A year ago today, President Obama signed the late U.S. Sen. John Chafee’s health care reform plan into law.

Sure, most people know the legislation as the Affordable Care Act – or, in less supportive circles, “Obamacare.” But when you get away from all the partisan bickering over the law, its actual nuts and bolts bare a striking similarity to the Health Equity and Access Reform Today Act of 1993, which the Rhode Island Republican proposed during the heat of President Clinton’s fight over health policy.

Don’t believe me? Check out this Kaiser Health News chart comparing John Chafee bill’s with competing Republican and Democratic proposals from 2009. As Kaiser’s Maggie Mertens pointed out in a February 2010 interview with one of Chafee’s co-sponsors, former Sen. Dave Durenberger of Minnesota:

In fact, the key provisions in the Chafee bill may seem familiar, as they bear a strong resemblance to those in the current Democratic Senate bill, and now in President Barack Obama’s proposal. A mandate that individuals buy insurance, subsidies for the poor to buy insurance and the requirement that insurers offer a standard benefits package and refrain from discriminating based on pre-existing conditions were all in the 1993 GOP bill.

Durenberger says the reason many of these ideas have been shunned by today’s Republicans, even called unconstitutional by some, is that political times have changed. “The main thing that’s changed is the definition of a Republican,” he said.

The bill Chafee crafted wound up being Democrats’ last, best hope for passing something comprehensive by the summer of 1994. “I trust John Chafee,” Sen. Ted Kennedy told fellow Democrats even as the legislation’s prospects dimmed. In the end, though, his bill died along with every other effort to pass major health legislation during that Congress.

Chafee’s ideas didn’t die, though – his top health policy aide, Laurie Rubiner, went on to work for Hillary Clinton, helping shape the health plan that Clinton unveiled during her presidential campaign – which also influenced Obama’s.

The American Enterprise Institute’s Norm Ornstein, an authority on all things congressional, emphasized the link between Chafee’s proposal and Obama’s amid the long legislative battle of 2009-10. “It is basically a marriage between Mitt Romney’s Massachusetts-care, and even more the John Chafee-David Durenberger-Chuck Grassley-Bob Dole alternative of 1993-’94 built around managed competition,” he told PBS’s Charlie Rose. (Orrin Hatch and Richard Lugar were also Chafee co-sponsors, at least initially.)

 Ornstein is a nonpartisan fellow, but liberals were happy to link Democrats’ 2009 legislation with Chafee’s while arguing in its favor.

“Everything Republicans originally wanted is in this bill,” Ezra Klein wrote after Senate Finance Committee Chairman Max Baucus released his draft version of the Affordable Care Act in 2009. “It is, in fact, a moderate Republican bill. It looks like nothing so much as the bill Republican Senator John Chafee Sr. proposed in 1994.”

Jonathan Cohn later added: “The similarities between what [John Chafee] proposed then and what Democrats are proposing now are nothing short of striking – particularly when you put them alongside what House Republicans now propose to do instead.” Or, for that matter, what Ted Kennedy wanted in the 1970s.

In a New York Times op-ed that urged Congress to approve Obama’s proposal despite its shortcomings, Vice President Biden chided Democrats for failing to compromise by passing Chafee’s bill in 1994. “Congress’s failure to pass health care reform that year led to 16 years of inaction – and 16 years of exploding health care costs and rising numbers of uninsured Americans,” Biden, who served with Chafee in the Senate, wrote.

None of that means Chafee’s plan would have necessarily worked well had it become law; Paul Starr, who worked on the Clinton White House health plan, offered an extended policy critique here. Jon Cohn also quoted this 1994 National Journal article about Chafee’s and Congressman Jim Cooper’s alternative bills:

The more visible the Cooper and Chafee bills become, the more questions arise about their technical and political feasibility. Many supporters of the two bills, when pressed, confess that they have misgivings about some key features and hint that they have signed onto them mainly for tactical reasons.

Conservative wonk Reihan Salam, who thinks Chafee’s bill differed from Obama’s more than Kaiser Health News’ chart suggests, added this:

And does the Chafee plan suggest that the Republican party has moved far to the right over the last decade plus? There’s no denying that there’s been some of this. But of course the Chafee plan lost support among Republicans in 1993 as its potential cost became clearer, as Paul Starr of Princeton noted in an excellent, comprehensive article on “What Happened to Heath Care Reform?” that appeared in The American Prospect in 1994. Having learned their lesson once, it’s hardly surprising that Republicans would start from their 1994 position rather than their 1992 position.

And also from the right, Ross Douthat pointed out that even if the Affordable Care Act does look like Chafee’s bill, that doesn’t make it conservative – or workable:

If you’re a liberal looking to put a bipartisan gloss on the proposed legislation, then, you’re much better off describing it as a “moderate Republican” package than as a semi-conservative one. This is a rhetorical tack that progressives often take, and they have a point: The Senate legislation is the kind of bill that the early-1970s Richard Nixon might have backed, or the early-1990s John Chafee (who crafted a Republican alternative to Clintoncare), or (self-evidently) the Mitt Romney of 2005.

But keep in mind that the kind of “moderate Republicanism” (or “Rockefeller Republicanism,” to use a better term of art) that bound all of those figures together was often closer to a liberal Republicanism — a pro-business version of the prevailing liberal paradigm, that is, rather than a intellectually-distinct alternative. … John Chafee’s views on most domestic issues (like those of his son, and successor) bore roughly the same relationship to an ideologically-consistent conservatism that Zell Miller’s views on, say, defense policy bore to the liberal mainstream when Miller was a Democratic Senator from Georgia.

I’ll leave it to wonkier souls than myself to determine just how much the details of John Chafee’s 1993 health plan prefigured Obama’s. But as Rhode Island marks one year since passage of the Affordable Care Act, I thought it was worth pointing out just how big a role the late senator’s ideas played in the debate over reform.

(photo: U.S. Navy)