Monday was the soft deadline for states to tell the U.S. Department of Health and Human Services (HHS) what their benchmark plan would be. Under the Affordable Care Act (ACA), states can select from a number of options (state employee plans, small-group plans, HMO plans or federal employee plans) to set a standard for how much coverage that policies sold on an exchange must provide in 10 areas of health care identified under the law.
Arizona Gov. Jan Brewer sent a letter to HHS last week stating her administration had selected the state employee plan to be Arizona's benchmark. Even for states like Arizona, which will likely have a federal-run exchange after doing no work so far to implement its own, they have been authorized by HHS to make their own decisions about essential health benefits.
For states that don't select a plan on their own, HHS has indicated it will default to the largest small-group plan in the state. At last count, according to Avalere Health, an independent consulting firm, 23 states have selected a benchmark plan, 8 states are actively discussing which to pick, three have said they won’t choose a benchmark and 17 are doing nothing.
Brewer made it clear that her state's decision to select a plan itself was not a show of support for the ACA as a whole.
"This decision is neither an endorsement of the (ACA), nor its underlying policies," Brewer wrote. "It merely affirms the conservative principle that, when it comes to critical health care decisions, the people of Arizona are in a better position to know what suits them than an unelected official in Washington, D.C."
Brewer said she had consulted with various stakeholder groups (businesses, insurers and health-care providers among them) in making the decision. She also said she explicitly wanted to avoid the federal government choosing a plan that includes abortion coverage. The Arizona state employee plan does not cover abortions.
As Governing wrote earlier this week, most states seem to weighing comprehensive coverage versus affordability when choosing a benchmark plan. "They're looking for the best option that provides the best of both worlds," Lisa Murphy, senior manager for Avalere's health-reform office, told Governing.
