Officials say that some much-ballyhooed programs in the 2010 healthcare reform law aimed at nursing homes could go without funding.

They include an initiative to more closely monitor for-profit nursing home chains and another to increase implementation of electronic health records in nursing homes.

Some programs might never go into effect even though Congress passed and President Obama signed into law the sweeping Affordable Care Act last spring, said Bruce Vladeck, a former Medicare administrator and healthcare consultant.

The main reason is the budgetary environment in Congress has changed drastically since the law was passed, Vladeck told Kaiser Health News. Or, as some might put it, the Republicans now have control of one chamber of Congress, creating a roadblock for many Democrat-led initiatives.

Other Affordable Care Act high-profile proposals that could be dead in the water include: a $50 million program that would help states experiment with new ways to fix malpractice disputes; a $24 million experimental program to improve emergency care services; and a $50 million program to open health clinics run by nurse practitioners that has received only $15 million.

Negotiations and backroom discussions on many of these issues were being discussed at press time.