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Budget Plan Sounds Impressive, Lacks Specifics on Many Issues

By Judith Havemann
The Washington Post
WASHINGTON

The fiscal plan laid out by Congress and the president to balance the nation's books may sound impressive. But now comes the hard part of figuring out precisely how to achieve the savings that negotiators claim to have made.

That job will fall to lawmakers, their staffers and the White House as they begin scouring federal programs looking for ways to carry out the broad goals set forth in the budget accord. Until that happens, analysts say, it is impossible to say with certainly what impact the budget cuts will have on the elderly, the poor, immigrants and others it is sure to affect.

"What they have agreed to is only the budget numbers," said John Rother, chief lobbyist for the American Association of Retired Persons. "They have not agreed to some of the underlying policies, which will have just as much impact on consumers as the numbers."

Although the negotiators agreed to require Medicare recipients to pay higher premiums - $4.50 more each month than they otherwise would have faced by the year 2002 - that is only a small fraction of the changes proposed to the program.

Most of the savings aimed at the federal health care program for the elderly will come from cutting payments to providers, mainly hospitals and health care plans.

But which types of hospitals will be cut and by how much is still up in the air. Negotiators didn't spell out, for example, to what degree so-called "teaching hospitals" will be cut. Yet because these research institutions are typically located in urban areas and treat large numbers of uninsured, analysts say how much they get squeezed could ultimately affect the patients they serve.

Budget negotiators also agreed to expand health care for about 5 million poor children, at a cost of about $17 billion over five years. What they left unclear was how the program would be administered and who would qualify.

If the program is set up as an "entitlement," basic federal benefits would be guaranteed and Washington would outline eligibility standards. If lawmakers decide to give money to the states to devise their own plans, it would be up to each state capital to decide what services are covered and for whom.