>> The following program is a PBS Wisconsin original
production. >> House Republicans passed
their budget blueprint, but the fate of Medicaid potentially
hangs in the balance. [MUSIC]
I'm Frederica Freyberg tonight on here. And now we check in
with members of the Wisconsin delegation in Washington on
taking a chainsaw to federal spending. Michael Osterholm has
the latest on the spread of bird flu and reimagining dementia
care. It's "Here& Now" for February 28th.
>> Funding for Here and Now is provided by the Focus Fund for
Journalism and Friends of PBS Wisconsin.
>> Lots happening out of Washington between Elon Musk's
cost cutting moves, eliminating positions and taking aim at
whole agencies. And Republican budget provisions that extend
tax cuts while at the same time looking for massive spending
reductions to offset them. We talked earlier with Wisconsin
Democratic U.S. Senator Tammy Baldwin and Republican U.S.
Representative Brian Steil. Thanks very much for being here.
>> Thanks for having me, I appreciate it.
>> So just to lay this out, the House Republican budget
resolution calls for $4.5 trillion in tax cuts, while at
the same time offsetting that with what could be more than
$800 billion in cuts to Medicaid and food programs. The Senate
version, as you know, spends on border security in the military
with these tax cuts to come. What is your reaction to these
proposals? >> Well, I was watching closely
as the House deliberated on the budget. At first it didn't look
like they had the votes, even within the Republican ranks to
get it passed. It did pass. And these cuts are primarily
targeting Medicaid. Are draconian. And I can tell you
that my phones have been ringing off the hook with people very
concerned about the impact it would have. Nationwide, over 72
million people rely on Medicaid in some fashion. People who are
in long term care are seniors. Oftentimes have Medicaid as the
primary payer for their care. A third of all children are on
Medicaid. Many pregnancies and deliveries are funded through
Medicaid, and people with disabilities disproportionately
in their adult lives rely on Medicaid. And the calls were
getting, for example, Renee from Milwaukee, who has stage four
metastatic breast cancer, is terrified about the possibility
of losing Medicaid, which pays for her treatments right now.
Without it, she and her husband would either face, face,
bankruptcy or a death much earlier than otherwise. If she
could continue her her Medicaid. This is devastating. The idea
that Elon Musk and his billionaire friends, Donald
Trump and others are trying to fund their tax breaks by taking
away your health care is just outrageous. And we've got to
organize and stand up against it.
>> And yet, Republicans say that what you're talking about is
simply fear mongering, that the word Medicaid appears nowhere in
this Republican House resolutio. >> You know what the budget
resolution directs various committees of the House to find
these deep cuts, and the committees that they have
directed to find these deep cuts are the ones with jurisdiction
over Medicaid. And jurisdiction over these nutrition programs.
For example, low income children. So they may run from
taking responsibility for their actions. But it is very clear
that they cannot achieve the type of deep cuts that they're
talking about to fund tax breaks for the top 5% of Americans.
They can't hide from the fact that Medicaid is the biggest
target. >> They also speak to waste,
fraud and abuse at significant levels in Medicaid. What about
that? >> So I am absolutely for
rooting out waste, fraud and abuse. And I think I speak for
all of my Democratic colleagues and certainly all my Republican
colleagues. This is something that we are unified on. If
President Trump was serious about rooting out fraud, waste
and abuse, he would not have fired 17 inspector generals
whose job it is to root out fraud, waste and abuse. These
inspector generals are non nonpartisan, impartial overseers
of agencies that spend people's taxpayer dollars. But yet
President Trump fired without cause the very people whose job
it is to do that. Now we have this new so-called Department of
Government efficiency, which is not a department of government.
It hasn't been set up by Congress. It hasn't been
empowered by Congress. It's headed by the richest man on
earth, Elon Musk, who is not a government employee, has not
been confirmed by the Senate, who has not run for office. And
won. And they aren't looking at efficiency, waste or abuse. They
are just taking a sledgehammer to these agencies.
>> Because with budget reconciliation, allowing
Republicans to pass their budget without the support of
Democrats. What can your side of the aisle do about the budget or
the chainsaw being taken to government operations?
>> Well, I'm going to focus particularly on the latter. We
have to remember our, our US Constitution. Congress makes the
laws and it is the administration that is to
implement and administer those laws. And while reconciliation
and the budget can pass on a simple majority vote in the
Senate, all other legislation requires bipartisan majorities.
And so we have already passed a set of laws that are being
defied by Doge, by Elon Musk, and by the Trump administration.
Some of that's going to be fought out in court. I'm kind of
thinking of the three CS as how we fight back. The courts, the
Congress and our constituents. That is how we are going to hold
folks to account. We still have a Constitution. We still have
laws that have been passed by this Congress and the previous
Congresses, and they need to be fully and faithfully implemented
by this administration. And if not, we need to stand up and
fight for the people of this country and Wisconsin.
>> Senator Tammy Baldwin, thanks very much.
>> Thank you. >> As we mentioned, the U.S.
House passed a budget resolution that seeks major tax and
spending cuts. The spending cuts are already underway at the
hands of Elon Musk and his Department of Government
Efficiency. We asked first Congressional District
Republican U.S. Representative Brian Steil for his take. And
thanks very much for being here. >> Thanks for having me on.
>> So you voted in favor of the House budget resolution
extending tax cuts and raising the debt limit by $4 trillion,
paired with potential cuts to Medicaid. Does this resolution
envision cutting Medicaid by more than $800 billion?
>> Following four years of reckless spending in the Biden
administration? This is our opportunity to get spending
under control in Washington. Frustratingly, there's a lot of
misinformation out there. The budget resolution that passed
last night actually has the word Medicaid in it zero times. What
this is really an opportunity to do is get broader spending under
control and make sure that we're being good stewards of taxpayer
dollars. In addition, we have an opportunity to make sure that
we're extending the tax cuts that really grew the economy, in
particular, as we came into the Covid pandemic. So this is about
rightsizing Washington, D.C, controlling spending and making
sure that we're protecting those tax reforms that are really
generating the economic growth we saw during the Trump
administration's first term. >> And so, are you suggesting
that the Democrats who are decrying cuts to Medicaid to the
tune of more than $800 billion, are just about talking points on
this? >> Well, there's a lot of fear
mongering that shouldn't be lost on anyone in Medicaid. What we
have a real opportunity to do is to help people and lift them out
of the need for the program. What do I mean by that? Instead
of measuring simply by the inputs, how much money are we
spending on some of our welfare programs? What we need to be
focused in on is how do we help individuals get good or better
paying jobs such that they're able to be self-sustainable? If
we're successful in doing that, what we'll do is two things.
We'll help the individual who is currently finding themselves on
government support, but also be in a position to reduce the
burden on the federal government.
g that you would oppose significant cuts to
Medicaid? >> There are opportunities to
make sure that the programs are there for the least amongst us.
People that fall on hard times for children in our country. I
would oppose cuts in those areas, but I do think there's
reasonable reforms that we can make sure individuals in
particular individuals who are childless, able bodied adults,
both have skin in the game. We help lift them up such that
they're self-sustainable and not dependent on government
programs. >> As to this budget blueprint,
former Wisconsin Congressman Reid Ribble, Republican, said
this. He said math is hard. He said to get to a balanced
budget, as Trump promised in his campaign would require tax
revenue to be equal to spending. You cannot extend 4.5 trillion
in tax cuts, while only cutting about 1.5 trillion in spending.
How do you reconcile that gap that he speaks to.
>> The budget situation in Washington, D.C. Decades has
been wildly out of control. Washington has spent way beyond
its means for a long time. The spending process in Washington,
D.C, is completely broken and needs to be absolutely
rewritten. That said, we need to take steps forward. And so, no,
the budget resolution that moves forward doesn't solve the
problem in one day. It is not a silver bullet. And
unfortunately, the problem in Washington, D.C. Is so
significant, no single action will probably solve it
unilaterally. But that doesn't mean we shouldn't take a step in
the right direction. And so the step that this is taking is
making sure that we're growing the economy so individuals can
get good and better paying jobs. And at the same time, begin the
process of truly reining in reckless government spending.
That really brought forth the inflation that we saw during the
Biden administration. >> Why raise the debt limit with
so many concerns around the deb. >> So the debt limit is a really
important issue. And what happens to the impact? What
happens to the borrowing rate for the federal government if
the debt ceiling was actually triggered, if the debt limit was
actually triggered, would be a higher borrowing cost in the
long run, what that will do is actually cost the federal
government more. So instead of going out and getting loans at
3.5%, federal government might find themselves at double that
rate. We're already paying roughly $1 trillion a year for
interest payments on the debt alone. To double that would be
draconian. And so, unfortunately, the federal
government is in the situation it's in due to decades of
reckless spending in Washington. But it would be economically a
disaster and a disaster for a lot of workers if we were in a
position where the federal government actually tripped over
the debt ceiling. >> What kind of response have
you gotten from your constituents?
>> The biggest challenge that I hear from people across the
district is people find it very difficult to get true, factual
information about what's going on in Washington, D.C. Without
bias and hyperbole. And so one of the things that I do through
my listening sessions and other means is go and speak to folks
about what is actually taking place in Washington and have an
adult conversation about the challenges we face about the gap
between the massive amount of spending that we have and how we
bring down the debt and deficit and have that adult
conversation. I think there's a broad frustration, society wide,
about how people obtain good factual information. In many
ways. That's why your program and programs like it are so
important. e the moves on
the part of the Trump administration and congressional
Republicans helping Wisconsinites?
>> I think we've seen a lot of progress very quickly with the
Trump administration. I think the number one thing that I
would commend the president on doing is securing the US Mexico
border right out of the gate. We reinstated stay in Mexico,
restarted border wall construction, ended abuse of the
parole system and stopped catch and release. The impact of that
has been a dramatic decrease on illegal immigration into the
United States. That has a big impact in the state of
Wisconsin, in particular, as it relates to either human
trafficking, but in particular the flow of illegal drugs, in
particular fentanyl, fentanyl, just in, for example, in Kenosha
County alone killed over 50 people last year in statewide
has killed hundreds. And so the president's action to secure the
border has been very positive. And the work now to get spending
under control in Washington, while we've made some
incremental progress, we have a lot of work to get done to
ultimately, at the end of the day, the goal of reducing the
cost of living so Americans can afford what they need.
>> We leave it there. Congressman Bryan Steil, thanks
very much. >> Thank you.
>> What do we know about the spread of bird flu in Wisconsin?
The avian virus has hit commercial poultry flocks in
Kenosha and Barron counties, where one worker also contracted
it. It's been confirmed in wild bird populations across the
state this winter, and it's suspected to have killed 90
mallard ducks on a pond in Outagamie County. Just this
week. Confirmation of that outbreak awaits test results. We
turn to Doctor Michael Osterholm, epidemiologist at the
University of Minnesota Center for Infectious Disease Research
and Policy, and thanks very much for being here.
>> Thank you. >> So what is the status of bird
flu in this region? And are we holding it at bay?
>> Well, first of all, one has to understand that the natural
reservoir or the location where this virus exists is actually
largely in waterfowl and waterfowl across the North
American continent are just about everywhere. There's over
40 million of these birds. And when they get infected,
sometimes they die, but oftentimes they won't. And
they're able to spread the virus in many locations at one time.
So we're seeing activity right now, not just in the upper
Midwest, but throughout much of the country. And it's when these
birds then have contact with other animal species, or for
example, in a waterfowl that may die, is consumed by another
animal species, they get infected. And what we've also
seen, of course, is when the poultry world where and we do
have an abundance of poultry, both chickens and turkeys, as
well as egg laying chickens in the upper Midwest. The final
area, of course, that we're so concerned about in Wisconsin has
every reason to be concerned is the issue of dairy cattle. We
saw a little over a year ago the spillover of this virus from
birds to dairy cattle. And the fact that the virus now can
replicate very well in the udder of the cow, something we did not
know until this past year. And so we've seen large outbreaks
throughout the country, primarily in the western states,
California being the really major location where we continue
to see transmission between cattle, dairy cattle after once
they became infected with that bird spillover.
>> What's the expectation as to the, you know, widespread spread
of this and even into Wisconsin and its dairy cattle?
>> Well, first of all, this virus is around the world right
now. We have a major outbreak ongoing right now in Antarctica,
in which a number of the penguin populations are at great risk
from this virus, and many are dying. So it's everywhere. What
we really need to look at, though, down the road, is from a
human disease standpoint. What are the animals we're most
likely to have contact with that could bring the virus to us? And
that really remains largely from the poultry side of the house,
as well as the dairy cattle. So yes, we might have contact with
the wild animal that dies, but you can obviously do that safely
with wearing gloves, etc. But when we're having everyday
contact with the dairy cattle or with poultry, that makes it a
very different situation because there are people can get
infected. What we worry about is one day that the virus will
continue to mutate and change in such a way that then can start
to develop infection in our lungs. And that would be
potentially the first step towards a new influenza
pandemic. >> That's exactly what I was
going to ask you about. What you what your concerns are around a
pandemic. >> Well, you know, I used to say
in the earlier days of influenza and the potential for a pandemi,
that you always have to sleep with one eye open. Well, today I
sleep with both eyes open as it relates to influenza. I think
that we've never seen this magnitude of transmission around
the world. We've never seen the number of opportunities for this
virus to change genetically. Think about every time a new
H5n1 virus is hatched out of a cell. That's like another throw
at the genetic roulette table for a mutation.
>> Is the CDC and other federal agencies keeping pace with bird
flu at this time? >> Well, over the course of the
last month with the new administration, we have to
understand that, you know, there may be some downtime in terms of
responding as there would be with any change in
administration. But we're also concerned that we're seeing
these dramatic cuts that are occurring that are pretty
indiscriminate, more of a machete approach than a surgical
knife. And with that, they are taking people who are critical
to responding to this kind of activity and what they can do.
We're also seeing right now the potential impact on research
funding. The NIH may have to change how much money they
provide universities to support basic research, which, if that
were to happen, it would be really a major research disaster
in this country. Much of that research that we see today is
things like applied research on vaccines for influenza and
coronaviruses. So I am very concerned about that. And we
already were not spending nearly enough to be commensurate with
the risk of pandemic flu plays. But with the recent potential
cuts, it could really be a real a real challenge.
>> Not to be alarmist, but how worried should we be?
>> Well, as I say, often the pandemic clock is ticking. We
just don't know what time it is. And I think from that
perspective, you know, it could happen tomorrow, but it could be
5 or 10 years from now. We don't know. But it's one of those
ones. You don't want to wait to find out that you weren't
prepared when it happened. And so I think the immediacy of our
of our work to try to come up with better vaccines is really
very critical. >> All right. Doctor Michael
Osterholm, thanks very much. >> Thank you.
>> You can watch the extended interviews with Doctor Osterholm
as well as Senator Baldwin and Representative Steil on our
website. In other health news, nearly 7 million people in the
U.S. Are living with dementia. And experts say that number will
double by the year 2060. In Wisconsin, 130,000 people have
Alzheimer's, making up half of all nursing home residents. As
this population continues to grow, so does the strain on
caregivers. One group is looking to an alternative care model
creating a dementia village in Sheboygan. A local nonprofit
says this will be the first of its kind in the United States,
modeled after a world renowned village in the Netherlands. The
79 acre plot will contain on site care workers, more than 100
homes and have amenities like a grocery store, restaurant and
theater. For more, we turn to dementia Innovations co-founder
and board president Mary Pitsch. And Mary, thanks very much for
being here. >> Thank you for inviting me.
>> So describe for us what makes this planned village, which you
are calling Lévézou, different from a nursing home?
>> Yeah, it's different on so many levels. I think one of the
things to think about is nursing homes were really designed for
people with frail that are frail, elderly people. Not for
those with dementia. Our village is designed specifically for the
unique needs of the person with dementia.
>> And tell me what Lévézou means.
>> So lévézou is really a new word. This is a new concept of
care and support. And we brought the words together. Living as
usual, living as usual is one of the core concepts of the
village. And it really just means that living as usual,
allowing the person with dementia to open their front
door and walk outside, living in a home that they own. An
environment that is designed to meet their needs. Again, just
living as usual. >> Why is that better for
residents? I mean, it seems obvious, but what have you
learned? >> You know, I think as we age,
there's a feeling oftentimes that safety at all costs. Right?
That safety at all costs. And what is that cost? All of us
take risk every day. We drove we walked across the street. But as
we age, and especially as we age with dementia, we kind of lose
the person. Besides their dementia. And allowing them to
be able to live in an environment that has positive
risk acceptance, we know there's going to be some risk. We know
they can live as usual, allows them to not lose their
personhood, not become only defined by their dementia, but
really about still being a person even as they age with
dementia. >> What sparked this idea?
>> So there's a bit of a story to that. I'll make it as short
as I can, but there was a group of us that got together to work
on our way that we responded to dementia crisis in our
community. And we weren't doing a great job about that. So if
somebody was dementia, was having some behaviors, we would
send law enforcement. They're not criminals. So we changed the
way we respond, and now we have EMS respond. We've trained over
4000 caregivers and professionals on de-escalation
in place, but we knew we could do better. We knew that was
still a Band-Aid approach. And we said, how do we do? Better is
by starting to look at the beginning. And that's their
environment. How do we never have to get to that response in
the first place? So we created and designed this environment.
>> How costly will it be for people to live there?
>> So we are a nonprofit and we made that decision to be a
nonprofit so that we could really support all income levels
to be able to live at Lévézou. We are looking at fees to be
able to be right in line with traditional care settings, but
they get so much more. And then we'll also have levels of care
and support, which is different than traditional levels of care,
generally speaking, who are kind of A11 fee no matter if you need
it or not. And we're going to be able to give them choices. In
addition, we do plan to have an endowment that will continue to
support those who are not able to afford it.
>> So this is the first of its kind in the United States. Is it
your expectation that this will be a model for other places?
>> We sure hope so. Somebody has to be first. We often get asked
why aren't others doing it? And I really believe the answer is
because it's a lot of work. Every decision we are making is
a new decision, but somebody has to be first, and then we can
help make sure that that model, this movement of care and
support, a change in how we look at dementia, will move
throughout the country. >> Meiss Mary Pitsch, thanks
very much. >> Thank you.
>> For more on this and other issues facing Wisconsin, visit
our website at PBS Wisconsin. And you can watch shorts about
our reporting on the PBS Wisconsin YouTube and Facebook
pages. 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 Friends of PBS
Wisconsin.