Washington -- House Republicans, after weeks of negotiations, narrowly passed a budget bill early Friday to cut $50 billion from Medicaid, food stamps, student loans and other programs over the complaints of Democrats that Congress is squeezing students, the elderly and the poor to pay for tax cuts for the rich.

The House approved the bill 217-215, after GOP leaders agreed to demands from moderate Republicans to jettison a measure to drill in the Arctic National Wildlife Refuge in Alaska and to slightly reduce proposed cuts to food stamps.

Still, the vote was so politically sensitive that House leaders didn't begin debate until 10 p.m. Thursday and didn't pass the measure until nearly 2 a.m. -- when most news reporters gone and only a few C-SPAN junkies could witness the fiery floor action. No Democrats voted for the bill, and 14 Republicans opposed it.

House Democratic leader Nancy Pelosi of San Francisco said in a floor speech that cutting money for Medicaid, child support enforcement and foster care as the House prepares to vote on $70 billion in tax cuts was a sin.

Republicans are launching an attack on America's children, on America's families, Pelosi said. They are also launching an attack on America's middle class, all of this to give tax cuts to the wealthiest people in our country.

But House Speaker Dennis Hastert, R-Ill., responded that the proposed cuts were needed to rein in the growth of federal spending on health care and other programs.

Medicaid is growing at a 7.3 percent growth rate per year, Hastert said. It has been growing for years. Is there a better way to do it? Is there a more efficient way to do it? Should we find some reforms to make it better? Yes, we should.

The House bill also would split the Ninth Circuit Court of Appeals in San Francisco, a goal of conservatives who have long complained the court is too liberal. But the breakup of the appellate court, which covers the country's Western region including federal cases that arise in California, is not part of the Senate budget bill. Sen. Dianne Feinstein, D-Calif., and senior members of the Senate Judiciary Committee are seeking to strip it from the final package.

The battle over the budget reconciliation bill now moves to a joint House-Senate conference committee, where lawmakers will have to make several critical decisions, including:

-- Will the final budget bill allow oil drilling in the Arctic National Wildlife Refuge?

The Senate version would allow drilling, but a group of House Republican moderates has pledged to oppose any final bill that would open the Alaskan wildlife refuge for development.

-- How deeply will lawmakers cut student loans?

The House bill would cut student loan programs by $14.3 billion, while the Senate version cuts them by $8.8 billion. The Congressional Budget Office has estimated the House bill would cause a typical college student with the average of $17,000 in student loans to pay an additional $5,800 in interest and fees over the length of the loans.

-- Will some legal immigrants lose their food stamps?

The House bill would cut off 220,000 people from food stamps by allowing legal immigrants to qualify for the food aid after seven years, instead of the current five years. The Senate bill does not cut food stamps, and moderate lawmakers are urging that it be dropped from the final budget package.

-- How will the cuts affect Medicaid recipients?

The House bill calls for $11.4 billion in cuts to Medicaid, while the Senate bill trims spending by only $4.3 billion. The House bill also would allow co-payments to rise over time with inflation and would deny Medicaid nursing home benefits to people with $750,000 in home equity.

-- Will child support enforcement be cut?

The House bill would slash funding for child support enforcement by $4.9 billion. The Senate did not include any cuts to child support enforcement.

-- Will Medicare be cut?

The Senate voted to eliminate $5.4 billion in subsidies for some regional insurance companies that agreed to participate in President Bush's Medicare prescription drug program. The House bill does not cut the subsidies.

Congress watchers expect that lawmakers are likely to split the difference between the House's $50 billion in cuts over five years and the Senate's $35 billion in trims. But the negotiations will be difficult for GOP leaders. Conservatives, especially in the House, have been pushing for deeper cuts. Republican moderates plan to lobby to restore funding for some programs.

House Republicans argue the heated rhetoric over the budget bill's effects is overblown because many cuts are simply limiting the growth rate of certain federal programs. For example, the proposed cuts to Medicaid would lower the annual growth rate in spending on the program from 7.3 percent to 7 percent.

But Democrats complained the cuts hit the wrong targets, including students struggling to pay for college. The Congressional Budget Office estimates the bill would increase costs to students and families by $8 billion, including nearly $5.5 billion in costs when students consolidate loans.

You're hurting the students of this nation, Rep. George Miller, D-Martinez, told Republicans in an angry floor speech. You're putting their families in debt. You're piling on the interest rates. You ought to be ashamed of it.