Affordable Care Act rooted in conservative thinking

When Democrats passed the Affordable Care Act in 2010 without a single Republican vote, they were criticized as being too partisan. In the end, however, the bill included many Republican ideas.

The keystone principle of the act — a mandate that all Americans buy health insurance — is rooted in conservative thinking. Additionally, the Democrat-controlled House and Senate committees adopted nearly 190 Republican amendments while writing the legislation, according to data compiled by The New York Times.

In contrast, Democrats complain that they had no input in creating the Republican health care plans proposed this year. Democrats, who have submitted numerous proposals, said they would further participate if Republicans dropped their insistence on repealing the Affordable Care Act.

“The door to bipartisanship is open right now, not with repeal but with an effort to improve the existing system,” said Sen. Chuck Schumer of New York, the minority leader.

“We’re ready to sit down, right now, if Republicans abandon cuts to Medicaid, abandon huge tax breaks for the wealthy and agree to go through the regular order — through the committees, with hearings, onto the floor, with time for amendments,” he said.

Democrats proposed 29 amendments to the House version of the Republican bill, but none passed.

Senate Republican leaders have proposed four versions of their plan, but at least twice the bills have failed to reach the floor because several Republican senators announced their opposition. They are trying to pass a bill without Democratic support, and with 52 seats their slim majority leaves little room for Republican dissent.

Soon after the Senate bill collapsed this past week, Schumer urged Republican lawmakers to start fresh and pursue a bipartisan effort — an idea that McConnell had floated a few weeks ago, when he realized his bill was in trouble.

“The ACA is a bill that is very bipartisan in nature,” said Allison K. Hoffman, a health care policy expert and law professor at the University of Pennsylvania, as critical ideas for the Affordable Care Act were borne of more conservative thinking.

The federal mandate to buy insurance is similar to a mandate that Mitt Romney, the 2012 Republican presidential candidate, had enacted as Massachusetts governor. The concept that people should be required to buy health coverage originated with conservative economists two decades ago and was initially embraced by conservative research groups like the Heritage Foundation.

“Historically, the parties used to talk to each other more,” Hoffman said. “But we’ve seen a real shutdown of cooperation over the past eight years.”