SACRAMENTO — Gov. Arnold Schwarzenegger's proposed budget promises higher costs and hurdles for thousands of Californians, from some children with cancer who would no longer get state help paying for chemotherapy to high school graduates who would be shunted to community colleges instead of universities.
The roughly $7 billion in government service cuts -- many of which are not specified in the budget documents -- would stall highway repairs, ban 13-year-olds from subsidized child care, make state workers pay more for their pensions and reduce payments to doctors who take care of Medi-Cal patients.
In introducing his budget before a bank of television cameras, Schwarzenegger called the cuts "very difficult decisions that I do not take lightly."
"It is difficult. It is painful," the governor said. "There are no two ways about it, because we have to make savings in so many different areas and programs. But it is the only way we can do it, because we don't have the money."
The heaviest cuts include capping enrollments in several programs, including Healthy Families, which subsidizes health insurance for poor children, and a program that covers the medical expenses of children with cancer, heart conditions, cerebral palsy and other serious disorders.
Alan Lewis, a cardiac pediatrician who treats patients under the program at Childrens Hospital Los Angeles, predicted a fractious debate over Schwarzenegger's proposals.
"It's unconscionable to take the economic savings that we know the state has got to do and put that burden literally on the life of a young child," Lewis said.
"This is looking a child in the eye and saying, 'No, you're going to have to wait to be treated.' "
But Health and Human Services Secretary Kim Belshe said the budget appears to hit children and the poor the hardest because California has historically been so generous.
"It strikes a responsible middle ground between two unacceptable alternatives -- the status quo and eliminating" the programs, she said.
Here is a look at the effect of Schwarzenegger's proposed cuts:
Health
Health and welfare programs would be reduced by roughly $2.7 billion, the largest share of the cuts.
The Healthy Families Program, which supplies health coverage for children in low- and moderate-income families, has grown from $59.3 million in 1998-99 to a projected $839.1 million in 2004-05. The governor proposes to cap enrollment at this month's level, an estimated 732,000 children, and ask higher-income families to pay more for benefits such as vision and dental coverage.
The enrollment cap would mean that no additional children would be covered until others dropped out. Until now, state policy has been to encourage children of the working poor to join.
Schwarzenegger proposed a similar enrollment cap in a program that treats 37,600 children and teenagers whose families earn too much to be eligible for Medi-Cal but who have severe medical needs. The cap, which would save $40.7 million, means that some children with cancer and other expensive medical problems would not receive state aid.
And he proposed to have patients in the Genetically Handicapped Persons Program pay for a portion of their coverage, saving the state $576,000.
Some of the deepest cuts are proposed in Medi-Cal, the $30-billion federal- and state-financed health-care system that serves 6.8 million needy people.
The governor proposed a variety of cost-saving measures, totaling $880.5 million, including a 10% reduction in what the state pays doctors, ambulance drivers and other health-care provides.
Whether the governor can impose that reduction remains unclear. Last year, the Davis administration proposed a 5% reduction in payments. A federal judge blocked the move last month.
California Medical Assn. spokesman Ron Lopp said he was discouraged that the governor had gone ahead and proposed the 10% cut in light of the judge's order.
The CMA has argued that doctors would stop treating Medi-Cal patients because the state would pay too little. "Doctors already are saying they can't make ends meet, and it's not worth it," Lopp said.
The California Healthcare Assn., representing hospitals throughout the state, praised the governor for not proposing cuts in reimbursement rates for nursing homes attached to hospitals or restrictions on Medi-Cal enrollment.
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Welfare
The budget would reduce benefits for 481,000 poor families on public assistance and redesign welfare programs to stiffen work requirements.
Effective April 1, benefits would drop 5% for poor families receiving aid under CalWORKS, California's welfare-to-work program. The grant for a mother and two children in the Los Angeles area would fall from $704 a month to $669. The loss in income would make such a family eligible for a $16 monthly increase in federal food stamps.
