I was at dinner with some California friends last night and the group in the booth behind us were doctors from CA discussing this very issue... this is not a minimal issue in CA, doctors are not going to willingly be forced into treating patients for less than the cost of keeping their doors open. Medi-Cal has not increased their fee schedule since 1965 and the average they pay per visit is less than $20 a visit... in 1965 that may have been doable, today it means - shut your doors and retire.