PHOENIX - Foes of planned cuts to the state's health care plan described them Monday as draconian and cruel.

But without a last-minute veto by the federal government, the first of these is set to take effect Sunday.

A top official of the Arizona Health Care Cost Containment System said after a two-hour public hearing that while there may be a bit of flexibility in what services are slashed and how many are affected, there will be cuts. AHCCCS assistant director Monica Coury said that's because lawmakers have reduced her agency's budget next year by $520 million, meaning there is no way to honor the requests of a parade of speakers at a two-hour hearing and keep the program the way it is now.

Coury also defended the plan as the most humane way to save money. "What we're trying to do is preserve coverage to the greatest extent possible," she said.

Coury said no one currently enrolled will lose coverage. She said refusing to provide benefits to about 130,000 people, mainly adults, who otherwise would be eligible, preserves coverage for the elderly, the disabled, children and pregnant women.

That did not satisfy foes.

"It is unfortunate that Arizona state government is balancing its budget on the backs of the most vulnerable, especially when other options are available," said Sarah Kader, attorney for the Arizona Center for Disability Law.

But given the legislative mandate, they are left with one option: sue.

"We think this proposal is contrary to the voters' desire," said Eddie Sissons, lobbyist for the Arizona Foundation for Behavioral Health, as voters in 2000 directed lawmakers to provide free care for everyone below the federal poverty level. Sissons said a 1998 constitutional amendment bars lawmakers from altering or repealing voter-approved programs.

Coury, however, said the position of the Legislature and the Brewer administration is that the 2000 initiative provides an escape clause if there are no available funds.

The more immediate question is whether the U.S. Department of Health and Human Services, which oversees all Medicaid programs, will give the go-ahead.

The first cuts come Sunday when the state stops taking applications for its "spend down" program. This is designed to cover people who do not qualify for AHCCCS but whose medical bills bring their income down to below 40 percent of the federal poverty level, about $7,400 a year. The program covers medical expenses for six months.

Timothy Schmaltz of Protecting Arizona's Families Coalition said that is shortsighted.

"How many new medical bankruptcies is this going to create?" he asked.

Coury said her agency hopes to get the final go-ahead for that change by the end of the week.

On July 1, the state would stop enrolling childless adults, people who are not required to be covered by federal Medicaid laws but who were added by the 2000 ballot measure. That move alone will shrink enrollment over the next year by 100,000.

Some other changes to raise money drew their own criticism, including co-pays for AHCCCS recipients, a $15 per family member per month premium, with a $5 charge for an office visit and $30 for going to the emergency room and a $25 fee for a missed doctor's appointment.

There were very specific complaints about a proposal to charge separate fees to those who smoke, as well as people who are obese and do not follow the regimen imposed by their doctors.

Tami Johnson, an attorney with the William E. Morris Institute for Justice, said that is bad policy.

"The stick or penalty approach does not work," she said.

Johnson is doing more than complaining: Her organization late last week filed a 32-page objection urging the Department of Health and Human Services to reject the state's request to waive federal rules.