Options for Medicare

The Medicare program likely would see major changes if a large debt deal is made. Republicans want to give seniors subsidies to buy private insurance, instead of a guaranteed Medicare benefit like the current program. Democrats oppose that idea, but Obama has been open to other cuts to Medicare.

Certner says a raft of premium increases and higher copays are being considered for Medicare. Negotiators also are targeting medigap insurance, which protects retirees from out-of-pocket costs, because critics say it discourages patients from limiting their medical spending.

And some lawmakers have begun talking about raising the eligibility age of Medicare. Stone says that could really hurt near-retirees who have gone for years without health insurance, putting off needed medical care until they turn 65 and qualify for Medicare. "You already have lots of moderate-income seniors under 65 who are struggling and postponing stuff."

Certner says he is concerned about proposals to cut the Medicaid program, which pays for much of the nation's long-term care. He says those programs are important to seniors who need help such as home-based care and community services.

For both Medicare and Medicaid, the larger the ultimate budget deal, the bigger the likely cuts to those programs, Certner says.

But Alan Viard, resident scholar at the American Enterprise Institute, says not reaching a deal could be expensive in the long run. The Social Security program will not be able to pay all its benefits starting in 2036, and Medicare will have a shortfall starting in 2024, under the current program. Economists worry that the nation's debt is becoming too high as a percentage of the economy.

"We have a huge fiscal imbalance over the long term in this country. The sooner we address it the better," Viard says. "Every year we wait, it becomes bigger and more difficult. The tax increases will have to be bigger. The spending cuts will have to be bigger. It will be a shame if we walk away from what may be an opportunity for bipartisan agreement."

Tamara Lytle is a freelance writer in the Washington, D.C., area who has covered government and politics for more than 20 years.