House payroll tax package charges rich seniors more to help pay for 'doc fix'

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The proposal raises $31 billion by reducing subsidies to high-income seniors, forcing them to pay a greater share of their Medicare premiums for doctors' visits and prescription drug coverage. The seniors' lobby AARP and many Democrats oppose means-testing, but President Obama endorsed the idea during this year's deficit-cutting negotiations. 

Proposed cuts to the health law include:

• Cutting the law's private insurance subsidies by $13.4 billion; 

• Repealing the law's restrictions on physician-owned hospitals; 

• Rescinding $8 billion from the Prevention and Public Health Fund; and 

• Reducing Medicaid spending on hospitals that treat uninsured people by more than $4 billion.

Instead of a 27.4 percent cut on Jan. 1, physicians would get a 1 percent increase in their Medicare rates for each of the next two years. 

The package extends several other expiring Medicare provisions, but not automatically, as in years past: 

• Payment increases for ground ambulance services would stay in place; 

• Outpatient therapy services would not be capped at $1,880, as currently projected; 

• Physicians in certain geographic areas would still get higher reimbursements; and 

• The Qualified Individual Program that provides Medicare premium assistance to low-income seniors would be extended.