By Lloyd Dean and Shannon Udovic-Constant In a time of reform, if there's one underlying truth that unites every health care provider in our state, it's this: We cannot successfully implement the Affordable Care Act and open the doors of health care access to all Californians without a strong, adequately funded Medi-Cal system , California's version of Medicaid. Medi-Cal is nothing less than the foundation of California's health care safety net. It provides coverage to millions of families who can't afford traditional primary and preventive care and protects those of us who can pay from having to bear the cost-shifting burden for those who can't. Nearly 1 out of every 4 Californians who have health insurance receive it through Medi-Cal. Yet, at a time when the state needs desperately to expand Medi-Cal to meet the new demands of federal health care reform, a law enacted in 2011 reduces access to Medi-Cal services by cutting the Medi-Cal payment rates by 10%. Health care leaders had challenged the law, but the federal court Friday denied an appeal to rehear the case, which allows the cuts to stand. This will shred California's safety net. Together, we represent the largest private hospital provider of Medi-Cal services in California and the largest San Francisco-based organization representing physicians who see Medi-Cal patients. We both have joined the "We Care for California" coalition comprised of nearly every health provider organization in the state—hospitals, community clinics, physicians, dentists, first responders, health plans and rank-and-file workers—to ensure that federal health reform is more than an empty promise. The coalition is sponsoring SB640 and AB900, which are co-authored by a majority of state legislators and address the obvious—slashing Medi-Cal funding while simultaneously trying to expand the program is a recipe for disaster. These bills would simply stop the 2011 cuts from taking effect. California Medicaid reimbursement rates are the lowest in the nation, even though California is one of the most expensive states in which to operate a medical practice. Last year alone, San Francisco-based Dignity Health and its member hospitals lost $571 million in the actual cost of providing high-quality care to Medi-Cal patients. Right here, the Jewish Home of San Francisco, the largest private nonprofit nursing facility in California, has issued pink slips to 300 workers and is contemplating bankruptcy, jeopardizing care for hundreds of Jewish seniors, because of Medi-Cal cuts. No one is more committed than we are to reach the long-sought-after finish line of universal health access for all Californians. Many of us have worked closely and collaboratively to make innovative programs such as Healthy San Francisco a successful model. But those of us who deliver high-quality, affordable care to those very Californians who need it most will never reach that finish line if Sacramento continues to cut our financial legs out from underneath us. Source: San Francisco Chronicle , May 28, 2013 . Lloyd Dean is the president and CEO of Dignity Health. Dr. Shannon Udovic-Constant is president of the San Francisco Medical Society and board trustee at the California Medical Association.