Clinics for poor families might struggle to stay afloat. People who have no insurance or are covered by Medi-Cal could be unable to find a doctor. The only way some people might get hospital care is to show up at emergency rooms.

Hospital officials, doctors and consumer advocates say proposed $1.1 billion cuts in California's Medi-Cal insurance program, which covers about 6.6 million low-income people, would worsen the current crisis over access to medical care.

"It really just starts snowballing," said Roberto Juarez, chief executive officer of Clinicas del Camino Real, a group of Ventura County clinics that relies heavily on government funding to provide care for farmworkers. "Health centers like ours are going to be hurt, if not closed, across the state."

Proposed by Gov. Arnold Schwarzenegger this month, the cuts are aimed at bridging the gaping canyon that is the state's $14.5 billion budget deficit. Doctor fees for treating about 110,000 Medi-Cal patients in Ventura County would be cut by about 10 percent. Reimbursement to some long-term care facilities and hospitals, including Ventura County Medical Center and Simi Valley Hospital, would also be cut.

The state cuts could mean hospitals would also get less in federal matching contributions to Medi-Cal.

People who qualify for Medi-Cal would have to prove their eligibility every three months, meaning some would likely be dropped out of the program. Medi-Cal patients would no longer qualify for dental care.

The budget still has to pass the Legislature and could change dramatically.

But the proposed cuts, paired with this week's vote rejecting a healthcare reform proposal that included insurance for people currently not covered and increased Medi-Cal reimbursement, are interpreted by some as omens. Instead of debating ways of fixing healthcare, the focus is on managing a broken system, said Anthony Wright of Health Access California.

"We're only talking about how to make it less worse," he said.

State officials say the healthcare cuts are no worse than proposed cuts to other programs.

Joe Munso, deputy secretary of the Health and Human Services Agency, said there's no way to address the state's huge deficit without cutting the $15 billion Medi-Cal program. He said state officials decided they couldn't change eligibility rules or drastically cut benefits. Instead, they targeted reimbursement.

No dramatic reductions in access

"We've reduced rates before and we haven't seen a dramatic reduction in access," Munso said, referring to previous cuts about half the size of the governor's latest proposal.

But the amount California reimburses doctors for Medi-Cal is already among the worst in the nation. If the rate drops 10 percent, even more physicians would opt out, said Dr. Ronald C. Thurston, president of the Ventura County Medical Association.

It would be harder for low-income people to get preventive care or treatment for ongoing conditions, Thurston said. The only way many of them would get care is by showing up in emergency rooms.

Several hospitals in the county, including Los Robles Hospital & Medical Center and St. John's facilities in Oxnard and Camarillo, already have contracts with the state to provide Medi-Cal services and would be paid the same rate.

Ventura County Medical Center, however, would lose money, both because of reduced Medi-Cal payments for doctor services provided by the hospital and cuts to facilities designated as safety nets. Some of the losses could be mitigated through other government programs.

If low-income people can't find help elsewhere, more could turn to a county system that might have fewer resources to provide care, said Mike Powers, director of the county Health Care Agency.

Stressing that not all programs for the poor and uninsured would be hit, he said the cuts could "reduce access for the most vulnerable in the community."

$2.8 million loss to county

The county would lose about $2.8 million to administer Medi-Cal programs, said Ted Myers, chief of the Human Services Agency. That could end the jobs of 21 eligibility workers, making it more difficult to process people applying for coverage.

Simi Valley Hospital opted out of its state Medi-Cal contract in December but still cares for some patients in the program and is reimbursed on a fee-for-service basis. Those payments would be reduced.

Hospital leaders say it's too early to determine the effect but that the budget woes reflect California healthcare.

"On the one hand, you have a governor who's doing his best to balance the budget and trim the fat," said Jeremy Brewer, spokesman for Simi Valley Hospital. "On the other hand, you have hospitals that are already operating at thin margins. Unfortunately, the patient is caught in the middle."