What's the next battle in reform wars?

It was a tough week in Washington for the Affordable Care Act.

First, House members voted April 13 to repeal the law's prevention and public health fund, which would grant authority to the HHS secretary to administer $17.75 billion in funding from 2012 to 2021. It's not expected to pass in the Senate, and the White House indicated its strong opposition to overturning this provision. The administration released a statement saying the president's senior advisers would recommend the president veto the bill if he's presented with it. But Republicans contend the fund not only grants too much power to the HHS secretary, but it also lacks details about how that funding would be spent.

“Every member who supports this fund should know nobody knows where this money will be spent,” House Energy and Commerce Health Subcommittee Chairman Joe Pitts (R-Pa.)—who introduced the bill—said on the House floor hours before the bill passed.

The next day, the House and Senate both passed the long-debated, final continuing resolution to fund the government for the rest of this fiscal year that ends in Sept. 30. That legislation not only cut funding for healthcare programs, but it also repealed the Affordable Care Act's free-choice voucher program and rescinds the start-up funds for the Consumer Operated and Oriented Plan, or CO-OP. (See Monday's issue of Modern Healthcare for more about the continuing resolution and how it affects last year's health reform law.)

Meanwhile, President Barack Obama on the same day signed into law legislation that repeals the Affordable Care Act's 1099 reporting provision, which would have required businesses—starting in 2012—to report all transactions worth $600 or more to the Internal Revenue Service. Disliked by members of both political parties, the 1099 measure wasn't a deal-breaker for the Affordable Care Act, and the same could be said of the free-voucher program. The repeal of the prevention and public health fund is not likely to hold weight, and the CO-OP will continue. So it's not as if these actions are devastating blows to the law.

But they do highlight the areas of the law that have just enough flaws to be vulnerable. The only question now is: What's next?