"....The idea goes back as far as 1989, when it was initially proposed by the conservative Heritage Foundation as an alternative to single-payer health care.[48] It was championed by many Republican politicians as a market-based approach to healthcare reform on the basis of individual responsibility. Specifically, because the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital participating in Medicare (which nearly all do) to provide emergency care to anyone who needs it, the government often indirectly bore the cost of those without the ability to pay.[49][50][51]....<snip>....
At the time of these proposals, Republicans did not raise constitutional issues with the mandate; Mark Pauly, who helped develop a proposal that included an individual mandate for George H.W. Bush, remarked, "I don’t remember that being raised at all. The way it was viewed by the Congressional Budget Office in 1994 was, effectively, as a tax."[48]
An individual health insurance mandate and an insurance exchange was also enacted at the state level in Massachusetts: In 2006, Republican Governor Mitt Romney signed an insurance expansion bill with strong bipartisan support, including that of Senator Ted Kennedy. Romney's successful implementation of the 'Health Connector' exchange and individual mandate in Massachusetts was at first lauded by Republicans. During Romney's 2008 presidential campaign, Senator Jim DeMint praised Romney's ability to "take some good conservative ideas, like private health insurance, and apply them to the need to have everyone insured." Romney himself said of the individual mandate: "I'm proud of what we've done. If Massachusetts succeeds in implementing it, then that will be the model for the nation."[60].....read....