What changes:

• John Roberts (and George W. Bush) are going to have to explain to the conservative movement what happened.
• Republicans move “Obama is a huge taxer” to the top of their message pile.
• Romney will be under more pressure to explain how he could lead a repeal of Obamacare through the Senate with, at best, a slim GOP majority.

What stays the same:

• The President still has health care as his signature achievement.
• Republican candidates from Romney on down will run against the ACA; few Democrats will run backing health care in an outspoken way.
• States will continue to implement the law.