“An irony of the Patient Protection and Affordable Care Act (Obamacare) is that one of its key provisions, the individual insurance mandate, has conservative origins. In Congress, the requirement that individuals to purchase health insurance first emerged in Republican health care reform bills introduced in 1993 as alternatives to the Clinton plan. The mandate was also a prominent feature of the Massachusetts plan passed under Governor Mitt Romney in 2006. According to Romney, ‘we got the idea of an individual mandate from [Newt Gingrich], and [Newt] got it from the Heritage Foundation.’”
– Tracing the Flow of Policy Ideas in Legislatures: A Text Reuse Approach
That irony led John Wilkerson of the University of Washington and his colleagues David Smith and Nick Stramp to study the legislative history of the health care reform law using a text-analysis system to understand its origins.
Scholars rely almost exclusively on floor roll call voting patterns to assess partisan cooperation in Congress, according to findings in the paper, Tracing the Flow of Policy Ideas in Legislatures: A Text Reuse Approach. By that standard, the Affordable Care was a highly partisan bill. Yet a different story emerges when the source of the reform’s policy is analyzed. The authors’ findings showed that a number of GOP policy ideas overlap with provisions in the Affordable Care Act: Of the 906-page law, 3 percent of the “policy ideas” used wording similar to bills sponsored by House Republicans and 8 percent used wording similar to bills sponsored by Senate Republicans.
Excluding “markup” bills, or amendments and legislative rewrites, 11 percent and 28 percent of policy ideas came from Congressional and Senate Republicans, respectively. For example, a proposal for nursing home transparency made by Republican Sen. Chuck Grassley of Iowa in March 2009 eventually appeared in the the health care reform law’s language.