SACRAMENTO — On Aug. 1, the California Endowment, the state's deep-pocketed nonprofit healthcare foundation, launched a $6 million advertising campaign designed to pressure lawmakers to act on healthcare reform before the year is out.

The TV ads, which show scenes of a crowded emergency room and of families grappling with medical bills they can't afford to pay, end with the message: "Californians are waiting for healthcare reform. What are California's leaders waiting for?"

To the dismay of healthcare advocates, an unanticipated answer to that question emerged last week: The state's political leaders may have to wait until a prolonged budget stalemate ends before they can move on other big issues — and time is running short.

On Saturday, Gov. Arnold Schwarzenegger accused Senate Republicans of stalling passage of the budget to crowd out time needed to negotiate legislation that would reduce the number of Californians without health insurance.

"There are people out there (who) want to hang on to the status quo," the Republican governor told a televised healthcare forum held in eight cities. "There are politicians in Sacramento who are holding up the budget so they don't have to go into healthcare reform.

"So let your legislators know how you really feel about healthcare reform, how much we need it," Schwarzenegger said. "It is inexcusable that someone would hold up the budget in order to make healthcare reform suffer."

Schwarzenegger plans a series of public appearances this coming week to try to pressure at least one more Senate Republican to support the budget.

On Wednesday, Senate President Pro Tem Don Perata announced senators will take up no other issues until a budget deal is done.

These developments have healthcare reform advocates worried, but not alarmed.

"We're still optimistic," said Mark Beach, spokesman for the California chapter of the AARP. "We still think there's a groundswell of support When it comes down to it, the leadership has good reason to show that something productive comes out of this session. They're not going to want to leave the session saying, We didn't get any good legislation.'"

The AARP, which has already spent $3 million on an ad campaign that attempts to generate public pressure for action, could ramp up that campaign in the weeks ahead, Beach indicated. He also noted the organization has sent out 1 million pieces of direct mail urging members to attend a healthcare rally Aug. 22 at the Capitol.

The rally is timed to coincide with lawmakers' return to the Capitol two days earlier. The Assembly, which passed a budget July 20, will have been out of town for a month. The Senate, which saw its summer recess cut short after it failed to approve a budget, will also return in full force that day.

To a large degree, no one anticipated the hard bargaining on healthcare reform would begin before Aug. 20 — so, in effect, nothing has yet been stalled. But if the budget delay drags on beyond that date, it could slow down negotiations that must conclude before Sept. 14, the day lawmakers adjourn for the year.

Anthony Wright, executive director of the consumer group Health Access, noted other major legislative deals have come together even more quickly, notably last year's landmark global warming legislation. He said healthcare legislation this year "is more fleshed out" than the global warming bill was at the same point last year.

"Deals have come together in less time," Wright said. "It's still possible for major healthcare reform to pass, as long as people don't use the budget as an excuse to do nothing."

Some advocates speculate the 14 Republican senators who are blocking passage of the budget may be partly motivated by a desire to stymie action on healthcare reform, which they oppose.

"There may be an effort to play out the clock," Wright said. "We don't want to give Senate Republicans an added incentive by telling them the budget delay will also block healthcare reform."

Steve Maviglio, spokesman for Assembly Speaker Fabian Nuñez, D-Los Angeles, said the most critical need to advance healthcare reform at the moment is, "The governor's got to engage. We need to find something he's going to sign, and quick. Otherwise, the governor is going to walk away from this year without a single major accomplishment."

Maviglio said there is some concern over Perata's vow to put the Senate in a deep freeze until the budget impasse is resolved.

Healthcare reform legislation, unlike the budget, can be passed with a majority vote, meaning that it can be sent to Schwarzenegger without the support of any of the GOP senators who are blocking the budget.

"I think it would be unwise to give them a victory," Maviglio said.

— The Associated Press contributed to this report.