As the Super Committee combs the federal budget for health savings, potential cuts to health aide providers could also curtail one of America’s fastest growing job sectors.

The Bureau of Labor Statistics projects job growth for home health aides to increase by 46 percent according to their 20 year outlook. The bureau also projects that the home health aide sector alone will add half a million jobs by 2018.

But those numbers rely on current levels of government spending as budget cutters in Washington are looking for innovative ways to cut health care spending while dampening the blow back from any unpopular decisions.

One way that the government can choose to reduce spending without directly affecting access for those Medicare beneficiaries is to cut payments to providers.

“You have to weigh all of these considerations,” said Edwin Park who is the Vice President for Health Policy at the left leaning Center on Budget and Policy Priorities.  ”You have to try to reduce the federal deficit and gleam possible efficiencies in the programs without affecting beneficiary care.  Looking at provider rates is one way to go.”

But many of those providers employ home health care workers and could curb hiring if Congress decides to reduce payments.

While there is no specific indication as to what the Super Committee has in store for Medicare payments, a report by the Medicare Payment Advisory Commission released in March does point to home health care as an area where efficiencies could be released.

“The Commission finds that the home health benefit has significant vulnerabilities that need to be addressed urgently and recommends policies to strengthen program integrity, improve payment accuracy, and establish beneficiary incentives.”

Specifically, the commission found that providers frequently encouraged patients to make multiple visits as a way to increase the number of times that the provider could bill Medicare for treating one condition.

The commission also pointed to the fact that recipients of government subsidized home health care aide do not contribute in any way towards the expense of the visit leading the commission to question the patients incentive to ration care.

Still some advocates say that forcing seniors to cost share with Medicare would be unfair especially when so much money is lost to Medicare fraud.

“Our approach there is avoiding across the board cuts that hurt everyone and the only people that are advantaged by across the board cuts are pirates and the crooks,” said Val Halamandaris who is the President of the National Association of Home Care & Hospice.

The 2010 health care law already slashes provider payments but more could be on the way.

Many home health care providers are looking to the future, have accepted the need for reform and are bracing for a new payment structures.

“As the federal government begins implementation of the new health care reform law, there are many changes on the horizon for home health. Among those changes are significant payment reductions, initiatives to improve patient care, and efforts to enhance program integrity,” Scott Ward, the President of the American Physical Therapy Association said in a statement.

But will these cuts translate directly into job losses?

“With labor costs being one of the biggest cost to how you run your physical therapist practice, any amount in how they’re being paid or reimbursed has significant impact on who they can employ,”  said Justin Moore, the Vice President, Government and Payment Advocacy at the American Physical Therapy Association.

In 1997, Congress passed the Balanced Budget Act which set formulas to cut payments to outpatient services which also translated into job losses in the physical therapy field.

During that time BLS was also projecting strong job growth for occupational therapists and was forced to revise their forecasts to adjust for new government policy.