ALBANY — After enjoying virtual veto power over Governor Pataki, the state’s health care industry is rethinking its tactics as it girds for battle against Governor Spitzer, a Democrat with a soaring job approval rating.

For the state’s health care workers union and hospital associations, the goal has not changed: to restore hundreds of millions of dollars in cuts proposed in the governor’s executive budget. In fact, the largest cost-saving measures in Mr. Spitzer’s $47.6 billion Medicaid plan, particularly a freeze in fee-for-service reimbursement rates, are almost identical to the cuts sought by Mr. Pataki a year ago.

This year, health care groups are confronting a less hospitable political landscape, according to Albany observers. During the Pataki years, the health industry was able to beat back cuts by relying on a strategy based on hard-hitting advertising campaigns that tore away at the governor’s popularity, as well as unyielding support from lawmakers.

What worked against Mr. Pataki may not work as well against Mr. Spitzer, who does not possess several weaknesses that made the last governor a soft target.

“We have a different person trying to enact the same sort of cuts,” a senior adviser to 1199 SEIU health care union, Jennifer Cunningham, told The New York Sun. “There has to be a more sophisticated approach here, which respects the desire of the governor and voters to see general reform but posits an alternative way of going about it.”

In the past, health care groups successfully appealed to a predominantly Democratic base of voters by casting Mr. Pataki as a Republican inflicting draconian health care cuts on the most vulnerable New Yorkers. “He took a beating in the polls for it. Every year he got an endorsement, every other year he got his brains beat in,” a source close to Mr. Pataki said.

Although they have millions of dollars on hand to spend on a television, print, and radio advertising campaign, health care groups face the challenge of chipping away the popularity of a governor who shares the same political party as most New Yorkers and who has marketed himself as a reformer who intends to shake up the Albany establishment. Mr. Spitzer’s more liberal political profile could make it more difficult for 1199 SEIU and the state’s two major hospital associations to link Mr. Spitzer’s health care policy with President Bush’s efforts to lower hospital reimbursement rates.

Public sentiment appears to be behind Mr. Spitzer’s aggressive style. A poll released yesterday by the Quinnipiac University Polling Institute found that more than 60% of voters surveyed statewide said they endorsed Mr. Spitzer’s recent description of himself as a steamroller.

During the Pataki years, the union’s greatest trump card was its support from both legislative houses, which put the governor in a weak bargaining position. Last year, Mr. Pataki agreed to restore more than $500 million in Medicaid cuts after the Senate and the Assembly “showed an ability and a willingness to override the governor,” the source close to Mr. Pataki said.

“The last couple of years, we weren’t negotiating with the Senate,” the source said. “It was Bruno saying to the governor, ‘Go get a deal with Dennis and you get a deal with Dennis, I’m with you,'” a reference to the majority leader of the Senate, Joseph Bruno, and the president of 1199 SEIU, Dennis Rivera.

Mr. Bruno, who is a subject of a federal investigation into his business interests and whose party is two seats away from losing control of the Senate, may not be as willing to take the political risk of an override. The state’s other legislative leader, Sheldon Silver, the Democratic Assembly speaker, is also on shakier political turf, having already gone to battle with the governor over the selection of the state comptroller.

For now, health care groups say they are weighing their options. Aides to the union and hospital associations say they are trying to reach out to the governor, who can make amendments to his executive budget up until next week. Despite the new landscape, the aides said they can swing voter opinion by convincing New Yorkers that Mr. Spitzer’s proposals are not part of a broader plan to restructure health care but are measures recycled from the Pataki administration.

If they go forward, they will also argue that Mr. Spitzer’s cuts, coupled with Mr. Bush’s proposed reimbursement reductions, would have a devastating impact on hospitals.

“The governor’s cuts are compounded by billions more in federal funding cuts for New York proposed by President Bush,” the president of Healthcare Association of New York State, Daniel Sisto, said yesterday at a legislative fiscal hearing. “The confluence of these two budget proposals will overwhelm our care providers, force administrators to make agonizing decisions, and ultimately imperil patient care. These cuts must be stopped.”

Health department officials say the governor is freezing hospital and nursing home rates as part of a long-term plan to correct what they say in an outdated rate system that gives less incentive for hospitals to serve more common community needs.

Mr. Spitzer is proposing to increase overall Medicaid spending to $47.6 billion, a rise of more than $1 billion over last year.