The re-election of President Barack Obama and the ushering in of Republican supermajorities in the Tennessee General Assembly leave Republican Gov. Bill Haslam in an intriguing dilemma this week.
Before Friday, Haslam will have to decide whether to opt for a federally run health insurance exchange as laid out in Obama's Affordable Care Act, or he will have to recommend that Tennessee pursue creating its own state-run system under the law.
Although the governor has said he leans toward the idea of a state-run exchange, the idea is almost certain to go against the grain of many Republicans, who would rather have nothing to do with the president's signature policy.
A recommendation by Haslam for a state-run system could set up an unlikely start to next year's legislative session, with an unprecedentedly dominant GOP showing division over how best to manage health insurance for Tennesseans.
In a recent AP report, Haslam said that although he was opposed to the new law as it was passed, he saw potential benefits to be had for not choosing to defer its implementation to the federal government.
"There are a lot of benefits to the state running it ourselves because we're going to run anything better than the federal government," Haslam said.
The governor also acknowledged the potential political difficulties of recommending a state-run system.
As he concludes state budget hearings and prepares to travel to Las Vegas on Wednesday for an annual Republican Governors Association conference, Haslam is scheduled to hold a conference call with lawmakers to discuss the issue.
House Majority Leader Gerald McCormick, who will participate in the call, said he had received feedback from a majority of GOP House members against the idea of a state-run exchange. McCormick said he had not been told what the governor's recommendation would be but added that he thought that lawmakers would be "open-minded" on the issue.
"They're open-minded, but the burden of proof is that this was created by the federal government," McCormick said. "I'm not sure it's a good idea for the states to get too involved in it to the point where we are held responsible for it. We're open to any arguments, and I do think that the state could run it more efficiently than the federal government, but I'd just as soon let them run it. We did not set this thing up; the federal government did."
McCormick said he wasn't sure if newfound GOP supermajorities in both legislative chambers would be enough to give Haslam the backing he needed were a recommendation for a state-run system to be made.
"It certainly would not be a unanimous vote," he said.
Haslam is one of at least five governors who held off from making a decision regarding exchanges until after the results of last week's election. Had Republican presidential candidate Mitt Romney been elected, he had promised to make pursuing a repeal of the law a central focus of his presidency.
For states that opt to create their own exchanges, the federal government would pay the full cost for the first three years of the program, according to a New York Times report.
The amount of federal funding would then be decreased in consequent years.
Haslam has until Friday to report his intention to the U.S. Department of Health and Human Services.