Now that those insurance exchanges are part of President Barack Obama's federal health care overhaul, however, they can't seem to run away fast enough.
Facing pressure from tea party groups, Gov. Nathan Deal and the House on Wednesday scuttled a bill that would have taken the first step toward creating a health exchange in Georgia under the federal law. Instead, they adopted a bill that would enter Georgia into a proposed interstate health care compact, essentially in defiance of the federal law.
The hasty retreat points to a delicate political dynamic: Should a state that is suing to overturn the federal health care law be working at the same time to implement it?
Tea party activists say absolutely not.
"You don't fight with one hand and raise the white flag with the other," Tea Party Patriots State Coordinator Julianne Thompson said.
But Deal said he must take a more pragmatic approach. While lawsuits challenging constitutionality of the law are pending, the state is still bound by it, he said. He'll now appoint an advisory panel to study Georgia's options on an exchange. A spokesman noted that Georgia residents will be forced into the national exchange if the state doesn't set up its own. The federal law requires most Americans to obtain health insurance, so the exchanges would be the place where many uninsured would turn to find it.
"If Georgia must have an insurance exchange under federal law, the governor wants to ensure that our exchange is established by and run by Georgians," Deal spokesman Brian Robinson said. "The alternative is having an exchange established by and run by Washington bureaucrats. The governor considers the latter unacceptable."
Health exchanges are essentially marketplaces where consumers who enroll can comparison shop for insurance plans. The aim is to bring down prices and get more people insured. The exchanges are set to open for business in 2014.
"These exchanges are rooted in some fundamental Republican principles: increased access to health care and free market solutions rather than government mandates," House Speaker David Ralston said in an interview with The Associated Press
"It's not a new concept. But what's new is that there is a lot of misinformation out there that this is related to an 'Obamacare' mandate," Ralston said.
Still, Deal and Ralston yanked the bill from a planned House floor vote on Wednesday, concerned about a revolt from some Republican legislators opposed to casting any vote that could be seen as supporting the federal health law.
It made clear that anything associated with Obama's federal health law is going to face a rough road in states where conservatives have rallied against it.
The 2007 bill that would have created health insurance exchanges was introduced by state Sen. Judson Hill, a Marietta Republican. It drew some top GOP co-sponsors: Chip Rogers, now Senate majority leader, and Tommie Williams, who has since become the chamber's President Pro Tempore. The bill faced fierce resistance from the insurance industry and failed to pass.
Hill said he still supports free-market exchanges where consumers can compare insurance information, but he said the federal plan would create one that is far too restrictive. Benefits must be standardized, which will limit participation by private insurers, he said.
"The idea of giving people more accurate information on coverage coupled with financial incentives and tax incentives, that's a concept that is worth continuing to explore," Hill said. "But the president has created a very different type of exchange."
Regulations governing the federal exchange have not been crafted yet.
Wayne Oliver, head of Newt Gingrich's Center for Health Transformation, said exchanges can have promise when tailored at a local, rather than a national, level.
"We believe in providing more choices," Oliver said.
However, since the exchanges aren't set to be up and running until 2014, he said Georgia has time to wait and see how the lawsuits challenging the health law pan out before the state commits time and effort to comply with it
Ron Bachman, a senior fellow with the conservative Georgia Public Policy Foundation, said even if the state sets up its own exchange he worries Washington will still be heavy handed in determining what is and is not allowed.
"I think the federal government is going to have enormous control no matter what the states try to do," Bachman said. "It's very appropriate questioning whether the state should be establishing a health exchange."