The U.S. House of Representatives was approaching a vote on a major bill Thursday that would change the way Medicare pays doctors, a moment marked by rare bipartisan compromise in the controversial area of health care spending. The bill would put an end to the nearly annual task known as the “doc fix,” when Congress recalculates the sustainable growth rate, a formula that determines how much Medicare reimburses doctors, based on economic growth. Congress has done this nearly every year since 1997.

If the measure passes, it would be “the first real change to Medicare in almost the last 20 years,” Rep. Phil Roe, a Republican from Tennessee, said, NPR reported. If Congress fails to pass the measure by the end of March, doctors will face a 21 percent pay cut when they treat Medicare patients. Medicare is government health insurance for people over the age of 65 or those who are permanently disabled.

In the place of the sustainable growth rate formula would be a steady, half-percent increase in Medicare payments to doctors every year until 2019. Then, a different system where doctors are financially rewarded or penalized based on their performance would begin.

The bill would increase the federal budget by $141 billion over the next 10 years, according to the Congressional Budget Office, and would cost a total of approximately $214 billion. The bill would also fund the Children’s Health Insurance Program for another two years to the tune of $5.6 billion.

President Barack Obama said Wednesday voiced his support for the bill, saying, “I’ve got my pen ready to sign a good bipartisan bill.” The bill has gained bipartisan support in the House, particularly after a deal was reached by House Speaker John Boehner and House Minority Leader Nancy Pelosi. Some Democrats in the Senate remain against it, the bill raising concerns that the bill contains language that would restrict abortions performed at local health centers. Two pro-abortion groups, NARAL and Planned Parenthood, oppose it.

Several Democratic members of the House, including Rep. Louise Slaughter of New York and Diana DeGette, said the bill would not hurt abortion access for women, but Senator Harry Reid said that the House and Senate versions of the bill differed. Others on the far right also oppose the bill because of concerns over cost and spending. Americans for Tax Reform, for instance, said it would take a decade for the fiscal benefits of the bill to kick in. In a statement, Heritage Action for America called the deal “a continuation of Washington’s broken status quo.”