For years, the Affordable Care Act's crises have lent themselves to binary outcomes. The law would pass, or it would fail. It would be upheld by the Supreme Court, or it would be struck down as unconstitutional. Barack Obama would win reelection, or Obamacare would be hollowed out by Mitt Romney. Over and over again, the choice was (or at least seemed) stark: Life or death. That's because the law was, for most of the last three years, a political abstraction, and the fight was over whether it would survive long enough to be implemented. That ended on Oct. 1.