OKLAHOMA CITY (AP) -- For 66-year-old Richard Boston, an Army veteran who has been disabled for more than 20 years, Oklahoma's Advantage program is a lifeline that allows him to continue living in his modest home in southwest Oklahoma City.
The state-funded program provides volunteers who do light housework and run errands. It also gives out medical equipment like a lift chair that allows him to get in and out of the bathtub despite his bad knees and back, the result of a disabling fall he suffered during his career as a truck driver.
"Without them, I don't know how I'd get by," said Boston, who lives on $875 a month. "I'd probably end up in a nursing home."
Oklahoma already ranks as one of the unhealthiest in the nation, and state health services like the Advantage program are heading to the chopping block as Oklahoma lawmakers try to find ways to plug a $215 million hole in the state budget.
That budget hole was supposed to be plugged by a $1.50-per-pack cigarette fee before the state Supreme Court ruled it unconstitutional because it didn't receive a three-fourth's majority vote. The funds were earmarked for three major health agencies: the Department of Human Services, Departments of Mental Health and Substance Abuse Services, and the Health Care Authority, which is the state's Medicaid agency.
Because DHS is required by court order to maintain funding for its child welfare programs, the Advantage program would almost certainly be decimated if the agency loses 10 percent of its budget — or an estimated $69 million it would have received from the cigarette tax — if lawmakers can't reach an agreement, said agency spokeswoman Sheree Powell.
The state's Medicaid agency has announced plans to slash reimbursement rates to health care providers by 9 percent beginning Dec. 1. The agency says that cuts are needed to make up for the loss of funding to its agency, cuts that could result in doctors and other health care providers refusing to treat Medicaid patients.
Already, several rural hospitals in Oklahoma have been shuttered. Since 2010, nine hospitals have declared bankruptcy and others have eliminated key services.
"Too many times my hospital and others around the state have been forced to choose between paying for food and medications for our patients or paying payroll taxes," said Jahni Tapley, CEO of McCurtain Memorial Hospital in southeast Oklahoma, where about 96 percent of the 300 births each year are to mothers who qualify for Medicaid.
"As it stands, my hospital loses $1.2 million each year simply because we offer Medicaid services," Tapley said.
Oklahoma ranked 46th among U.S. states in overall health in 2016, according to the United Health Foundation, a national not-for-profit foundation dedicated to improving the world's health. The state ranks eighth highest in the nation for uninsured residents, with 11 percent of its population without health insurance, and received particularly low marks for its high prevalence of smoking and its high premature death rate.
While the Legislature is considering a variety of tax increases to shore up the state budget, any tax hike is a tough sell to Republicans, many of whom campaigned on lower taxes and cutting government spending.
"I've campaigned on being a limited-government conservative," said Rep. Kevin Calvey, R-Oklahoma City, one of many House Republicans who opposes any new taxes. "I think there's a great deal of waste in state government, and I think that's what we need to be going after instead of raising taxes."