By Ted Nesi

PROVIDENCE, R.I. (WPRI) – Rhode Island officials say it’s “full speed ahead” for the state in implementing President Obama’s health care law locally after the U.S. Supreme Court upheld it as constitutional. More than 50,000 more residents are expected to sign up for Medicaid at a cost of $1.9 billion over five years.

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• Related: Q&A: Lt. Gov. Roberts on what’s next for health reform in RI (June 28)

Ferguson (r) with Costantino and Roberts

“Is this the happiest day of my life? Pretty much!”

That’s what a smiling Christine Ferguson told me at a press conference this morning when I asked how it felt Thursday to see the health policy she developed as a senior aide to the late U.S. Sen. John Chafee upheld as constitutional by the U.S. Supreme Court.

Ferguson, who started working for Chafee’s son on Monday as head of Rhode Island’s new health insurance exchange, said unequivocally that President Obama’s signature accomplishment is what she drafted for Republicans two decades ago. ”It is based on the John Chafee bill of 1993,” she said. “It is pretty much exactly how we envisioned it.” She added: “I think it’s a great day.”

Ferguson was a key architect of the Health Equity and Access Reform Today Act of 1993, introduced by the senior Chafee that year as the Republican alternative to the Clinton administration’s so-called “Hillarycare” proposal. (Oddly enough, Hillary Clinton’s 1993 proposal was crafted in partnership with a Rhode Islander, too – Ira Magaziner of Greenhouse Compact fame.)

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There’s some irony in Governor Chafee’s appointment on Thursday of Christine Ferguson as director of Rhode Island’s new Health Benefits Exchange, the agency that will run the state’s Affordable Care Act health insurance marketplace.

In the 1990s, Ferguson worked for Chafee’s father, Republican U.S. Sen. John Chafee, as a health policy advisor. In that role, she was a key architect of the Health Equity and Access Reform Today Act of 1993, Chafee’s GOP alternative to President Clinton’s health reform legislation.

“Christine Ferguson of my staff and Sheila Burke of Senator [Bob] Dole’s staff have been absolutely essential in preparing this legislation,” Chafee said on the Senate floor when he introduced the bill in November 1993. “Without their knowledge and drive and energy, we would not have this bill today.”

At the center of Chafee’s 1993 bill was a provision requiring every American to purchase health insurance by January 2005 – an individual mandate. The same policy has now become anathema to conservatives, who are hopeful the U.S. Supreme Court will rule it unconstitutional before the end of this month.

Ferguson may be one of the few constants in the two-decade health care debate – someone who put forward an individual mandate as a Republican aide in the 1990s and will now run an insurance exchange reliant on the mandate, put into law by a Democratic president and implemented by a center-left independent governor.

• Related: Today marks the first anniversary of – ‘Chafeecare’ (March 23, 2011)