ATLANTA — A day after Barack Obama's re-election, Gov. Nathan Deal suggested that he will not implement a Georgia health insurance exchange as part of the 2010 federal health care overhaul that ranks as the president's signature legislative achievement.
Deal told The Associated Press on Wednesday that he wouldn't disclose his decision until notifying federal authorities. But he noted that the state stopped planning an exchange once federal agencies wrote regulations that he says restrict Georgia's ability to design its own program.
The decision to stop, Deal says, is "probably a pretty good indication of where we are headed."
The law gives states the option to run the exchanges or default to the federal government. The exchanges would allow individuals to shop for private insurance.
Whether consumers would notice real differences between a federal or state exchange remains to be seen. But Deal's reticence underscores the continued philosophical and political wrangling that surrounds implementation of the Affordable Care Act.
Congress set a Jan. 1, 2013, deadline for states to have an operable exchange. Deal has until Nov. 16 to submit an outline for an exchange or notify federal authorities that Georgia declines to open its own.
Deal said he was initially inclined to consider a state-run exchange, and in 2011, he appointed a committee that advised him on how to proceed. That panel opted against recommending a state-managed exchange.
By the time the U.S. Supreme Court ruled on the constitutionality of the law's key provisions this spring, Deal said he would wait until after the election to make a decision. Republican challenger Mitt Romney had promised to "repeal and replace" the law, a prospect that now is moot given the president's re-election and Democrats retaining control of the U.S. Senate.
Asked for an example of a policy that Georgia couldn't implement as part of the exchanges, Deal cited "association plans," a concept that would allow a professional or trade association to form a large group insurance pool — similar to large employers — to spread risk and, theoretically, make coverage affordable.
The governor said the Obama administration's preferred approach is to push uninsured individuals to the exchange markets where they can buy individual plans. Many of those customers will have their premiums subsidized by the federal government, depending on their income levels.
Cindy Zeldin is executive director of Georgians for a Healthy Future. As a member of Deal's advisory panel on exchanges, she filed a minority report urging the governor to pursue a state-run exchange.
At this point, she said, "Georgia is too far behind the planning stage" for that to happen. Under a federally managed exchange, she said, "Consumers will still have largely the same experience in terms of visiting a website and shopping for coverage."
But she said a state-run exchange might better serve consumers who have trouble, because regulators and staff members "know the Georgia insurance market" better than federal authorities.
House Speaker David Ralston, a Republican like Deal, has previously said he would prefer Georgia take the lead because of a "strong inclination for states to craft solutions to state problems." But, he said, "it all depends on the strings attached and whether the rules would actually let us design a Georgia plan."