The 1993 HEART Act was very much like the ACA, built around the individual mandate to purchase private health insurance, primarily through your employer. Romneycare was massaged out of this.
From what I understand, the HEART act wasn't really backed by Republicans, it had only 20 or so R's on it and was actually more of a ploy to prevent other more substantive bills from passing. It was designed to obstruct not to pass, later Dole supported a more restricted bill and HEART was never even debated. The vast majority of R's didn't support it, it was basically a political maneuver.
It was straight up co-sponsored by very nearly a majority of Senate Republicans (18 out of 42 at the time). It's hard to say a "vast majority of R's didn't support it". Though recently Republicans have been trying to distance themselves from it because it doesn't make their reaction to the ACA look great. There's a lot of rewriting of history.
Yes it didn't get debated, but the formal debate stage of a bill is pretty late in the process these days. It's been theater at best for at least a century. The actual debating happens at the stage the HEART Act got to.
It got dropped because the Republicans won congress in the midterms and didn't actually want to change anything about health care; the HEART act was just what they came up with as a proposal if they were to be forced.
It got dropped because the Republicans won congress in the midterms and didn't actually want to change anything about health care;
Right? So Republicans did not support it, or want it. It was just part of the Clinton Plan politics and negotiation. When Clinton failed, HEART totally disappeared.
recently Republicans have been trying to distance themselves from it
Of the 18 Republicans who co-sponsored it, none are still in politics, 14 of the 18 are now dead. Republicans today have literally nothing to do with it. It is getting silly to say a Republican today has any connection or responsibility for this proposal that never even came close to a vote, and not one current Republican has any connection to.
> Right? So Republicans did not support it, or want it. It was just part of the Clinton Plan politics and negotiation. When Clinton failed, HEART totally disappeared.
The ideal Republican plan was to have no healthcare reform. When faced with the proposition that no reform would cease to be tolerated, this was absolutely the Republican plan for health care reform, broadly supported by Republican leadership.
> Of the 18 Republicans who co-sponsored it, none are still in politics, 14 of the 18 are now dead. Republicans today have literally nothing to do with it. It is getting silly to say a Republican today has any connection or responsibility for this proposal that never even came close to a vote, and not one current Republican has any connection to.
They still mostly existed in politics at the passing of the ACA and the initial push back from the Republicans. Both the HEART Act and the ACA existed within the US's Sixth Political System.
Good point! But HEART was just a tactical response to the Clinton plan. Never a part of the party platform, not something candidates ran on, and it disappeared as support for the Clinton plan died. When Republicans won the presidency back in 2000, and held the house, and briefly the Senate, they didn't make any attempt to bring back HEART. It was never the Republican plan for health care. It is also somewhat of a mischaracterization to call it a mandate for health insurance, it was much more narrowly focused covering catastrophic events.
Some side notes. It was introduced by Lincoln Chafee, who then switched to the democratic party. Heritage itself disowned it. The author later wrote, "I headed Heritage's health work for 30 years, and make no mistake: Heritage and I actively oppose the individual mandate, including in an amicus brief filed in the 11th Circuit Court of Appeals to the Supreme Court." There was also never any intent to have a punitive mandate, just a tax credit would be lost if for people who didn't buy insurance - more carrot than stick.
> Good point! But HEART was just a tactical response to the Clinton plan. Never a part of the party platform, not something candidates ran on, and it disappeared as support for the Clinton plan died. When Republicans won the presidency back in 2000, and held the house, and briefly the Senate, they didn't make any attempt to bring back HEART. It was never the Republican plan for health care.
It was the republican plan for healthcare reform. They didn't want to reform healthcare, but when forced to, this was their plan. And it had been for years; the Heritage Foundation had been kicking the plan around since about 1989.
> It is also somewhat of a mischaracterization to call it a mandate for health insurance, it was much more narrowly focused covering catastrophic events.
That's not my read. Can you point to where in the draft text of the act that makes you say that?
> Some side notes. It was introduced by Lincoln Chafee, who then switched to the democratic party.
It was introduced by John Chafee, lifelong Republican.
And it was co-sponsored by Bob Dole (Senate Minority leader before becoming Majority leader the next year, and who would become the Presidential nominee in 1996), and had the support of Newt Gingrich, the Republican Leader of the House, and frankly the leader of the Republican party at the time.
It had broad Republican support including by Republican leadership.
> Heritage itself disowned it. The author later wrote, "I headed Heritage's health work for 30 years, and make no mistake: Heritage and I actively oppose the individual mandate, including in an amicus brief filed in the 11th Circuit Court of Appeals to the Supreme Court."
Yeah, over night any Republican caught supporting the ACA would be metaphorically tarred and feathered by the party. That didn't mean that they didn't previously literally write the basis for the ACA, only that they were trying not to get blamed for it.
> There was also never any intent to have a punitive mandate, just a tax credit would be lost if for people who didn't buy insurance - more carrot than stick.
It literally called for a tax to enforce the individual mandate. Honestly more of a tax than the ACA which simply withheld tax refunds and at the time was still grey area as to whether or not that actually counted as a true tax.
> SEC. 1501. REQUIREMENT OF COVERAGE.
>
> (a) In General.--Effective January 1, 2005, each individual who is
> a citizen or lawful permanent resident of the United States shall be
> covered under--
> (1) a qualified health plan, or
> (2) an equivalent health care program (as defined in
> section 1601(7)).
> (b) Exception.--Subsection (a) shall not apply in the case of an
> individual who is opposed for religious reasons to health plan
> coverage, including an individual who declines health plan coverage due
> to a reliance on healing using spiritual means through prayer alone.
...
> ``SEC. 5000A. FAILURE OF INDIVIDUALS WITH RESPECT TO HEALTH INSURANCE.
> ``(a) General Rule.--There is hereby imposed a tax on the failure
> of any individual to comply with the requirements of section 1501 of
> the Health Equity and Access Reform Today Act of 1993.
https://en.wikipedia.org/wiki/Health_Equity_and_Access_Refor...
This was the Republican alternative to the time's Hillarycare proposal, and was authored by the Heritage Foundation of Project 2025 fame.