Lawmakers plan additional assistance to help Americans keep their health insurance if they lose their jobs.
But even some congressional leaders concede the help will be insufficient. "Let's be honest," said Sen. Richard J. Durbin (D-Ill.), a close Obama ally. "We won't be able to save every soul here."
At least 44 states are facing budget shortfalls over the next two years totaling more than $350 billion, according to a recent survey by the Center for Budget and Policy Priorities, a liberal Washington-based think tank.
Unable to run deficits like the federal government, states have been scrambling for months to cut aid to schools, universities and, increasingly, residents who rely on the state for medical care.
Nationwide, roughly 60 million low-income people -- half of them children -- use the Medicaid program to get some form of healthcare, including basic physician services, prescription drugs, X-rays, dental care and even hospice care.
Some of those services are now in jeopardy.
Florida is poised to cut its home services for poor senior citizens, such as bathing and meal preparation, as nearly 19,000 seniors in the state are on a waiting list to get the care rather than be sent to nursing homes.
Utah lawmakers are looking at cutting public health programs and eliminating coverage for about 20,000 low-income people who rely on the state-funded Utah Primary Care Network.
"The scale of this is unprecedented," said AARP Vice President Elaine Ryan, who has spent nearly three decades working on health policy at the state and federal level. "I really have never seen anything like this."
Some states have tried to avoid cuts in services by delaying or reducing payments to doctors and other medical providers who treat low-income patients.
This is taking a toll, however, as a growing number of providers stop treating those with state-funded insurance.
Nevada's largest county closed its outpatient oncology clinic last year, citing decreases in Medicaid funding for treating low-income cancer patients.
Now, advocates in Las Vegas are having to counsel patients to look at getting care by moving to other states where they have relatives.
"We're essentially creating medical refugees," said Stacey Gross, community programs manager at Susan G. Komen for the Cure of Southern Nevada.
Melvin Siegel, who operates five nursing homes serving some 400 seniors around Springfield, Ill., said he is close to closing because of slow payments from the state.
Nursing homes, which rely heavily on Medicaid, often don't have the option of rejecting patients on public assistance.
"There is no place to go," said Siegel, 79, who said he has borrowed against his home, life insurance and retirement savings to keep in business. "If this falls apart, I'll be penniless. . . . It's never been this bad."
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noam.levey@latimes.com
