A number of Dorchester and Mattapan health centers, unions and advocacy groups have joined a citywide coalition called Put Patients First to urge the governor to halt funding cuts to the Boston Medical Center and the Cambridge Health Alliance.

The group's leading organization, political heavy-hitter SEIU Local 1199, recently resceduled a rally planned for Jan. 15 - the same day as Gov. Deval Patrick's State of the State address - to Jan. 29, after the presidential inauguration.

Some $114 million has been cut from BMC's FY 2009 state payments all told, and the cuts are on track to jump to over $220 million in FY 2010, according to hospital representatives. The hospital took drastic action last month, cutting staff, benefits, programs and capital spending.

"We're potentially looking at a huge cliff in fiscal '10," said Thomas Traylor, BMC's vice-president of government programs. "There's no way BMC can do what we do with minus $200 million."

The directors of Dorchester House and Codman Square Health Center, which are licensed under BMC, say if something isn't done to reverse the tide of budget cuts, their funding could suffer heavily as well. Dot House gets around 10 percent of its entire budget from BMC and Codman around 18 percent. The South Boston and East Boston community health centers are also dependent on BMC.

Last month BMC cut $2 million in support it routinely gave to the Quincy Medical Center.

"Just from the Dorchester perspective were talking about a lot of jobs and services here… there would be massive cutbacks," said Bill Walczak, director of Codman Square Health Center. "The legislature and the governor should be very concerned."

The potential cuts would represent over 20 percent of BMC's $800 million budget, and threaten hundreds of jobs and potentially even basic services like the hospital's busy emergency room, a destination for most ambulances blaring sirens out of Dorchester.

The cuts derive not only from the worsening economy and Patrick's reaction - tightening up spending with "9C" cuts - but also from the lingering effects of health care reform itself, known as Chapter 58.

Both BMC and Cambridge Health Alliance are benefited by tens of millions in funding thanks to "Section 122" in Chapter 58, which was meant to be a three-year financial cushion while the reformers figured out how to address payments for hospitals like BMC and Cambridge Health - which serve a much higher proportion of low-income people than most.

Though many have flocked to Commonwealth Care - at Codman Square the number of uninsured patients has dwindled from around 50 percent to less than 15 percent&emdash;reimbursement rates to hospitals for those covered are less than they were for the uninsured under the old Free Care plan. And the Safety Net Trust Fund, meant for the remaining fraction of uninsured patients, is far smaller than the old Uncompensated Care Pool and many uninsured aren't eligible for it.

For the last two years, Section 122 has kept BMC and Cambridge Health rolling despite these problems, but in FY 2010 it will simply go away. That will be a $191 million cut for BMC, and nearly half of the subsidy, some $84 million, isn't being honored by the state in FY 2009.

Additionally, changes in Medicaid rates were cut by $14 million for BMC in the FY 2009 state budget, and Patrick cut them a further $16 million with 9C cuts.

"In our view the rates are supposed to grow and instead they've gone backwards," said Traylor. "We can't do what we do with payments of 60 cents on the dollar compared to our costs."

Those cuts add up to $114 million in this year's budget for BMC, and potentially $221 million in FY 2010. Cambridge Health Alliance is facing a similar crisis.

"The extent to which the BMC has been taking the hits in order for the state to bring the budget into balance, the hospital and the Cambridge Health Alliance feel they have been disproportionally affected by the cuts," said Joel Abrams, director of the Dorchester House. "And justifiably so."

The governor made over $1.4 billion in cuts to the state budget in October and has recently told reporters he will need to make $1 billion more to keep the ever shrinking budget in balance. The reductions will come close to shearing 10 percent off the $28 billion state budget.

"We recognize that BMC is an important provider, particularly to low-income populations," said Jennifer Kritz, a spokesperson for the Patrick administration's Executive Office of Health and Human Services. "We're working with them to mitigate budget reductions and find sustainable payment reductions… Unfortunately, when we are facing a budget shortfall it is impossible not to impact BMC and other safety net providers."

In late December, Patrick joined New York Governor David Patterson and others in a letter to the president-elect asking for an $800 billion economic stimulus package, which would include a $250 billion boost for "countercyclical" programs like the Federal Medical Assistance Program (FMAP).

If Obama takes up the suggestion, or something like it, it could directly improve Patrick's ability to fund the two critical safety net hospitals. But, as the Boston Globe reported last week, Patrick is hinting that he may divert Medicaid money to other areas of the state budget in anticipation of FMAP money.

"We can displace that money for other needs," he reportedly said at a press briefing.

To members of the coalition, that raises the specter that Patrick might not fully restore funding to the hospitals even if the FMAP funding comes through.

"There is nothing specific that the hospital can be assured of and that is really the problem," said Traylor. "We meet all the time but they just sort of go on and on and they're not fruitful with a vision of what can happen here."

Under SEIU 1199, some political pressure could come to bear, however. The Dorchester-based SEIU union has quickly become a political powerhouse in Massachusetts. It sent hundreds of volunteers to New Hampshire and ran massive phone banks for the campaigns of both Sen. Hillary Clinton and President Elect Barack Obama last year and was key in Patrick's own electoral victory in 2006. With political fundraising starting to heat up for the 2010 Governor's race, it would be bad time for Patrick to break with SEIU.

"We'd like there not to be a rift," said SEIU 1199 vice-president Victoria Turner, an ex-employee of BMC. "We'd still like to support the governor. We just want him to do the right thing with this money."