So let’s warm up the crystal and see if I can peer into the future.
Let’s say that the Supreme Court upholds the ACA either in it’s entirety in a 5-4, or a more narrow ruling with something like a 6-3 split. (Sounds like bowling for precedents.)
The Republican base, energized by the need to repeal the ACA, recovers their enthusiasm, holds the House, takes the Senate and the White House in the trifecta of American Politics, but their hold on the senate is less than 60 votes.
What happens after that?
Well the Republican base demands that the House pass the repeal of the ACA, Romney says he will sign it, and the Bill goes to the Senate, where the Democrats filibuster it. ACA= tyranny and as tyranny cannot be allowed on a procedural trick, the Republican initiate their nuclear option and destroy the filibuster. The repeal passes on a party line vote, amid a storm in insults, shouting, and images of sick people without healthcare, and Romney signs it.
The filibuster once broken, even if the rules were changed for just one vote and then changed backed, is forever a dead letter. The Republicans, knowing that all power is fleeting, use the newly empowered government to pass tax cuts and changes along more party line votes.
What happens, when it must eventually occur, when the Democrats have the three institutions under their control? Of course they will pass the legislation they have long desired and wanted, using the same techniques with the same party line vote tallies.
This could also start the other way, ACA is struck down, and the Democrats hold the Senate and White House and regain the House. (Fairly unlikely I think.) Then blowing up the filibuster and on a party line vote they sweep into existence a single-payer system. Etc etc.
Of course, by that point, we no longer a system of stable laws and government as each change in power can lead to a whiplash of new laws, repeals, and changes controlled only by the whim of political passions.

This is not a good thing. This scares me.