Another way the new law is unusual: the director of the state department of health, a political appointee, has the unilateral power to revoke variances given to clinics without a transfer agreement. The director also determines whether transfer agreements are satisfactory.
Ohio's history of antiabortion legislation made the confluence possible. In addition to the transfer agreement requirement for abortion clinics, the state has a longstanding ban on taxpayer funding of abortions and a requirement that abortion clinics be registered as ambulatory surgical centers.
A requirement for transfer agreements alone is more widespread in the country, though still relatively rare in the field of abortion restrictions. Eight states require them, according to data compiled by the Guttmacher Institute. Kentucky, Michigan, Nebraska, Pennsylvania, Tennessee, Virginia and Wisconsin are the other seven.
Abortion-rights advocates say that the agreements are not medically necessary, both because complications during abortions are rare and because in an emergency any patient would be admitted to a nearby hospital.
"We want clinics to be safe," said Kellie Copeland, the executive director of NARAL Pro-Choice Ohio, "But our fear is that this red tape, and really that's all it is, will be used an excuse to close clinics."
Abortion opponents counter that sending a patient to an emergency room on her own is not the same as having a settled relationship with a hospital.
Already, transfer agreements have made it difficult for Ohio abortion clinics to stay open. One of two clinics in Toledo closed earlier this year after losing its affiliation with the University of Toledo Medical Center. In fact, it was the University of Toledo agreement that inspired the legislation; the public hospital was under pressure from antiabortion advocates, including some state legislators, not to renew the agreement.
Only 18 of Ohio's 207 hospitals are public, according to the Ohio Hospital Association. But in some regions (such as Toledo) there are no other hospitals that have been willing to enter into transfer agreements with abortion providers. The spread of religiously-affiliated medical centers adds to their concern.
One thing the two sides agree on: when it comes to abortion restrictions, Ohio is a trendsetter.
"Ohio is a testing ground for abortion restrictions," said Elizabeth Nash, a policy analyst at the Guttmacher Institute, a non-profit that supports abortion rights. In 2012 the state was the first to attempt to ban abortions after a fetal heartbeat is detected. That bill died, but similar legislation has succeeded in other states; Ohio's new law requires doctors to search for a heartbeat and inform women seeking abortions if they find one.
Twenty-week bans like the one in Texas have been subject to court challenges; Ohio's transfer agreements law was challenged back in 2002, but survived after years of legal wrangling.
"Ohio has a history of advancing common-sense pro-life initiatives. We are very conscious to not overreach," said Ohio Right to Life President Mike Gonidakis. "We believe in the incremental approach: one step at a time, advancing legislation that will withstand court scrutiny."
Some abortion advocates disagree.
"In my view there are some serious legal problems with that provision," said Jordan Goldberg, the state advocacy counsel for the Center for Reproductive Rights. "The state is literally trying to tie a knot that you can't get out of." The law could be seen as a de facto ban in parts of the state, she argued, or it could be challenged as failing to relate to a legitimate government purpose.
The legislation isn't likely head to the Supreme Court as some hope bans like the one in Texas will. But in the end, it could prove very influential.