Grassley said the cuts would be felt not by the programs' beneficiaries but by hospitals, doctors, pharmacies and drug companies. The government would pay less for drugs for Medicaid patients, for example, and it would adopt a performance-based system of paying doctors and hospitals under Medicare.
Sens. Gordon H. Smith of Oregon and Olympia J. Snowe of Maine, the two committee Republicans in the vanguard of resistance to Medicaid cuts, signed off on Grassley's package.
But Sen. Max Baucus of Montana, the committee's top Democrat, said Grassley should not count on any Democrats to join him. Baucus particularly complained about the "stingy" Medicaid allowance for Katrina victims.
For their part, some conservative Republicans are reportedly upset that the Katrina aid is too generous. If the Democrats hold the line, Grassley cannot afford to lose a single Republican. The committee has scheduled a vote on the package Tuesday.
The vote could be crucial to this year's effort to rein in federal spending.
Rep. Michael N. Castle, a moderate Republican from Delaware, said he and his fellow moderates did not want to be forced to go on record for a package of spending cuts if the measure was destined to die in the Senate.
Castle said he did not expect the Senate to approve even a $35-billion spending cut bill.
"Increasing the [spending cuts] from $35 billion to $50 billion seems to be an exercise in futility," Castle said.
Not to House conservatives, it doesn't.
Rep. Todd Tiahrt (R-Kan.) said Congress could easily reach $50 billion by making government more efficient.
"We ought to look at how we can streamline the system," he said. "The Kansas Medical Society says the healthcare system spends 1.1 hours on paperwork for every hour on patient care."
Rep. Patrick T. McHenry (R-N.C.) said he had never met a spending cut proposal that was too big. "The debate has shifted in Washington from how much are we going to spend to how much are we going to cut," he said.
The challenge facing Congress, McHenry said, is "how to help our neighbors in the Gulf [Coast], while at the same time keeping our fiscal house in order. We have the leadership in the House that's capable of rising to the challenge."