A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / While it is known that over 266,000 Arizonans enrolled in health coverage through the federal Marketplace and Medicaid from October 2013 through May 2014, little analysis has been performed to examine whether enrollment by diverse racial and ethnic groups sufficiently reduced disparities in coverage. We obtained publicly available data from the Census Bureau comparing rates of uninsured by race/ethnicity from 2013 to 2014 in Arizona from the American Community Survey. The uninsured rate in Arizona for the total civilian no institutionalized population dropped from 17% in 2013 to 13.6% in 2014. The uninsured rate in Arizona for whites declined from 15.7% to 12.2%, for African Americans declined from 17.4% to 11.1%, for American Indian/Alaskan Natives declined from 26.9% to 24.1%, for Asian Americans declined from 15.1% to 11.0% and for Hispanic/Latino declined from 27.5% to 22.2%. We conducted interviews with nine community organizations in order to identify barriers that must be addressed moving forward to lessen insurance coverage disparities among various minority groups. Technological literacy and functionality, lack of funding, lack of personnel, physical vastness of many populations, language, and cultural differences were commonly identified as barriers to enrollment. Mistrust of government and confusion regarding the specific provisions within the ACA pertaining to Native individuals were also cited.

For several decades, the cost of medical care in the United States has increased exponentially. Congress enacted the Patient Protection and Affordable Care Act (PPACA) of 2010 to ensure affordable healthcare to the citizens of the United States. The purpose of this case study was to explore physicians' perspectives regarding physician-centric business models evolving under the requirements of PPACA legislation. Complex adaptive systems formed the conceptual framework for this study. Data were gathered through face-to-face, semistructured interviews and e-mail questionnaires with a purposeful sample of 20 participants across 14 medical specialties within Northeast Texas. Participant perceptions were elicited regarding opinions of PPACA legislation and the viability of business models under the PPACA. In addition, a word cloud was used to identify 3 prevalent or universal themes that emerged from participant interviews and questionnaires, including (a) use of mid-level practitioners, (b) changes to provider practices, and (c) lack of business education. The implications for positive social change include the potential to develop innovative models for the delivery of medical care that will improve the health of the aggregate population. Healthcare leaders may use the findings to advance the evolution of physician business models that meet the needs of healthcare stakeholders. These findings may also inform healthcare leaders of the need to develop cost-effective and innovative organizational models that are distinct to individual patient populations.

Cette thèse propose un éclairage inédit sur la stratégie politique employée par le président Barack Obama pour réduire les inégalités raciales ; ceci dans un contexte dominé par le fort ressentiment de la population blanche envers les politiques sociales en général et les mesures dites « raciales » en particulier. La présente analyse s’appuie sur l’exemple spécifique de la réforme de santé Obamacare, fruit d’une stratégie politique soigneusement et prudemment choisie, mais qui a vu le jour au terme d’une bataille houleuse. La réforme fut élaborée dans un contexte d’extrême polarisation partisane en matière de politique sociale et de questions raciales, mais aussi au sujet de l’intervention de l’État. Ayant pour but la création d’une législation significative quoique politiquement acceptable, Obama a opté pour une stratégie politique de neutralité raciale en ciblant toutefois des problèmes spécifiques aux Afro-Américains. Ainsi, cette thèse démontre en quoi cette tactique s’est basée sur des considérations tant de faisabilité politique que d’efficacité afin de répondre aux besoins économiques spécifiques à la population noire. Il s’est également agit d’analyser comment l’administration Obama a réussi, après presque un siècle de tentatives infructueuses, à promulguer une loi mettant en place un système de couverture de santé universelle ; loi que les attaques répétées du Parti républicain ont profondément mutilé. Nous démontrons enfin qu’à l’instar de la non-extension de Medicaid qui a particulièrement nuit à la population noire, la réforme d’Obama, puisque basée sur un système préexistant, a finalement ravivé les problèmes de stratification raciale. / This dissertation examines the political strategy used by President Barack Obama to address racial inequalities in a context dominated by a rejection of social policies in general, and race-specific initiatives in particular. This analysis is based on the example of health care reform. The legislation known as Obamacare, passed in 2010, which is composed of two Acts, the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act, was the result of a careful political strategy and a heated political battle. Obamacare was enacted in a context of strong partisan polarization around issues of social policies, racial inequalities, and the scope of government intervention. To achieve meaningful, yet politically acceptable, legislation, Obama chose a race-neutral, but issue-focused approach. This approach was mainly based on considerations of political feasibility, but also on considerations of efficiency in furthering black economic interests. Thus, this dissertation examines the foundation, application, and outcome of Obama’s political strategy as applied to health care reform. On the one hand, his administration managed to enact comprehensive health care reform after almost a hundred years of frustrated attempts. On the other hand, subsequent Republican attacks maimed the reform. Moreover, as the reform was built on the existing system, previous issues of racial stratification resurfaced. The non-extension of Medicaid was particularly detrimental to African-Americans. Yet, despite its imperfections, Obamacare, by creating for the first time a system of universal health care coverage in the US, has contributed to make public opinion more favorable to a single-payer system, in other words, a fully government-run health care system.

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.

Electronic medical records (EMRs) or electronic health records have been in use for years in hospitals around the world as a time-saving system for patient record keeping. Despite its widespread use, some physicians disagree with the assertion that EMRs save time. The purpose of this study was to explore whether any time saved with the use of the EMR system was actually devoted by doctors to patient-care and thereby to improved patient-care efficiency. The conceptual support for this study was predicated employing the task-technology fit theory. Task-technology theorists argue that information technology is likely to have a positive impact in individual performance and production timeliness if its capabilities match the task that the user must perform. The research questions addressed the use of an EMR system as a time-saving device, its impact on the quality of patient-care, and how it has influenced patients' access to healthcare in Nigeria. In this research, a comparative qualitative case study was conducted involving 2 hospitals in Nigeria, one using EMRs and another using paper-based manual entry. A purposeful sample of 12 patients and 12 physicians from each hospital was interviewed. Data were compiled and organized using Nvivo 10 software for content analysis. Categories and recurring themes were identified from the data. The findings revealed that reduced patients' registration processing time gave EMR-using doctors more time with their patients, resulting in better patient care. These experiences were in stark contrast to the experiences of doctors who used paper-based manual entry. This study supports positive social change by informing decision makers that time saved by implementing EMR keeping may encourage doctors to spend more time with their patients, thus improving the general quality of healthcare in Nigeria.

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.

Background: Since 1965, there have not been any major revisions of the healthcare laws in the United States, until the recent implementation of the Affordable Care Act (ACA). However, ACA is not well understood and is often controversial. The purpose of this study is to: (1) evaluate the relationship between the employers’ and the employees’ perceptions regarding the ACA mandates for small businesses, (2) evaluate the relationship between the self-reported and the tested knowledge of individuals regarding the ACA mandates for small businesses, and (3) determine if socio-demographic factors influence individual’s perception of the law. Based on the gathered information, we aim to develop a socio-ecological model of ACA acceptance to address the barriers and facilitators to implementing the new law and recommend changes to address any deficits. Method: An online questionnaire was distributed anonymously to employees and employers of small businesses. The data gathered included information on the participants' knowledge and perceptions on the law and their socio-demographic information. Kendall correlation test, generalized linear regression models and bootstrapping resampling method were employed to detect differences in the perceptions & knowledge of employees and employers, to evaluate the association between self-reported and tested knowledge, and to generate a SEM model of ACA perception and acceptance. Results: Based on the analysis, we found that job status significantly affects the individual perception of the law (p = 0.004). The study showed a statistically significant negative association between the self-reported knowledge and the actual-tested knowledge of individuals (r= -0.4174, p-value of 0.01159). We found that interpersonal level had the highest impact on perception (coefficient of 5.67, p-value0.05). Conclusion: Individual perception is a key factor in adoption of new policies. A socio-ecological model of ACA acceptance can be a powerful tool in addressing the barriers and facilitators to the successful implementation of the new law and to modify the policies to address any deficits in the law.

This thesis investigates the complex relationship between political institutions and health care policy through framing techniques employed in political discourse in the Patient Protection and Affordable Care Act (PPACA). It addresses how rights and market framing interact in the development, passage and further discourses on the PPACA. President Obama’s discourses are analyzed using qualitative critical discourse analysis of five remarks and addresses given between 2009-2013. These speeches are unpacked and catego-rized to illustrate the change in framing techniques over time. Three main findings are presented after the analysis portion: market framing is used more frequently in the developmental stages of the PPACA, mixed rights and market framing are largely conveyed through anecdotes, and the “right to affordable health care” is forwarded as an argument. These findings support the main argument that rights and market frames have a high level of interaction in the development of the PPACA.

The purpose of this thesis is to examine the Affordable Care Act through an analysis of the United States Supreme Court's holding in The National Federation of Independent Business v. Sebelius. In order to better understand the Supreme Court's reasoning in that case, this paper will first examine the history and the function of the Supreme Court, which will demonstrate the Court's power to either augment or diminish the power of the states in relation to the federal government. This paper will then discuss the background of the Affordable Care Act, the procedural history of the case, and the majority's analysis supporting its decision. The concurring and dissenting opinions of the other justices will be discussed to present the various viewpoints regarding the proper role of the federal government and the implications this case may have on federal/state conflict. The Supreme Court ruled in favor of the Department of Health and Human Services. The 5-4 decision was extremely close and the opinions given by each Justice highlighted the various flaws and benefits of the Act it was looking to uphold. Further research of Supreme Court cases in our country's history reveal the trend of augmenting and diminishing state's rights. This thesis will examine the constitutionality of the aforementioned decision, the effects it will have on each of the states within the United States, and the impact the citizens will experience.

Jana Leichterová Conservative Criticism of Obamacare and its Transformation in the Context of Donald Trump Running for President Abstract The thesis deals with the debate over the health care reforms in the United States. It focuses specifically on the debate over the Affordable Care Act, also known as Obamacare, a health care reform initiated by President Barack Obama that was signed into law in March 2010. The goal of the thesis is to identify the main arguments of the conservative criticism of the Affordable Care Act, and to determine whether the debate transformed with the emergence of Donald Trump onto the political scene. The thesis provides historical context of the three main approaches to the health care policies in the United States throughout the 20th century: the Social Security path of strong government in the 1930s, the mixed "American way" with government providing social benefits to citizens through private institutions in the 1970s, and the approach of unregulated free market since the 1980s. Obama's health care originates in the urge for a national solution of the high number of uninsured citizens (more than 50 million in 2009) and rising cost of health care. The reform has three essential pillars: 1. the reform of the health insurance market that unifies the diverse state approaches and...