STILLWATER — Thursday’s U.S. Supreme Court decision to uphold the mandates in the Affordable Health Care Act leaves Oklahoma’s state leaders and lawmakers with a decision to make.

Under the federal Patient Protection and Affordable Care Act, the state has until November to create its own state-run health insurance exchange or be absorbed into the federal system.

Oklahoma lawmakers nearly created a state-run health insurance exchange in 2009 after a Republican-majority Legislature sent an exchange bill to Democratic Gov. Brad Henry to sign. The exchange idea had widespread support but never materialized amid the economic collapse and budget crisis.

That support disappeared after the health care exchange became a requirement in President Barack Obama’s Affordable Care Act. State leaders rejected $54 million in federal money offered to Oklahoma to help create its exchange.

In recent years, the Legislature has opted to wait to consider any health care exchange bill until the Supreme Court decided if Obama’s health-care initiative was constitutional..

Now, the November deadline looms.

The state does not have the luxury of waiting until the Nov. 6 general election to see whether changes in the White House or Congress might mean a repeal of the law.

The Associated Press reported Wednesday that a spokesperson for Oklahoma Gov. Mary Fallin said she had not decided on how the state should proceed if the Supreme Court upheld the law’s constitutionality.

In a statement Thursday, the governor didn’t mention a special session. Instead, Fallin’s comments focused on the possibility of repealing the federal law and the need to support the presumptive Republican presidential nominee — Mitt Romney.

“Today’s decision highlights the importance of electing leaders who will work to repeal the federal health care law and replace it with meaningful reform focused on common-sense, market-based changes,” she said.

Fallin also said Oklahoma is united in its opposition to the Obama’s plan.

“Oklahomans have voiced their opposition to the federal health care bill from the very beginning, having approved a constitutional amendment to block the implementation of this bill in our state,” she said. “We believe that — rather than big government bureaucracy and one-size-fits-all solutions — the free-market principles of choice and competition are the best tools at our disposal to increase access to health care and reduce costs.”

Rep. Cory Williams, D-Stillwater, said he expects the governor will eventually call the Legislature back for a special session to keep Oklahoma from being absorbed by the federal system.

State Rep. Lee Denney, R-Cushing, and State Sen. Jim Halligan, R-Stillwater, didn’t respond to interview requests.

Williams said lawmakers should remember health insurance exchange was originally an Oklahoma idea. .

“Any Republican that is being honest with you will tell you that this was in the works well in advance of the (health care law),” he said. “It just got caught up in an untimely political debate.”

While most of the state’s leadership disagrees with the Supreme Court decision, the state should move forward with setting up its own insurance exchange system, Williams said.

“In all honesty, Oklahoma needs to quit taking the wait-and-see approach. It is what it is. Go forward, make it the absolute best system you can for your citizens in the current environment. If the environment changes, then go back in and adjust accordingly later,” he said. “But we have lost $54 million and 18-months worth of planning and implementation and now risk being a part of the system that polling in our state shows everybody despises. All because we have failed to act.”

O'Bannon is a reporter for the Stillwater NewsPress.