(Bloomberg) -- When Ruth Haskins, a gynecologist in Folsom, California, does a pelvic exam and Pap smear on a woman with insurance, she gets $95 to $200. If the patient is elderly, federal Medicare pays $36. For the low-income on Medicaid, the state gives $25, and it’s about to go down.

The reduction comes as Medi-Cal, California’s Medicaid program for 8.5 million people too poor to afford health care, is on the verge of adding 1 million participants under President Barack Obama’s health-system overhaul, according to the state Health Care Services Department.

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