>> The following program is a PBS Wisconsin original
production. >> Wisconsin is reporting
that our first cases of measles in 2025 were
confirmed over the weekend. >> State health officials
encourage vaccinations as measles hit Wisconsin and in
Rx Uncovered. Health benefit advocates help patients get
the medicine they need. I'm Frederica Freyberg. Tonight
on "Here& Now" the latest economic outlook forest
land, wildfires, the rise of measles and part five of our
series Rx Uncovered. It's "Here& Now" for August 8th.
[MUSIC] >> Funding for "Here& Now"
is provided by the Focus Fund for Journalism and
friends of PBS Wisconsin. >> A whole new spate of
tariffs went into effect this week. Job numbers were
weaker than expected this summer, and business
analysts say consumers are tightening their belts. How
do economic trends nationally translate to how
Wisconsin is faring now and going forward? We asked
Steven Deller, UW-Madison professor of agricultural
and applied economics, and thanks for being here.
>> Thank you. >> So when you look at the
broad economic landscape, what are you seeing.
>> From a Wisconsin perspective? And I think
this is kind of generally true across the country is a
lot of businesses have gone into a wait and see mode.
That's why the job numbers are weak. We're not seeing
an increase in unemployment rates. We're seeing a
decline in the number of hires, primarily because
businesses are unsure what's happening. And when we're
unsure, we kind of go into a lockdown mode. We go into a
holding pattern, if you will. So I think that's why
the job numbers are as weak as they are, and it's going
to take a while for this to kind of play out.
>> And so this is this mostly around tariffs or
interest rates or inflation or all of it.
>> I think it's all of it. I think the major concern is
that we're not sure exactly what the policies are going
to be. The tariffs are on. The tariffs are off. They're
back on again. They're off again. And it's that
uncertainty businesses I mean there's kind of we know
what we know. We know what we don't know. We can make
educated guesses. And then what's going on. That's
uncertainty. And when we're in a situation like that,
that's when people just hunker down. They go into
wait and see mode. And, you know, in terms of like
consumers, it is kind of anticipatory shopping. It is
kind of like, okay, now let's go into a wait and see
mode. And it's just we don't know what's happening.
>> So you said that the trends kind of are the same
nationally and in Wisconsin. But is there anything
specific to Wisconsin that we should be watching. For?
>> Wisconsin? Our highs, our growth periods are not as
strong as the national averages. Our lows are not
as weak as the national averages. So Wisconsin is
kind of steady, if you will. You have to go back to the
farm crisis of the early 1980s, before Wisconsin kind
of broke that trend. So I think Wisconsin's going to
be kind of in a stable mode for a little while.
>> And yet are the things that make Wisconsin more or
less vulnerable to a downturn?
>> Not necessarily. One of the reasons is because our
economy is pretty diversified. We don't we're
not heavily dependent upon one particular industry. I
mean, you can point to some of the big ones, like
agriculture, food recreation. So there's some
industries that maybe might be susceptible. But in
general, Wisconsin's a pretty diversified economy.
>> So all of this said, are you seeing indications of a
slowdown nationally and in Wisconsin?
>> Yes. And I think that's what the job numbers are
saying. And in talking with businesses around the state,
and again, I tend to talk to the smaller businesses,
which tends to dominate most of Wisconsin. They're just
in a again, a wait and see mode. They're they're
delaying expansion plans. They're not going into
shutdown mode. And one of the reasons they're not
going into shutdown mode is because they have such a
difficult time hiring labor. Wisconsin has been facing a
structural labor shortage for years, long before
Covid, and particularly coming out of Covid and
businesses. Remember that difficulty of hiring people,
so they're really hesitant to lay people off because
they don't want to go through that again. So
again, they're in that wait and see mode.
>> And so you're looking at kind of a business activity
as a bellwether. Are there others?
>> Yes. One is consumer expenditures. One of the
things is we saw an increase in consumer expenditure
after the announcement of the tariffs. And the reason
for that is people were thinking, oh, I'll buy it
now. I'll buy it before the tariffs hit. So there was
kind of a spike in spending from consumers. Well that
kind of spike has you know those purchases have played
out now. And now they're going into a wait and see
mode. So I think if we start to see consumer expenditures
slow down much more than they already have, then
that's a warning sign. The other thing is we're seeing
the housing market start to slow down, and there's other
factors going on there. But again, I think it's that
reflection of just I'm going to delay making any major
purchases because I'm not sure what's going to happen.
>> All right. We leave it there. Steven Deller thanks
very much. >> Thank you.
wildfires is a regular feature these days in
Wisconsin. According to current maps, there are 700
active wildfires in Canada, most of them categorized as
out of control. What's the risk of wildfires or forest
fires in Wisconsin? And could cuts in federal
funding of the U.S. Forest Service? If forest
management in Wisconsin, we're joined now by James
Barnier forest fire protection section chief for
the Division of Forestry. And thanks very much for
being here. >> Thank you.
>> So I know that the Wisconsin DNR also has these
fire management dashboards online. How has this year
compared historically for wildfires in Wisconsin?
>> This year is fairly unique. It was one of our
more uncommon types of events. We've had. As you
might remember, a drier than normal winter. We saw a
significant number of fires in January and February,
which we traditionally don't see. So those fires cause a
lot of great a lot of work on our staff to be prepared,
be ready. Typically, when we're trying to get ready
for our typical spring season, which is March,
April and May. And so that really took a toll on our
staff overall from that working those two months
earlier. Traditionally, we see snowfall during that
time frame. >> Right.
>> So what are conditions like right now for fires in
Wisconsin? >> Well, to be honest, we're
just starting to get back into some drought
conditions. We're starting to staff up again and just
prepare for fires for the summer months.
>> When a fire breaks out. What kind of fuels it
spread? >> Well, most of our fires
are caused by people, and typically in the state of
Wisconsin, most of our fires are wind driven, usually
with low RH and higher temperatures, but mostly
with wind. And low RH is what we see drives most of
our fires. And that usually that light fuels that grass
type fuels that would spread really fast. And then once
that gets ignited, the fire gets a lot bigger. There's
called ladder fuels. Those ladder fuels get you know,
get into the tops of the trees. And then when you see
those really significant type of crown fires.
>> So you have told us that it is not likely that
Wisconsin would ever see fires like those in in
Canada. Why not? >> Why wouldn't say we
wouldn't see types of fires of that magnitude of 250,000
acres. We probably wouldn't see that size of fires. But
we do see a lot of significant what I would
say, catastrophic for the state of Wisconsin. Anything
between, you know, 3000 to, you know, 15,000 acres,
those types of fires in the are common. You know, every
so often in the state of Wisconsin and have
significant impacts across the state.
>> A number of DNR firefighters have been in
Canada. Tell me about that. >> So we've sent up 20
people to both Ontario, and Manitoba. And during that
time frame in, they're actually fighting fires and
working within that organization on their IMT
incident management teams to help facilitate that. So
doing so, it is a significant event.
>> How much forest land does Wisconsin have and who's
responsible for its management, fire prevention
and firefighting. >> Just in general, there's
about 57% of the forested lands is privately owned and
about another 10% industry owned. And the rest is
government entities. And so we provide Wisconsin DNR,
provide support with those landowners through, you
know, sound forest management practices to
provide some management plans for them or through,
you know, industry working through industry foresters
and ensuring that we have a good, solid forest, healthy
forest to help limit those large scale fires.
>> So we know that state officials have concern about
federal cuts to states from the U.S. Forest Service.
What role do the feds play in wildfire management?
>> They provide us a lot of funding sources. So, yes,
roughly a little over $2 million to support
perspectives associated with wildfire preparedness. And
that where would that money go? Well, we work heavily
with our partners, local fire departments. Our one of
our key components within the state of Wisconsin. And
we provide grants to those to help facilitate responses
to those fires. Also for our needs, for our training
responsibilities, our tools, our resources, and even some
of our funding of our positions.
>> James Barnier, thanks very much for joining us.
>> Thank you. >> Measles was declared
eliminated in the U.S. 25 years ago, but this year
marks the most cases since then, with spread of the
disease to 40 states and more than 1300 cases.
Earlier this month, Wisconsin reported nine
cases in Oconto County. But health officials say they
believe any spread there is contained. Still, Wisconsin
kindergartners have one of the nation's lowest
vaccination rates against measles, with less than 85%
of them up to date on the measles vaccine. Last year.
That's compared to about 92.5% of kindergartners
nationwide, according to the CDC. We turn to Doctor James
Conway, pediatric infectious disease specialist at the UW
School of Medicine and Public Health. And thanks
for being here. >> Happy to be back.
>> So with Wisconsin vaccination rates, how at
risk are we for measles outbreaks?
a sitting duck. You know, as we see people traveling and
introducing the disease into various areas, all it takes
is one person who's incubating the disease to
show up in an area with under-immunized populations.
In a way, it goes. That's really how these things get
started. >> Are you surprised that we
haven't seen that kind of outbreak?
surprising given our low rates and how much travel
people have been doing as we've come out of Covid and
gotten back to more normal activity. You know, we know
that disease gets introduced fairly regularly. You know,
while many of them are related to the Texas
outbreak, we still see cases countries. And so all it
takes is one person showing up in the right place at the
right time. >> Now, I understand that
Wisconsin is one of only 13 states that has a personal
conviction waiver for parents to opt out of the
vaccine. Is that opt out on the rise?
>> Yeah, it's been debated. You know, there are medical
waivers in every state, and some states also have
religious waivers. But this personal exemption waiver is
something that's a little unusual. And it really
allows people that just have a deep held personal
conviction to opt out of it. Some states are discussing
actually allowing more of that while other states are
shutting it down and actually trying to contain
that activity. >> So what's it like for a
doctor like yourself to see a preventable disease like
this spreading? >> Yeah. It's heartbreaking.
I mean, I saw plenty of measles earlier in my
career, both in my training here in the United States
and in my work globally. And, you know, as we worked
so hard to eradicate polio when I was younger, measles
was really the next one on the chopping block. And in
the 90s, we were very optimistic. We were getting
closer. You know, I've seen so many children suffer with
this disease. Adults don't do well with it either. And
then having to see people unfortunately subjected to
this again, you know, it's really both preventable. And
just so unfortunate. >> How transmissible are
measles? >> Measles is probably one
of the most transmissible things on the planet. You
know, we talk about the fact that you probably need about
95% of people to be vaccinated in any community
to keep an outbreak from spreading. And so when we're
sitting well below 90%, you know, it's really almost
something that is inevitable. But it is by far
one of the most contagious things on this planet at
this point. kind of the symptoms of, of
measles, but it can be fatal.
1 to 2 people per thousand are going to be killed by
this. Probably 10% get hospitalized. So it is, you
know, really a very high risk disease, especially in
young kids, the elderly, people with compromised
immune systems. But even people that survive it. I
mean, it's a miserable disease.
>> And there are certain groups that cannot get a
vaccine. And any spread would put those people at
risk who who really does not get the vaccine.
>> Yeah. So this is one of the few vaccines that's
still considered a live viral vaccine. So these are
viruses that have been essentially engineered to be
less transmissible, but they still can cause some
symptoms in people that don't have a good immune
system. So people that have had bone marrow or other
organ transplants shouldn't be getting these vaccines.
Patients that are under chemotherapy for other types
of cancers, people that are on immune compromising
drugs, they just can't get the vaccines. And so they
really do depend on the rest of us to essentially build a
firewall for them. >> Now, I learned that in
Milwaukee, the vaccination 75%. They are now giving out
800 doses of this vaccine. But how at risk is a place
like Milwaukee? >> Yeah, so that's exactly
the worst nightmare. Because, you know, one of
the things we need to remember about measles is
people are contagious before they have symptoms. So 3 or
4 days before you're actually ill with obvious
shedding that virus. And so when you've got even 75 or
80% of people immunized, that means 1 in 5 people are
vulnerable. Those get transmitted. It's got a long
incubation period. So people can be walking around for
weeks, not remember where they got it. And so from a
public health standpoint, chasing down where it
started and getting people into quarantine and
isolation is really a nightmare.
>> All right. Well, Doctor James Conway, thanks very
much. >> Thanks for having me.
>> On health care. We continue our coverage on
prescription drugs. Over the last month, Rx Uncovered has
looked at why patient costs for drugs are going up and
coverage for drugs is going down. In our final story,
patients are not alone as they try to afford their
specialty drugs and navigate complex health insurance
policies. Here and now, producer Marissa Wojcik
speaks with advocates helping patients understand
their health plans and challenge claim denials.
>> How far are they away from bankruptcy?
>> They pretty much billed me $83,000 per infusion.
>> They are as far away as a chronic diagnosis.
>> The right medication can be expensive, but critical
for chronic illness patients. Advocates like
Nilsa Cruz know this all too well.
>> The reason why I became a patient advocate is it was
actually baptism by fire. >> When she started as
administrator for the Milwaukee Rheumatology
Center, more than 20 years ago, she also became the
clinic's de facto patient advocate.
>> Patients coming back or calling back because their
medication is not covered, perhaps they cannot afford
the out-of-pocket expense. After going through a very
tedious process of a prior authorization, only to come
and find out that it's unaffordable, delays and
denials. Some patients suffering, too. Because the
patients really don't understand what's going on
with their benefits. >> Today, she's known and
even sought out for her ability to help patients
navigate complex health benefits.
>> I come to this clinic because of their patient
advocate. >> Janelle Zeihen came to
Cruz when her last clinic didn't know how to help her
navigate her health plan benefits. So she came to
this rheumatology clinic for her Crohn's, a type of
inflammatory bowel disease. >> It starts with like a
like somebody sucker punching me right up into my
chest. And then. And that's pretty much the inflammation
starting. >> Crohn's disease can be
debilitating and life threatening, especially when
not treated. >> It is extremely painful.
I can barely walk when it happens. Being on the
entyvio that I get, it's been life changing.
>> When she got a new job, her entyvio was no longer
covered under her new plan. >> They specifically carved
out all tier four drugs, which are chemo's HIV drugs
and any infusions. >> Tier four drugs are also
referred to as specialty drugs.
>> When you have a complex condition, what you get
slapped with is this penalty called specialty drug
because a pharmacist might have to monitor or look at
something more closely, which they should be doing
for every drug anyway. >> Ann Lewandowski also
knows how difficult but essential it is finding the
right medication. >> Accessing it because of
insurance barriers and other issues can also be as much
or more challenging. >> She has her own
experience with autoimmune disorders and healthcare.
>> You're really in survival mode and you're just trying
to figure out, like, do I go to work and make money? Or
do I deal with this disease? >> Part of her expertise.
>> I am also a patient. >> Comes from being a
patient, and she uses that knowledge to help others
better understand these complex systems.
>> We have these market distortions, right? We have,
depending on what your diagnosis is, who your
insurance company is to patients walking in with
even the same diagnosis are going to be charged
completely different prices. And I think that's really
problematic. >> I've seen plan documents
where they're limiting, you know, drug expenditure, like
anything over 100,000 is out. I've seen plan
documents where cancer drugs are not covered, where none
of none of the rheumatology drugs are covered.
>> Often patients that can't afford an expensive drug
qualify for patient assistance programs through
the pharmaceutical company. But these programs are
usually for people with little to no health
coverage. >> I am insured at $400
premium cost. >> Janelle was covered by
her employer's self-funded health plan, even though
it's specifically carved out her medication, leaving her
to cover the cost. >> Big time pharma is
starting to say no, it's not happening. Companies are
saying these funds are patients who are literally
uninsured. Pharma will deny that free drug for the
patient because benefits have been carved out and
made non-essential by the plan. And you're literally
functionally uninsured. >> Having coverage, at least
on paper, disqualified her for patient financial
assistance. Why some drugs are covered by some health
plans and not others is an opaque and complex system.
>> The pricing structure in this country when it comes
to pricing these drugs and reimbursement, and what
actual costs are, is so messed up. It's so messed
up. >> These carve outs to not
cover expensive drugs are becoming more common among
self-funded health plans like Janelle's, which are
governed by different laws than fully insured health
plans. >> We know health insurance
can be complicated and confusing.
>> Secretary Nathan Houdek oversees the office of the
Commissioner of Insurance. >> And what makes it even
more confusing for people is that health insurance is
really regulated by a number of different agencies at
both the federal and state levels.
>> This state agency regulates fully insured
health plans. If a patient wants to challenge an
insurance denial, they come here.
don't understand if they have employer sponsored
coverage is whether that's fully insured coverage or
whether that is self-funded coverage.
>> Self-funded coverage is regulated by federal law,
but you can still start with this office.
>> If someone has health insurance coverage through a
self-funded plan, then we will kind of hand them off
to we like to refer to as kind of a warm handoff to
the Department of Labor, because it's the federal
Department of Labor that actually regulates
self-funded plans. >> Because of this, no
matter what kind of plan, Secretary Houdek recommends
reaching out. >> Unfortunately, studies
have shown that of all the coverage and claim denials,
only a small percentage are appealed. And that's really
because people don't know what their rights are.
People don't know that there is a place where they can
turn to answer questions, to be a resource, and our
office is here to help with that.
>> Fully insured versus self-funded plans. Health
experts say they both have their own issues. The rules
are just different. >> I have a lot of empathy
for employers, right? I mean, if you are a
manufacturer here in Wisconsin. You're making
cheese. You're making steel parts, whatever. Making
yachts. It really doesn't matter. You are not a health
care expert. >> For Janelle, her case was
even more complicated than most. But Cruz was with her
every step of the way. >> First of the year go
through. conversation, Janelle, you
literally told me I'm just settle on not getting my
treatment this year. >> She helped Janelle file a
complaint with the US Department of Labor.
>> Please keep in mind that for any given patient to
file a complaint with the Department of Labor takes
guts because you're now dealing with filing a
complaint against your employer. And the fear of
getting fired, even though it's totally illegal.
>> It does make it hard to go into work, because I also
don't know if I'm going to be walking into work and
being walked out because of this. And for retaliation or
whatnot. >> There are still these
very gray questions of law that honestly make me a
little scared to be a patient and speak up and
encourage people to exercise their legal rights, which
are to speak to their employer and say, hey, this
is a wrong denial. >> During open enrollment,
Janelle decided not to use her employer's health plan,
opting to find a fully insured one on the
marketplace. my employer, I would be
right back to where I would start and that would be just
that's not even an option. >> She pays more in
premiums, but her medication is covered without the help
of advocates. Many patients are left deciding between
their medication or their savings.
>> Can patients do this themselves? Probably not,
because the statistics have shown that very few patients
will take it to the next level. It's too cumbersome.
If you look at denial letters, the steps are in
there and it's Yvonne cumbersome for me. However,
having said that, I'm constantly looking for ways
to make it easier for my patients to appeal.
>> For her patients. Cruz goes all in to help them
find relief. >> Thanks for everything.
>> Relief from the physical pain of a chronic illness
and relief from the financial pain of treating
it. Reporting from Milwaukee. I'm Marissa
Wojcik for "Here& Now". >> For more on this and
other issues facing Wisconsin, visit our website
at PBS Wisconsin. Org and then click on the news tab.
That's our program for tonight. I'm Frederica
Freyberg. Have a good weekend.
[MUSIC]
>> Funding for "Here& Now" is provided by the Focus
Fund for Journalism and