In any state budget impasse, attention inevitably focuses on the areas of conflict, and the public’s focus will soon turn to the reluctance of most Republican lawmakers to vote for a plan that would ask voters to extend temporary taxes for another five years.

But even as the debate over revenues begins in earnest, we shouldn’t lose sight of the deep spending cuts that are part of the plan moving toward both floors of the Legislature this week.

The cuts in the health care safety net, in particular, will make it more difficult for the neediest among us, including children and the elderly, to obtain the care they need to stay healthy or to get well once they are sick.

The cuts reduce payments by 10 percent to doctors, hospitals and nursing homes that care for the poor. California already has among the lowest reimbursement rates in the country, paying, on average, less than half what doctors get under the Medicare program.

The current rates are so low that most doctors refuse to treat Medi-Cal patients. These cuts will only exacerbate that problem, making it even more difficult for patients to find a doctor.

If they do find one, the number of visits will be limited to seven per year unless the doctor certifies that more are necessary. In most cases they will, but this new bureaucratic hurdle is still expected to reduce doctor visits as a way to save the state money.

The budget adopted by the Assembly-Senate conference committee also eliminates Medi-Cal coverage for over-the-counter drugs, limits coverage for hearing aids and sharply reduces services meant to keep seniors living independently and out of nursing homes.

One particularly unrealistic cut will seek to impose hefty fees on Medi-Cal patients who need care. The program will charge a $5 co-payment for doctor’s appointments, a $50 fee for emergency room stays and $100 a day, with a $200 maximum, for hospital visits.

Almost everyone on Medi-Cal has an income below the federal poverty level. Does the Legislature seriously believe that these people will be able to pay $100 or $200 if they end up in the hospital? More likely, those costs will be absorbed by the rest of the system. Private insurers, and privately insured patients, will pay more while the state pretends it has shaved some costs from the public system.

The budget seeks a greater share of participation from families enrolled in the Healthy Families program, a subsidized insurance program for low-income families who are often one-step away from full public assistance.

Monthly premiums for these families will increase by 75 percent to 100 percent, depending on their income level. The new family maximum will be $126 for families whose incomes are between 200 percent and 250 percent of the federal poverty level. Many will not be able to afford the higher premiums, and they will join the ranks of the uninsured. Again, this will simply add to the cost-shift as paying patients are asked to pay more to make up the difference.

Democrats on the conference committee voted for these cuts in hopes that the action would persuade Republicans and eventually the voters to pass the tax extensions that Gov. Jerry Brown is seeking.

If those taxes are not extended, another $11 billion or $12 billion in cuts will be necessary. And if that’s the case, these cuts to the safety net will be only the beginning.

Daniel Weintraub is editor of the California Health Report at