America's Health Insurance Plans says "affordability should be the cornerstone" of consideration in establishing EHB. It supports providing states with a two-year transition period to create an affordable EHB package. AHIP suggests that "HHS should examine the cost and medical evidence of mandates and develop a framework for excluding some state mandates from inclusion in the EHB package."
It recommends that "HHS establish a deadline—no later than June 30, 2012—for states to select an EHB benchmark. If states do not select the benchmark plan by the deadline, HHS should specify the fallback plan as the largest small-group plan in the state by the deadline."
Michigan Consumers for Healthcare, which represents more than 110 community and health advocacy organizations in the state, says the bulletin provides too much flexibility to the states by allowing them to benchmark to a reference plan. "This approach relies too heavily on a palette of inadequate options that insurance companies already provide, and would allow states to create EHB packages that fall short of the robust, comprehensive coverage contemplated by the Affordable Care Act."
The American Medical Association, while generally supportive of the HHS bulletin, raises several operational issues in its comments. "If each state is going to choose from among the four benchmarks suggested by HHS, what is the process that each state will use in choosing the standard and what will the criteria be? How will HHS review and provide the necessary oversight of potentially hundreds of state- and plan-defined benchmark standards?"
It notes that "consumers, physicians, and other providers, and other stakeholders will need to have access to all of the plans under consideration. This will be quite a daunting challenge and require substantial oversight resources by HHS and the states, which may be difficult given continuing budget constraints at both the federal and state levels.