Obamacare repeal was a severe election casualty, but the very untenable nature of the law may force Congress to take another look, and slow down or change some budget-breaking and job-killing features of the law.

Stuart M. Butler of the Heritage Foundation, writing on the Journal of the American Medical Association web site, contends that the "core elements of the ACA remain very much in play," because the effects on the deficit and on job creation are likely to pressure Congress to make changes to the law:

...lawmakers will be desperately searching for ways to delay or cut spending to deal with the deficit. That adds up to 2013 being a year for buyer's remorse in Congress and around the country.

The reaction of employers to the ACA is likely to be the first pressure point for changes in the ACA or at least the suspension of some of its provisions.

With employers reluctant to hire and considering more part-timers in the face of the Obamacare mandates, continued weak employment numbers combined with rising costs for the law's insurance exchanges could

...force Congress to reopen key ACA coverage provisions, perhaps as part of a deficit reduction package. Effects on employment and continued increases in health care costs could also increase the prospects of a bipartisan redesign of employer-based coverage within a tax reform package.

Mr. Butler also observes that with 30 Republican governors contending with pensions and other growing state costs, and Congress "desperately trying to curb spending," the 2014 expansion of Medicaid may face strong resistance at both state and federal levels.

The Independent Payment Advisory Board, or IPAB, is likely to grow more unpopular, according to Butler, as seniors see cutbacks to doctors and hospitals, and repeal of that provision had "strong bipartisan support" in the House.

Additionally, mounting Medicare cost pressures may give the Ryan Medicare plan "renewed traction" in Congress as a better alternative than forced cost reductions through IPAB.

House Speaker John Boehner echoed Butler's Obamacare observations in an interview after the election:

I think there are parts of the healthcare law that are going to be very difficult to implement and very expensive. And at the time when we're trying to find a way to create a path toward a balanced budget, everything has to be on the table. 

And House Majority Leader Eric Cantor (R-Va.) adds, in a letter to his House GOP colleagues:

If we successfully make the case publicly, bills that could reach the president's desk include ... repeal of IPAB...

There are some issues that I suspect Senator Reid will have a difficult time compelling his members to oppose outright.

The Obama administration will continue to go full steam ahead on implementing the Affordable Care Act, but even the sacred cow of liberalism is subject to the reality of escalating deficits, continued unemployment and public scorn.