Jack Bigel once told me, ‘Hey kid, if you’re around long enough, you’re gonna have to get used to change.’
“There’s some good benefits in this thing,” Mr. Nespoli added. “I think this program specially fits municipal workers.”
The one new financial burden retirees would face, Mr. Croghan said, was an “increase in co-pays for certain doctors’ visits.” But there was also better coverage in other areas under the program, he said, and on the whole “it would be extremely similar to what we had under Senior Care, which retirees have been extremely comfortable with.”
Speaking of both the MLC negotiators and the city’s team led by Ms. Campion and her top adviser on health-care issues, Claire Levitt, the OSA chair said, “I think this was a pretty good job they did, because this was definitely scary” to many retirees.