Texas advocates for the elderly and poor are urging Congress to "act responsibly" as it struggles to overcome the national debt ceiling impasse, possibly through big changes to Social Security, Medicare and other programs that help people who rely heavily on government programs.

The fallout from several proposals -- including changes to Medicaid and Medicare and deep spending cuts in social programs -- could hurt government support and services for millions of Texans, the advocates say.

President Barack Obama even suggested last week that failure to raise the debt ceiling could delay the distribution of Social Security checks. More than 3 million Texans receive Social Security benefits, according to the latest figures available.

"There is a lot of anxiety," said Leonard Strub, an Allen retiree on the AARP Texas executive committee. "We don't know what they are going to agree on, but what they're talking about will definitely have an impact. A lot of us are expecting our standard of living to go down."

Changes to Medicare and Medicaid would greatly affect Texas, where roughly 4 million people are on Medicaid or the Children Health Insurance Plan and 3 million receive Medicare, according to the Center for Public Policy Priorities in Austin. About 2.5 million people on Medicaid are children.

Texas already has about 6.4 million uninsured people.

"All the people who are factually oriented and not part of the political fray understand and agree that we have to have cost containment in these programs," said Anne Dunkelberg, the center's associate director. "It is a matter of degree, how quickly you try to do it and a matter of creating a priority to protect our most vulnerable in that process."

Medicare concerns

The debt ceiling and growing deficit have brought about an array of proposals. One is an increase in the Medicare eligibility age, proposed by Obama as part of a "bargain" that would reduce the deficit by $4 trillion. Tim Lee, executive director of the Texas Retired Teachers Association, said a chief concern among its 73,000 members is that Medicare reform will put a greater financial burden on retirees for medical costs.

Changes to Medicare could also affect the association's retirement system. Many retirees use Medicare as their primary insurer but supplement with the retirement system's healthcare program, known as TRS-CARE, he said.

That $1 billion fund is already stressed by soaring medical costs and is forecast to operate in the red within two years. Contributions from current educators, school districts and the state support the fund.

"If Medicare significantly changes its reimbursement structure, it could certainly put more pressure on the state program," Lee said.

Medicaid reform would deeply affect disabled Texans, said Mike Bright, executive director of the Arc of Texas. Of more than 40,000 Texans with intellectual or developmental disabilities who receive long-term care, the majority get Medicaid.

Among the services they receive are group homes, in-home support, respite care and therapies, he said. "Any significant cuts in those services could be disastrous for individuals with intellectual disabilities and their families," he said.

Jeff Miller, a policy specialist with Disability Rights Texas, a nonprofit advocacy and protection organization for disabled Texans, said his group gets funding from six federal grants.

"If discretionary spending is cut, we would absolutely be on the chopping block for the grants we receive," Miller said. "And that would directly translate into fewer people that we can serve."

Trickle-down effect

Steep spending cuts in domestic programs could also trickle down to local programs assisting low-income Texans, such as those helping with energy and food costs, transportation and housing, said Bee Moorhead, executive director of Texas Impact, a grassroots religious network.

Many people don't realize how much federal domestic programs help people on a local level, she said. Cutting government assistance would shift a greater burden to local nonprofit or faith-based organizations, she said.

"That's where everyone turns immediately when those services get cut," Moorhead said. "But the resources that are available in nonprofits and faith-based organizations do not match up well with the level of need. It is in no position to step in and take over for government programs that find themselves without money."

The prospect of deep federal cuts is disheartening, she said, because the most severe proposed cuts to social service programs at the state level were avoided during the recently completed legislative session.

"It's like walking into the street, seeing a car is coming and jumping out of the way -- only to get run over by a bus," she said.

Alex Branch, 817-390-7689

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