Copyright AM New York
A coalition of NYC workers, retirees, and an advocacy organization is suing to block a sweeping health-benefits restructuring that would reshape coverage for roughly 750,000 public-sector workers and retirees. The lawsuit, filed Tuesday, challenges the city’s plan to replace its long-standing, insured health-care coverage with what the coalition calls an unlawful, self-funded model that would strip away protections guaranteed by state law. The legal challenge comes on the heels of a vote last month by the Municipal Labor Committee, a coalition of more than 100 city worker unions, approving a shift of active employees and pre-Medicare retirees to a new plan beginning Jan. 1, 2026. The City has previously stated that the new plan will maintain zero premiums and save approximately $1 billion annually in health-benefit costs. City officials did not immediately return requests for comment on the Oct. 29 lawsuit. The legal challenge argues that the city’s plan to replace the GHI Comprehensive Benefits Plan with a new Administrative Services Only model, branded NYCE PPO, violates the New York City Administrative Code. The code requires that municipal workers, retirees, and their dependents be provided with health insurance coverage through licensed insurers that assume financial risk and are regulated by the state. Under the new structure, the City would pay medical claims directly from its own budget, while UMR, a subsidiary of UnitedHealthcare, and EmblemHealth would administer claims but not insure them. The lawsuit argues that because the City would no longer be using a licensed carrier, the plan cannot legally qualify as “health insurance coverage” without amending the Administrative Code. By making the City of New York responsible for paying claims, the coalition says, coverage would depend on the City’s finances and political priorities. The petition also cites contract language that allows the City to change benefits, copays and deductibles at any time, calling it unlawful and arbitrary. “New York City’s new self-funded healthcare plan will strip hundreds of thousands of municipal employees, retirees, and their dependents of key protections guaranteed by state law, including essential-benefit standards, state oversight, and solvency requirements,” said Gregory J. Dubinsky of Holwell Shuster & Goldberg LLP, who filed the suit. “The plan states the City will be in charge of deciding plan benefits. This suit seeks to compel the City to follow the law and provide health coverage through a licensed, regulated insurer that operates under statutory safeguards,” Dubinsky added. ‘If the City runs out of money, we will run out of healthcare’ The Administrative Services Agreement for the new plan is currently under a 30-day review by City Comptroller Brad Lander, which is sunsetting on Nov. 13. He may certify or reject the contract at any time before the deadline. Lander’s office did not immediately respond to requests for comment on the matter. The advocacy group behind the challenge, Hands Off NY Care, has also hired a mobile LED truck to circle the Lander’s office this week to highlight the pending decision and the lawsuit. The lawsuit also includes first-person accounts from employees and retirees who say the change puts their health and lives at risk. George Anderson, a clinical advocacy director raising two toddlers, said he fears losing access to his children’s doctors in New Jersey because the city has provided incomplete information about covered providers under the new plan. Migdalia Acevedo, who worked near Ground Zero during the Sept. 11, 2001, terrorist attacks and suffers ongoing medical issues, said she is accelerating a planned hip replacement into 2025 to ensure the procedure is completed before her coverage is shifted. “If the City runs out of money, we will run out of healthcare,” she said in an affidavit. Another plaintiff, Samy Mahmoud, who has Crohn’s disease requiring frequent costly infusions, told the court he is “one automatic denial away” from financial catastrophe if the city delays paying claims under the proposed plan. Retirees also express concerns about losing the lifetime benefits they say they were promised. Raeann Singleton, who is undergoing treatment for uterine cancer, warned that even a temporary lapse in coverage “could cost [her] [her] life.”
