Sequester cuts hit poor, elderly, cancer patients

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The first warnings about the spending cuts were dire.

In March, as the sweeping $85 billion reductions known as sequestration kicked in, President Barack Obama called them "stupid" and "arbitrary" and said they could thwart economic progress. Opponents said the administration was using scare tactics, predicting doom even though the cuts amounted to a tiny slice of the federal budget.

Public opinion is divided: Fifty-six percent of Americans surveyed in an ABC News-Washington Post poll in May disapproved of the cuts, but far fewer — 37 percent — reported they'd been personally hurt. Still, that was up from 25 percent in March. Support varies by income, according to the poll; it's highest for those with incomes of $100,000 or more.

More than three months into the sequester, it's far too soon to measure the full impact of the start of a 10-year budget-cutting plan that was supposed to be so undesirable that it would force both sides on Capitol Hill to come up with something better. That didn't happen.

Many more furloughs are planned. Bills have been introduced to spare certain people, such as cancer patients, from the cuts' effects. Others have been exempted. Congress, for example, passed a measure putting air traffic controllers back to work after flights were delayed around the country.

But there is pain and anxiety, too, notably among the poor, the elderly and the sick — and social service agencies that serve them. Here are some of their stories:

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When the budget was cut for Steve Nolder's public defender office, he knew someone had to go.

As chief federal defender for the southern district of Ohio, Nolder had to find a way to slash 11 percent from the budget. He didn't believe in going the last-hired, first-fired route, not when he'd recruited lawyers who'd uprooted themselves to join his office.

"I just didn't think it was fair for me to change the rules based on the fact that they trusted me to come and work here," he says. "Could I look at people who had been loyal to me over the years and eliminate them without any justifiable reason that was within their control? ... I certainly never took this job to ruin people's lives and I wasn't going to do that."

So he did what seemed most logical: He fired himself.

Nolder figured his 26 years of experience would give him the best opportunities for a career in private practice. "Sure, there's a school of thought that maybe you should go down with the ship," he says. "I'm hoping that by leaving, the ship doesn't go down."

Nolder is among 12 lawyers who handle about 1,200-1,250 cases a year in the district covering Cincinnati, Dayton and Columbus. They're so busy, he says, they could use another two attorneys.

Nolder's 18-year career as a public defender will be over at the end of June, and that's been agonizing.

"It's like dying a slow death," he says. "I love it here. It's the best way to practice law, period, end of discussion."

He says he'll be fine but doubts his departure will really save money.

"If people are concerned about fiscal responsibility, this is anything but," he says. "The cases don't go away, the representation doesn't go away. You just have to have others provide it."

Private, court-appointed attorneys — generally paid $125 an hour — will likely take up the slack for cases his office can't handle, says Nolder. And he could be one of them.

"That," he says, "is the ultimate irony."

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Jessica Harrell had to reassure her 4-year-old daughter she hadn't been thrown out of school when her Head Start classroom in Kentucky was shut down.

Tishauna Douglas, a teacher in the program, had to figure out how she'd support her three children after losing her job

Nationally, Head Start, which serves nearly a million children of low-income families, had to slice 5 percent off its $8.1 billion budget. Some chapters have eliminated classes, scaled back transportation or shortened their school year.

When the Head Start program for 16 counties in western Kentucky lost about $750,000 in funding, it laid off about 50 people, mostly teachers, and reduced its roster by more than 160 children, according to Aubrey Nehring, chief executive officer of Audubon Area Community Services in Owensboro, Ky. Three centers were closed entirely.

What's especially difficult, he says, is that about 75 percent of these Head Start parents were working or in school. "They cannot afford child care and still work," Nehring explains. "Most have minimal family support. That's the saddest part of the story. You have families making real progress climbing out of poverty, then you come and take that opportunity away from them."

Harrell, 26, waited months to get her daughter, Vamira, into Head Start. She'd drop her off before heading to a paralegal job, then pick her up after work (she was laid off early this year). She noticed significant changes in her daughter. "She can count better, she knows her alphabet, she knows different animals," Harrell says. "She learned a whole lot there."

When her daughter's classroom was among a dozen eliminated, Harrell says, "it broke my heart," even more so when her little girl asked, "Why did they kick me out?"

Douglas was stunned to lose her teaching post after almost five years with the program. "I thought of myself as a great employee," she says.

But she adds, "I couldn't have a pity party too long." She quickly planned her next step, deciding to return to college to complete her bachelor's degree in education.

Still, Douglas wonders why Head Start has to make sacrifices. "How can you make cuts in education? It's the root of everything," she says. "The politicians should cut the money they get for themselves ... That would be a great idea."

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The letter from the Florida Department of Economic Opportunity felt like a punch in the face to Charles Medler.

"You have exhausted your Emergency Unemployment Compensation (EUC) Tier III benefits," the letter read. No more were available.

The 57-year-old from Interlachen thought he had four more weeks of benefits coming. It was just $275 a week, but it made a huge difference.

"You plan, 'Well, OK. We're good for another month or month and a half. I still have a little more time left,'" Medler says. "And you start planning for that, and then all of a sudden, bang, the rug gets pulled out from underneath you?"

Tier III are federally funded benefits that start when a worker has exhausted 19 weeks of payments by the state. But while other states made the cuts by trimming the amount individuals receive, Florida's solution was to lop off the last four weeks of benefits for up to 100,000 laid-off workers.

It was just the latest setback for Medler. In November 2011, he was laid off by Georgia-Pacific Wood Products after more than 30 years. He took his pension early, which reduced his monthly payment from $1,000 to $627.

Medler says the loss of their middle class lifestyle pushed his already emotionally fragile wife over the edge. Their divorce is all but final.

After having to let two cars go, he's left with a 16-year-old minivan with about 150,000 miles on it. He has two mortgages on his home, totaling about $15,000 more than the current appraised value.

While handing out resumes and applying for jobs, Medler takes whatever odd jobs he can find. He's dug ditches, mowed yards, raked leaves and fixed pipes. He also volunteers at food pantries and churches — partly to give back, but also in hopes that it might lead to a job.

In the meantime, he has cut everything he can — even trips to nearby Gainesville for go-carts with his sons, Richard, 17, and Ryan, 16.

Ryan told his dad that if he got a job this summer, he'd like to contribute to the household. Medler can't believe it's come to this.

"It has been a very life-changing experience," he says gravely.

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Nearly eight years after Hurricane Katrina left her stranded on an Interstate 10 overpass, Leila Tennessee thought she was finally back on track.

For several years after her return from exile in Texas, the 46-year-old New Orleans woman shuttled from relatives' homes to cars to storm-wrecked, derelict houses. Finally, after nearly four years on a waiting list, she received word in February that she'd been approved for a $756 monthly Section 8 housing voucher.

So excited to be leaving the single room she'd been renting, she worked out a deal with her new landlord to move into the two-bedroom shotgun house in the Ninth Ward in late February — a few weeks before the assistance was scheduled to kick in.

But not long after, she was informed that the voucher had been recalled — one of about 700 frozen because of the sequester, the Housing Authority of New Orleans says.

"It's a hurting feeling," Tennessee said recently.

Life has never been easy for her, but it was once tolerable.

She says she quit school after the 11th grade to take care of her new baby and her mother, who was dying of cancer. For two decades, a longtime boyfriend kept her comfortably housed and fed, but he died in 2004.

Then came Katrina.

Tennessee says she was living with a boyfriend in the city's Gentilly section when the storm flooded their home. After four days in the moldering second floor, she was taken by boat to the I-10 bridge; a bus carried her to Huntsville, Texas.

She returned to New Orleans after about seven months and has struggled ever since.

She had a job supervising post-event cleanup at the Superdome, but that work was sporadic and has recently dried up. She gets by with money from cleaning houses, washing cars and cutting grass with a borrowed lawnmower, plus $198 a month in food stamps.

The pastor who owns the house has agreed to let Tennessee and her boyfriend pay $175 a week. Despite hot weather, she hasn't been using the central air conditioning, in an effort to cut down on the electric bill.

In early June, she got a job frying chicken at a restaurant and hopes it will lead to something full time.

"I still need help," she says as a grandchild wails in the background. "I don't know where the next week's rent coming from."

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Rita Nahta's first hint that something was awry was when the research scientist at the Emory University School of Medicine opened her email several weeks ago. She noticed something different about her federal grant for breast cancer studies: It was for three months.

Not a year's allotment as she was accustomed to — about $208,000 — but just a quarter of that.

The National Institutes of Health overall budget has shrunk by about $1.6 billion because of the sequester, and Nahta, an assistant professor of pharmacology, hematology and oncology at the Atlanta school, says she doesn't know when, or if, there will be another check.

"At times, it's almost overwhelmingly stressful," she says. "It's difficult to plan ahead. I have to be really careful about using the money. ... There's a term 'high risk, high reward' research.' You want to make significant contributions and that takes risks. But you don't want to do that when you're not sure how much money you have."

Nahta and her five trainees have found ways to stretch their dollars, reusing certain chemicals, buying supplies in bulk and pooling resources with other labs at the university. She refuses to dwell on any possible hardships. "I don't want to stir fear in people. .... I'm trying to stay optimistic," she says. "That's what my lab picks up."

Still, she can't hide her frustration. "I'm concerned," she says, "our scientific programs will be undermined and that will set us back as a country," delaying important discoveries.

Nahta, a breast cancer researcher since 1995, has been receiving NIH grants for the past seven years. She studies how drug resistance develops in breast cancer cells, work she says is critical for developing medicines to combat the disease.

She's continuing to work hard while looking for alternative sources of public and private funding and wondering about the next check.

"It puts that extra bit of fear and drive and uncertainty into everything," she says.

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For years, Melvin Lewis was the ideal candidate for the Meals on Wheels program that faithfully rolled up to his door in Maine twice a week. A cancer survivor and diabetic, he scraped by on a tight budget and had difficulty getting around.

Lewis dropped the program for several months when he moved into a nursing home, but after his health improved this spring, he settled into his own efficiency apartment. The 79-year-old widower then reapplied — only to discover it wasn't that simple.

Spectrum Generations, the social service agency that serves the elderly, disabled adults and their families in six central Maine counties, has been trying to absorb a $70,000 loss in federal aid even as it faces increased demands for help. For the first time in its 40-year history, agency officials say, there's a waiting list for its Meals on Wheels program. Lewis is among about 110 names.

"The stories of people waiting are horrendous," says Lynda Johnson, one of the agency's nutrition coordinators. "There are people who have terminal cancer, people in wheelchairs or with dementia. It's been horrible. It's hard to say, 'No, I cannot help you at this time.'"

Some private citizens have agreed to subsidize meals for someone in need until the new budget year begins. "Good deeds do arise out of the mess," Johnson says.

Delivery has been reduced from twice to once a week to save money, and this new austerity has been explained to recipients, says Debra Silva, the agency's vice president of public education.

"They understand — somewhat," Silva says. "They've heard the word sequester. They know there are cuts. They hope they'll go away. Some have written letters and made calls. ... That's impressive because this is a population that doesn't like to make waves."

Lewis, a former textile mill worker, says he has little left after paying rent and buying about $150 in groceries each month, though his daughter often helps out. "It's very hard to live this way," he says. "I'm almost 80. I have a few good years left and I'd like to live them in comfort."

He sometimes visits a church-run food kitchen but it's two miles away and he uses a walker, so he can't make the trip without a ride. He also stocks up at a food pantry once a month. "I can cook. Don't get me wrong," he says. "But sometimes it's hard for me to plan a good meal" — because ingredients are too costly.

Lewis says he's been told why there's less money available: "Government, politics — I just don't understand it half the time."

He's also been told it may take time before he gets back in the program. He's trying to be patient.

"If they say no, then no is the answer," he says. "I guess I just have to accept it."

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Sequestration has meant longer drives and other inconvenience for many Medicare patients seeking treatment, because local clinics can no longer afford to provide the care.

"It's a little like we're the frog in the hot water, you know?" says Dr. Barbara McAneny, head of the New Mexico Cancer Center in Albuquerque, repeating the old story of the heat being turned up gradually until "you have a boiled, dead frog."

McAneny says her practice has had to turn away at least 10 patients in order to keep its clinic in Gallup — which serves mainly poor Navajo patients — afloat. She is paying financial counselors and pharmacy technicians to find free drugs and copay assistance to avoid having to drop any more clients.

Never lucrative, margins for cancer treatment have gotten progressively slimmer in recent years, McAneny says. She says the 2 percent cut for Medicare under sequestration was "just one more kick in the teeth for community oncology practices."

"We're just getting eroded away," she said during a recent day at the Gallup facility.

McAneny says she recently had to tell a patient from the mountain community of Ruidoso that she couldn't take her on. A hospital in Roswell — more than two and a half hours east — couldn't take her, so McAneny suggested the University of New Mexico in Albuquerque, about three hours to the north.

"We would lose $1,500 a dose, and I just can't do that," McAneny says with a sigh.

She says the woman hung up on her.

"It hurts to have patients get mad at you, and it hurts to have to send them to someone else," she says. "I don't blame them. I'd be angry, too."

Across the country, doctors at the Charleston (S.C.) Cancer Center began informing patients early this spring they would need to seek treatment elsewhere.

For Gene Smith, who receives infusions of five drugs to fight metastatic colon cancer, the switch means the 66-year-old Vietnam veteran will lose a full day of work every two weeks for the next year — or as long as his treatment lasts.

"I'm a little bit more fortunate than most people," says Smith, noting that he has military insurance.

A bill pending in Congress would reverse the cuts for cancer treatment by exempting chemotherapy drugs from the sequester. But Smith questions the political will to fix things.

"Well," he says, "the story is: You want it messed up, put the government in charge."

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Jay Jesse believes there's fat in the defense budget, but this is not the way to trim it.

He had to lay off about 50 workers this spring when his Colorado company, a military information technology contractor, didn't receive an expected $20 million from the Air Force. The reason, he says, was the sequester.

"It's certainly not fatal, but it's a big blow," says Jesse, president and CEO of Intelligent Software Solutions, Inc. The loss amounts to about 10 percent of annual revenues for the Colorado Springs-based company whose primary customer is the Department of Defense.

The $20 million was part of a larger contract to build a system that will allow the military and intelligence agencies to better share terrorism or threat information, which he says is especially relevant after the Boston Marathon bombing. Questions were raised then about whether authorities had shared with Boston officials warnings from Russia about one of the suspects.

As of now, Jesse says he doesn't know if the project will proceed.

"I'm not one of those people who say the world will come to an end if we don't get our money," Jesse says. "But the better we share our information, the less likely something will slip through the cracks."

The layoffs — less than 10 percent of the company's payroll — were the first for the company in six years.

"These were very good people and we hated to see that we could no longer support them," he says. "You have the feeling you're not living up to your end of the commitment."

Jesse says he thinks it's possible to cut as much as 15 percent of the defense budget without doing any harm.

"The problem is sequestration just hacks with an axe indiscriminately," he says. "I couldn't randomly cut 10 percent of my budget without killing my company. I do think this is a dangerous activity."

The consequences, Jesse says, may not be known for years.

"Uncertainty is the word I've heard a million times in the last year," he adds. "This isn't uncertainty inflicted upon us by an enemy. This is an uncertainty we built ourselves."

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Sharon Cohen is a Chicago-based national writer. She can be reached at scohen@ap.org. Allen G. Breed is a Raleigh, N.C.-based national writer.

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