A report in the September issue of Health Affairs traces the circumstances, conversations, and decisions that led Mitt Romney to support the inclusion of a mandate for individuals to obtain health insurance, included in the Massachusetts health reform bill he signed into law in 2006.

Martha Bebinger, health policy reporter for WBUR, the National Public Radio affiliate in Boston, recounts how the newly inaugurated Gov. Romney met with close friends and advisors in the early days of 2003 to review options for dealing with the uninsured and rising health care costs, which he realized were a key budget buster for the state. Bebinger retraces Gov. Romney’s steps leading to his embracing the mandate in 2005. Speaking to reporters that year, he characterized the mandate as “the ultimate conservative idea.” It’s based on a principle, he said, “that people have responsibility for their own care, and they don’t look to government to take care of them when they can afford to take care of themselves.”

Bebinger looks at the implications of Romney’s decisions – then and now – on a potential Romney Administration faced with repealing the Affordable Care Act.