Advocates for the poor and disadvantaged say they are troubled by Gov. Linda Lingle's plan to cut $42 million from a state program that provides health insurance for low-income adults, insisting that the move may ultimately hurt the pocketbooks of all Hawai'i residents.

Lingle said about 112,00 low-income adults would be affected by the cuts to Quest and Medicaid programs, which provide healthcare benefits for low-income adults in Hawai'i.

Lingle was vague about how the cuts would be administered. The $42 million in cuts, which are spread over two years, would amount to a 4.3 percent reduction in the total Medicaid spending in Hawai'i, Lingle said.

State Human Services Director Lillian Koller, in a two-paragraph statement, indicated her agency had not yet determined how the cuts will be made.

"Hawai'i has some of the most generous Medicaid benefits in the country, so I believe we can reduce spending without placing a significant hardship on our clients," Koller said, adding that no one will be removed from the program. "We will carefully examine the Medicaid expenditures and benefits in the days and weeks ahead to determine the most appropriate areas where we can reduce spending."

Lingle said, "While I believe this is a modest reduction considering total Medicaid spending, I recognize it will in some cases have a big impact on those whose benefits will be scaled back. We must live within our means, and that requires that we provide what the government can afford while maintaining service levels as best we can."

Debbie Shimizu, executive director of the state's chapter of the National Association of Social Workers, said it was "unconscionable" for the Lingle administration to even consider cuts in health insurance benefits to the poor.

"Especially at this time when everybody is hurting, you're affecting the ones who are least able to weather this type of budget cut," Shimizu said. "It's low income, it's those who are struggling to get by."

"Where will these people go to get help?" asked Alex Santiago, chief executive officer for PHOCUSED, Protecting Hawaii's Ohana, Children, Underserved, Elderly and Disabled. "It's not like they are not going to get sick."

Santiago said without proper access to care and medicine, those affected by the cuts are more likely to end up in an emergency room, where the cost may be passed to insurers who will in turn raise premiums to the rest of the population.

Brian Schatz, executive director of Helping Hands Hawai'i, echoed Santiago's comments.

"These people are the most vulnerable, and in the end if you cut health insurance, they'll end up in emergency rooms and drive up healthcare costs for all of us and not save us any money," Schatz said.

State Sen. Suzanne Chun Oakland, D-13th (Kalihi, Nu'uanu) who chairs the Senate Human Services Committee, said to qualify for Medicaid, an adult in a family of four needs to make less than $950 a month.

"That's a little less than $12,500 a year," Chun Oakland said, adding that many on Medicaid are too sick to work in the first place.

"People with more chronic health problems may become more destabilized and unable to work," she said.