Ohio faces cultural and linguistic challenges in trying to educate and market the state's new health insurance exchange to limited-English speakers and hard-to-reach populations.

Here are the most commonly spoken languages besides English for people over age 5 in the state:

Number of speakers Spoke English less than "Very Well"

Ohio Population Age 5 and Older 10,734,806 232,224

Spanish 220,860 85,486

German 56,444 14,512

Chinese 31,106 15,584

French 31,081 7,724

Arabic 25,305 7,757

Pennsylvania Dutch 23,306 8,315

Italian 19,876 4,792

Russian 14,829 7,641

Greek 13,157 3,540

Hindi12,458 2,093

Polish11,533 3,551

Vietnamese 11,225 6,714

Source: U.S. Census, 2007 estimates.