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Congress Works on $213B Doc Payment Plan

Bipartisan House leaders are working on a $213 billion plan to permanently change how doctors are paid for treating Medicare patients, a costly problem that's vexed Congress for years, a document circulating among lawmakers showed Tuesday.

Many of the plan's details had already been disclosed by lobbyists, legislators and congressional aides. But some particulars were new, such as setting a 2020 starting point for higher out-of-pocket expenses for people buying new Medigap policies, which cover costs not insured by Medicare.

Around $140 billion of the proposal's 10-year costs would be financed by adding to federal deficits, the paper says.

Of the roughly $70 billion remaining, around half would be paid for by boosting some beneficiaries' costs. That would include the higher Medigap costs and boosting premiums that people earning over $133,000 yearly pay for Medicare doctors and drugs.

The remaining $35 billion would come from Medicare providers and hospitals, though the document provides no details about that.

Aides to House Speaker John Boehner, R-Ohio, and Minority Leader Nancy Pelosi, D-Calif., have been working behind closed doors on the agreement, which aides and lobbyists have said could still change.

The agreement would also provide extra funding for a popular program that provides health care for around 8 million low-income children a year but runs out of money Oct. 1.

The document does not specify how much extra money the agreement would contain for the Children's Health Insurance Program. Lobbyists and others have said it would extend the program's funding for two more years, though many Democrats say they want a four-year extension.

Under a 1997 law, Medicare payments to doctors are scheduled to drop by 21 percent on April 1. Congress has repeatedly headed off similar cuts for more than a decade, and past efforts to permanently change the formula have foundered, usually over disagreements about how to pay the expenses.

Under the agreement, the existing formula that has been forcing those cuts would be erased. A new system would give doctors an annual 0.5 percent payment increase for the first five years, followed by steps aimed at giving physicians incentives to charge patients based on the quality of their care, not the number of services they provide.

Those changes largely follow a bipartisan bill written in 2014 that failed after lawmakers could not agree on how to pay for it.