'Hard decisions' give Medicare a trim

The department estimated that Medicare spending for 2008 would total $454 billion and benefit 44.6 million people.

Bush also called for almost $26 billion in cuts for Medicaid, which provides healthcare for the poor, over the same period.

Some congressional Republicans expressed misgivings. "These are alarming proposals to our healthcare system, and many have already been denied by Congress," said Sen. Gordon H. Smith (R-Ore.).

Sen. Michael B. Enzi of Wyoming, the ranking Republican on the Health, Education, Labor and Pensions Committee, stopped short of criticizing the budget, but noted: "At the end of the day, the House and Senate control the purse strings ... [and] the final document may look very different from the president's proposals."

On children's insurance, Bush proposed to renew the politically popular State Children's Health Insurance Program, which is set to expire this year. The federal-state program provides coverage to as many as 6 million children whose parents make too much to qualify for Medicaid, but too little to afford private insurance.

Democrats estimate it will take as much as $15 billion in additional spending over five years just to maintain the current caseload, but Bush proposed only about $5 billion. Administration officials said their calculations show no children would lose coverage, but advocates for the poor were highly skeptical of such assurances.

Even if Bush's healthcare budget is unlikely to survive as a whole, Democrats may resurrect parts of it to help pay for their own priorities -- such as an expansion of coverage for children.

"This is like a menu of issues on the table," said David Certner, a top lobbyist for AARP. "These are much larger cuts than Congress would entertain, but members may pick and choose among them as they put together their own proposals."

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ricardo.alonso-zaldivar@latimes.com