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The Ontario Health Insurance Plan is a provincially supported health care program that required fifteen years to develop and emerged though seven distinct and frequently controversial stages. It was said at the time to have generated more heated debate in the House than any other legislation that previously had been approved by the provincial government. The purpose of this report is to provide a comprehensive review of these seven stages, the arguments that accompanied each stage, and the impact of the stages on the local community. In the final section we discuss how certain elements in these stages, if known at the time, may have offered ways to help avoid the mandatory enrolment requirement that has continued to be one of the main pitfalls of the Affordable Care Act in the United States.