Republicans Told They Must Slash Medicare, Report Says : Budget: House leaders are warned growth in elderly, poor health care will have to be cut by $491 billion if GOP campaign promises are to be kept.

House Republican leaders have been told they will have to cut Medicare and Medicaid growth by $491 billion to keep their campaign promise of tax cuts and a balanced budget in seven years, a newspaper reported today.

In closed-door briefings shortly before Christmas, outside advisers to the House Budget Committee chairman said federal spending on the health programs for the elderly and poor will have to be cut by about 20% by the year 2002, the Boston Sunday Globe reported.

Health policy specialists say such cuts would force far-reaching changes in the way the 65 million recipients of the two programs receive and pay for medical care.

Among the possible changes:

* Requiring people to pay much more of their own health care costs unless they join health maintenance organizations or other managed-care networks.

* Converting people’s current entitlement to a wide range of medical services into a certain amount of money to spend on health care. They would not be able to exceed that cap.

Republican leaders have acknowledged that all federal programs except Social Security are susceptible to cuts, but no figures are expected to be laid out until spring.

In comments to the Globe, aides to Rep. John R. Kasich (R-Ohio), the budget committee chairman, as well as aides to other leaders sought to distance themselves from specifics but agreed that the figures capture what the Republicans are contemplating.

According to estimates put together by Tim Muris, a Ronald Reagan Administration budget official who specialized in health costs, lawmakers probably will have to trim Medicare by $223 billion, about 13%, over seven years, and Medicaid by $268 billion, about 18%, the Globe reported.

Such cuts would be almost twice those in President Clinton’s ill-fated health care reform plan.