July 03--One key component of the Affordable Care Act is the health insurance exchange, or an online marketplace where consumers can find an array of health plans and choose the one that best suits their needs. The exchanges are designed for those who do not have health insurance through their employer or do not qualify for Medicaid or another public program. Insurers will compete for customers. Subsidies will be available to help those with lower incomes cover the cost.

Many states already have taken steps to set up exchanges. With the Supreme Court upholding the new health-care law last week, the impetus now is there for all states to get started. A deadline looms. By January 2013, states must demonstrate to federal officials that the exchanges will be operational the following year. States also have a choice. They can say no to an exchange. The federal government then will take up the job.

What will Ohio do? John Kasich and Mary Taylor showed the state's hand last week. Taylor, the lieutenant governor and state insurance director, explained: "At this point, the governor and I don't see how it is in the best interest of Ohioans to have a state-run exchange." She added that they don't see where they would find the additional money, the state citing a cost of $43 million a year, hardly a bank-breaker at the Statehouse,

Taylor described the federal option as "the lesser of two evils," the description yet another reflection of her intense opposition to the health law.

Actually, the lack of a state exchange isn't so bad. Again, the feds would fill the void. In the congressional debate, a strong argument was made for one national exchange, simpler, more streamlined and accessible. Then, the cry quickly sounded, "Beware of big government!" Thus, as one of many compromises, the task fell to each state, many Republicans nodding their approval.

Even more curious about Kasich and Taylor settling for a federal exchange is that each long has pitched for state-designed solutions as the preferred policy course. The governor has put forward a smart and aggressive plan to remake Medicaid, the joint federal-state, health-care program for the poor, disabled and indigent elderly. A state-run exchange represents an opportunity to build better collaboration and coherence.

In the past, the governor has voiced his support for the concept of a health exchange. His positive words make sense, the exchange offering a market-driven approach and serving a real need, too many Ohioans lacking adequate health insurance, just one misfortune away from financial ruin.

No surprise the exchange originally was a Republican idea. Mitt Romney constructed one in Massachusetts as part of sweeping health-care reform. It has worked well. The concept was central to bipartisan legislation sponsored by Sen. Ron Wyden, an Oregon Democrat and then Sen. Robert Bennett, a Utah Republican.

Mary Taylor has cited as the "best solution" repeal of the health law, after Romney captures the White House. Repeal is easy to propose, much harder to achieve. At each turn, Taylor has found a reason to delay. Yet most striking is all the Kasich team proposes to abandon in maintaining its opposition to a state-run health exchange.

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