Zinberg writes on predicted effects of the Affordable Care Act on reimbursements. As 30 million patients pour into the system, half onto Medicaid rolls, and cash-strapped state governments likely reduce payments for their visits (after federal prop-up payments shrink in 2016), Zinberg asks whether most physicians will see Medicaid patients at all, since many already refuse to. The Act also assumes Medicare reimbursements will fall by 30% over the next 3 years, and stipulates steady yearly declines in Medicare reimbursements (which were sold politically as net-even, since physicians will make up for it with increased productivity), as well as a constant ratcheting-down by the increasingly empowered Independent Payment Advisory Board. Sigh. JAMA 2011;305(19):2011-2012.