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