Building Bipartisan Healthcare Reform with Conservative Bricks

Republicans now control both chambers of Congress and the White House, yet they have been unable, on their own, to fulfill their pledge to repeal and replace the Affordable Care Act (ACA or “Obamacare.”) The Democratic leadership, for the time being, seems content to watch Republican failures from the sidelines. Meanwhile, however, rank and file voters from both parties are becoming impatient. A Morning Consult/Politico poll taken in March found that 72 percent of Democratic voters, 71 percent of Independents, and 75 percent of Republicans thought the parties should work together more on healthcare reform. 

Just what kind of healthcare program might draw enough bipartisan support to pass both houses of Congress? No ACA replacement could draw significant Democratic support unless it clearly moved closer to the goal of universal, affordable health care, not away from it. At the same time, since Republicans control the committees and leadership in the House and Senate, any reform would have to start with ideas that have an acceptable conservative pedigree. 

The practical question, then, is whether it is possible to build bipartisan healthcare reform from conservative bricks. Here are three conservative ideas that might do the job.

Little-Watched Non-Employment Index Confirms Strength of Job Market Recovery

As the Fed hesitates over the pace of further monetary tightening, some critics say that standard unemployment data from the Bureau of Labor Statistics (BLS) overstate the strength of the recovery. By focusing on the number of employed as a percentage of the labor force, the critics say, the BLS ignores those who have dropped out of the labor force altogether. However, a little-watched indicator from the Richmond Fed, the Non-Employment Index (NEI), suggests that the critics are wrong.

The labor force, which forms the denominator of the standard unemployment rate (also known as U-3), consists of all persons who are working or have actively looked for work in the preceding month. People who want a job, but have stopped working, are omitted from both the numerator and denominator. In a typical month, there are millions of such labor force dropouts, even though they are not reflected in the standard statistics.

In an effort to take at least some of those labor-force drop-outs into account, the BLS publishes a supplementary index known as U-5, which includes discouraged and marginally attached workers in both its numerator and denominator. These groups include all those who want a job and have looked for one within the past year, but not within the past month. Discouraged workers cite their belief that there are no jobs to be found as their reason for not looking for work. Marginally attached workers give other reasons, such as family responsibilities. People who say they want a job but have gone longer than a year without looking for one are not counted in either U-3 or U-5.

Universal Catastrophic Coverage Would Make an Excellent Centerpiece for the Next Round of Healthcare Reform

Republican attempts to reform the U.S. healthcare system have fallen short, yet again. Sen. John McCain, who cast the deciding vote against the last-ditch version of repeal-and-replace put forward by the Senate leadership, told his colleagues,

We must now return to the correct way of legislating and send the bill back to committee, hold hearings, receive input from both sides of the aisle, heed the recommendations of nation’s governors, and produce a bill that finally delivers affordable health care for the American people. We must do the hard work our citizens expect of us and deserve.”

More tinkering won’t do it. It is time to get serious about keeping the promises GOP leaders made at the very outset of the debate over healthcare reform—not just to repeal Obamacare, but to replace it with something that provides “coverage protections and peace of mind for all Americans—regardless of age, income, medical conditions, or circumstances,” while ensuring “more choices, lower costs, and greater control over your health care.” There is no point in making a new push for healthcare reform without putting some bold new ideas on the table. 

Universal catastrophic coverage (UCC) would make an excellent centerpiece for the next round of healthcare reform. In fact, UCC is not even particularly new to the conservative playbook. Respected thinkers like Martin Feldstein, who would go on to serve as Ronald Reagan’s chief economic adviser, promoted the idea already in the 1970s. In 2004, Milton Friedman, then a fellow at the Hoover Institution, also endorsed the concept. UCC would make healthcare affordable, both for the federal budget and for American families. And because it would throw no one off the healthcare roles—not 22 million people, not 2 million, not anyone—it offers a realistic chance of the bipartisanship that polls show both the Republican and Democratic rank and file want.