Senate leaders have reached a compromise on a one-year Medicare “doc-fix,” paid for with a tweak to the health care reform law.

The deal prevents a deep cut in Medicare doctors’ payments with changes in how much money consumers would have to repay if they receive too large a subsidy in the health insurance exchanges after 2014.

Majority Leader Harry Reid of Nevada, Minority Leader Mitch McConnell of Kentucky, Finance Committee Chairman Max Baucus of Montana and ranking Republican Chuck Grassley of Iowa announced the deal late Tuesday.

“Working together, we put together a longer-term solution to provide the certainty doctors need and the security patients deserve,” Baucus said in a statement.

The proposal is expected to be presented on the Senate floor under a unanimous consent request, according to congressional aides. It prevents a 25 percent payment cut due to go into effect Jan. 1.

Democrats are under pressure to pass a full-year patch during the lame-duck session because Republicans are already eyeing the next patch as a vehicle to tie to repeal efforts next year. Democrats weren’t eager to change the repayment mechanism to pay for the doc fix, but did so knowing that if they didn’t, Republicans would likely use the money to pay for other programs in the future.

But Democrats were quick to stress that the proposal doesn’t impact who would be eligible for the tax subsidies in health reform and is crafted to have minimal impact on people with the lowest incomes. The White House was instrumental in helping assuage recalcitrant members, according to Congressional aides.

In 2014, some consumers will be able to buy health insurance through exchanges, web portals similar to Orbitz or Expedia. Low- and middle-income consumers will be eligible for tax subsidies to help pay for their coverage. The deal announced Tuesday would change how much money consumers would have to repay if they misreport their income or their income grows mid-year.

Under the health care reform law, if a person gets more of a tax subsidy than they’re eligible for, they would have to repay no more than $250. Families would have to repay no more than $450. The deal on the table would raise those caps to between $600 and $3,500, depending on income.

The changes would free up about $19.2 billion to cover the one-year Medicare patch, according to Congressional aides familiar with the Congressional Budget Office estimates. It would impact about 200,000 people.

The proposal’s one-year time frame not only eliminates a potential repeal vehicle for Republicans, it’s also a win for doctors. In 2010, there were five short-term “doc-fixes” that physicians say made the Medicare program too instable. The cut even went through briefly over the summer but was repaired retroactively.

The cuts are based on a long-outdated formula that tries to control Medicare spending by implementing required cuts to how much the program pays doctors. But the cuts have become so steep that Congress has prevented all of them from going through in recent years.

The only solution to preventing the frequent cuts would be a new program that would, on paper, cost upwards of $200 billion.

The bill also extends certain Medicare and Medicaid programs, including hospital reclassifications, geographic adjustments, exceptions to a Medicare therapy cap and increased rates for ambulance services in some rural areas, among others.

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