<P> An individual mandate to purchase healthcare was initially proposed by the politically conservative Heritage Foundation in 1989 as an alternative to single - payer health care . Stuart Butler, an early supporter of the individual mandate at the Heritage Foundation, wrote: </P> <P> If a young man wrecks his Porsche and has not had the foresight to obtain insurance, we may commiserate, but society feels no obligation to repair his car . But health care is different . If a man is struck down by a heart attack in the street, Americans will care for him whether or not he has insurance . </P> <P> The Heritage Foundation changed its position in 2011, calling the individual mandate unconstitutional . </P> <P> From its inception, the idea of an individual mandate was championed by Republican politicians as a free - market approach to health care reform . Supporters included Charles Grassley, Mitt Romney, and the late John Chafee . The individual mandate was felt to resonate with conservative principles of individual responsibility, and conservative groups recognized that the healthcare market was unique . </P>

Affordable care act's individual and employer mandates