As if doc­tors were not get­ting paid enough already, the Afford­able Care Act promised a boost to their earn­ings, but with a dead­line, at which time it would not only be tak­en away but fur­ther cuts would be applied.  Just at the time when mil­lions more peo­ple are enrolling in Medi-Cal, a recent study by the Urban Insti­tute esti­mat­ed fee reduc­tions will aver­age about 40% nation­wide.  In large states like Cal­i­for­nia, New York, New Jer­sey and Illi­nois, the cuts could exceed 50%  The orig­i­nal tem­po­rary pro­gram increased fees for 2013 and 2014 but that has now been removed, and attempts to get Con­gress to extend it have been rebuffed.    So what hap­pens now?  Doc­tors might not drop their cur­rent Medi-Cal load, but what are the expec­ta­tions (and what is appro­pri­ate from a rev­enue stand­point) for their accept­ing new Medi-Cal patients?