In a speech at the Bowling Green Chamber of Commerce last week, Mary Taylor explained why Ohio will not set up a state-run insurance exchange as part of making coverage more accessible under the Affordable Care Act. The lieutenant governor and state insurance director amplified her thinking to the Toledo Blade: “Quite frankly, we’ve looked at the guiding principles that we’ve been using since we took office and our core values around health-care transformation or health-care reform, and a state exchange is just not consistent with those core values.”
Isn’t it a core value of John Kasich and his team to prefer state action over the federal government taking charge?
The governor often urges Washington to follow the lead of his problem-solvers in Ohio.
Saying no to a state-run exchange does not mean Ohio will escape the concept. The law calls for the federal government to perform the job if a state refuses. Taylor has described the federal option as the “lesser of two evils.” A greater measure of state control amounts to the darker choice, for a governor with big plans to reshape health care in the state?
Isn’t it a core value of the Kasich operation to embrace market-oriented solutions, the private sector bringing its methods to public work? In one of her many condemnations of the new health-care law, Taylor declared last September that “Ohioans deserve a consumer-driven, market-based approach that provides adequate protections, along with accountability, affordability and transparency.”
Let’s review the basics of the exchanges. Most Americans gain health insurance through their employer or a public program, most likely Medicare or Medicaid. Yet many do not have such options. They must purchase coverage on their own, and many find the prices prohibitive. They go uninsured. Count 1.5 million in Ohio without health insurance.
One way to address this problem would be to expand the public programs. The new health-care law does broaden Medicaid. The law also builds on the private insurance market through an exchange, or a place (most likely online) where consumers can go to find an array of health plans competing to provide coverage.
An exchange would operate under rules and standards, with oversight provided by a board. Consumers would find information about health plans, say, their record on wellness or managing chronic illnesses. There would be a mechanism for enrollment and consumer assistance. Under the new law, subsidies are available to help with the cost, averaging more than $6,000 per person and extending to families of four with annual incomes up to $92,200.
Putting together an exchange is a big and complex challenge. Worth stressing are the objectives, the protections, accountability, affordability and transparency Taylor champions — not to mention improving the health and easing the financial strain of many now without coverage.
Isn’t it a core value of the governor to welcome bipartisanship?
On this subject, too, he has lectured Washington. Be like Ohio! he tells national audiences.
Hard to dispute the bipartisan pedigree of the health insurance exchange. It is a Republican idea embraced by Democrats. Mitt Romney brought an exchange to Massachusetts. An exchange was a key feature of the Healthy Americans Act, a proposed reform bill sponsored by senators from both parties.
The Affordable Care Act initially contained a national health exchange (and the promise of lower administrative costs). Republicans howled about overreach. So Democrats bent, leaving states to set up exchanges, reflecting, in part, arguments about consumers feeling more invested and negotiations with health plans proving more productive at the state level.
Doesn’t the governor at his core value his prowess in budgeting?
He rarely misses an opportunity to celebrate the closing of an $8 billion hole in the state budget — without raising taxes. Now the lieutenant governor appears overwhelmed by the prospect of locating $40 million to operate a health exchange.
Really, the sum is beyond the reach of such fiscal genius?
Other states have been moving forward with their exchanges, led by Democratic and Republican governors. Innovation Ohio, a liberal think tank in Columbus, highlighted last week how the federal government has been helping. Kentucky has gained $66 million; Pennsylvania, $34 million; Michigan, $10 million; Indiana, $7 million; Minnesota, $31 million; Illinois, $38 million.
Mary Taylor gave back $1 million designed to help consumers contest denials by insurers.
The amounts track with how much progress a state has made. Innovation Ohio also stressed that the feds now are making money available for planning and operations.
At the Bowling Green chamber, the lieutenant governor heaped familiar scorn on Washington, citing the “scant” information about how states are required to comply. What explains the advances in other states? Might they see value at the core of the health exchanges? You would think the Kasich team would.
Douglas is the Beacon Journal editorial page editor. He can be reached at 330-996-3514, or emailed at firstname.lastname@example.org.