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Published: 11/16/2012

Less-healthy choice

His hopes for repeal of the Affordable Care Act dashed by Mitt Romney’s failed presidential bid, Gov. John Kasich must now enforce the health-care reform law in Ohio. Without enough time to create a state-run health insurance exchange, an active partnership with the federal government would have been the best available option.

Instead, the governor is handing all responsibility for the exchange to Washington. That decision is not in the best interest of Ohio health-care consumers or employers.

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Ohio’s Republican leaders could have resolved to determine how best to carry our federally mandated health reform. Instead, they joined other GOP-led states in a failed lawsuit that challenged the constitutionality of the law. President Obama’s re-election quelled their last hope for repeal of the law.

The reform law requires each state to have an exchange — essentially an online market where consumers can buy health insurance, compare rates, and learn about and choose coverage levels. If a state chooses not to create its own exchange, the federal government will assume that responsibility.

A state exchange would have given the state greater flexibility and control. It would have been tailored to the specific needs of Ohio’s consumers, health insurers, and businesses.

But Lt. Gov. Mary Taylor, who doubles as state insurance director, said this week that the Kasich administration will “let the federal government run the exchange.” She said a letter from the governor to the U.S. Secretary of Health and Human Services today will make that decision official.

About a dozen states and the District of Columbia have said that they will set up their own exchanges. As many as 17 states are expected to let the federal government run theirs.

The decision against a state exchange left a federal-state partnership as Ohio’s best option. It would have allowed Ohio more control over the things it does that already work and made it easier to make the transition to a state-run exchange in the future. Moving from a one-size-fits-all federal exchange to a state-designed system would be hard and disruptive.

State exchanges also would have given the President’s health-reform law its best chance to succeed. More than 30 million people, including more than 700,000 in Ohio, are expected to gain health coverage under Obamacare.

Most remaining uninsured Americans would be covered by expanding Medicaid, with the federal government footing almost the entire bill. States can opt out of the Medicaid expansion; Mr. Kasich has not said what he plans to do.

Too many governors and legislatures in too many states have been more interested in making sure health-care reform fails than in reducing the number of uninsured Americans, improving the health of the nation, and controlling medical costs. Now it is too late for these states, including Ohio, to take control of their future, unless they have been preparing in secret as they protested in public.

Ms. Taylor insists that she and Mr. Kasich want to work with Congress to “fix” the 2010 law. After two years of foot-dragging and obstructionism, that assertion invites skepticism. Letting the federal government run Ohio’s insurance exchange feels like more of the same.



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