The Affordable Care Act and ongoing talk of repealing and replacing it has long, long roots. Since the days of Truman, most people have agreed that universal health insurance is a good thing; but what we can't seem to agree on is how to pay for it. LDI Senior Fellows Mark Pauly and Patricia Danzon, in 1991, proposed a plan that required every American to buy insurance, through the use of tax credits. These credits and the deductible on each policy would vary by family income. How to pay for all this? They would end the present tax exemption for employer-sponsored health insurance. Individual mandate? Tax credits? Sound familiar?