The changes would garner about $19.2 billion to cover the one-year patch.

Liberal Democrats aren’t likely to be keen on taking any money away from the tax subsidies in health reform.

“I think there’s going to be a little pushback from the progressive side,” a health lobbyist told POLITICO.

But so-called “pay-fors” are in short supply. And both parties are reluctant to pass another short-term patch to prevent the payment cut to Medicare doctors. They argue that the short-term repairs add instability to the Medicare programs.