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?