Alternate headline: Harry Reid ensures Trump victory … again. If Reid remained awake in Searchlight, Nevada to see it, though, he might have been one of the very few. Thanks to Democrats exhausting — in more than one sense — every procedural delaying tactic possible, the vote to confirm Tom Price as Secretary of Health and Human Services didn’t take place until 2 am today. The result was a foregone conclusion:

Senate approved Tom Price's nomination for HHS secretary around 2 a.m. ET by vote split on party lines https://t.co/zNX0Pmaqux pic.twitter.com/W1Wgdot19L

— CBS News (@CBSNews) February 10, 2017

The Senate has confirmed Rep. Tom Price to serve as secretary of the Department of Health and Human Services.

The 52-47 vote came just a day after the Senate confirmed Sen. Jeff Sessions, R-Alabama, as President Trump’s attorney general.

Price, 62, is a Georgia Republican who spent his career as an orthopedic surgeon before entering Congress in 2005. In the last Congress, Price succeeded Paul Ryan — after he became speaker — as the chairman of the House Budget Committee, where he laid out budget proposals that called for an Obamacare repeal.

There had been rumblings that Democrats want to find a way around the all-nighters and allow some confirmations to get to final votes more expeditiously. They have discovered that their obstructionism isn’t wooing Republicans to their side on Trump’s nominees — it may even be helping Republican leadership to close ranks. However, there was no doubt that they would drag out Price’s confirmation as much as possible, because his appointment is the most dangerous to Barack Obama’s signature legislative achievement and legacy:

But the bitter opposition to Price’s nomination — which culminated with Democrats delaying a final vote for nearly 30 hours — served as a preview of the fight to come over the future of American health care. And Price could well start that fight immediately by using his authority as secretary to roll back or not enforce select pieces of Obamacare — the mandated benefit package, perhaps, or the hot-button birth control coverage rules.

It’s possible to overestimate the impact Price will have on ObamaCare, but only just. People forget how much of ObamaCare’s structure comes from regulation rather than legislation. The mandates and the taxes are statutory, and require repeal to eliminate (and can’t be defunded any other way either), but much of the enforcement mechanisms and definitions are left to HHS leadership to craft. Because Democrats didn’t want to do the required work of the overhaul at the time, they peppered the Affordable Care Act with the phrase “the Secretary shall determine” repeatedly.

Well, now the Secretary is a conservative Republican, and the determinations are going to start reflecting that — immediately. The first thing to go will almost certainly be the contraception mandate, and with it the lawsuits against employers who balked at it for religious reasons. The Little Sisters of the Poor can get back to their hospice work rather than spend money on lawyers to keep the government from forcing nuns to buy contraception. Price will have plenty more of those kinds of decisions to make while Congress deals with the dismantling of the ACA statutes, and Price’s actions will go a long way to ending ObamaCare as we know it.

Now that this fight is over, Democrats may well decide to throw in the towel and get past these confirmations a little more quickly. They don’t have any real ground in these fights, but they will in the FY2018 appropriations process. It will all depend on just how soon they come to grips with reality.