Administration officials and Republican negotiators say the money can be taken from health care providers like hospitals and nursing homes without directly imposing new costs on needy beneficiaries or radically restructuring either program. Before the talks led by Vice President Joseph R. Biden Jr. broke off 12 days ago, negotiators said, they had reached substantial agreement on many cuts in the growth of Medicare, which provides care to people 65 and older, and Medicaid, which covers lower-income people. Those proposals are still on the table when Congress reconvenes this week, aides said, and are serious options that Democrats could accept in exchange for Republican concessions that raise revenues. “Congress smells blood,” said William L. Minnix Jr., the chief lobbyist for nonprofit nursing homes.... The new health care law trimmed Medicare payments to most providers. Many states, in fiscal distress, are cutting Medicaid, which is financed jointly by the federal government and the states. If Congress and the president now make additional cuts, hospitals say, they will close some services and increase charges to patients with private insurance. Hospital executives from around the country plan to visit Capitol Hill next week to deliver this message: “Cutting Medicare and Medicaid payments to hospitals will hurt the ones we love, especially the most vulnerable — children, seniors, the poor and disabled.” Mr. Minnix, the lobbyist for nonprofit nursing homes, said: “The issue is not money. The issue is the effects on people, vulnerable people.” The American Medical Association and AARP, the lobby for older Americans, have joined hospitals and nursing homes in fighting other proposals that would limit federal spending as a percentage of the gross domestic product. Members of Congress of both parties have introduced bills that would automatically cut spending across the board if such limits were about to be breached.

Once upon a time, this kind of move might have been called penny wise and pound foolish. Theis reporting that the Obama administration and Democrats on the debt ceiling negotiating team are offering up "tens of billions" in cuts to Medicaid and Medicare in return forrevenue increases.

The cuts might be not direct cuts to benefits, but like the Social Security COLA cuts being considered, would still hurt the populations served by the programs because providers will reduce services or stop seeing Medicaid or Medicare patients. If they keep these services in place, but receive reduced payments for them, they will pass that cost on to the private insurance population, and health care costs will increase even more.

All of which contributes to compromising the Affordable Care Act further, and lessening its potential for success makes it potentially more unpopular and more vulnerable. Also out the door are the goals of making health care both more affordable and easier to access. Then there's the reality of increasing the hurt on already vulnerable populations. Finally, it's going against the expressed preferences of the majority of voters in poll after poll for taxing the wealthy in order to hold these programs safe. Bad policy, bad politics.