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The following program is a PBS Wisconsin original production.

Frederica Freyberg:
House Republicans pass their budget blueprint, but the fate of Medicaid potentially hangs in the balance.
I’m Frederica Freyberg. Tonight on “Here & 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 28.

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Funding for “Here & Now” is provided by the Focus Fund for Journalism and Friends of PBS Wisconsin.

Frederica Freyberg:
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 Bryan Steil. Thanks very much for being here.

Tammy Baldwin:
Thanks for having me, I appreciate it.

Frederica Freyberg:
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?

Tammy Baldwin:
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 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, our 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 we’re 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 bankruptcy or a death much earlier than otherwise if she could continue 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.

Frederica Freyberg:
And yet, Republicans say that what you’re talking about is simply fear mongering, that the word Medicaid appears nowhere in this Republican House resolution.

Tammy Baldwin:
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.

Frederica Freyberg:
They also speak to waste, fraud and abuse at significant levels in Medicaid. What about that?

Tammy Baldwin:
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 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.

Frederica Freyberg:
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?

Tammy Baldwin:
Well, I’m going to focus particularly on the latter. We have to remember our U.S. 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.

Frederica Freyberg:
Senator Tammy Baldwin, thanks very much.

Tammy Baldwin:
Thank you.

Frederica Freyberg:
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 1st Congressional District Republican U.S. Representative Bryan Steil for his take and thanks very much for being here.

Bryan Steil:
Thanks for having me on.

Frederica Freyberg:
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?

Bryan Steil:
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.

Frederica Freyberg:
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?

Bryan Steil:
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.

Frederica Freyberg:
Are you saying that you would oppose significant cuts to Medicaid?

Bryan Steil:
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.

Frederica Freyberg:
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?

Bryan Steil:
The budget situation in Washington, D.C. for 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. 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.

Frederica Freyberg:
Why raise the debt limit with so many concerns around the debt?

Bryan Steil:
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.

Frederica Freyberg:
What kind of response have you gotten from your constituents?

Bryan Steil:
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.

Frederica Freyberg:
How do you see the moves on the part of the Trump administration and Congressional Republicans helping Wisconsinites?

Bryan Steil:
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 U.S.-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 and 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, have the goal of reducing the cost of living so Americans can afford what they need.

Frederica Freyberg:
We leave it there. Congressman Bryan Steil, thanks very much.

Bryan Steil:
Thank you.

Frederica Freyberg:
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 Dr. Michael Osterholm, epidemiologist at the University of Minnesota’s Center for Infectious Disease Research and Policy, and thanks very much for being here.

Michael Osterholm:
Thank you.

Frederica Freyberg:
So what is the status of bird flu in this region and are we holding it at bay?

Michael Osterholm:
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 in 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.

Frederica Freyberg:
What’s the expectation as to the, you know, widespread spread of this and even into Wisconsin and its dairy cattle?

Michael Osterholm:
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 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.

Frederica Freyberg:
That’s exactly what I was going to ask you about. What your concerns are around a pandemic?

Michael Osterholm:
Well, you know, I used to say in the earlier days of influenza and the potential for a pandemic, 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.

Frederica Freyberg:
Is the CDC and other federal agencies keeping pace with bird flu at this time?

Michael Osterholm:
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 challenge.

Frederica Freyberg:
Not to be alarmist, but how worried should we be?

Michael Osterholm:
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 happens. And so I think the immediacy of our work to try to come up with better vaccines is really very critical.

Frederica Freyberg:
All right. Dr. Michael Osterholm, thanks very much.

Michael Osterholm:
Thank you.

Frederica Freyberg:
You can watch the extended interviews with Dr. 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.

Mary Pitsch:
Thank you for inviting me.

Frederica Freyberg:
So describe for us what makes this planned village, which you are calling Livasu, different from a nursing home?

Mary Pitsch:
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 — that are frail, elderly people, not for those with dementia. Our village, Livasu, is designed specifically for the unique needs of the person with dementia.

Frederica Freyberg:
And tell me what Livasu means?

Mary Pitsch:
So Livasu 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 care 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.

Frederica Freyberg:
Why is that better for residents? I mean, it seems obvious, but what have you learned?

Mary Pitsch:
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.

Frederica Freyberg:
What sparked this idea?

Mary Pitsch:
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 with 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 4,000 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 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.

Frederica Freyberg:
How costly will it be for people to live there?

Mary Pitsch:
So we are a nonprofit and we made that decision to be nonprofit so that we could really support all income levels to be able to live at Livasu. 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 a one 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.

Frederica Freyberg:
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?

Mary Pitsch:
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.

Frederica Freyberg:
Mary Pitsch, thanks very much.

Mary Pitsch:
Thank you.

Frederica Freyberg:
For more on this and other issues facing Wisconsin, visit our website at PBSWisconsin.org/news. 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.

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Funding for “Here & Now” is provided by the Focus Fund for Journalism and Friends of PBS Wisconsin.