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Senate Speaker Ron Ramsey attends a State Building Commission meeting in Nashville, Tenn., on Thursday, Nov. 15, 2012. The Blountville Republican told reporters afterward that he expects Gov. Bill Haslam to decide to keep the Tennessee's options open about whether to create a state-run health insurance exchange, or to have the federal government operate the marketplace required under the President Barack Obama's health care law. (AP Photo/Erik Schelzig)