Local medical professionals and public health officials worry that a bad situation is about to get much worse.

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For an increasing number of uninsured or underinsured patients in Monterey County, who number about 112,000, health care options are steadily dwindling. Fewer private clinics are accepting government-sponsored health plans like Medical and Medicaid. That places more strain on patients to pay for their own medications and treatments. More than 6 million California residents (or one in six) lack any sort of health insurance. And there’s little hope of that changing soon.

Gov. Arnold Schwarzenegger last week vowed to veto SB 840, a bill authored by state Sen. Sheila Kuehl that would have created a state healthcare system. The bill, which was tweaked and re-tweaked over two years in the state Legislature, would have guaranteed universal health care for all California residents—including the undocumented.

The bill is built on the idea that if everyone had access to primary care, the cost of providing care to uninsured patients facing acute illnesses—which has skyrocketed—would decrease dramatically, resulting in a break-even.

Schwarzenegger cited his no-more-taxes pledge in announcing his planned veto. Even Democratic challenger Phil Angeledis, once a firm supporter of SB 840, has backed away from openly supporting the now-doomed bill.

Meanwhile, a new federal rule requiring proof of citizenship for residents who are enrolled in Medical, who total about 65,000 locally, could result in more patients with no coverage.

The Medical rule went into effect July 1. It requires agencies like Monterey County’s Social Services department to purge (or deny access to) anyone that can’t prove they’re a US citizen from the program. Most current enrollees are children and seniors.

Bill Elliot, Monterey County’s director of Social Services, worries this policy could do more harm than good.

“My biggest fear is that this more restrictive measure and more difficult verification process will result in a falloff of those who attempt to go through all the obstacles to get health coverage,” Elliott says. In other words, enrolling residents into the program—a major goal for the staff at the County-run hospital—just became a whole lot harder.

Many county officials statewide at first threatened to defy the federal government and not implement the policy, but they have since relented, Elliott says.

Maria Giuriato, a Salinas city councilwoman and county social services official, stresses that while the County will implement the rule, it probably won’t result in many illegal immigrants losing their coverage because the undocumented haven’t been eligible for Medical since the 1990s.

Those who stand to lose out the most, she says, are residents who are eligible for the program but are scared away by its more burdensome bureaucracy. As for undocumented immigrants, the government trend to marginalize them from healthcare services continues.

Many public health officials and medical professionals interviewed for this story believe that the undocumented in this population are in the most danger of experiencing a healthcare crisis.