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ing it more expensive for small business to employ workers,” he said. “It [the ACA] did nothing meaningful to reduce health care costs. In particular, the fail- ure to address our nation’s medical li- ability crisis telegraphed to me that the pain and suffering in this legislation was not equitably distributed among all the constituents that are driving health costs forward.” Dr. Goldsmith also said that Medicaid expansion in the law would perpetuate deep inequities in health care and threat- en state finances.


But, he says, it is not certain that any-


thing can be done to change ACA, even with voters giving the Republicans a ma- jority in the U.S. House in 2010. “If you’re sitting there wondering what’s going to happen with all this stuff, it’s not obvious that anything is going to happen in the ensuring 18 months.” Dr. Goldsmith said. “The Democrats do not have enough power or political stuff to completely implement the legislation, and the Republicans do not have enough votes to kill it. And even if they did, it


is not obvious that they have something credible to replace it with.” Dr. Goldsmith said the “very signifi- cant flaws” in the legislation are not go- ing to be addressed because “neither party has any incentive to collaborate to fix it.”


So what does the future hold? Dr. Goldsmith says there will be intense pressure on state Medicaid programs that could have dire consequences for state budgets. Half of the 32 million ad- ditional Americans who are expected to gain health insurance coverage under ACA will get it through Medicaid. And, he says, there are another 12 million Americans who are eligible but not en- rolled in Medicaid who likely will seek that coverage because of the law’s man- date that individuals get coverage. “Where are we going to get the money as a society — states or federal — to add another 25 million people to coverage under this program?” he asked. “The numbers just don’t work. So while a lot of people are either concerned or wait- ing for the Supreme Court to kill the in-


dividual mandate, the real problem with this legislation from a structural stand- point is that it relies far too much on a program that is financially insolvent and that our states cannot presently afford.” Another problem with ACA is that


lawmakers could not reach consensus of a new method of paying physicians and hospitals to replace fee for service. That led Congress to include more than 20 pilot programs that he said would be a “stampede of hobbyhorses” as Congress tries out new models. The only problem, Dr. Goldsmith said, is that few of the ideas are new, and many — including accountable care or- ganizations — have been tried and failed to truly control health care costs.


Minority students earn medical school scholarships


Nine minority students entering Texas medical schools each received a $5,000 scholarship from TMA at TexMed 2011. Recipients demonstrated high aca- demic achievement, commitment to community service, and outstanding health care experience. Winners were chosen from a highly competitive field of promising future physicians entering medical school this fall. TMA created the Minority Scholarship


The TMA Board of Trustees awarded nine $5,000 scholarships to gifted minority medical students at TexMed 2011. TMA Foundation Vice President Russell Kridel, MD, left, and then-TMA Board of Trustees Chair Carolyn Evans, MD, right, presented the scholarship awards. Recipients are, left to right, Victor Jackson, Natalie Diaz, Ernest Juarez, Ana Salazar, Sergio Montano, and Antonio Toribio. Not pictured are Aziza Kedir, Sarah Villarreal, and Vanessa Parada.


14 TEXAS MEDICINE July 2011


Program to help diversify the physician workforce to fulfill the needs of Texas’ in- creasingly diverse population. The schol- arship encourages exceptional minority students to enter medicine by lightening the financial burden of medical school. Through the years, TMA has awarded 65 scholarships totaling $325,000 to minor- ity medical students. This year’s nine scholarships were made possible by a grant from the as- sociation’s philanthropic arm, the TMA Foundation, thanks to generous gifts from physicians, their families, and cor- porate supporters. The recipients are:


• Natalie Diaz, of Carrollton, gradu- ated from Texas Christian University and will enter The University of Texas


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