As lawmakers finish off their spending plan for state operations, a wide variety of programs are considering the impacts of budget cuts. One is the state public health center system, where reductions could leave communities without some types of care.Download AudioThe Southeast Alaska community of Wrangell has been without a full-time public health nurse since the previous staffer left in March.Fill-ins from other centers are spending a few days there every other week. One is Susan Bergmann, a nurse manager who supervises that center from Ketchikan.“I’m not recruiting at this point. I have not received permission to do so,” said Bergmann. “They are still waiting for final decisions to be made in the House and Senate with their budget.”The nursing program faces a 15 to 20 percent reduction in its annual budget of about $30 million.Chief of Public Health Nursing Linda Worman said that will affect the level of service provided to low-income Alaskans and those without insurance.“There will mostly be closures this year … what the final dollar figure is,” Worman said.A smaller budget cut, made last year, caused the 10-nurse Seward Public Health Center to close.Worman said her agency is working on plans for further reductions, but isn’t ready to identify locations or positions.She said such decisions are based in part on need, such as communities with high tuberculosis rates.Bergmann said that’s not much of a problem in Southeast, but it is in parts of Western Alaska.“They also look at are the community providers able to provide the services that public health provides,” said Bergmann. “In Wrangell, the answer is yes, we have other providers.”Worman said the main focus of the public health program is on younger Alaskans, though others can still find some help.“We’re still going to do immunizations,” Worman said. “We’re still going to do reproductive health through the life span. … if we cannot be their safety-net provider.”The state has around 190 nursing positions at 22 public health centers. Worman says those jobs make up about 80 percent of her agency’s budget.“This is an unprecedented reduction,” said Worman. “However, we still believe that … what the state budget looks like … targeted in any way.”Wrangell, Haines, Cordova and Valdez are one-nurse sites with open positions at this time. Worman says that doesn’t necessarily mean they’ll close.