What if a Republican President leaves the Affordable Care Act intact?

Healthcare Finance News points out that despite the rhetoric, it's not so clear that the inauguration of a President Romney, Santorum, Gingrich or Paul would actually lead to the appeal of the Patient Protection and Affordable Care Act (PPACA) or Obamacare. Why not?

• If you took middle school civics, you may recall that the President doesn't repeal laws himself. That duty is reserved for Congress. If Republicans retain their House majority and take control of the Senate, they may be in a position to move things along. But it's far from certain that Presidential coattails would be long enough to give the GOP a filibuster proof majority in the Senate
• Some popular provisions of the ACA will be hard to take away, such as the right to keep dependents on coverage until age 26 and the restrictions against using pre-existing conditions as a way to deny coverage
• Romney says he'll grant waivers to the law from all states, but that depends on states requesting the waivers. Some will, some won't
• If the law is repealed it has to be replaced with something. That something will be a tough sell --assuming Republicans can even agree on what it is
• Repealing the law may drive up the deficit, depending on how it's done. That may mean having to look elsewhere in the budget for cost savings... or tax increases (disguised as something else, of course)