TALLAHASSEE, Fla. (AP) -- Nearly 20,000 people with catastrophic illnesses would no longer have hospital care paid for by the state.

Ten thousand inner-city Miami school kids wouldn't see a doctor as often.

County health departments, which provide much of the primary care for Florida's poor, would see their budgets slashed nearly in half.

If the proposed health care budget that emerged in the state House on Thursday remains as is, it also would mean no more coverage of dental care, vision care or hearing aids for adults in the Medicaid program.

And at a nursing home in Venice, nursing assistant Amy Runkle may go from caring for 20 elderly people on the night shift to having 30 people to turn, bathe, help to the bathroom and make sure they're getting enough water.

"How am I supposed to do that? It's impossible," asked an exasperated Runkle. "It's very unsafe."

State legislators writing the budget for the coming year are in a bind with tax collections in a free-fall.

Republicans who control the Legislature are staunchly opposed to raising taxes, so they say cutting back on services is inevitable. Democrats were incensed at the proposals.

"These are not things a civilized community does," said House Democratic Leader Dan Gelber of Miami Beach. "It isn't fair, it isn't right, it isn't moral."

The deepest proposed cuts in years aren't something lawmakers want to do, said Rep. Aaron Bean, the chairman of the House's health care committee. But they have no choice until the economy improves.

"It's a bummer," said Bean, R-Fernandina Beach.

Democrats are outraged that Republicans won't consider more use of state savings or entertain any ideas for bringing in more tax dollars.

The Senate and House are both working on budgets that include hundreds of millions in health care cuts. The final versions of each chamber's budget are expected to be ready for the full House and Senate to debate next week. The differences in the two plans would then have to be worked out. And Gov. Charlie Crist gets a say, with veto power over individual items in the spending plan.

Proposed cuts hit at a wide swath of state government programs, from Everglades clean-up, which is completely eliminated from the House's spending plans, to education, where some school districts are discussing the likely need to cut sports and other extracurricular activities. Miami-Dade schools, for example, have raised the possibility they will eliminate field trips and cut the number of school police or security officers.

Both the Senate and House are proposing actual reductions in the amount of per-student spending in K-12 education, something that hasn't happened in nearly four decades. Normally when lawmakers discuss cuts to education, they're talking about reducing the amount of increase in a given year.

But plans to cut programs in health are raising particular concerns, because of the potentially painful, some even say fatal, results in some cases.

The House's proposed budget would allow nursing homes a two-year break from minimum staffing requirements to cope with a 10 percent cut in what the government pays them.

And with less money and no requirement to do otherwise, most homes like the one where Runkle works would probably quickly cut employees, she said.

"It's a for-profit company, why wouldn't they?" Runkle said.

Reducing staff in nursing homes would be a reversal of recent improvements that advocates for the elderly have been fighting for for several years. Among the critics of the idea is the huge senior lobby AARP, which usually carries a lot of weight in senior-laden Florida.

"AARP is appalled that the House would even consider this," said AARP's Florida director, Lori Parham. "The idea that the House would abdicate responsibility to the industry for our most frail and vulnerable residents is unacceptable."

Another health care initiative targeted for a cut is the Area Health Education Centers program, which provides medical care in poor, underserved communities like Miami's Little Haiti, and the rural farming areas of central Florida, often using medical students.

The program also has six doctors who provide primary care for more than 10,000 children in 11 inner-city Miami schools. The proposed $7 million cut - about 2/3 of the program's budget - would likely mean two of those doctors would be laid off, said Dr. Arthur Fournier, the director of the initiative's Miami program.

"It would gut the program," Fournier said. "These are doctors working in underserved communities providing essential services."

Hospitals aren't spared in the House plan. The rate Medicaid pays for both outpatient and inpatient treatment would be cut by 10 percent.

County health departments would take one of the biggest hits, with the House proposing to reimburse 61 percent of what they spend instead of 100 percent. That's a $55.8 million cut when federal matching money is factored in.

"We've got an infant mortality rate that is one of the highest in the nation, and many of those pregnant moms go to the county health departments for services," said Rep. Loranne Ausley, D-Tallahassee. "How can we do that?"