Ohio will not set up its own health care exchange, and will instead opt to have the federal government do it for them. The online exchanges are a key provision of the Affordable Care Act. Theyâre designed to bring customers together and increase their buying power and spread risk. Governor John Kasich wrote in a letter to the Obama administration today that states lack flexibility to build and manage their own exchange, and would cost up to $22 million more than the start-up money available from the fed. Joel Ario helped the Obama administration come up with a blueprint for the exchanges. He says having the fed run Ohioâs exchange will save some headaches, but he says the state will also lose some regulatory power. âAnd that in the case of the exchange involves setting the standards on how insurers get into the exchange, picking the insurers who gets into the exchange, deciding how products will be approved for the exchange," Ario says. In his letter, Governor Kasich said âOhio will not let the federal government take over regulatory control of its insurance industry,â? which the governor says creates 400,000 direct and indirect jobs.