Janice is currently residing in Longshore Care, a memory care unit, in her Texas home town paid for by Medicaid. Jamie is a teacher who retired after 32 years of service. Jamie’s insurance is through a Humana Medicare Advantage Plan provided by the Teacher Retirement System. Both Janice and Jamie have been stressed lately from worries over anticipated changes in the health care and insurance systems on which they rely.   

Impact to Texans of Changes to Affordable Care Act : Some Known, Some Unknown

It is not certain what the impact to Texas seniors will be if the U.S. Senate version of the replacement for the Affordable Care Act a/k/a Obamacare is passed. John Cornyn and Ted Cruz, the two sitting Texas Senators, can’t even agree on whether the bill, dubbed the “Better Care Reconciliation Act of 2017,” should pass. Cornyn supports it while Ted Cruz has declared opposition, in part because it doesn’t cut enough federal government spending on health care, including Medicaid.

Texas never accepted the Medicaid expansion offered by the ACA, so it seems reasonable to assume the loss of the expansion in the proposed bill should have little or no effect on Texans. However, the reduction from 400% to 350% of the poverty level to qualify for Medicaid will make a difference to Texas Medicaid recipients. Some seniors whose long-term nursing home expenses have been paid by Medicaid will have to pay out-of-pocket for all or part of that cost.

In Janice’s case, the portion of her monthly income above the 350% poverty level, which her stay-at-home spouse had been able to use, will instead be allotted to the nursing home.

The proposed Medicaid cuts in the “Better Care Reconciliation Act of 2017” will change Medicaid from a program that paid all costs to allotting a set amount to be paid per recipient. Clearly, this will not result in better care and, in many cases, the care will be worse or cease entirely, thereby negatively impacting many, if not all, of those receiving Medicaid benefits in Texas.

Impact to Seniors from Changes to Teacher Retirement System are Known

            Unfortunately, the impact to Jamie and other retired Texas teachers from changes to the Teacher Retirement System is certain. Jamie’s premiums will triple and his benefits will be reduced. Since Jamie’s spouse but no other dependents are covered, his premiums will go from $205 to $590 a month. This means he will be spending more than 22% of his monthly teacher retirement annuity check on health insurance premiums.  

            Single retirees over 65 will pay $146 per month for their Medicare Advantage plan while a retiree over 65 with spouse and children will pay $1,074.

            Jamie and his fellow retirees will see other reductions in benefits. Their deductible will be raised from $150 to $500. The maximum out-of-pocket the retiree pays annually will be raised from $3,150 to $3,500. Co-pays for doctor’s office visits will change from $5 to 5% for primary care and from $10 to 5% for specialists. Co-pays for in-hospital treatment will be raised from $250 to $500 per visit with out-patient co-pay raised from $75 to $250.

             Despite the fact that teacher representatives lobbied against these drastic changes which penalize retired teachers, the legislature passed and Governor Greg Abbot signed into law the bill earlier this month.

Seniors Called to Action

All seniors should be diligent in making certain their representatives in Congress are addressing adequately their needs in making changes to or abolishing the ACA. Although we do not entirely know the impacts, the consensus seems to be that the Senate bill will more negatively impact seniors than other age groups.

Retired teachers in Texas should continue to fight the legislature and the governor to reverse the changes made to TRS. Our teachers are one of the most valuable assets this state has. Since teachers’ salaries have been historically low in Texas, this reduction of benefits they richly earned presents a double whammy and a slap in the face they don’t deserve.

W. Reed is an attorney with Katten & Benson, an Elder Law firm in Fort Worth. She lives and practices in beautiful Somervell County, near Chalk Mountain.