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 is seeking to jump-start his legislative agenda with a bipartisan gamble: a $200 billion Medicare deal that’s already dividing conservatives in his rowdy conference.

The Ohio Republican sees the deal as a steppingstone to what could be a broader overhaul of the costly entitlement system. Tax and entitlement reform are two of 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’s biggest priorities, but they’ve languished since he took power in 2011.

By the end of this week, the House committees responsible for healthcare issues could roll out a plan to halt recurring cuts to Medicare doctors. And the legislation could hit the floor by next week, just days before the latest round of cuts is slated to take effect.

Boehner has been personally involved in the months-long negotiations from the very start.

ADVERTISEMENT

Top aides to both Boehner and Minority Leader Nancy Pelosi (D-Calif.) began discussing a possible deal earlier this year, around the same time their bosses were publicly quarreling over funding for the Homeland Security Department. Talks continued in the relevant House panels: the Energy and Commerce and Ways and Means committees.

And in the past few weeks, both Boehner and Pelosi have spoken several times as they’ve closed in on a deal to end the automatic cuts to Medicare reimbursements for physicians, as well as extend a popular children’s health program known as CHIP.

“This is an opportunity to start the process of getting real entitlement reform done,” said a GOP leadership aide.

That likely will be Boehner’s pitch when he presents the plan Tuesday morning to rank-and-file Republicans in his conference.

There isn’t much time. Without action by March 31, doctors will see a 21 percent cut in their payments under Medicare, as part of automatic cuts driven by the sustainable growth rate formula. The last 17 times Congress faced a similar deadline, it simply punted by putting off the cuts.

Now, leaders finally appear close to a long-term solution.

The package would be paid for through a combination of means testing -- that is, making wealthier seniors pay more for Medicare -- and reforms to the costly private supplemental health insurance plan known as Medigap.

These aren’t new ideas. They surfaced in the grand-bargain talks between Boehner and President Obama, as well as during the bipartisan supercommittee deficit negotiations and the fiscal-cliff talks.

But they never took hold.

The Medicare cuts only impact wealthy seniors, so most House Democrats are expected to back the plan. The question is whether enough conservatives will get on board to give political cover to Boehner’s leadership team, which has repeatedly struggled this year to pass any controversial bills through the chamber.

While the reforms will be phased in and won’t fully be paid for in the first decade, Boehner will make the case to conservative critics that the deal will yield greater out-year savings after 10 years.

For now, conservatives appear divided over the Boehner-Pelosi plan. The Grover Norquist-led group Americans for Tax Reform supports the emerging deal, while Heritage Action is trying to whip up opposition among conservatives. Founding members of the 40-person House Freedom Caucus, a new band of conservative lawmakers aimed at pulling leadership to the right, are split as well.

Rep. John Fleming John Calvin FlemingTrump wants Congress to delay Census deadlines amid pandemic Meadows sets up coronavirus hotline for members of Congress The Hill's Morning Report - Iran strikes US bases in Iraq; Trump to speak today MORE (R-La.), who also co-chairs the GOP Doctors Caucus, is in favor; Rep. Justin Amash Justin AmashOn The Trail: How Nancy Pelosi could improbably become president History is on Edward Snowden's side: Now it's time to give him a full pardon Trump says he's considering Snowden pardon MORE (R-Mich.), a Tea Party favorite, is opposed.

“[M]ore irresponsibility,” Amash tweeted along with a link to The Hill’s story about the emerging Medicare deal.

Norquist, a major force on the right, said that, while he could not predict what will happen, a “doc fix” deal could be a “model of success” for a larger entitlement deal.

“Can this be replicated once you do it once? Maybe,” he said. “I don’t know that it will lead to the other, but it certainly increases the chances.”

While the emerging doc-fix deal would not be fully paid for, Norquist supports it, because he said it saves money compared to a future of continuing short-term patches.

Some GOP fiscal hawks could cite the deficit, but Norquist predicted most would back the deal, realizing that the agreement is only rolling back a “make-believe spending cut” to begin with.

“I think, at the end of the day, virtually every Republican will vote for it,” he said.

So far, there has not been much criticism of the emerging deal from the conservative wing of the GOP that frequently causes headaches for Boehner.

A spokeswoman for Rep. Bill Flores William (Bill) Hose FloresPatient Protection Pledge offers price transparency Texas GOP lawmaker calls for 'carbon neutral' but 'energy dominant' future OVERNIGHT ENERGY: Biden calls climate change one of America's four major crises | National parks chief says coronavirus staff shortages shouldn't prevent access | Trump hits California officials over wildfires MORE (R-Texas), the chairman of the conservative Republican Study Committee, said he would wait to see the bill and its budget score before commenting.

Dan Holler, a spokesman for Heritage Action for America, which is strongly against a fix that is not fully paid for, said conservative members would be more vocal than they have been so far once the deal is released publicly.

“I don’t think folks were expecting it to bubble up as fast as it did last week, and members were out of town,” Holler said.

The Club for Growth, National Review and The Washington Post editorial board have also come out for fully paying for the fix, he pointed out.

Holler also rejected the idea of building toward a larger entitlement deal down the road.

“There is not common ground between this president and conservatives in Congress on entitlement reform; there is just not,” he said. “And it’s foolish to go on a path pursuing that.”