Change is coming to doctors treating 68 million low-income Americans. Critics of Obama-care are calling the change — a dramatic cut to Medicaid reimbursements starting on Jan. 1 — a bait and switch scheme.

Whatever it’s labeled, the nearly 50 percent cut in federal reimbursements to primary care doctors treating Medicaid patients is sure to be a headache — for both doctors and some of their patients.

One goal of Obamacare was to expand access to regular health care. To accomplish this, subsidized health insurance has been offered to people who did not receive health benefits through work or otherwise had no health insurance.

Another way access to care was increased was through expanded Medicaid, the health care program for low-income Americans. But sending millions of new patients to doctors’ offices posed several problems. One was a concern over a shortage of primary care physicians. Another was the historically low federal reimbursement rate for doctors treating Medicaid patients. To address this problem, Obamacare increased the reimbursement for treating Medicaid patients — but only temporarily.

The two-year reimbursement increase stopped at the end of 2014. Now, doctors treating Medicaid patients are facing payment cuts of about 43 percent.

Obamacare, known formally as the Affordable Care Act, did help bring nearly 10 million more Americans into Medicaid. Now, with nearly one in five Americans getting health care through Medicaid, the program is a major program in every state.

The higher payments were intended to encourage primary care doctors to take on more Medicaid patients. But now that the reimbursement rate is being cut nearly in half, returning to the earlier, low rate, health care experts worry that some doctors might not be able to continue treating Medicaid patients. Even if doctors want to continue providing care, the lower government payments could cause doctors’ time with low-income patients to be a money loser. The new payment schedule could threaten the practices of doctors who see a high percentage of Medicaid patients.

Imagine a doctor working in a poor rural area or serving a low-income inner-city population. With the Medicaid rate reduction, that doctor’s practice could be seeing a major drop in revenue. With less money coming in, can the doctor continue to employ nurses, physician assistants and office help? Must poor patients be turned away to keep the practice open?

Restoring the higher reimbursements or at least some sort of increase might be necessary to allow doctors to be able to afford to treat low-income patients.

Adding to the doctors’ challenges, in many cases, is that Medicaid patients require more care, at least initially. This is because they might have gone years without regular medical care and might be dealing with long-term health issues due to lack of regular treatment.

The money to provide care to Medicaid patients will have to come from somewhere. What some call excess profit in the U.S. health care seems mostly to be found in the big pharmaceutical companies, the health insurance companies, larger hospitals and doctors in certain specialties.

Where to find money to fund expanded Medicaid returns to the second stated goal of Obamacare — reducing heatlh care costs. So far, at least, the health care reform law has failed to achieve that goal. It’s time for Congress to revisit the issue.