Comment Rescue – Why you should care about Delaware Democrats throwing retirees under the bus
Why should you care about this issue?
RISE Delaware’s email address for more information: risedelaware@gmail.com
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https://gofundme.com/f/risedelaware
1. See Senator Karen Peterson’s comments in this morning’s article in delawareonline. She is dead on about people trading benefits for pay. This is a social contract that is now broken and retirees are being blamed by Carney and his ilk when this problem was first raised in 2005. It’s taken 17 years to get a grip on this problem? By the way, Carney was Lt. Gov. in 2005.
2. How will this affect you? One example–We are already seeing the result of low pay with the large number of teacher vacancies in Delaware. People have no incentive to teach our children when they can drive to other states for higher pay.
3. To DSEA—Thanks for throwing your retirees under the bus! These people taught my daughter and many other Delaware children, and I am appalled at your lack of concern for the welfare of Your retirees. You are dreaming if you think that you will get larger salaries for current teachers in return that will compensate for this betrayal of your retirees.
4. The GA has done nothing. Other than a few brave souls such as Kowalko, Lynne, Wilson Anton, and Ennis, it has been crickets. These folks will be on this plan after they retire so although they were duped by the Carney crew into voting for this, they refuse to do anything about it. They do not deserve your vote in November.
Ed Note: Comments with multiple links sometimes get stuck in moderation.
Legis town hall on October 10th. Will they now have answers to the questions so far unanswered?
from
Rep. Debra Heffernan
“I’ve heard many concerns from our state retirees regarding the 2023 Medicare Advantage Plan. I encourage those affected to attend our upcoming Town Hall meeting on this topic, which will be held in the Brandywine High School auditorium from 6-8 p.m. on October 10.
Following a presentation about Delaware Medicare Advantage by representatives from Highmark, the Delaware Office of Pensions, and the Office of Governor John Carney, attendees will have the opportunity to voice their questions and concerns.
Please see the flyer below for additional details.”
https://www.facebook.com/RepDebraHeffernan/posts/pfbid02gktKZ2mbMCp14pQC8VUXFnwiWeBHgksRCDEZwkEBkqJgoAp7C4yreQEWEr54ecQTl
I guess what I am confused about is if the goal is Medicare for all, why is this bad?
Because this is not “Medicare for All”. This is an option (Part D) added by those who advocated for privatization of Medicare. Medicare is a federal plan operated by the federal government. As such, it is not subject to state insurance department regulation. Medicare Advantage is a private program operated by private insurance companies and is, therefore, subject to state insurance department oversight.
When I last worked at the Delaware Department of Insurance and had involvement with Medicare Advantage, the biggest concern was that such plans were really not available in lower Kent and in Sussex Counties. When I looked into it, the problem was exacerbated by the fact that Medicare Advantage insurers were paying providers much less than the Medicare rate, and most providers refused to sign on.
The other major problem with Medicare Advantage is that it is a PPO plan. PPO plans require an insured needing a specialist to first see their Primary Care Provider and then receive Prior Authorization for specialist referrals and medical procedures. This has two detrimental results- There is a long waiting time in Sussex County (and increasingly elsewhere) to see most specialists- 4-6 months is not unusual. There is also a growing long wait time to see primary care doctors (4-6 weeks). That long wait for a specialist, combined with Medicare Advantage’s history of initially denying authorization, can be catastrophic for individuals in serious need of specialist treatment and medical procedures.
Public hearings are great when one wishes to inform the people of what is being considered, getting feedback and making changes to a proposal. A public hearing to explain to Delaware state retirees what has already been decided is worthless- unless the legislature is considering a Special Session to amend or delay the proposed changes.
Delaware has a social contract with its retired state employees. They should be able to rely on the medical insurance coverage in existence when the retired. If the State decided it had to make a change like this for budget reasons, it should be rolled out for future retirees, but after consultation and deliberation.
Mitch Crane
former Deputy Insurance Commissioner ( not a state retiree)
I thought with PPO plans you could see anyone without authorization or a referral as long as they were in the network? Has something changed?
Yeah, I work at a doctor’s office. You have HMO and PPO confused. Our patient’s won’t have required referrals any more than the usual paperwork and phone call.
They will suffer more denials from authorizations for tests and procedures, but that’s different than the point you made.
Yeah, none of what Mr. Crane is talking about here is even remotely correct. No refferals in this plan. No requirment for a PCP. No out-of-network costs. No deductibles or co-pays. Private market Medicare Advantage plans are not the same as the state’s negotiated plans. Highmark’s doctors essentially stand in as a defacto PCP to manage care. You also have the ability to go to out-of-network providers as long as they accept medicare and are willing to see the patient. And yes, I’m certain that the reimbursment is less than what those pirates at Christiana Care were milking from the system for so many years prior…. GOOD! The more I get details about this, the more I think that the anti-change crowd is full of far more misinformation than truth. A bunch of former legislators who irresponsibly buried their heads in the sand for decades all of a sudden taking a stand now because the unsustainable system that they left untouched for their retirement is in jeopardy of being corrected. I’m not donating to pay the attorneys of the hospital industry so they can continue to charge medicare patients $500 for a bandage. They need oversight. If pre-authorizations brings that about, then fine. What healthcare plan in 2022 doesn’t have pre-authorizations?!?!?
To everyone reading this: This is why no one understands what is happening. This is a complicated issue and it involves the nuances of federal programs that would make people of sound mind fall asleep when reading this exchange. Unfortunately, the devil is in the details, as Ross Perot once said. Or maybe my mother said that…
The problem with Medicare Advantage plans is that they are actually more expensive than Original Medicare at this point. Last year the Medicare Advantage Plans sucked an additional 12 billion dollars from the Medicare Trust Fund and so cost 4% more than Original Medicare, which of course is accepted by 98% of physicians in the U.S.
Please be aware that Medicare Advantage plans are privatized by giving insurance companies federal funds, and often subsidies as well, to privatize our healthcare. Make no mistake, this is a move to a privatized, managed care healthcare system. People are duped into getting these plans and unwittingly give up the protections of the Orignal Medicare program. Yes, they are cheaper but they are not the same as Original Medicare.
State legislators, many of whom are not the Medicare age of 65, have no idea
that Medicare Advantage plans are privatizing our healthcare and draining federal coffers at a faster rate than Original Medicare. And precious few seem to care. And I have no idea why this is called a PPO plan when there will be real problems and costs when you go out of the proposed plan’s network.
To Mitch Crane–
I was told by someone who spent years in the healthcare field that the State of Delaware’s (SOD) proposed plan was a Part C plan. Evidently, as claimed by the SOD, employers are able to make adjustments and craft individualized Medicare Advantage plans for employees. But this is still a Medicare Advantage Plan.
It was also stated at the Newark Town Hall by one of the presenters on September 15 that this is a Part C plan. That was the first time that anyone from the administration had admitted that this plan was not Original Medicare so at least that was a modicum of honesty. Still not sure about the Part D issue if this plan is a Part C plan.
I made a couple of mistakes. Yes, requiring referral is HMO like
Medicare Advantage is Part C. Part D is prescription coverage for traditional Medicare
Yes, the Agreement with Highmark does allow the State to negotiate specific coverage. The main issues that need to be negotiated are Pre-Authorization and permitting covered individuals to see any doctor with referral
Thanks for pointing out my mistakes. I should have proofread better
Dear all,
Please note that the RISE rally against privatization will go on regardless of weather. We have access to the New Castle County Chambers in the event that it rains. The building is located directly adjacent to the outdoor plaza where the rally is scheduled to be held. Hope you can attend this important event.
Representative John Kowalko