[3][4] Many of the ideas in the bill were originally proposed by Stuart Butler in 1989, when he worked at The Heritage Foundation,[5] however, some conservatives believed that it was too liberal.
[6] It was introduced as an alternative to legislation unveiled earlier that year by then-President Bill Clinton.
[8][9] It shared many important features with the Affordable Care Act, which was signed into law by President Barack Obama in 2010 on March 23, 2010, including the individual mandate,[10] which was upheld by the Supreme Court in NFIB v. Sebelius as a reasonable exercise of congressional taxing authority.
[11] However, there were some differences between HEART and the ACA, including that HEART did not require employers to contribute to the cost of their employees' premiums, and did not require states to expand Medicaid, a provision of the ACA that was ruled unconstitutional by the Supreme Court in NFIB v.
[12] Also, HEART, unlike the ACA, included medical malpractice tort reform.