It’s Decision Time: The Future of Health Insurance Exchanges in Tennessee


The election is finally over, and the initial raucous that overcame the nation is beginning to subside. This peace is only illusory, as consequences of the outcome are beginning to sink in for those distraught Republicans who held onto hope of a Romney-led administration repealing the Affordable Care Act.  Nationwide, Governors must decide the manner in which their state will handle the insurance exchange system that the ACA mandates. They can choose between running their own insurance exchange within their state, letting the Federal government run the exchange for them, or dividing the tasks between the state and federal governments [1].

In Tennessee, Governor Bill Haslam still appears to be undecided on which program he will choose. The deadline to report a decision to Department of Health and Human Services was originally set for last Friday, November 16, but it has been extended until December, giving the Governor more time to contemplate the choice.

Gov. Haslam seems to be leaning towards supporting the state-run exchange. His spokesman recently released a statement saying that the governor believes in the efficiency and cost effectiveness of the state run programs, but the uncertainty the specifics workings of the program is contributing to his reluctance in making a decision [1]. Along with other Government officials, Gov. Haslam has complained that the federal government has not answered important questions detailing the particulars of how these state-run exchanges would operate [2]. “My initial concerns about the Affordable Care Act have only been more fully realized when I see the impact that it’s going to have on our state budget, small businesses and providers,” Gov. Haslam stated last week, conveying his concerns. “It is a complex decision and there are so many answers that we do not have yet” [1].

Even if the federal government were to provide answers, Gov. Haslam would still face the obstacle of opposition to the state-run exchange within the state legislature. He must gain their support in order to approve the exchange, and with a Republican supermajority in both the House and Senate, this is not looking likely [2]. The problem for Republicans in the legislature is that supporting the state-run exchange would be a stark change in the stance they’ve taken against the Affordable Care Act from its inception. Many Republicans strongly oppose favoring the state-run exchange out of principle, which is compounded by the fact that many of their constituents are against it as well [2].

Furthermore, GOPers are concerned about the possibility of having to take the blame for a failed exchange system. As state Senator Mike Ketron put it, “If it’s going to be exchange either way, would you want to take the blame for the way it’s being run? Irregardless, if it’s going to be bad one way or the other, why would I want the blame for that?” [2].

Ultimately, is up to Gov. Haslam to choose the program that benefits Tennessee the most and it is up to members of the state House and Senate to support him, partisanship aside. A poll by Middle Tennessee State University reported that 68% of active voters in the state, both Republican and Democrat, approve of the job Haslam has done as Governor [3]. This indicates that popular support for whatever decision Gov. Haslam makes should be fairly easy to mobilize, so there is no reason that the state legislature should not take advantage of Haslam’s popularity to implement the most beneficial plan for the state.

There is no longer the faint hope that a Republican will come into office and repeal the Affordable Care Act. Obama’s reelection has only solidified the fact that 2014 is nearing rapidly and with it more provisions of the ACA will be put into action. This political reality makes it futile to resist the legislation based on partisanship alone. Even if Republicans don’t agree with the law, it is necessary to assess the choices that the law gives them and their potential effects on the people and the economy of the state. One of the three options is inevitable. If the state-run exchanges amount to the best option, then there is no reason to oppose it on the basis of party politics alone. Gov. Haslam himself states it best, pointing out that he has continually opposed the ACA, but knows he must “put emotions aside and make tough decisions on the serious issues that impact Tennesseans”[2].






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About author

Kristin Vargas

Kristin is a junior from Illinois double majoring in Political Science and Public Policy, with a concentration in Health Policy. At Vanderbilt, she is also a member of Momentum Dance Company, for which she dances, choreographs and handles public relations. She has interned for Illinois Congressman Robert Dold in both his district office and on his reelection campaign this past summer. With her major concentration in Heath Policy and all the excitement surrounding health care in the current political environment, her most passionate political interest is health care policy. She also is very interested in anything involving the Supreme Court, its history, and its impact on politics.

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