WASHINGTON (AP) — Confused about the federal budget struggle? So are doctors, hospital administrators and other medical professionals who serve the 100 million Americans covered by Medicare and Medicaid.

Rarely has the government sent so many conflicting signals in so short a time about the bottom line for the health care industry.

Cuts are coming, says Washington, and some could be really big. Yet more government spending is also being promised as President Barack Obama's health care overhaul advances and millions of uninsured people move closer to getting government-subsidized coverage.

"Imagine a person being told they are going to get a raise, but their taxes are also going to go up and they are going to be paying more for gas," said Thornton Kirby, president of the South Carolina Hospital Association. "They don't know if they are going to be taking home more or less. That's the uncertainty when there are so many variables in play."

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