Just days after giving governors more time to declare whether states would commit to running online marketplace for subsidized health coverage, the Obama administration released hundreds of pages of proposed rules on required benefits and other aspects of implementing the federal health law.
But Arizona Gov. Jan Brewer still has important unanswered questions about the health exchange, particularly about how a federally created exchange would work if the state were to choose that option, Brewer health policy adviser Don Hughes told The Associated Press.
The exchange will provide a digital on-ramp for middle-class households to obtain subsidized private insurance. That's part of the law's plan to provide health coverage for millions of Americans now without it.
Another part of the law that would provide coverage for more people expands the federal-state Medicaid program to provide its government-paid coverage to more low-income people.
Whether Arizona participates in the law's optional Medicaid expansion is another controversial decision facing Brewer further down the road, and one her staff has said she'll unveil in her January budget proposal or possibly sooner.
But a deadline on the exchange decision still looms. On that issue, it's a question of who creates the exchange, not whether one is created.
Amid many Republicans' continuing opposition to the overall law, there's debate over the exchange itself, including how costs would be split and how much leeway the federal government would give states on things like oversight.
The eventual outcome of those debates could help determine how favorable the exchange's design is to consumers and affected businesses such as health insurers.
While some states have already committed to running exchanges and others have said they won't, Arizona is among those still on the fence.
"A lot of governors are asking the same questions and asking for the same information," Hughes said.
Hughes said he's reviewing proposed federal rules released Tuesday on covered benefits, pre-existing medical conditions and wellness coverage.
But he said significant questions remain unanswered, including what responsibilities would be imposed on the state if it opts to let the federal government run an exchange for Arizona and whether the federal government will come through with planned systems and services for determining a person's eligibility for coverage or subsidies.
"It's hard to know whether we do it or let the feds do it without knowing what the rules are," Hughes said. "The rules need to be done. I need to know what the federal exchange is going to look like."
U.S. Health and Human Services Secretary Kathleen Sebelius extended the Nov. 16 exchange decision deadline to Dec. 14, saying she was responding to governors who said they needed more time and information.
Creation of a state-run exchange for Arizona would require legislative approval, and such a proposal would stir controversy at the Republican-led Legislature.
Many GOP lawmakers and conservative groups such as the Goldwater Institute oppose the health law, while social-service advocates and a coalition of business groups, hospital and insurance companies are urging Brewer to establish a state exchange.
Hughes said the law does provide "a great deal of flexibility for states on both major policy issues and technical issues," but he declined to respond directly when asked whether the law's opponents are wrong in their criticism on that issue.
"They hate me already," he said, noting that some critics of the law have dubbed him Brewer's "health care czar."