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“It would have helped to have the essential benefits package worked out some time ago,” said Mr. Hazel, the Virginia official. “That’s the basic thing — how can you price it and figure out what your rules will be?”

The Obama administration says its approach gives states flexibility, and some officials said they appreciate that.

Kansas Insurance Commissioner Sandy Praeger, a Republican, said she is frustrated with states that blame their own inaction on the administration. A dozen states have passed bills to set up exchanges, but 17 have yet to take any legislative steps forward.

“This is the hallmark of the president’s first term in office, and I think it’s being fought by conservative Republican states, and I think a lot of it is political,” Ms. Praeger said.

She plans to issue recommendations for how her state should proceed, but fears her state’s Republican-led Legislature and Gov. Sam Brownback, also a Republican, won’t take action.

More questions than answers

No matter how they felt about the administration’s approach, states, employers and insurers are left with a laundry list of questions, including how they should go about approving a benchmark plan, how close a plan must come to meet the law’s requirements to be considered acceptable and how to define categories less commonly covered, such as habilitative services.

Acknowledging that there is no widely accepted definition of what qualifies as “habilitative,” the administration has offered an example of a service it could include: speech therapy for a child who is not talking at the expected age. Businesses say the example isn’t enough and that they need to see final rules.

At the core of the arguments are concerns about the ultimate costs of the plans. If states select a benefit-rich plan as their benchmark, insurers will charge more in premiums for all of their plans, and that could raise costs for businesses.

“If you were to require all auto manufacturers to make cars with sunroofs and leather seats, cars are going to be more expensive,” said Katie Maloney, a health care policy specialist at the U.S. Chamber of Commerce. “What if someone wants to buy a beater?”

While large businesses are allowed to purchase plans outside the exchanges that may not offer the same minimum coverage, they can’t impose any lifetime limits on any essential benefits they do offer. Uncertain of the costs, some large businesses are reconsidering whether to cover any essential benefits at all, Ms. Maloney said.

As they try to figure it out, the clock keeps ticking toward January 2014, when many of the law’s key provisions take effect.

“I think there are more questions than there are answers,” Ms. Maloney said. “We’re urging agencies to issue rules that are clear and simple. We’re looking at a very shortened crunch time.”

Insurers are also preoccupied with the question of whether thousands of new provisions will combine to lower costs or make plans more expensive.

Uncertainty over health care reform began unnerving some business owners even before Congress enacted the legislation.

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