WASHINGTON – As Congress opens a politically charged exploration of ways to pare the deficit, President Barack Obama is expected to seek hundreds of billions of dollars in savings in Medicare and Medicaid, delighting Republicans and dismaying many Democrats who fear his proposals will become a starting point for bigger cuts in the popular health programs.

The president made clear his intentions in his speech to a joint session of Congress last week when, setting forth a plan to create jobs and revive the economy, he said he disagreed with members of his party "who don't think we should make any changes at all to Medicare and Medicaid."

Few Democrats fit that description. But many say that if, as expected, Obama next week proposes $300 billion to $500 billion of savings over 10 years in entitlement programs, he will provide political cover for a new bipartisan congressional committee to cut just as much or more.

And, they say, such proposals from the White House will hamstring Democrats who had been hoping to employ Medicare as a potent issue against Republicans in 2012 campaigns after many congressional Republicans backed a budget that would have substantially altered Medicare by providing future beneficiaries with a subsidy to enroll in private health care plans.

Rep. Emanuel Cleaver II, D-Mo., and chairman of the Congressional Black Caucus, said: "Ninety-eight percent of the president's speech was excellent. The Democratic caucus and the black caucus are fired up. But you will find that we have some differences with the president's plan as it relates to Medicare and Medicaid. We would rather see some kind of increase in revenue as opposed to cutting these programs."

By offering such proposals, Cleaver said, the president "cancels out any bludgeoning that Democrats might give the Republicans over Medicare and Medicaid."

Health policy experts and lobbyists see the situation in a similar way.

Julius W. Hobson Jr., a lobbyist who used to work at the American Medical Association, said he viewed the savings to be proposed by Obama as "an opening bid, the floor, the foundation for the kind of cuts Republicans want to make."

"Republicans will give a political answer: The president's plan is not enough," Hobson said. "It may not be enough in their eyes, but they will take it and build on it."

The prospect of further cuts worries health care providers because it comes on top of the new health care law, which reduced payments to most providers to help offset the cost of extending coverage to millions of uninsured Americans.

Medicare and Medicaid account for 23 percent of federal spending this year, and their costs are growing faster than the rest of the budget because of increasing enrollment and medical inflation.

Under current law, the Congressional Budget Office says, the two programs will account for 28 percent of federal spending in 2021.

Controlling these costs is a goal for Republicans on the powerful House-Senate committee on deficit reduction, whose proposals are supposed to receive up-or-down votes in both chambers before the end of the year.

"I give the president credit for identifying and recognizing the problem," Rep. Jeb Hensarling, R-Texas and co-chairman of the deficit-reduction committee, said. "It's a very, very hopeful sign that the president would say this – that Medicare and Medicaid are the major drivers of our long-term liabilities, and nothing else comes close."

By contrast, Rep. Frank Pallone Jr. of New Jersey, the senior Democrat on the Health Subcommittee of the Energy and Commerce Committee, is nervous about further health care savings to be proposed by the White House. "Medicare and Medicaid cannot sustain additional cuts, whether in benefits or provider payments," Pallone said.

Democrats' concerns are evident in a list of deficit-reduction options circulated in the last few days by Rep. Sander Levin of Michigan, the senior Democrat on the Ways and Means Committee.

The document criticizes the idea of raising the Medicare eligibility age to 67 from 65, and notes, "This policy idea was floated by the president near the end of the debt-ceiling debate" in July.

"This policy does nothing to control costs," the document says. "It simply shifts substantial costs from Medicare to other parts of government and to private and public employers."

In a separate memorandum, Levin said Democrats on the Ways and Means Committee would soon have a private meeting to discuss "the case we will make against cuts to entitlement programs."

Kenneth E. Raske, president of the Greater New York Hospital Association, said that further cuts in the growth of Medicare and Medicaid would not only impair access to care, but lead to a loss of jobs in the health care industry, directly contravening the president's goal of job creation.

"Health care could be sacrificed in favor of construction jobs," Raske said.

The American Hospital Association says that 194,000 hospital jobs could be lost if the deficit-reduction panel is unable to reach agreement and forces automatic across-the-board cuts in spending.

Health care represents nearly 18 percent of the U.S. economy and has been adding jobs even as other industries have laid off workers or refrained from hiring. Hospitals are the largest component of this sector, with roughly 5 million employees.

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