But President Clinton immediately attacked the bill, saying it contains "outrageous provisions" that would devastate the quality of care for the elderly, especially people in nursing homes.
Just hours after the committee approved the bill early yesterday morning, Mr. Clinton, who had already threatened to veto the package, used unusually harsh language and vivid images to assail it.
"Think about it," he said in his weekly radio address. "Who wants a Medicaid police with vast power to seize your assets and put you out of your home and make sure you have nothing left to pass on to your children?
"I don't think it should be a precondition that if a husband has to go into a nursing home, his wife has to go into the poorhouse."
The 11-9 vote in the Finance Committee came just after midnight and was along party lines.
The bill, which would change 30 years of policy in Medicaid and Medicare, is fundamental to the Republicans' scheme to balance the budget. It would cut projected spending on Medicaid, the health program for low-income people, by $182 billion, or 19 percent, over the next seven years.
It would reduce projected spending on Medicare, the insurance program for the elderly and the disabled, by $270 billion, or 14 percent, over seven years.
More important are changes proposed by Republicans in both )) houses of Congress. They would dismantle the current Medicaid program and give each state a block grant, to finance health care for the poor with few federal requirements.
Mr. Clinton focused on two proposals affecting Medicaid recipients. One, found only in the House bill, would repeal a 1988 law that requires states to protect some income and some assets of elderly people whose spouses are in a nursing home.
The other proposal, found in the Senate and House versions of the legislation, would repeal federal standards for nursing homes written into law in 1987, after Congress documented unsafe conditions in scores of institutions.
Republicans say that state officials can be trusted to look out for the welfare of their citizens and to set and enforce standards for nursing homes. But in his address yesterday, President Clinton painted the worst possible picture of what might happen.
"Any state government can force people whose husbands or wives have to go into nursing homes to give up their car, their furniture, even their home, before their spouse can qualify for any medical support," he said. "Everything they've worked for their whole lives, gone."
The original version of the Senate bill contained no protections for the income and assets of spouses of nursing home residents on Medicaid. But by voice vote, the Finance Committee adopted an amendment offered by Sen. Kent Conrad, a North Dakota Democrat, to retain such provisions in the current law.
Mr. Clinton asserted that the Republican budget plan would "devastate the quality of medical care for seniors" by repealing uniform national standards adopted for Medicaid in 1987.
He did not mention it, but the Republicans would require states to set their own standards in areas broadly defined by the federal government.
The changes in Medicaid and Medicare will be included in a comprehensive bill to balance the federal budget. Mr. Clinton said, "Congress should strip these outrageous provisions from the budget bill."