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House leaders work toward bipartisan $200B deal on Medicare doctor payments

WASHINGTON – In a rare show of unity, top House Republicans and Democrats are working toward a $200 billion agreement revamping how doctors are paid for treating Medicare patients, a package that would be largely financed by adding to the federal deficit, lobbyists said Friday.

The potential deal could still change as House leaders gauge support and make adjustments to win votes. But its basic elements seem generally set, including an end to an 18-year-old formula that has long bedeviled Congress, repeatedly prompting lawmakers to block unrealistically deep cuts in doctors’ Medicare reimbursements.

Without congressional action, the next cut — this one 21 per cent — is due to begin April 1. Racing that deadline, House aides have been crafting the plan behind closed doors, with Senate aides of both parties being kept informed.

The package is also expected to include money for a children’s health program whose budget will soon run dry. Some lobbyists say the agreement would include around $5 billion for the Children’s Health Insurance Program, which is popular with both parties but especially so among Democrats, enough to keep it running for another two years.

Both parties have long favoured eliminating the current Medicare formula for reimbursing doctors but clashed over how to finance that.

Under the emerging agreement, lawmakers would not pay for the roughly $140 billion expense of eliminating fee cuts that would otherwise occur over the next 10 years, lobbyists said.

An additional $60 billion in the package would pay for a new system of annually updating how doctors are paid under Medicare, some other expiring Medicare and Medicaid programs, and the children’s health program.

Those expenses would be financed with savings including increased costs to some high-income Medicare recipients and cuts in reimbursements to some Medicare providers.

Some conservatives are already lining up against the proposal because of its red ink. Others are supporting it, saying the changes are badly needed.

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AP Special Correspondent David Espo contributed to this report.