The objective of this study is to test whether the Affordable Care Act will have an effect on the professional tax preparation industry of Kingsport, Tennessee. To accomplish this objective, the researcher collected surveys concerning taxpayers’ initial reaction to the realization that the law affects their 1040. A two proportion test for equality was performed and failed to reject the idea that the ACA will have an effect on the tax preparation industry of Kingsport. Because this study failed to prove that the change in legislation causes a jump in clientele for the professional tax preparation market, the fight for market share falls to marketers. They will decide who will benefit from this landmark piece of legislation.

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Patients with dementia, especially Alzheimer’s disease and particularly those in early stages, are susceptible to become victims of predators: Their agnosia (see Case 1) prevents them from detecting and accurately interpreting subtle signals that otherwise would have alerted them that they are about to fall for a scam. Furthermore, their judgment is impaired very early in the disease process, often before other symptoms manifest themselves and usually before a diagnosis is made. Patients with early stages of dementia are therefore prime targets for unscrupulous predators, and it behooves caregivers and health care professionals to ensure the integrity of these patients. In this case study, we discuss how a man with mild Alzheimer’s disease was about to fall for a scam were it not for his vigilant wife. We discuss what went wrong in the patient/caregiver interaction and how the catastrophic ending could have been avoided or averted.

Ways in which the implementation of the Patient Protection and Affordable Care Act (ACA) affect parents with chronically ill children are not well understood. The purpose of this phenomenographic study was to gain greater insight into the perceived experiences of parents of chronically ill children regarding implementation of the ACA in a southern state. Argyris's intervention theory provided the framework for the study. Face-to-face interviews were conducted with a purposeful sample of 12 female parents who are caregivers of chronically ill children. Data were analyzed and coded to identify categories and themes. Findings indicated that parents view physicians and policymakers as key actors in their communities to create more equitable services for parents of chronically ill children through the expansion of Medicaid services in southern state. Many participants did not perceive that the ACA had made significant changes to services received prior to its implementation. Findings may assist health care providers, insurance companies, legislators, and other policymakers to develop appropriate health care policies and interventions to lessen the financial burden experienced by parents of chronically ill children. Providing more support services that address the physical, emotional, and financial needs of parents may improve the health outcomes of their chronically ill children.

The Affordable Care Act (ACA) seeks to increase the low-income population’s access to health care coverage by expanding Medicaid eligibility and providing subsidies to individuals meeting certain income thresholds. The citizens of Texas would benefit greatly from the ACA provisions, as the state offers limited opportunities for individuals to access insurance, evidenced by the 6.3 million residents without health care coverage. But political leaders in Texas have a long-standing commitment to limited government, low taxes, and states’ rights in a federal system of government. In the 1990s, Texas legislators, with bipartisan support, laid the groundwork over the last decade for the minimal, yet significant preparations that administration used to coordinate ACA implementation. Yet legislators’ commitment to limited government and states’ rights placed additional constraints on the ability of the Texas Health and Human Services Commission (HHSC) to implement ACA provisions by refusing to utilize the 82nd legislative session to prepare the state for impending deadlines. Instead, administrators developed an interagency effort, the Eligibility Modernization Project (EMP), to streamline eligibility determinations and increase clients’ access to information and services. EMP’s initiatives mirror ACA provisions, but also seeks to achieve policy goals that both Republican and Democratic legislators support, such as providing effective and efficient eligibility determinations. Nevertheless, legislators and administrators must go beyond EMP’s efforts to adequately prepare the eligibility system for impending ACA deadlines. Policy recommendations include further streamlining and integrating the health subsidy system with a state-based health insurance exchange, increasing access to coverage by expanding Medicaid eligibility, adequately preparing the workforce for changes, and promoting long-term planning. These solutions will provide a sounder infrastructure for HHSC to prepare for ACA coordination and implementation, while increasing access to health care coverage for the low-income population. / text

Successfully designing and delivering a large-scale information technology (IT) system to meet new organizational objectives is a difficult undertaking in any context. The failure of the federally-facilitated online health insurance exchanges – known most commonly by their website address Healthcare.gov – to properly function when they opened for operations in 2013 provides a case study in how politics and policy-making can uniquely complicate IT projects in the public sector. Analysis reveals several instances where the legislative and regulatory process contributed to the project’s initial failure: from the project’s inception, elected representatives oversold the familiarity and simplicity of the site; statutory and regulatory law amplified the underlying technological complexity of the exchanges; partisan tensions extended the uncertainties around project scope until much too late in the process; legal and political concerns for maintaining stated delivery deadlines came at the cost of adequate testing and site functionality when it first opened; and the team appointed to oversee the project was more sensitive to political challenges then technological ones. Based on these findings, several recommendations are provided to help future representatives and government administrators minimize the negative toll that politics and policy-making can exact on a public sector IT project’s success. These include actively managing expectations, increasing information flow, simplifying functionality, providing fluid but reasonable delivery timelines, and appointing independent and technically savvy project leadership. Using Healthcare.gov as a case study on the effects politics and policy can have on developing IT systems can better prepare legislators and the public for future challenges of developing and implementing technology solutions in the public sector. / text

The Affordable Care Act (ACA), passed on March 23rd, 2010, contains widesweeping legislation aimed at reforming the current U.S. healthcare system. The ACA has been lauded by its proponents and deeply criticized by its opponents. The current paper included two experimental studies designed to test if the individual insurance mandate requirement is a specific source of the psychological and behavioral resistance displayed toward the ACA. In study 1 the individual insurance mandate requirement did not produce greater negative attitudes towards the ACA or the current Presidential administration and it did not predict attitudes towards the longevity of the ACA. Democrats were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA and Democrats also reported a lower likelihood of the ACA being repealed in comparison to Independents, Republicans or Libertarians. In study 2, the non-significant individual insurance mandate findings from study 1, were replicated in study 2. However, Democrats again were found to have significantly less negative attitudes towards the ACA and towards the longevity of the ACA in comparison to Independents, Republicans and those with no political affiliation. Democrats also indicated that they were less likely to vote for a political candidate who supports the repeal of the ACA in comparison to Independents, Republicans and those with no political affiliation. Implications and future research directions are discussed.

The Little Sisters of the Poor v. Burwell, a 2016 landmark religious liberty case, illustrates the ongoing debate between religious non-profit organizations and the government regarding the contraception mandate of the Affordable Care Act. Although the Little Sisters, in part because of their public relations and political advantages, received a relatively favorable outcome at the Supreme Court, their true successes lie on their impact on conservative politics and on the 2016 election. The Little Sisters became a significant component of political and religious leaders’ strategy to reframe the issue.

Class of 2015 Abstract / Objectives: Characterize all patients in the emergency room diagnosed with anxiety disorders from 11/01/2013 until 5/31/2014 to identify insurance coverage and demographic trends. Methods: Retrospective descriptive study of patients who present to the emergency department between 11/01/2013 – 05/31/2014 and discharged with a primary documented diagnosis of an anxiety disorder. Age, race, and gender were recorded in addition to insurance coverage. Results: 406 visits were reviewed: 212 (52.2%) males and 194 (47.8%) females. Average age per visit: 40.34 (SD=13.388). Race recorded with each visit: 189 (46.6%) white, 146 (36.0%) Hispanic, 42 (10.3%) African American, and 29 (2.2%) other. The most common insurance coverage was Medicaid at 63.3%, while 6.4% of visits had no insurance coverage. There was a significant difference in the distribution in number of ED visits between genders (Mann-Whitney U=17,407.5, p=0.007, sig ≥0.05). A Kruskal-Wallis Test showed a significant difference in the number of ED visits between racial groups X²=43.434, p=0.000 as well as a significant difference between Medicaid and other insurance groups X²=37.778, p=0.021. Conclusions: Men appear to have a higher frequency in anxiety symptoms requiring an ED visit than women do. White patients tend to have a greater frequency in anxiety symptoms followed by Hispanic patients. Medicaid tends to be the most prevalent insurance coverage used.

Expenditures on health are currently an important and growing item of public as well as private budgets in the developed world. This diploma thesis analyzes two different approaches to the function of health insurance on the example of the Czech Republic and the United States of America. The theoretical part will generally characterize access to health care through different theories; there will be also introduced the system of health insurance and the agents on health care market. The specifics of the health care market will be also explained. The analytical part of the work will focus on health insurance systems in the Czech Republic and the United States and their development, with accent on major reforms of recent years. With mutual comparison of the two systems, thesis will examine the shortcomings of public health insurance and private health insurance, including the effectiveness of their removal. Afterwards, the analysis of selected indicators of health care will be provided. The aim of the work is an analysis of the different systems of health insurance in the Czech Republic and the United States with relationship to the recent reforms and evaluation of their mutual effectiveness.