President Obama's proposal to transform the Medicare Payment Advisory Commission is meeting resistance from lawmakers, doctors, hospitals, and some advocates for older Americans. Obama's proposal would transform the agency, known as Medpac, which has just 36 employees and a budget of $10.5 million, and typically holds seven meetings a year. In annual reports to Congress, the existing commission recommends Medicare payment rates for hospitals, doctors, nursing homes, and other healthcare providers. Recommendations of the proposed new entity could take effect unless blocked by Congress.