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Jon Greenberg
By Jon Greenberg November 15, 2013

Is the ACA the GOP health care plan from 1993?

If there’s one thing conservatives might hate more than Obamacare, it’s hearing that Obamacare springs from Republican ideas. The Heritage Foundation, the granddaddy of the right-wing think tanks, fumed when President Barack Obama said it was the source of the concept of the health insurance marketplaces where people could shop for the best deal. (We rated Obama's claim Mostly True.)

Squaring off with Sean Hannity on his Fox News Channel show, Democratic public relations consultant Ellen Qualls could barely get these words out:

Qualls: History lesson. This was the Republican plan ...

Hannity: This was not the Republican plan.

Qualls: … in the early '90s.

Hannity: No Republican supported it. Not one Republican voted for this.

Qualls: Yes, in the '90s ...

Hannity: That’s a lie.

Qualls: … during the Clinton administration, this was the ‘Let’s fix the private insurance system ...

Hannity: No. No.

Qualls:  … and make it work’, instead of making it a government system.

Time out!

Is the Affordable Care Act really the same as "the Republican plan in the early '90s?"

Short answer -- sort of. There was a Republican bill in the Senate that looked a whole lot like Obamacare, but it wasn’t the only GOP bill on Capitol Hill, it never came to a vote and from what we can tell, plenty of conservative Republicans didn’t like it.

Qualls told PunditFact that she was thinking of the Senate bill.

1993: Health care takes center stage

President Bill Clinton took on an ill-fated effort to reform health care in 1993. As the president’s task force (led by First Lady Hillary Rodham Clinton) worked behind closed doors to craft solutions to ever-rising health care costs and a growing number of uninsured families, Republicans scrambled to forge an alternative.

Republican Sen. John Chafee of Rhode Island was the point man. The bill he introduced, Health Equity and Access Reform Today, (yes, that spells HEART) had a list of 20 co-sponsors that was a who’s who of Republican leadership. There was Minority Leader Bob Dole, R- Kan., Sens. Orrin Hatch, R-Utah, Charles Grassley, R-Iowa, Richard Lugar, R-Ind., and many others. There also were two Democratic co-sponsors.

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Among other features, the Chafee bill included:

  • An individual mandate;

  • Creation of purchasing pools;

  • Standardized benefits;

  • Vouchers for the poor to buy insurance;

  • A ban on denying coverage based on a pre-existing condition.

"You would find a great deal of similarity to provisions in the Affordable Care Act," Sheila Burke, Dole’s chief of staff in 1993, told PunditFact via email. "The guys were way ahead of the times!! Different crowd, different time, suffice it to say."

That said, the Senate plan from 1993 was not identical to the health care law that passed in 2010. The Republican bill did not expand Medicaid as Obamacare does, and it did have medical malpractice tort reform, which the current law does not. In contrast to the current employer mandate, the Chafee bill required employers to offer insurance, but they were under no obligation to help pay for it.

Policy differences aside, health care scholar and former Clinton adviser Paul Starr at Princeton University said the Affordable Care Act is distinct in one other important way.

"The Chafee plan did not spell out how increased coverage would be financed," Starr said. "It was more of a symbolic bill than an actual piece of legislation."

In fact, after the bill was introduced, the Senate never took it up again.

Conservative pushback

Even before Chafee brought his bill forward, some conservatives were trying to scuttle it.

More hard-line senators such as Phil Gramm, R-Texas, House Republicans and the Heritage Foundation saw the Chafee bill as an unacceptable compromise. What they wanted was outright defeat of the president’s approach.

No single alternative emerged, but there were a variety of Republican proposals. One in the House drew more co-sponsors than any other, 72 of them. It was called the Action Now Health Reform Act, but its scope was limited. Much of it focused on insurance for small businesses and the self-employed. It offered some protections for people with pre-existing conditions and included changes in medical malpractice law.

There was a smorgasbord of other House Republican bills. Like Chafee’s bill, none of them went anywhere.

Our ruling

Qualls said the Affordable Care Act "was the Republican plan in the '90s." The bill she had in mind did have a strong roster of Republicans behind it, and it did share many major features with the Affordable Care Act. There were some significant differences but in a side-by-side comparison, the similarities dominate.

However, to call it the Republican plan, as though a majority of Republicans endorsed it, goes too far. The House Republicans took a different path, and there was opposition from more hard-line members of the Republican coalition. It is telling that the Chafee bill never became a full blown bill and never came up for a vote.

We rate the statement Half True.

Our Sources

Fox News, Hannity, Nov. 12, 2013

Email interview with Ellen Qualls, Qualls Communications, Nov. 13, 2013

Mediaite, ‘That’s a Lie!’ Hannity Fights Dem Guest Defending Broken Obamacare Promise, Nov. 12, 2013

PolitiFact, Obama says Heritage Foundation is source of health exchange idea, April 1, 2010

PolitiFact, Facebook post says Republicans embraced individual mandate in 1993, April 19, 2012

The American Prospect, What happened to health care reform?, Winter, 1995

Library of Congress, S.1770 -- Health Equity and Access Reform Today Act of 1993, Nov. 22, 1993

Email interview with Sheila Burke, senior public policy adviser, Baker Donelson Caldwell & Berkowitz, Nov. 13, 2013

Kaiser Health News, Summary of a 1993 Republican health reform plan, Feb. 23, 2010

PBS, A detailed timeline of the health care debate, May, 1996

Email interview with Paul Starr, professor of sociology and public affairs, Princeton University, Nov. 13, 2013

Kaiser Health News, Chart: Comparing health reform bills, Feb. 24, 2010

Kaiser Health News, The Democrats' 2010 Health Reform Plan Evokes 1993 Republican Bill, Feb. 23, 2010

Library of Congress, H.R.101 -- Action Now Health Care Reform Act of 1993, Jan. 5, 1993

Chicago Sun Times, GOP Prepares to Fight Democrat Health Plan, May 12, 1993

Email interview with Henry Aaron, senior fellow, Brookings Institution

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