"If you are going to cut reimbursements, you ought to have closer facilities," Mr. Florio said, adding that the V.A. transportation limits would buttress efforts to get the outpatient clinic.

Democrats would reduce growth by $124 billion over seven years by cutting reimbursements to doctors and hospitals and using managed-care programs; Republicans would scale back by $158 billion and increase premiums and co-payments.

Even as more uninsured people come to the center, Mr. Spinner said, the state has cut reimbursements for some of the services the center offers.

The psychologists' decision comes after thousands of medical doctors have joined unions in recent years, with the psychologists, like the physicians, frustrated that managed care companies have cut reimbursements and restricted treatment and the frequency of patient visits.

Electric utilities are cutting reimbursements for installing more efficient heating, cooling, lighting and other equipment at work and at home.

Insurers might, for example, hold back a portion of the payments due physicians and hospitals, and then cut reimbursements by the proportion that total bills exceeded the allotted expenditure for the group insured.

Deciding to cut reimbursements for costly cases could hurt hospitals like his, he said.

The stock fell when the company issued a profit warning after the government announced plans to cut reimbursements for drug purchases by 6 percent.

Managed care has controlled health care costs by rationing the delivery of services and cutting reimbursements to doctors and pharmacies.

Mr. Pataki would also cut reimbursements for treatment of Medicaid patients who continue in traditional fee-for-service coverage.