Research & Commentary: Ohio Health Insurance Exchange

Published February 17, 2012

Uncertainty over the future of the federal health care law has led many states, including Ohio, to avoid implementation of health insurance exchanges. Recently state Sen. Michael Skindel (D-Lakewood) introduced Senate Bill 277, which would establish the Ohio Health Benefit Exchange Program and an agency to oversee it.

Ohio has received a $1 million planning grant from the federal government. But financial assistance from the federal government will end by 2014, forcing states that have implemented exchanges to bear the entire financial burden themselves.

Proponents of state implementation claim a federal insurance exchange would limit state authority, whereas crafting one will give the state flexibility and control over health care. Opponents say a state health insurance exchange and a federal exchange would be one and the same. Lt. Gov. Mary Taylor, for instance, has raised concerns the state will have “little control” over the new government bureaucracy.

According to the Patient Protection and Affordable Care Act (PPACA), all state health insurance exchanges must be approved by the federal government, and the federal government, not the state, will have authority and oversight over the exchanges. The law gives the federal government full authority to commandeer any exchange that does not meet all federal requirements.

As stated by the Citizen’s Council for Health Freedom, “the reality is that control over the exchanges will reside in Washington, not the states—it is forming a federal exchange with a veneer of state flexibility.”

The following documents offer additional information about health insurance exchanges.

Taylor Continues Criticisms of Health Insurance Exchange 
Columbus Dispatch outlines Ohio Lt. Gov. Mary Taylor’s argument that a state-crafted health insurance exchange will not give states greater authority over health care.

Emerging Issues Call Series: Health Insurance Exchanges
In the first of The Heartland Institute’s Emerging Issues Call Series, Legislative Specialist Kendall Antekeier and Research Fellow Benjamin Domenech discuss health insurance exchanges.

State Insurance Exchanges: The Case Against Implementation Health Care News Managing Editor and Heartland Institute Research Fellow Benjamin Domenech provides several reasons states should avoid implementing a health insurance exchange. He writes, “Any exchange created to pass muster with HHS Secretary Kathleen Sebelius and the current rules within Obama’s law will be fundamentally flawed.”

Policy Tip Sheet—State Health Insurance Exchanges—state-health-insurance-exchanges-post-scotus
Heartland Institute Legislative Specialist Kendall Antekeier outlines the arguments against state health insurance exchange implementation and provides facts about previously attempted exchanges. Antekeier writes, “If a state moves forward with implementing an exchange, it could invest valuable time and taxpayer dollars in developing a system only to discover it does not comply with final federal regulations.”

Should Virginia Create a Health Insurance Exchange?
Michael Cannon of the Cato Institute explains why Virginia and other states should not craft an insurance exchange. “Creating its own exchange will not allow Virginia to control its own health insurance markets. In the end, there is no such thing as a state exchange,” Cannon writes.

Obamacare Exchange Scheme Could Destroy Insurance Marketplace
This Health Care News article explains how health insurance exchanges could impact the insurance market: “In practice, they [health insurance exchanges] are delivery mechanisms for bureaucracy and could spur a public takeover of the health care system.”

Consumer Power Report: Don’t Go Exchanging
Health Care News Managing Editor and Heartland Institute Research Fellow Benjamin Domenech explains the “threat of an instituted ‘federal’ exchange—where a state presumably would have no input during the process—is a more hollow threat than ever before.”

Research & Commentary: Lessons from Massachusetts and Utah Insurance Exchanges
This Research & Commentary outlines two states’ experiences with health insurance exchanges, finding they have not produced the desired results but instead increased state health care costs. Heartland Institute Senior Fellow Peter Ferrara is quoted explaining how the Massachusetts exchange increased costs by 42 percent in less than three years.

Research & Commentary: Exchange Regulation and State Implementation–commentary-ohio-health-insurance-exchange
Health Care News Managing Editor and Heartland Institute Research Fellow Benjamin Domenech outlines the exchange regulations distributed by the U.S. Department of Health and Human Services and discusses the risks for states in implementing exchanges.

Nothing in this Research & Commentary is intended to influence the passage of legislation, and it does not necessarily represent the views of The Heartland Institute. For further information on this subject, visit Health Care News at, The Heartland Institute’s website at, and PolicyBot, Heartland’s free online research database at

If you have any questions about this issue or the Heartland website, contact Heartland Institute Health Care Legislative Specialist Kendall Antekeier at [email protected] or 312/377-4000.