The following program is a PBS Wisconsin original production.

>> Wisconsin Governor Tony Evers here.

incumbent calls it quits for the next round, leaving a long list of governor wannabes on both sides.

While in Washington, summer recess starts early.

[MUSIC] I'm Frederica Freyberg.

Tonight on "Here& Now", a wide open race for Wisconsin governor.

Republican U.S. Representative Bryan Steil on federal budgets.

We continue our series uncovered, looking at pharmacy decline and an old bridge in western Wisconsin will soon be closed and replaced.

How many other bridges in the state need work?

It's "Here& Now" for July 25th.

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

>> Big news in state politics.

Wisconsin Governor Tony Evers announced this week he will not run for reelection to a third term.

His announcement means Wisconsin will see the first open race for governor in 16 years.

A crowded field of Democrats are expected to vie in a primary next August.

Likewise, several Republicans have either declared or expressed interest in running for governor.

The election is November 3rd, 2026.

Head spinning feints and fights in Washington this week, and the Republican House speaker cut short the legislative session as some congressional members demanded votes on releasing the Jeffrey Epstein files.

Our next guest was among those who got an early recess Wisconsin first Representative Bryan Steil joins us.

And thanks very much for being here.

>> Thanks for having me on.

>> So first off, what is your reaction to Toni?

Evers not running for a third term?

>> I think what you're going to see is a large number of Democrats get in the race and run to the left, but what we have to do is get our state back on track, not measuring things like education by just how much money we're spending, but on how well we're doing, whether or not students are being taught how to learn, not what to know, whether or not we're getting the spending.

And in Wisconsin, under control and money back to hard paying taxpayers, I think you're gonna have a robust debate.

I think at the end of the day, we have a great opportunity to have a conservative governor once again.

candidate at this point?

>> No, I'm not running.

I'm going to be running for reelection to the House of Representatives.

We'll watch the Republican field play out.

But I think we have a large number of great, strong candidates who will in one of them will ultimately be successful.

session was cut short, as we said by the speaker, attributed to what the Wall Street Journal called, quote, furor over disclosures from the Epstein investigation.

What's your reaction to the distraction that the whole Jeffrey Epstein file is causing.

>> The broader media landscape loves to talk about Epstein.

They don't want to talk about the president's success of securing the border, about the positive impacts of the tax package that was just passed.

I think it's a lot to do about nothing.

I think I lean on the side of more.

Disclosure is always a good thing.

The sunlight is the best disinfectant.

And I think actually we should just move forward with this, disclose what's legally permissible.

It's obviously under a court seal.

It's not under the direct control of Congress.

And then get really back and try to draw the attention of the media, who loves to be distracted by this.

Back to the most important issues of the day.

>> Now, a new Marquette Law School national poll shows that 41% of respondents support the reconciliation bill that President Trump signed into law, while 59% oppose it.

Of course, with sharp, partisan divides, why did you vote in favor?

>> Look at the underlying provisions inside the bill.

Let's talk about what we got done.

Almost every single thing is not popular.

Once the American people understand what's in the bill.

This is about doubling down and making sure that the border is secure.

Wildly popular.

The president's moves to do that and then building to make sure that's permanent a good thing.

Investing in the military at a period of time of dangerous global instability, making sure the 2017 tax cuts are permanent, to build on the economic growth that we saw leading into the pandemic, and then doubling down on that, in particular for seniors, those working overtime or those who are earning tips.

And then finally getting spending under control.

And this is where the demagoguery has been probably the most challenging.

Putting in place work requirements for able bodied, childless adults is an 8020 issue in the state of Wisconsin, as indicated by the not so long ago referendum.

That's what this bill does.

It actually secures the program for those it was designed for permanently disabled adults, children, pregnant women.

And it simply says if you're an able bodied, childless we're asking you to be looking for work, volunteering or working a minimum of 20 hours a week.

And so the provisions of the bill, as American people learn more and more about them, I think will only become more popular because to get this country back on track.

>> So the Congressional Budget Office did estimate that this law will cut federal spending on Medicaid and Chip benefits by $1 trillion, due in part, the CBO says, to at least 10.5 million being eliminated from the program.

>> But let's dive into those numbers, right, because the numbers to try to scare people in the state of Wisconsin.

Wisconsin has had work requirements for many of our welfare programs, in particular Snap benefits since the 1990s, when Governor Tommy Thompson put them in place in Medicaid.

We don't have the exact work requirements that the federal government has or that this law passes.

What this law does is simply say, if you're an able bodied, childless adult, we want you to be looking for work, going to school, volunteering, or working 20 hours a week.

This is an 80 over 20 common sense issue.

If you say if you dig further into that, who is the CBO examining the positive view that as those people find themselves, find themselves with an opportunity to get a job, to volunteer, that we won't see folks losing their, their their health benefits, what we'll see is people getting into a good or a better paying job with the ultimate goal of many of these able bodied, childless adults getting into the workforce and receiving their health care from from their employer.

Like many hardworking, hardworking families in the state of Wisconsin do.

>> What about changes to the Affordable Care Act that I understand, and according to Congresswoman Moore, will raise premiums and also impose other restrictions, restrictions potentially causing people to lose their coverage.

>> Give me give me the details on that.

I think what what you're taking there is national analysis on the state of Wisconsin that doesn't apply.

Wisconsin didn't expand Medicaid.

And so some of the reforms are made in other states apply differently.

dangerous about the demagoguery that some individuals want to engage in.

They want to take a national narrative and apply it to Wisconsin.

Wisconsin, I think very thoughtfully, did not expand Medicaid further into the able bodied, childless working age population.

And so, again, of the 1.2 million individuals in the state of Wisconsin who currently are on Medicaid, Tony Evers appointee noted that there's about 163,000 of them that are that are of the demographic that we should look at, able bodied, childless adults.

Well over half of those are already already working 20 hours a week, going to school, volunteering, 63,000 are not or are not documenting it.

And so this is about making sure that we're strengthening the program for those that it's designed for no changes.

And in fact, in my opinion, strengthening Wisconsin after the passage of the state budget will actually receive about $1 billion a year more in federal money.

We have a whole debate about that, but more money is coming in.

And so the left is trying really hard to demagogue on this issue.

As the facts got out, you saw a quick pivot into Epstein, which was the lead question of your interview.

So what we need to do is to dive in, get the information out to the American people about how we're strengthening the program.

And I think as the American people learn more and more about this, it's only going to be more popular.

Again, the work requirements in the state of Wisconsin had a referendum 8020, popular.

>> As to the recent Rescissions package that stripped appropriation funding from USAID and the Corporation for Public Broadcasting.

Do you expect and support additional Rescissions as a way to cut costs going forward?

>> Washington has a massive spending power.

We're spending almost $2 trillion a year more than we're taking in in the debt as well over $30 trillion.

I think we need to go through the federal budget with a fine tooth comb to remove waste, fraud and abuse, look at programs that could find either other sources of funding or aren't necessary.

And so I think it's appropriate to make sure that we're combing through the federal budget, looking for ways to save taxpayer dollars.

And again, in a period of time where every extra dollar we spend is effectively a dollar borrowed from China, I think it's absolutely appropriate to dig through the federal budget and look for ways to save funds for hard working families.

>> U.S. Representative Bryan Steil, thanks very much.

>> Thank you.

>> On health care, we continue our coverage of prescription drug prices, which continue to climb for patients and pharmacies, while coverage of them continues to plummet.

In RX, uncovered "Here& Now", producer Marissa Wojcik examines the complex systems driving these trends.

This week, we look at the impact on pharmacies, both big and especially small, and why their disappearance is hurting patients.

>> We have been in business for over 70 years.

>> The local drugstore was once upon a time a staple in communities across the country.

every month and it's scary, and we think about how how long can we last?

>> Today, whether it's the local drugstore or a chain pharmacy, the brick and mortar presence is dying.

>> The feasibility of having an independent pharmacy is becoming very challenging.

>> Nicole Schreiner is the new CEO of Streu's Pharmacy in Green Bay and president elect on the board of the Pharmacy Society of Wisconsin.

>> We get up in the morning because we want to truly help serve our patients.

>> Alongside her commitment to the mission, she takes on her new dual roles in one of the most challenging times for pharmacies.

From 2010 to 2021, 30% of drugstores in the US closed.

Last year alone, 2300 pharmacies closed, half of them being independent or mid-sized businesses.

issue for patients.

We oftentimes talk about in rural areas.

You know, patients having to travel, you know, perhaps 20 miles to a find a pharmacy that would be able to provide their medications.

And but we're having that even in urban city areas.

>> For some, a visit to the pharmacy is a quick step.

Picking up 1 or 2 prescriptions.

But for many patients, it's much more than that.

>> Your pharmacist a lot of times will be a critical component of your medical care team.

>> Senate President Mary Felzkowski authored legislation trying to help local pharmacies keep their doors open.

>> We saw our small, independent pharmacy starting to go out of business in rural Wisconsin.

When it may take months for a patient to get a clinic visit.

Pharmacists say they bridge that gap.

Available for anyone to walk in and ask questions at any time.

And prevention leads to healthcare savings.

>> For patients with asthma.

We did a study with the Pharmacy Society of Wisconsin and showed that when they sat down with a pharmacist on two 30 minute interventions, that they reduced the number of ER visits, the number of hospitalizations.

These things are making a difference in overall reducing health care dollars spent.

>> Like with most retail stores, it'd be reasonable to assume that internet sales are putting pharmacies out of business.

And while mail order and online retailer giants like Amazon do compete with on site service advocates, diagnose a much deeper and chronic issue.

>> PBMs pharmacy benefit managers have been around for a very long time.

>> Pharmacy benefit managers or PBMs act as middlemen between drug manufacturers, wholesalers, providers, insurance companies and pharmacies.

>> And they've monopolized and they've gotten in between prescribers and the delivery of drugs, driving up the cost of drugs instead of lowering them.

>> The three largest PBM companies accounted for 80% of prescription claims last year.

>> They'll claim that they negotiate with drug manufacturers and prescription drug costs.

However, despite these claims, PBMs regularly inflate what patients pay and force pharmacies to operate a loss.

>> It's become very powerful, and independent pharmacies like myself have no negotiating power anymore.

With these PBMs.

>> The impact of PBMs that PBMs are having on rural pharmacy is staggering.

>> The legislation takes aim at a number of their practices, including not allowing patients to fill prescriptions at certain pharmacies.

>> PBMs dictate where prescriptions can be filled.

>> Punitive audits against pharmacists who inform patients of lower cost options.

>> What to charge a patient.

>> And perhaps the biggest of all for pharmacies.

>> What they will reimburse a pharmacy.

>> Reimbursing the price of medications below cost.

>> And when they'll pay the pharmacy.

>> Forcing them to take losses.

At a Senate health committee hearing, numerous local pharmacies attested to this issue.

>> My pharmacy is currently operating in the red right now solely due to PBM reimbursement rate margins estimated to PBMs have increased by 46%, and during the same time, margins to pharmacies have decreased by 47%.

>> The contracts have become basically take it or leave it.

They've continued to erode year after year after year, and it's estimated that independent pharmacies, depending on your particular location in the country, can have anywhere from 20 to 40% of their claims are actually reimbursed below cost.

>> But not all health industry experts agree.

>> We believe all these provisions will be associated with increased costs to health plans and sponsors.

the bill, such as health insurers, say it will increase prices for health plans.

Employers and patients.

The exorbitant cost of drugs, they say, begins with the drug manufacturers.

>> Instead of taking away the few tools that health plans and employers use to address ever increasing drug prices, the legislature should focus on fixing the market distortion caused by drug manufacturer pricing schemes.

hard on showing them through data from other states that have allowed that have the same legislation, where it's actually lowered the cost of health care.

>> Whatever the cause, the impact on the patient is real, like the ability to obtain diabetes medications.

>> GLP ones, those.

Some pharmacies are just choosing not to carry them because they get reimbursed below their cost.

>> Or having your insurance accepted.

choosing not to carry particular plans because of the poor reimbursement.

>> Every day in my pharmacy, I witness patients facing exorbitant co-pays, sometimes exceeding $500 for medications they cannot afford.

These patients are confused.

They're overwhelmed, and they're forced into impossible decisions about their health.

>> For a patient having to fill prescriptions at multiple pharmacies, the consequences can cost them their lives.

>> Recently, when learned that they had a duplicate prescription that was at another pharmacy from a different doctor.

If they had gone home and taken both, they would have needed emergency care and it could have been fatal.

>> From the extremes of the pandemic to the work they do every day, independent pharmacists say their commitment is to their community.

>> What happens if PBMs continue to drive us out of business?

Who will step up during this crisis?

Who's going to be doing seven day a week testing?

Who's going to deliver meds late at night for a hospice patient who's going to get a call at 2 a.m?

I just got that last week.

It won't be a mail order pharmacy in another state that's doing that.

>> Being able to provide that service to patients and to be part of making sure that they are taken care of, is really what we want to ultimately do.

>> Reporting from green Bay, I'm Marisa Wojcik for "Here& Now".

>> In other news.

Imagine you're running late for work, but you have to take a water taxi or ferry over the river instead of driving over a bridge.

That's what will confront people in western Wisconsin when the bridge over the Mississippi River that connects De Soto to Lansing, Iowa, is removed this fall and replaced in 2027.

As Erika Ayisi reports, the Lansing bridge, also named the Black Hawk Bridge in Crawford County, has been under repair while still in use, but soon it will close altogether for replacement.

>> Closure, demolition and rebuilding are the new plans for the Black Hawk Bridge.

>> The initial plan for the new bridge was that the old Black Hawk Bridge would remain open until the new bridge was completed.

>> But that plan has changed.

The village of De Soto President Timothy Gillespie says the announcement of the upcoming bridge demolition has residents worried about crossing the Mississippi River into Lansing, Iowa.

>> Unfortunately, the Black Hawk Bridge will have to be closed in October, and so it'll be about two years before the new bridge is ready.

>> The new bridge is being constructed along the existing bridge.

According to the Iowa and Wisconsin Departments of Transportation, the east side of the existing bridge is posing a risk to the new bridge's completion.

>> And they said it's becoming a safety issue.

And they have to continue to drive the pilings down.

And so it's going to weaken.

They think the existing bridge.

And that'll become a safety issue a hazard.

>> The livelihood of local businesses on both sides of the river are at stake.

>> There's just going to have a very negative effect on a lot of businesses, not only in De Soto, but certainly in Lansing, Ferryville, Genoa, Harpers Ferry, New Alvin, Iowa.

All of those communities are going to be affected by this.

>> The bridge has been closed temporarily, briefly in the past.

How were passengers impacted during those times?

>> Well, they had a people ferry that they started and that was working pretty well.

It you know, it's still pretty difficult for people to use a people ferry to, to, to get to work.

>> A people ferry and car ferry like this one could help business owners like Erwin Buckmaster sustain his Lansing restaurant with Wisconsin customers.

and more people would want to be involved and indulge in that car ferry, as opposed to just shuttling, busing and getting trucked across the river.

>> Transportation officials are exploring a car ferry service, but Gillespie says it will not meet the daily demand of cars crossing the bridge.

able to bring 1214 cars at a time over, and that's certainly not going to take the place of the traffic that was on the Black Hawk Bridge.

>> Justin Shepherd of Shep's Riverside Bar and Grill says customers need multiple crossing plans for businesses to stay afloat, especially through winter.

>> As far as business goes, you know they'll run a shuttle hopefully until the ice comes through and then after the ice is in, you know, we don't really know how that's going to work because they don't have a plan for in place for that either.

closest bridge is U.S. Highway 18, connecting McGregor, Iowa, to Prairie du Chien, about 45 minutes away from the Lansing De Soto Bridge crossing.

>> And there's also a medical clinic over in Lansing.

And so if we can't get over there, then the people are going to have to go to Prairie du Chien or La Crosse, which is 30 miles in either direction.

the new bridge's signature singing sound, wider width and indigenous name reference to Chief Black Hawk will remain the same as Gillespie and other area village presidents seek government aid.

>> Going to be looking for some kind of a federal or state aid to help support the loss of revenue that's going to occur.

So hopefully we can get some some assistance.

>> Reporting from De Soto I'm Erica Ayisi for here.

And now.

>> That bridge opened in 1931.

How aged are other bridge crossings in Wisconsin?

According to the National Bridge Inventory, of the more than 14,000 bridges in this state, nearly a thousand are classified as what they call structurally deficient.

We turn to Wisconsin Dot Bureau of Structures Director Josh Dietsche for more.

And thanks very much for being here.

to join.

a bridge to be structurally deficient?

>> So it's a term that probably sounds a little scarier than it is really.

It just means that there is something, some kind of deterioration that's been noted with the bridge.

We always try to stress that.

That doesn't mean it's unsafe.

If there's a bridge open in the state, open to travel on.

You can feel safe traveling across it.

>> So does Wisconsin have a lot of older bridges, like the one like the Lansing Bridge?

>> Not many that are quite as old as.

>> The.

average age of the bridge is about 42 years old.

So yeah, something as old as the Lansing is a little bit atypical.

>> In Wisconsin.

What specific bridges need immediate repair or removal?

Are there any?

>> Again, I would stress that if it's open, it's safe.

So we always have a program where we're going in and rehabilitating or replacing bridges.

So you mentioned that there's over 14,000 bridges in the state.

About 2% of those are classified as being in poor condition.

Kind of at a high level.

We as we inspect bridges, they get rated as either good, fair or poor.

And so again, with about 2% of those bridges in poor condition, those are the ones that we're focusing on.

Again, not because they're unsafe, not because you shouldn't be traveling over them, but just because they're going to need some work to keep them in service.

In the near future.

So those are the ones that we've got in the program that are in the planning stages for, you know, again, getting some kind of rehabilitation or potentially being replaced.

>> How heavy of a lift is it to inspect all of these?

More than 14,000 bridges across the state of Wisconsin?

are surprised when we talk about it that we do have that many bridges in the state.

You know, about the big ones that you travel over.

But there's so many that are over just small creeks or small rivers that you probably don't even realize where you're going over a bridge.

So yeah, of those 14,000, about 5000, a little over 5000 are owned by the state, and the remainder then are owned by local municipalities, cities, villages, towns, and so on and so forth.

So the state bridges are inspected by mostly by state forces, although we do use consultant engineers as well.

And the same thing on the local side, the local side, they do have some local staff that will inspect bridges, but they lean heavily on consultant engineers as well.

So when the bridges are in good condition, basically new, they can be inspected on as much as a four year cycle.

But for the most part, bridges are required to be inspected on a two year cycle or as they get in that worst condition, into poor condition on a on an annual basis.

So yeah, it's a heavy lift depending on the size of the bridge, it the larger bridges may take up to a week to inspect some of the larger bridges.

Like you referenced the Lansing Bridge or some of our more signature bridges.

Others, you know, it can be done in a morning or an afternoon.

But yes, it's definitely a pretty big effort.

>> We took a look at the work that's happening on that bridge from De Soto to Lansing, and it made me wonder, how tricky is it to repair bridges while they're still in use?

>> Yeah, it depends on the situation.

You know, obviously the traffic is a big thing that plays into that, plays into that on.

You know, if you're trying to repair a bridge on the interstate, there's going to be lane closures.

There's a there's a large bridge over the Wisconsin River just north of Portage that's being replaced right now.

If you've driven through that area.

And in that case, you'll see lane closures or lane shifts.

So it's definitely possible.

But yeah, it does present some complications for sure.

But again, we make we make sure to do it in a way that is safe for sure.

And as we try to minimize the disruption to the traveling public as much as we can.

>> All right.

Well, we are all glad to know that the bridges are safe.

John Dietsche, thank you so much.

>> No problem.

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- [MUSIC] weekend.

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

Friends of PBS Wisconsin.