The undecided fate of health care for retired city workers will hang over whichever candidate wins the race for mayor — and it’s already shaping the Democratic primary.

Earlier this month, the campaign of Queens Assemblymember Zohran Mamdani, who has surged from obscurity $600 million a year.

That puts Mamdani at odds with the leadership of District Council 37, the prominent municipal workers union that selected Mamdani as one of its three endorsed candidates for mayor, as part of a ranked slate that includes City Council Speaker Adrienne Adams and Brooklyn state Sen. Zellnor Myrie. 

DC 37 executive director Henry Garrido has championed the Medicare Advantage deal to help pay for current workers’ raises and as an alternative to increasing their out-of-pocket costs.

For months, as they sought and then secured the endorsement of the 150,000-member union, Mamdani, Adams and Myrie all declined to sign a pledge pushed by retired city workers committing the candidates to not force retirees into Medicare Advantage. 

Myrie’s campaign declined to state his position on Medicare Advantage, and a spokesperson for Adams underscored in a statement that health care decisions for workers and retirees “are made by the mayor’s office and the city’s municipal labor unions”.

“Speaker Adams s quality healthcare choices for retirees and city workers, and has repeatedly urged the mayor’s office to stop prolonging the court battles and resolve these issues as the entity of city government with authority over the decisions,” campaign spokesperson Matthew Wing said. “As mayor, Adrienne will make protecting quality healthcare choices for retirees and city workers a top priority and bring everyone to the table to deliver a fair solution.” 

Former Gov. Andrew Cuomo, who continues to lead in polls, did sign the pledge — without saying how he will find the health care cost savings DC 37 and other unions signed on to. His website does not mention Medicare Advantage at all.

Cuomo spokesperson Jason Elan says that the former governor opposes the plan because it’s “not a viable option.”

“Because the New York State courts have already ruled that the proposal violates the rights of retirees and cannot be implemented, the potential savings were never real,” he said in a statement. “This becomes just one more in a series of liabilities created by under-budgeting expenses in the Adams istration’s FY 26 Budget — an amount that the Citizens Budget Commission estimates could be as high as $3.6 billion — that the next mayor will have to address.”

A lawsuit from retirees has so far blocked the Medicare Advantage transition, in a case now first inked in pacts between the municipal unions and former mayor Bill de Blasio in 2021.

It’s not that Mamdani has been inconsistent. Before the DC 37 endorsement process started, he came out against the switchover last year in an interview with a labor-focused news outlet where he said he was “firmly opposed to privatization” and “reckless attempts to strip municipal retirees from the traditional Medicare benefits they were promised and earned,” calling the switch to Medicare Advantage “irresponsible and wrong.”

But that hasn’t stopped the NYC Organization of Public Sector Retirees, which successfully sued to stop the switch, from going after the democratic socialist.

Mamdani, Adams and Myrie are frequent online targets of the group’s president, Marianne Pizzitola, who claims Mamdani’s vow to do away with Medicare Advantage is not enough to satisfy her . She notes that none of the three attended the group’s April 17 mayoral debate.

She has been the driving force behind the candidate pledge to preserve traditional Medicare for the city’s retirees, along with three other demands: speed up Medicare reimbursements; establish a grace period for bereaved dependents of retirees before they lose access to health insurance, and agree to open communication with her group.

“If you’re not g my pledge, do you really have my back, or are you just saying that for votes?” Pizzitola said Wednesday. “And it’s awfully ironic that the three candidates not doing that are endorsed by DC 37.”

She also is furious at current Mayor Eric Adams, who when running for the job in 2021 said that he was “troubled” by then-mayor de Blasio’s planned Medicare Advantage switch — only to turn around and embrace it once he had to balance the city budget as mayor.

Pizzitola said given Adams’ bait-and-switch, her group won’t accept anything but the pledge as a true commitment to their values. 

“He told us one thing as a candidate and another as mayor,” she said. “Eric Adams gave us his word, he knocked on de Blasio, and then he signed the Medicare Advantage contract anyway.”

Meanwhile, DC 37’s leaders have vowed to go on the offensive against local and citywide candidates who legislation that would scuttle the Medicare Advantage deal. 

Last month, the union voted to rescind its endorsement of another democratic socialist lawmaker, Brooklyn City Councilmember Alexa Avilés, over her for a bill that would enshrine in law retirees’ rights to traditional Medicare. DC 37 is among public sector unions that oppose the bill because they claim it would infringe on their collective bargaining rights.  

A DC 37 spokesperson said that Garrido was not available to comment on Mamdani’s opposition to Medicare Advantage. In an interview last month with THE CITY, Garrido had attacked Cuomo for refusing to say how he’ll pay for the union contracts without the anticipated Medicare Advantage savings.

“Because that’s the problem with everybody, right? They say, ‘no Medicare Advantage because the retirees hate it.’ Okay, fine. How are you going to pay for the difference?,” he asked, addressing the question to Cuomo. “Are you going to create s for the rest of the workers? Right? Because that’s our concern, the concern of all the unions.”

Cuomo has told the Citizens Budget Commission that “New York City can and should achieve savings by addressing the root causes of health care inflation.”

Mamdani’s promised for decades. 

The NYC Retirees announced their endorsement earlier than most groups, backing independent candidate Jim Walden — a partner at the law firm representing them in their Medicare Advantage litigation — last November. 

Pizzitola said the group is not issuing ranked endorsements for the Democratic primary, but instead OKs every candidate who signs on to their anti-Medicare Advantage pledge on its website, and will leave it up to their to decide who to vote for.