Hundreds of thousands of impoverished Arizonans with health problems apparently will have to tough it out following a court ruling today that upholds healthcare cuts.

Maricopa County Superior Court Judge Mark Brain ruled that a group of people suing the state can't forced Arizona lawmakers to keep funding their free health care.

Proposition 204, which passed in 2000 by an overwhelming majority of voters, expanded the Arizona Health Care Cost Containment System to include residents without children who earn up to 100 percent of the federal poverty limit. Previously, most Arizonans could only qualify if they earned up to 34 percent of the poverty limit.

An AHCCCS document from January states that 238,000 people were enrolled under the expansion in 2009, but by January of this year the number had risen to 377,000.

The "Healthy Arizona" initiative was supposed to be funded by a massive settlement from Big Tobacco. But, as Brain notes in his ruling, the tobacco money proved "insufficient" over time, forcing the fund to be repeatedly supplemented by the big pool of taxpayer money known as the General Fund.

The plaintiffs had argued that the 1998 Voter Protection Act should have kept the voters wishes from being dashed. But Brain ruled that the Voter Protection Act only prohibits lawmakers from tinkering with voter-approved measures, and doesn't require them to fund anything.

With the state practically on the verge of bankruptcy, Governor Jan Brewer approved a budget this year that cuts out the expanded rolls of AHCCCS users, saving hundreds of millions of dollars. Brewer said today that she didn't take her actions "lightly."

"The human impacts are real," Brewer wrote in a prepared statement. "But I and members of the Legislature were elected to make difficult decisions. In this case, our decision to freeze future Medicaid enrollment of adults without children spared devastating cuts to other critical state services, including K-12 education and public safety. As previously constructed, Arizona's Medicaid program was unsustainable. State expenses climbed 65 percent in just four years."

The 377,000 adults affected by this ruling better hope they don't get sick.

But, if they do, there's always the emergency room.