An "exchange" is a clunky word for a place to buy health insurance online.
Individuals and small businesses will be able to comparison shop, like what you do on Orbitz for a flight, or Amazon for an office chair--you've got all your options lined up in front of you before you decide to buy.
SILVERS: It's a big website--that's all it is.
J.B. Silvers is a professor of healthcare finance at Case Western.
Of course, even the best online shopping sites can get complicated – non-stop flight or multi-stop; does the price include baggage; what if I need to change my ticket later?
How to simplify?
Well, Washington, recognizing that the health insurance marketplace differs from state to state, is giving each state the opportunity to design an exchange that works best for it.
But Ohio is one of a few states that has shown little interest in complying with the requirement. Columbus officials blame uncertainty.
TAYLOR: It's hard to make decisions when you don't have clear guidance so we would say it's really too soon, without Washington giving us clear guidance about what their expectations are, to start making decisions about the direction that is best for Ohio.
That's Ohio Lt. Governor and insurance commissioner, Mary Taylor. She describes the state's approach to the exchange as wait-and-see.
Case professor J.B. Silvers puts it more bluntly. He says Ohio is practicing…
SILVERS: Approach avoidance. Act like it's not there. Assume that it will go away, like a bad cold.
And it may. The Supreme Court is set to rule any day now on the constitutionality of the Affordable Care Act. Several justices have signaled that they may vote to throw out part or all of the law.
And some state officials, particularly republicans who don’t like the law anyway, see no reason to spend time and energy on an exchange until the legality of the health reform law is settled.
TAYLOR: We believe we still have time.
But others say if the law is upheld, Ohio’s options may have run out, triggering action by the federal government to design the state’s insurance exchange.
BLASKO: Will we have a state-run exchange for 2014? No I don't think that's going to be realistic.
That’s Joe Blasko, Vice President of the Northeast Ohio Health Underwriters Association, a group that represents insurance brokers.
Brokers hope to play a role helping consumers navigate multiple insurance choices and their association prefers a state-designed approach to exchanges.
BLASKO: When we have to come down to the two options that we have--whether it be our own or whether it be the federal--I think you definitely have to look at the dollars.
Here again there is uncertainty or at least debate – one study indicated it would cost Ohio more than $60 million to implement its own insurance exchange but it'd cost the state less than a third of that to implement the federal model.
Case Western Reserve finance professor Silvers says that …in the end… it won’t really matter for consumers whether Ohio’s insurance exchange is a state or federal design.
SILVERS: As long as it shows what my market looks like, gives me the data I need to know, I don't care where it comes from.