On Capitol Hill, the debate over cutting the nation's social programs is framed in sums so vast as to become abstract.
But barely two miles away, within the small, bright, preschool classrooms of the Easter Seals Child Development Center, there is no dispute about the usefulness of every federal dollar.
For this is where George Essel, 3, who could not walk eight months ago, now bustles about, helping his classmates with a simple science experiment. And this is where Cailin Meja-Santos, also 3, paralyzed from the waist down, eagerly explores the hallways wearing her new leg braces.
These children and nearly every other child at the center are beneficiaries of Medicaid, the nation's $330 billion health care program for the poor and disabled. And Medicaid has become a prime target as Congress develops a broad fiscal plan to trim the federal deficit over the next five years.
Directors at the Northwest Washington center say they can't predict how cuts by Congress would affect their therapy program for disabled children. But they know that three-quarters of the program's $800,000 annual budget comes from Medicaid, and they are very worried.
"It can't get cut," Tara Esler said simply. Still, she knows that Congress or the local government could unilaterally reduce the rate of reimbursement for each child. Or limit the services the children could receive. Or strike families above a certain income level from receiving Medicaid.
Early today, Republican leaders in the House mustered the votes for a nearly $50 billion package of budget reductions that would slash spending on a wide variety of programs, although planned cuts to food stamps, Medicaid and student lunch programs were trimmed.
Some House members, uncomfortable with the broad cuts prescribed by the leadership, delayed a vote on the package last week. This week, they deliberated over compromise versions of the bill, stripping out some of the deeper reductions in the food stamps program and Medicaid.
House Republican leaders said some budget cutting is necessary to save Medicaid, whose national caseload has grown by nearly 40 percent in the past five years and whose costs have risen by more than half from 2000 to 2004.
"If you want Medicaid patients to lose health care, the best thing to do is nothing," Rep. Joe Barton (R-Tex.) said recently.
The reforms, Barton said, will ensure the future health of the program by eliminating waste and fraud and encouraging state flexibility and personal responsibility.
According to an analysis by the Center on Budget and Policy Priorities, about $30 billion of the savings would be realized through reductions in benefits and increased cost sharing, said Leighton Ku, a senior fellow. Other analysts have predicted that the changes imposed upon the working poor could drive millions of families out of the Medicaid system entirely.
Democrats, including the House minority whip, Steny H. Hoyer (Md.), have denounced the proposed cuts.
"Low-income families and children rely on this assistance for their health and well-being," Hoyer said.
In Alexandria, the Campagna Center offers Head Start and Early Head Start classes to 330 poor children every day.
Executive Director Katherine Morrison said any loss in Medicaid or other aid would hurt many of her families.
"These cuts are being made at the same time as tax cuts are being made for the wealthiest people in the United States," Morrison said.
K.C. Patel, a Gaithersburg engineer, is also worried. For 20 years, Medicaid has been a lifeline for his son, Samir, 38, who is severely disabled by cerebral palsy.
"My son is my life. He is my friend, my mentor," the senior Patel said.
He and his wife, Divya, work hard to care for their son. But they say they cannot do it alone, and they are getting older. Their son, with the help of his Medicaid waiver, receives daily therapy at the Lt. Joseph P. Kennedy Institute in Northeast Washington.
"Without this program, we would not be able to take care of Samir," the father said. "What will happen if the program changes?"