The president sharply defended entitlement programs benefiting people with disabilities as he laid out his plan to reduce the nation’s budget deficit Wednesday, but said some change is needed.

In a speech at George Washington University, President Barack Obama said he wants to trim $4 trillion from the federal deficit over the next 12 years through a mix of spending cuts and increased taxes for the wealthy.

But, he said fixing the nation’s budget woes should not come on the backs of the elderly and those with disabilities, contrasting his approach with a Republican plan that the U.S. House of Representatives is expected to consider Friday. Under that proposal, Medicaid would be dramatically altered and significant control of the health program would be transferred to the states.

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“It’s a vision that says up to 50 million Americans have to lose their health insurance in order for us to reduce the deficit,” Obama said of the Republican plan. “Some are middle-class families who have children with autism or Down syndrome. Some of these kids with disabilities… require 24-hour care. These are the Americans we’d be telling to fend for themselves.”

Obama’s plan does call for modifying Medicaid through a simpler reimbursement structure for states, among other efficiency efforts designed to save $100 billion over 10 years.

On Social Security, however, Obama said he does not want to make any immediate changes since the program is not a major contributor to the deficit.

Republicans were quick to criticize Obama’s approach, setting the stage for a fierce budget battle. House Speaker John Boehner, R-Ohio, called the president’s proposal a “non-starter.”