The biggest reservation I had (still have) about Obamacare is that the provisions that pay for its array of new subsidies, from the “Cadillac tax” to the $500 billion hit on Medicare Advantage, will require ongoing political fortitude. Can we be confident Congress will follow through as the federal government and states gradually implement the law?

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Recent precedents don’t bode well. When Congress began drafting the Medicare prescription drug law roughly 10 years ago, for instance, there weren’t nearly enough members concerned about cost containment. Eventually, Republicans like Rep. Bill Thomas designed the controversial “donut hole” — a gap in subsidized drug coverage — to bring down the bill’s overall pricetag.

What happened to the “donut hole”?

Obamacare will phase it out over 10 years.

It’s not unreasonable to assume that Congress will likewise be pressured to back off on things like the “Cadillac tax,” and anything else that imposes pain.

In the immediate aftermath of the Supreme Court ruling, the hordes already are descending. The Wall Street Journal reports:

A new front opened Friday in efforts to reshape how the federal government implements President Barack Obama’s health-care overhaul now that the Supreme Court has ruled to keep the law in place.

Employers, insurers, hospitals, drug makers and others are angling for an advantage as the government writes the regulations and sets the policies that will bring the law to life.

Hospital owners want the government to reduce the $155 billion in health-care payment cuts they agreed to during negotiations over the law. Makers of medical devices hope to roll back a 2.3% tax on their sales contained in the measure. Insurance companies want more leeway to charge older people higher rates than younger ones. Drug makers are aiming at a provision that could squeeze how much Medicare pays for medicine.

Keep an eye on this going forward. It’s on this front that, if it survives congressional repeal efforts, Obamacare will stand or fall.