Fiscal conservative groups are pushing back against the GOP-led proposal to end automatic payment cuts to Medicare doctors without fully making up the costs — which one group says would cost $400 billion over 20 years.

GOP leadership is working on a $200 billion deal, of which about $70 billion would be offset. Proponents argue that eliminating the yearly “doc fix” legislative battle would ultimately save money and pay for itself within the next two decades.

But a new report from the Committee for a Responsible Federal Budget is throwing cold water on the Congress’s plans.

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“While it is true that the savings will be greater in the second decade, costs will grow as well,” the group wrote in the report. “Under the current framework, costs will most likely remain higher than savings in the second decade as well as the first.”

The nonpartisan group of self-described budget hawks estimated that the proposal would cost at least $400 billion over the next 20 years. That's far more than the $170 billion estimate from the Congressional Budget Office on a similar bill last year.

The budget group said that anyone who predicts the proposal will pay for itself within that time period is “counting the long-term savings while ignoring the long-term costs.”

A deal on SGR is a new focus for Speaker John Boehner John Andrew BoehnerLongtime House parliamentarian to step down Five things we learned from this year's primaries Bad blood between Pelosi, Meadows complicates coronavirus talks MORE (R-Ohio), who has worked closely with Minority Leader Nancy Pelosi to end a decades-long problem with a Medicare formula that triggers automatic cuts to doctor payments. Congress has acted 17 times to make temporary changes to the payments, though failed to reach a deal on a long-term fix.

Heritage Action, a conservative group that also opposes any SGR deal that is not fully offset, also blasted the imminent deal on Thursday, hours after members of the House and Senate introduced bipartisan bills.

In a blog post Thursday, Heritage Action accused several top Republicans of changing their stance on the policy.

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The group compiled a list of quotes from 10 Republican lawmakers who have recently criticized an SGR proposal that would not fully offset the costs.

“Some argue that SGR reform does not need to be paid for. I respectfully disagree,” Rep. Joe Pitts (R-Pa.) said at a hearing in January 2015.

While some Republicans say they are reserving judgment until they see specific budgetary details, the proposal has seen little opposition so far — even among GOP fiscal conservatives.