Here's a moral choice for Americans this holiday season: Give more tax breaks for millionaires and cut payments to nursing homes, leaving our elderly out in the cold, or put a break on the tax cuts for the wealthy and protect funding for the Medicaid program-the only health lifeline for 51 million Americans, including seniors in nursing homes.

That's the decision we will soon be asked to make. The president is preparing his budget request for 2005, and will make key decisions by the end of January, including-most likely-making all previous tax reductions permanent. That will cost about $1.65 trillion over a 10-year period. At the same time, the Pentagon is expected to ask for another $70 billion for our military efforts in Iraq. Nonetheless, the president says that, over the next four years, he wants to cut in half our country's unprecedented deficits of about $422 billion. And let's not forget about Social Security privatization. If the most-talked-about option is honestly accounted for, it will increase deficit borrowing by about $1 to $2 trillion.

Maybe in some twilight zone of a parallel universe he could do all these things, but in our universe, the numbers don't add up. To achieve these goals, he will have to ask for massive, massive cuts in existing programs.

What existing programs could possibly make a dent in the funding of these various new proposals? Cut Social Security when you claim you are reforming it without cuts? No way. Cut Medicare? That will be tough, especially considering potential senior voter turnout.

What's the next biggest domestic social program? Medicaid.

Medicaid is the federal-state health safety net that serves about 51 million low-income Americans. This number includes about 25 million children, 8.4 million severely disabled, and 6.4 million seniors, of whom 1.3 million-mostly widows over age 80-are in our nation's nursing homes. Most of these nursing home residents are seriously ill, and it is estimated that about 70 percent of them have some memory loss, such as Alzheimer's disease. Even if they had homes to go to, the severity of their condition means they wouldn't receive suitable care from their families. Yet, with the average cost of nursing home care running about $55,000 a year, most American families are unable to save for this expense. Thus, Medicaid pays for about two-thirds of all nursing home residents, and provides about half the funding of our nation's nursing homes.

Medicaid is the program that the president proposed to cap and cut in his 2003 and 2004 budgets, but he never really pushed those proposals. This coming year, if he is to achieve his other goals-permanent tax cuts but with deficit reduction-he will have to push, and push hard for massive Medicaid cuts.

In 2003, he proposed a system that would have cut about one-sixth of total Medicaid spending. By reducing federal spending on Medicaid, the proposal just shifts costs to state and local governments, which can either raise local taxes or just carry out cuts in services. Families USA calculated that if cuts were to be achieved by reducing the number of people covered by Medicaid, it would increase the number of uninsured Americans by about 7.4 million people (45 million were already uninsured in 2004). Of course, the cuts could also come out of payments to hospitals, doctors and nursing homes.

And that takes us back to our most vulnerable elderly, who, because of the budget decisions we are about to make, will be at risk of receiving poor-quality care-if they can afford any care at all. 

We can keep the promise of cutting taxes for millionaires. Or we can look after the sickest and most vulnerable in our society. 

The choice will be made by the administration in the next few weeks. Please, in the holiday spirit, urge your members of Congress and U.S. senators not to cut and cap the Medicaid program payments to your state.