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MELISSA BLOCK, host: Medicare and Medicaid largely escaped the axe in the deal's first round of cuts. But as NPR's Julie Rovner reports, people who depend on those programs worry that they're still in the crosshairs.

JULIE ROVNER: The new date for health care watchers is November 23rd. That's when the so-called Super Committee of 12 House members and senators will have to come up with an additional $1.5 trillion in deficit reduction. Health industry consultant Bob Laszewski says there's no way health programs will be left out of that package.

BOB LASZEWSKI: Medicare and Medicaid are just a huge part of the budget. And you can't ignore the fact that we've - that the Super Committee is going to have to deal with health care costs. There's just no getting around it.

ROVNER: Likely near the top of the list to get trimmed will be payments to doctors, hospitals and other health care providers. That includes those who already saw their Medicare reimbursement cut in last year's health law.

They're suddenly going to find that they're going to have to give again, and they're going to have to give big.

That's not sitting well with those health groups. Rich Umbdenstock heads the American Hospital Association.

RICH UMBDENSTOCK: These are already programs that underpay hospitals by about 90 cents or less on each dollar, and so additional cuts are just untenable at this time.

ROVNER: Doctors face an even bigger problem. They're already looking at a 29.5 percent pay cut next January 1st unless Congress acts to change it. Cecil Wilson is the immediate past president of the American Medical Association.

Dr. CECIL WILSON: And our concern, of course, is that this will affect access to care for senior citizens. It will make the Medicare program not reliable, and physicians will have to have to make really excruciating choices of whether they can still see the number of Medicare patients they have been seeing.

ROVNER: But to fix the doctor pay problem will cost more than $300 billion. Health industry consultant Bob Laszewski says that just digs the hole deeper for the Super Committee working on the deficit issue.

LASZEWSKI: In order to salvage something here for the physicians, providers elsewhere are going to take some pretty big hits just to help prop up the doctors.

ROVNER: And it might not just be providers. Beneficiaries and benefits are exempt from the cuts that would take effect if the Super Committee can't come up with a plan. But the committee itself can do whatever it wants, and Laszewski says he wouldn't be surprised to see wealthier beneficiaries asked to pay a little more.

LASZEWSKI: Because you can always tax rich people starting tomorrow.

ROVNER: Which, of course, is not sitting well with groups that represent Medicare beneficiaries. Max Ritchman is with the National Committee to Preserve Social Security and Medicare.

MAX RITCHMAN: There aren't enough people in the categories that are talked about - wealthy people - to have much of an impact.

ROVNER: Meaning, he says, that any new cost to patients would inevitably be extended to those in the middle class as well. David Certner of the AARP, meanwhile, says his group is concerned that the whole deficit debate has been too narrowly focused on just what the federal government pays for health care.

DAVID CERTNER: Health care costs are a problem. Going after Medicare and Medicaid doesn't go after health care costs, at least not in the way they're going about it.

ROVNER: He says the main goal of budget cutters recently has been not to save money in health care but to move it around.

CERTNER: Most of the debate this, you know, the last couple months, has really been about cost shifting, whether it was to the states, to employers and, particularly from our perspective, to beneficiaries.

ROVNER: While Congress has certainly cut spending to Medicare and Medicaid before, provider groups have always been effective in staving off draconian cuts in the past. But Laszewski says this time could be different. There's only 12 members of the Super Committee, and the budget deal has them on a pretty tight leash. Julie Rovner, NPR News, Washington.

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