EDITORIAL: Wednesday Grinches are threatening health care for kids

Dec. 13--In a world of health care controversy, one issue is clear: Children deserve health care.

Children have CHIP, the Children's Health Insurance Program.

In Florida, it's called KidCare. In Georgia, it's called PeachCare for Kids.

Yet Washington, with its incessant nastiness, is messing around with CHIP despite wide bipartisan support. It has been caught in the fighting over Obamacare.

Congress has yet to fund the program now, two months past its deadline.

The fight involves funding. The House agreed to charge higher premiums to wealthier Medicare recipients, cut money from Obamacare and shorten the grace period for Obamacare recipients who fail to make premium payments.

As reported by Kaiser Health News, states are warning families the program may not be available. Without federal money, states could freeze enrollment or suspend operation.

This affects 9 million children and 370,000 families nationally, families who earn too much to qualify for Medicaid.

Congress needs to get to work for the American people and not leave for the holiday break until this is resolved.

MAKING MONEY ON OBAMAcARE

Insurers are finally making money on Obamacare. That's the good news.

The bad news: They're doing it by raising rates.

As Politico reported, health plans raised premiums on the Obamacare exchanges by an average of 20 percent this year, which created sticker shock for consumers.

"The turnaround follows three years of financial bloodletting for insurers in the Obamacare markets," Politico reported.

Some large insurers like UnitedHealth and Aetna largely abandoned the Obamacare markets. Nearly half of America's counties nationwide have just one insurer selling Obamacare policies.

Meanwhile, the Trump administration is not helping matters by undercutting subsidies to insurers that they use to make up for large numbers of sick people in their insurance pools.

In health insurance markets generally, consumers have been asked to take on more of the cost burden with higher deductibles and co-pays.

In 2016, out-of-pocket costs by consumers rose faster than at any time since 2007, reported Health Affairs in The Washington Post.

The share of people in high-deductible plans rose from 20 percent to 29 percent from 2014 to 2016. And the size of the deductibles rose from 7 percent to 12 percent.

DRUG PRICES ZOOM

One of the causes of high out-of-pocket spending for consumers involves prescription drugs.

A panel of the National Academies of Sciences, Engineering and Medicine recommended urgent steps to rein in outrageous increases.

In a 201-page report, the panel blasted marketing directly to consumers and efforts by drugmakers to block or delay lower-priced versions.

"There is little value in new drugs that patients cannot afford," the panel reported. But even long-established drugs are seeing huge price increases.

Among the panel's recommendations:

--Federal regulators need to reduce roadblocks to the introduction of generic and biosimilar drugs.

--Use federal purchasing power to negotiate lower drug prices or patients on federal programs like Medicare,

--More public reporting by drugmakers and insurers on how prices are determined.

--More information on the effectiveness of drugs to allow comparisons.

--New limits on how much patients must pay for drugs.

The drug industry, reported the Los Angeles Times, called these ideas "a rehash of outdated ideas that would undermine the competitive market."

But the panel reported, "Congress should require disclosure of information from insurance plans about the average net prices paid for prescription drugs, including patients' cost-sharing among plans and from biopharmaceutical companies about average net volume of and prices paid for drugs across each sales channel."

Also the Federal Trade Commission should act on anti-competitive practices.

Large drug makers spend more on marketing and administration than on research and development, the panel stated.

Where research and development is needed to produce new drugs, accommodations should be made. But this is all about transparency.

Everyone in the health care chain needs updated information on drug costs and effectiveness to maximize low cost and high quality.

Meanwhile, health spending rose to 18 percent of America's gross national product in 2016. Yet Americans are no healthier than people in developed countries.

HELPLESS AT HOSPITAL

A hospital charged $1,877 to pierce a 5-year-old's ears, reports ProPublica.

This is one outrageous reason why health care in America costs so much.

When a mother brought her child to a Colorado hospital for a medical procedure, the surgeon offered to throw in a perk -- an ear-piercing.

The mother assumed this would be free. But her insurer concluded that it wasn't necessary, so the hospital sent her a bill for the full amount.

After ProPublica got involved, the hospital removed the charge as a courtesy.

Here's the problem:

The system worked perfectly.

Unnecessary tests, higher-than-needed levels of care and effective surgeries are the norm in American health care.

No matter who pays upfront -- the consumer or an insurer -- the costs are reflected in the entire system.

Experts estimate at least one-quarter of all the money spent in American health care is wasted.

A study at the intensive care unit at Harbor-UCLA Medical Center determined that more than half the patients didn't need the expensive care.

Nobody in the system is evil.

But the results can be.

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