>> ERIC: OUR NEXT GUEST IS A FAMILIAR FACE WITH A NEW BOOK.

"THE BIG ONE: HOW WE MUST PREPARE FOR FUTURE DEADLY PANDEMICS" EXAMINES THE NATION'S HANDLING OF THE COVID-19 CRISIS IN ORDER TO IDENTIFY NECESSARY PREPARATIONS FOR FUTURE VIRUSES.

MICHAEL OSTERHOLM LEADS THE UNIVERSITY OF MINNESOTA'S CENTER FOR INFECTIOUS DISEASE RESEARCH AND POLICY.

YOU'VE GOT A UNIQUE FORMAT FOR THE BOOK, I GOTTA TELL YOU.

IS IT SCIENCE FICTION, SCIENCE FACT OR A COMBINATION?

>> WELL, THE SCIENCE FICTION PART, WHICH YOU'RE REFERRING TO, WE ACTUALLY START OUT THE BOOK WITH A SCENARIO OF WHAT COULD REALLY HAPPEN.

SO THIS ISN'T SCIENCE FICTION IN THAT SENSE.

IT'S A REALITY CHECK.

AND EACH CHAPTER BUILDS FROM THAT FICTIONAL PIECE, THEN GOES INTO THE NONFICTION PART.

BUT IT TIES TOGETHER SO PEOPLE CAN UNDERSTAND WHY AT THIS TIME IN THE PANDEMIC RE WE WORRIED ABOUT THIS OR WE NEED TO DEAL WITH THAT.

SO IT'S REALLY TO TRY TO PROVIDE A ROAD MAP OF WHAT A PANDEMIC WOULD LOOK LIKE.

AND AS MUCH AS PEOPLE THINK THAT COVID WAS REALLY BAD AND, OF COURSE, LOSING ONE AND A HALF PERCENT OF OUR POPULATION DYING FROM COVID IS BAD, BUT A MUCH MORE SEVERE PANDEMIC OF 10 TO 12, 20% OF PEOPLE DYING IS A REALITY.

AND WE HAVE TO UNDERSTAND THAT AND WE'RE NOT PREPARED FOR IT.

>> Cathy: AND WE'RE TALKING ABOUT A VIRUS, PERHAPS, THAT WOULD BE STRONGER AND FASTER, IN A SENSE, THAN COVID?

>> WELL, COVID WAS PRETTY FAST.

SO IF IT WAS THIS FAST, IT WOULD STILL BE A PROBLEM.

BUT INSTEAD OF THE 1.5% OF THE POPULATION DYING, LITERALLY, WE COULD EE MORE.

REMEMBER, THERE WERE TWO CORONAVIRUSES, THE SAME KIND OF VIRUS AS COVID THAT HIT US IN 2003 WITH SARS, AND 2012 WITH MERS.

THEY WERE NOT HIGHLY INFECTIOUS BUT THEY KILLED 20 TO 35% OF THE PEOPLE THAT GOT IT.

AND WE NOW HAVE VIRUSES THAT HAVE THE MACHINERY TO BE TRANSMITTED IKE COVID AND HAVE THE SAME PACKAGE ON BOARD THAT COULD KILL, LIKE ERS AND SARS.

AND, SO, WE HAVE TO BE MUCH BETTER PREPARED AND, UNFORTUNATELY, WE'RE GOING JUST THE OPPOSITE WAY RIGHT NOW.

>> Cathy: YOU KNOW, YOU AND I WERE TALKING EARLIER IN THE WEEK, AND I ALMOST FELL OFF MY CHAIR WHEN YOU SAID THAT THERE ARE ALREADY BATS IN CAVES IN CHINA THAT ARE HARBORING SOME REALLY SERIOUS VIRUSES.

>> YEAH.

THERE'S ANIMALS ALL AROUND THE WORLD.

AND REMEMBER RIGHT NOW, WE HAVE NEVER HAD THE KIND OF EXPOSURE TO THESE VIRUSES THAT WE DO NOW.

WHY?

BECAUSE TO FEED 8 BILLION PEOPLE ON THE FACE OF THE EARTH, WE'RE EATING MORE BUSHMEAT, WE'RE NOW GOING INTO THE DARKER JUNGLES, WHERE NOT ONLY THE PLANT FLOOR IS MORE DYNAMIC, BUT ALSO THE SAME THING WITH THE VIRUSES AND SO FORTH.

SO WE'RE HAVING MORE EXPOSURES.

WE HAVE A MAJOR NEW EBOLA OUTBREAK RIGHT NOW IN THE DRC.

YOU KNOW, AND, SO, THIS IS SOMETHING THAT'S REALITY.

WE HAVE TO BE BETTER PREPARED.

>> Eric: YOU SAID WE'RE NO BETTER OFF THAN WE WERE IN THE SPANISH FLU OF 918.

>> WELL, JUST ABOUT.

I MEAN, LET ME JUST GIVE OU A CASE IN POINT BECAUSE IT REALLY TIES THE FUTURE TO NOW.

IF WE HAD AN INFLUENZA PANDEMIC RIGHT NOW LIKE AN 1918 PANDEMIC WITH THE CURRENT ABILITY TO MAKE VACCINES FOR FLU, WE USE CHICKEN EGGS FROM THE 1940s AND CELL CULTURE.

IN THE FIRST YEAR TO 15 MONTHS OF THE PANDEMIC, WE COULD MAKE ENOUGH VACCINE TO COVER ABOUT A QUARTER OF THE WORLD.

THAT'S IT.

WE HAD GREAT HOPES WITH THIS NEW MRNA TECHNOLOGY THAT WE COULD ADOPT IT FOR FLU THAT, IN FACT, WE COULD MAKE ENOUGH VACCINE IN THE FIRST YEAR TO DELIVER TO THE WHOLE WORLD.

THE DIFFERENCE BETWEEN THOSE SCENARIOS ARE MILLIONS AND MILLIONS OF DEATHS.

AND WE JUST GOT RID OF ALL OF OUR MRNA RESEARCH WORK IN THE UNITED STATES GOVERNMENT JUST PULLED IT OUT.

>> Cathy: LET'S TALK ABOUT WHAT IS HAPPENING.

AS YOU SAY, THEY PULLED THAT.

THERE'S ALSO, OF COURSE, -- THERE'S A MESS WHEN IT COMES TO VACCINES IN THIS COUNTRY.

SO, THE COMMITTEE THAT MAKES THE DECISIONS MET THIS WEEK, AND IT SEEMED VERY CONFUSING AND KIND OF DISACCORDING.

-- DISORGANIZED.

>> YOU KNOW, THINK I'VE SEEN HIGH SCHOOL STUDENT COUNCILS OPERATE WITH MORE FUNCTIONAL CAPABILITY THAN I SAW AT THIS COMMITTEE HEARING.

AND I WATCHED THE WHOLE TWO DAYS.

TODAY I SAW A VOTE BEING TAKEN THAT LITERALLY BLEW ME AWAY.

THEY VOTED WHETHER OR NOT TO REQUIRE EVERY PERSON IN THIS COUNTRY WHO WOULD GET A COVID SHOT TO AVE TO HAVE A PRESCRIPTION ISSUED FIRST.

NOW, HOW MANY OF US CAN GET IN TO SEE A PHYSICIAN IN A TIMELY WAY THAT WE COULD GET A PRESCRIPTION FROM THEM?

WELL, FORTUNATELY, THE VOTE WAS 6-6, IT DIDN'T PASS.

BUT THAT RECOMMENDATION AS SUCH STILL GOES ON TO THE ACTING DIRECTOR OF THE CDC AND THE SECRETARY OF HEALTH AND HUMAN SERVICES, I.E., Mr.

KENNEDY.

AND AT THIS POINT, THEY COULD PUT THAT INTO PLACE.

IT WOULD NOT SURPRISE ME IF THIS WEEK WE FIND OUT, YOU CAN'T GET YOUR SHOT WITHOUT A PRESCRIPTION.

TALK ABOUT A BARRIER TO ENTRY.

TALK ABOUT HOW HARD IT WILL BE FOR PEOPLE TO GET VACCINE.

>> ric: SO LIKE LOCKDOWNS, THE PLEXIGLAS AT A CHECKOUT COUNTER, MASKING, STAY SIX FEET AWAY, NONE OF THAT WAS HELPFUL?

>> IT WAS NOT.

AND, IN FACT, IT GAVE, WHAT I CALL, HYGIENE THEATER TO THE WHOLE RESPONSE.

AND THIS IS ONE OF THE THINGS I TRY TO DO IN THE BOOK.

YOU KNOW, I'M AS HONEST AS I CAN BE.

WHY?

BECAUSE WE HAVE TO BE BETTER PREPARED FOR THE FUTURE.

WE CAN'T GLOSS OVER THE MISTAKES THAT WERE MADE.

WE NEED TO BE HUMBLE AND COME FORWARD AND SAY THAT.

AND THERE'S A MODEL FOR.

THIS YOU KNOW, I HAD THE OPPORTUNITY, FORTUNATELY, TO WORK AT HHS, DEPARTMENT OF HEALTH AND HUMAN SERVICES, RIGHT AFTER 911, I -- 9/11, I SPLIT MY TIME BETWEEN THE UNIVERSITY AND THERE.

I WATCHED THE EARLY DAYS OF THE 9/11 COMMISSION.

NONPARTISAN EFFORT THAT REALLY LOOKED AT WHAT CAUSED 9/11 TO HAPPEN, WHAT COULD WE DO DIFFERENTLY.

AND IT HAD TREMENDOUS IMPACT FOR THE FUTURE.

WE'VE DONE NONE OF THAT WITH THIS OVID PANDEMIC.

WE DON'T HAVE ANY CLUE, NECESSARILY, WHAT IT WAS THAT WE COULD DO BETTER.

>> Eric: THE BIG ONE, IT'S AVAILABLE AT ALL THE USUAL OUTLETS?

>> I GUESS SO.

THAT'S WHAT I HEAR.

>> Eric: GOOD LUCK WITH YOU IT.

>> Cathy: GOOD TO SEE YOU.

THANK YOU.

>> CATHY: STATE OFFICIALS ARE WAITING FOR NEW RULES ON MEDICAID CUTS FROM THE FEDERAL GOVERNMENT.

THE CHANGES ARE A RESULT OF THE RECONCILIATION BILL THAT PRESIDENT TRUMP SIGNED INTO LAW IN JULY.

REPORTER KAOMI LEE WENT TO COOK COUNTY TO FIND OUT WHAT THIS COULD MEAN FOR ONE NORTHERN COMMUNITY.

>> Kaomi: DAWN DAVISON LIVES ON PASTORAL DOUBLE TRACK LAKE IN GRAND MARAIS, THE VIEW FROM HIS DOCK IS SPECTACULAR, YOU BUT THE 74-YEAR-OLD'S LIFE IS FAR FROM COMFORTABLE.

>> I HAVE A DISEASE CALLED CIPD, WHICH IS CHRONIC INFLAMMATORY DEMILATING, POLYNEUROPATHY.

>> Kaomi: HE SAYS IT'S AN AUAUTOIMMUNE DISEASE WHERE THE LINING OF THE NERVES IS EATEN UP BY HIS OWN BODY'S IMMUNE SYSTEM.

>> IT'S A STRANGE DISEASE, YOU LITERALLY USE THE REFLEXES IN YOUR KNEES.

>> Kaomi: EVEN SIMPLE THINGS LIKE WALKING CAN BE DIFFICULT.

RELIEF IS HE CAN GET TREATMENT AT NEARBY NORTH SHORE HEALTH.

>> I GET IMMUNOGLOB YIN IV HERE AT THE LOCAL HOSPITAL.

THE TREATMENTS TAKE JUST UNDER SEVEN HOURS EACH, IT'S EVERY OTHER WEEK.

>> Kaomi: NOW HE'S WORRIED WILL WHETHER THAT WILL CONTINUE.

CONGRESS PASSED THE RECONCILIATION BILL THIS SUMMER.

SUPPORTERS SAY IT WILL REDUCE MEDICAID SPENDING BY ELIMINATING FRAUD AND ABUSE.

BUT OTHERS ESTIMATE THAT MILLIONS OF PEOPLE WILL LOSE THEIR HEALTH INSURANCE BY 2034, EVEN THOSE WHO QUALIFY.

IN MINNESOTA, STATE OFFICIALS ESTIMATE 140,000 PEOPLE WILL LOSE COVERAGE.

DAVISON ISN'T ON MEDICAID, HE HAS PRIVATE INSURANCE.

STILL, HE FEARS THE CUTS COULD PUT ALL SERVICES AT RISK, INCLUDING HIS TREATMENTS.

>> THEY WOULD HAVE TO CUT BACK ON STAFFING, WHICH WOULD TAKE AWAY SOME PROGRAMS.

>> Kaomi: THE ALTERNATIVE WOULD BE A TWO-1/2-HOUR DRIVE TO DULUTH.

>> IT'S ONE OF THOSE QUESTIONS I THINK A LOT OF PEOPLE ASK, WELL, WHAT KEEPS YOU UP AT NIGHT?

>> Kaomi: THE CEO SAYS SHE'S CONCERNED ABOUT WHAT THE LAW SAYS AND DOESN'T SAY.

ONE THING SHE DOESN'T WANT TO DO IS SCARE THE PUBLIC.

>> THERE'S A LOT IN THERE AND WE JUST DON'T KNOW.

WE HAVE TO BE NIMBLE, WE HAVE TO PAY ATTENTION.

AND WE HAVE TO BE ABLE TO LOOK AT WHAT MIGHT BE HAPPENING, WHAT'S COMING DOWN, AND THEN HOW COULD THAT IMPACT US.

>> Kaomi: NORTH SHORE HEALTH IS A RURAL-BASED CRITICAL ACCESS HOSPITAL WITH 16 BEDS.

IT HAS AN ANNUAL GROSS REVENUE OF $27 MILLION.

MEDICAID ACCOUNTS FOR 15% OF THAT.

THE PROVIDER ALSO HAS HOME CARE, COUNTY AMBULANCE SERVICES, AND 37 NURSING HOME BEDS.

>> WELL, I KNOW THAT 50% OF OUR HOME CARE PATIENTS ARE COVERED BY MEDICAID.

I KNOW THAT 85% OF OUR NURSING HOME RESIDENTS ARE COVERED BY MEDICAID.

YOU KNOW, WHEN I TALKED ABOUT HOME CARE, IF THERE ARE GREAT IMPACTS, IS THAT A SERVICE LINE THAT WE HAVE TO ELIMINATE?

IS SENIOR SERVICES AND AND OUR NURSING HOME A LINE THAT WE HAVE TO ELIMINATE?

>> Kaomi: UNDER FEDERAL POVERTY GUIDELINES, PEOPLE EARNING JUST OVER $15,000 OR LESS A YEAR ARE ELIGIBLE.

BUT MAIN WILL NOW BE SUBJECT TO NEW WORK REQUIREMENTS.

THE NEW LAW REQUIRES PEOPLE UNDER 65 TO WORK 80 HOURS A MONTH OR BE IN SCHOOL PART TIME.

THERE ARE SOME EXCEPTIONS.

BUT FOR MENTALLY ILL PEOPLE, EXPERTS SAY IT WILL BE HARDER TO GET COVERAGE.

>> THE PROBLEM IS, WHEN YOU'RE NEW IN THIS DIAGNOSIS, 24 YEARS OLD, RIGHT, HAVING THEIR FIRST SCOTT COUNTY EPISODE, YOU'RE NOT -- PSYCHOTIC EPISODE, YOU'RE NOT YET DECLARED ISABLED AND IT TAKES A LONG TIME TO BE DECLARED DISABLED BY THE SOCIAL SECURITY ADMINISTRATION.

>> Kaomi: AND THERE WILL BE NEW PAPERWORK, A LOT OF IT.

SHE SAYS CERTIFICATION AND RECERTIFICATION EVERY IX MONTHS COULD TAKE AN AVERAGE OF EIGHT MONTHS TO EVEN GET A RESPONSE.

MUCH OF THE PROCESSING WORK WILL FALL TO COUNTIES, BUT WITH LITTLE ATTACHED FUNDING.

SUE ABDERHOLDEN SAID SHE FEARS MANY ELIGIBLE PEOPLE WILL FALL THROUGH THE CRACKS.

>> AND THEN YOU KIND OF DESTABLIZE THE WHOLE MENTAL HEALTH SYSTEM BY HAVING PEOPLE WHO DON'T HAVE INSURANCE AND NOW YOU HAVE A LOT OF UNCOMPENSATED CARE.

AND YOU HAVE PEOPLE WHO CAN'T ACCESS CARE, WHICH COULD INCREASE, FRANKLY, PEOPLE WHO ARE HOMELESS, ENDING UP IN OUR CRIMINAL JUSTICE SYSTEM.

>> Kaomi: JOHN CONNOLLY IS THE STATE'S MEDICAID IRECTOR.

HE SAYS, MANY PROVISIONS OF THE LAW ARE NOT GOOD FOR THE STATE.

>> SOME PROVIDERS WILL HAVE LOWER PAYMENTS.

THE STATE WILL HAVE MORE LIMITATIONS ON ITS ABILITY TO RAISE REVENUE FOR THE PROGRAM TO, AGAIN, JUST SUPPORT MEDICAID BROADLY AND ALSO SPECIFICALLY PROVIDER PAYMENT.

SO WE'VE BEEN VERY CLEAR, I THINK, FROM THE BEGINNING OF THE DISCUSSION OF THIS LEGISLATION AND WHAT BECAME LAW THAT WE WERE VERY WORRIED ABOUT ITS IMPACTS.

>> Kaomi: LIKE OTHER STATES, DHS IS NOW WAITING FOR THE NEW RULES FOR IMPLEMENTATION FROM THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.

THE LAW APPROPRIATES $200 MILLION NATIONWIDE FOR STATES TO MAKE THE CHANGES.

HOWEVER, DHS ESTIMATES IT WILL COST $165 MILLION IN MINNESOTA ALONE.

NORTH SHORE HEALTH CEO KIMBER RALSTAD SAYS SHE REACHED OUT TO REPUBLICAN CONGRESSMAN PETE STAUBER.

>> I SHARED MY CONCERNS.

I'M THANKED FOR MY CONCERN.

NO REAL RESPONSE, NO.

>> Kaomi: STATES CAN APPLY TO CMS FOR GRANTS FROM A NEWLY ESTABLISHED $50 BILLION RURAL HEALTH FUND.

IN REPLY O "ALMANAC," CONGRESSMAN STAUBER SAID, I SUPPORTED THIS CRITICAL BILL BECAUSE IT DIRECTLY BENEFITS RURAL HEALTHCARE PROVIDERS LIKE NORTH SHORE HEALTH.

THE RULE HEALTH TRANSFORMATION PROGRAM IS THE SINGLE LARGEST INVESTMENT IN RURAL HEALTHCARE IN AMERICAN HISTORY.

MORE SPECIFICALLY, IT ALLOCATES 10 BILLION ANNUALLY FROM 2026 TO 2030 TO THE CENTERS OF MEDICAID SERVICES.

50% OF THIS FUNDING WILL BE EVENLY DISTRIBUTED ACROSS STATES, WHILE THE OTHER ALF IS BASED ON EACH STATE'S RURAL POPULATION AND HE NUMBER OF RURAL FACILITIES.

THIS GUARANTEES MINNESOTA AT LEAST $100 MILLION PER YEAR TO KEEP RURAL HEALTHCARE PROVIDERS OPEN.

>> WE FELT THAT IT WAS JUST AS SAFE AS THE TWIN CITIES IN TERMS OF HEALTHCARE DELIVERY.

>> Kaomi: SAM AND HIS WIFE MOVED THEIR YOUNG FAMILY FROM GRAND MARAIS TO THE TWIN CITIES URING THE PANDEMIC.

NOW HE'S ON THE BOARD OF NORTH SHORE HEALTH.

THE HOSPITAL LOSES MONEY EACH YEAR.

EVEN WITH A $1.8 MILLION PROPERTY TAX LEVY TO MAKE UP FOR SHORTFALLS.

MOVED FROM THE TWIN CITIES TO GRAND MARAIS.

>> AS A HOSPITAL, THERE