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That same day, a 27 percent cut in Medicare reimbursements to doctors would take effect unless lawmakers act, a reduction that could convince some doctors to stop treating Medicare patients.

Obama and congressional Democrats have proposed dropping next year’s payroll tax rate to 3.1 percent, but an extension of this year’s 4.2 percent rate seems likely to prevail. The payroll tax is the major source of financing for Social Security.

Obama also wants to leave in place the current maximum of 99 weeks of benefits for the long-term unemployed. A payroll tax cut bill approved by the House reduces that total by 20 weeks, which the administration says would cut off 3.3 million individuals. Democrats are hoping to soften if not reverse what’s in the House version.

Even without the Keystone pipeline dispute, bargainers had still not reached agreement on how to extend a payroll tax cut through 2012, with major disagreements remaining over how to finance the package.

The spending bill advanced after Democrats blocked a series of GOP assaults on Environmental Protection Agency regulations, though the agency’s budget absorbed a cut of more than 3 percent.

GOP leaders did succeed in delays in regulations of coal dust and eliminating federal funding of needle exchange programs.

War costs would be $115 billion, a $43 billion cut from the previous year.