<Ul> <Li> The Community Living Assistance Services and Supports Act (or CLASS Act) established a voluntary and public long - term care insurance option for employees, </Li> <Li> Consumer Operated and Oriented Plans (CO-OP), member - governed non-profit insurers, could start providing health care coverage, based on a 5 - year federal loan . </Li> </Ul> <Li> The Community Living Assistance Services and Supports Act (or CLASS Act) established a voluntary and public long - term care insurance option for employees, </Li> <Li> Consumer Operated and Oriented Plans (CO-OP), member - governed non-profit insurers, could start providing health care coverage, based on a 5 - year federal loan . </Li> <P> An individual mandate coupled with subsidies for private insurance as a means for universal healthcare was considered the best way to win the support of the Senate because it had been included in prior bipartisan reform proposals . The concept goes back to at least 1989, when the conservative The Heritage Foundation proposed an individual mandate as an alternative to single - payer health care . It was championed for a time by conservative economists and Republican senators as a market - based approach to healthcare reform on the basis of individual responsibility and avoidance of free rider problems . Specifically, because the 1986 Emergency Medical Treatment and Active Labor Act (EMTALA) requires any hospital participating in Medicare (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 . </P>

The patient protection and affordable care act of 2010 title v