There will be no repealing the Affordable Care Act — at least for the next four years. That much was settled last Tuesday with the re-election of President Obama and the retention of Democratic control in the U.S. Senate. For the administration of Gov. John Kasich and others at the Statehouse, the question becomes what role Ohio chooses to play in achieving the goals of health-care reform.
The deadline is this Friday for states to declare how they intend to establish a health exchange, an online marketplace where uninsured citizens and small businesses can shop for coverage among qualified private health plans.
Ohio is yet to announce how it plans to proceed on the exchange, a delay that is not entirely surprising. For one, state officials have argued they needed the time to consider the best option. Besides, federal officials have not been swift in clarifying regulations and guidelines for implementation. Just as pertinent, many Republicans here hardly have been receptive to the reform legislation. Ohio joined a lawsuit that challenged, without success, the constitutionality of the law and took a wait-and-see approach, hoping for repeal under a Republican president.
The law offers states three options to get an exchange up and running by January 2014. They can set up and operate their own within federal guidelines or the federal government will do it for them. Or states can partner with the federal government, a hybrid setup, to perform certain key functions with federal oversight, for example, certifying health plans to participate in the exchange; conducting education and outreach programs for consumers and small businesses; and monitoring health plans for compliance on such things as benefits, premium rates and reporting standards.
Realistically, with a 2014 deadline looming, it is already late for Ohio to construct a state-based exchange. Besides, Lt. Gov. Mary Taylor, who doubles as director of the state Department of Insurance, signaled early on the administration’s tepid interest in a state-operated exchange. For an administration that rails loudly against federal intrusion on state functions and touts the importance of states as laboratories of innovation, it appears a baffling abdication of state control over an insurance market that would attract hundreds of thousands of Ohioans.
State officials now indicate they are “leaning” toward the hybrid model. As things stand, that would be the most practical option. Many of the activities permitted to states in the exchange model currently are performed by the state insurance department. In that regard, Ohio still may exert significant influence on how health reform plays out here.