"Essential Benefits" and Health Reform The Obama administration surprised supporters and critics when it decided to let states define the "essential health benefits" that must be provided to their citizens under health care reform. The move could lessen opposition in Republican-led states and increase the chances that they will move ahead on building new health insurance exchanges to comply with the reform law. The impact on most consumers may be minimal. Even the most fiercely antiregulation states will not be free to approve extremely miserly policies, because they will have to be comparable to popular and fairly comprehensive "benchmark" private plans. There are concerns that insurance company lobbyists - who are even more powerful in many states than in Washington - will find ways to shape requirements to favor their bottom lines rather than consumers. In the longer run, it would be better to set a national standard. That would also be easier for federal regulators to monitor. The health care reform law requires private health insurers that sell policies to individuals and small businesses to provide, starting in 2014, a set of "essential health benefits" in 10 categories, including hospitalization, ambulatory care, maternity care, prescription drugs and laboratory services. The law also said the benefits should be comparable to those provided under "a typical employer plan." But it left it up to the secretary of health and human services to define what benefits are "essential" and what employer plans are "typical." Now Secretary Kathleen Sebelius has bucked those decisions to the states, at least for a two-year transition period in 2014 and 2015. The benchmark the states will be required to use could be one of the three largest plans covering small businesses, state employees or federal employees in the state or the largest health maintenance organization serving commercial customers. The administration contends that a similar benchmarking approach has worked well in the Children's Health Insurance Program. It also believes that differences among the states in demographics, economics, patterns of illness and the way medicine is practiced warrant starting cautiously from current benchmarks. Federal health officials will need to monitor developments during the transition period to make sure consumers and employers can easily compare the benefit packages offered by private insurers. In the long run, it would seem best to move toward a system in which all Americans enjoy the same benefits with only limited state-by-state adjustments.