Whether you love it or hate it the Affordable Care Act is here to stay. This is probably single most important policy development that we know will result for President Obama beating Mitt Romney last night.
If Republicans had won a majority in the Senate and Romney had taken the White House is it very likely they would have used reconciliation to repeal they law. They would probably would have fully repealed it or at least modified it so dramatically that would effectively be a completely different law.
Even if Romney had won but the Democrats retained control of the Senate the law would likely ended up being very different than what Obama intended. Romney would not only have had significant latitude in determining implementation, but the veto would have given Romney serious leverage to negotiate for Senate Democrats. Romney probably could not have gotten Senate Democrats to repeal the whole law, he probably could have force them to make some big changes as part of broader budget deals.
With Obama in the White House we know the law will be implement as Obama intended it to be. House Republicans could theoretically try to force Obama to make some changes to the ACA in another budget showdown, but there seems to be no real chance that Obama will agree to something he would see as undermining his signature piece of legislation.The Affordable Care will be implement in 2014 as it currently is.