It’s abundantly clear that it is going to take time to repeal and/or replace the Affordable Care Act. And, despite the fact that the republican draft would sunset the ten essential benefits in 2019, it would require a change in the law and therefore 60 votes in the Senate to eliminate these provisions entirely. While it may be nearly impossible to throw out this provision without the necessary votes, perhaps these benefits can be diluted to reduce the costs of plans so that they remain close to employer sponsored health plans and therefore compliant. Put simply, diluting is easier to do than outright changing the law.

One benefit that the Republicans have discussed is preventive and wellness services and chronic disease management. Under the ten essential benefits provision, these services are covered without cost sharing. The thought is that several of these benefits could be trimmed to shrink costs. Among the proposed benefits to be limited is the requirement that birth control be provided without an out-of-pocket cost to women.

Also on the block for limitations of benefits are mental health and substance abuse disorders, prescription drugs, and pregnancy, maternity and newborn care. Within these, and really most all of the ten essential benefits, is room for paring back services without garnering the 60 votes in the Senate.

In addition, Obamacare requires that “rehabilitative and habilitative services and devices” be covered. Many employer plans don’t include habilitative services, which help people with developmental disabilities learn and improve functional skills. Although federal officials have issued regulations that define habilitative services and set limits for covered service visits, given the fact that all employer plans don’t include this benefit may allow for changes in this provision.

As we have seen repealing and replacing a 2000+ page piece of legislation is no easy task. Although these seem like small steps, it may be the way the ACA is dismantled.