The Patient Protection and Affordable Care Act (ACA) aimed to increase accessibility to medical resources for those previously uninsured. Certainly, the ACA has expanded insurance to millions of Americans, however, the evidence and discourse surrounding health accessibility calls into question why, despite the growth of insured Americans, the increase in health insurance coverage under the ACA has not lead to greater accessibility for low income minorities. I propose that disparities in preventive care, the emergency room, and primary care provider services stand as barriers for low income minorities. Insurance coverage does not necessarily equate to greater accessibility if individuals do not have the means to utilize those resources.

An analysis of the evolution of the Commerce Clause, the Justices on the Supreme Court, and the arguments presented in this case indicate that the minimum coverage provision of the Patient Protection and Affordable Care Act will be struck down. Although the Court will likely be split 5 to 4 along ideological lines, each of the justices will have a unique rationale behind their decision. Chief Justice Roberts, Justice Scalia, and Justice Kennedy were heavily targeted by both parties’ oral and written arguments because there was speculation that any one of these traditionally conservative justices could be the fifth vote to uphold the individual mandate. However, it does not appear likely that the federal government supported their claims well enough to yield such a result. Instead, the Court will respond in the negative to the issue of "Whether Congress had the power under Article I of the Constitution to enact the minimum coverage provision." The Court’s interpretation of the Congress' commerce power has undergone two major expansions since the Constitution was ratified, and both of these expansions were met with a contractionary response to prevent the commerce clause’s growth into an unchecked power. This Court will not open a new frontier of power for the Congress, but rather it will respect the limits on Congressional power established by the Rehnquist Court.

Passage of the Patient Protection and Affordable Care Act (PPACA) in 2010 prompted the question of how independent businesses may react to the employer mandate in the PPACA. The law is based on the theory of managed competition and it is more likely to affect businesses with fewer employees than to affect larger businesses that already offer health insurance. The purpose of this quantitative, pre-experimental study was to examine the strategic responses of independent retail business owners in Hillsborough County, Florida, regarding their perceptions of the employer mandate in the PPACA. Before 2014, there was a great deal of non-peer-reviewed literature in which researchers made predictions about the PPACA and independent business perceptions regarding the new law. To determine independent business owners' perceptions of and strategies for addressing the PPACA, a random sample of 309 independent retail businesses in Hillsborough County was invited by e-mail to participate in an online survey. The quantitative data were analyzed using descriptive statistics, t tests for hypothesis testing, and chi-square goodness-of-fit analyses to confirm the results without using means. None of the alternative hypotheses were supported, indicating that the PPACA may not have an adverse effect on job creation for independent retail businesses in Hillsborough County. The findings of this study can indirectly promote positive social change by communicating to independent business owners and individuals that healthcare insurance options exist. This question was important to academics and business professionals, because the strategies employed by business owners may affect job creation.

In June 2012, the Supreme Court of the United States decided the fate of the Patient Protection and Affordable Care Act in a case called National Federation of Independent Business v. Sebelius. While initially the decision seemed favorable to supporters of the bill, Chief Justice Roberts’ majority opinion could likely render the bill ineffective in implementation and it creates more Constitutionally confusing precedent than it resolves. Among the questions that now rise to the surface are: will Congress be able to raise the tax to a level where it will become effective? What is now mandatory for states to adopt into their Medicaid programs? Where is the line for the federal government with regards to coercion? What are the definitions of direct and indirect taxes? And, how binding is the Origination Clause of the Constitution?

On March 23, 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA) into law. This reform, it is argued, is projected to increase insurance coverage of pre-existing conditions, to expand access to insurance for more than 30 million Americans, and to increase estimated National medical spending while lowering projected Medicare spending. This thesis sought to investigate and analyze the perceptions of senior citizens in Central Florida about PPACA and their perceived effects on the healthcare quality provided to them under this law. Four sections of PPACA bill, thought to specifically pertain to the elderly, were selected for this study; respondents were asked their opinions regarding PPACA's aspects of: (1) the reform on preventive healthcare services; (2) Medicare Part D (prescription drugs); (3) Medicare; and (4) Medicaid. This thesis employed both qualitative and quantitative methodologies; data were collected and analyzed with findings presented and discussed.

Cette thèse inscrite dans la tradition intellectuelle de l’American Political Development analyse les liens dialectiques entre l’entrepreneuriat des présidents des États-Unis sur la question de l’assurance maladie, l’essor du système de santé américain contemporain et son produit le plus récent, le Patient Protection and Affordable Care Act (2010). Il s’agit d’analyser les influences réciproques entre un exécutif qui subit de très fortes contraintes institutionnelles dans ce champ précis des politiques publiques et un système de santé dont les fondements et les contours sont en perpétuelle mutation. Les réformes de santé, de par leur nature transversale et polémique, leur complexité mais aussi leur poids dans l'économie américaine, agissent directement sur les équilibres de la gouvernance publique. Elles doivent être considérées comme un laboratoire et un accélérateur d’innovations pour la présidence, dans un système politique où sa sphère d’action est limitée, tant par les freins et des contre-pouvoirs que par l’influence d’autres entrepreneurs politiques dotés d’une légitimité d’action égale voir supérieure à se saisir de la question épineuse de la santé. L’adoption du PPACA, sa promulgation par un président démocrate après un siècle de rendez-vous manqués avec les réformes ambitieuses de l’assurance maladie, ainsi que sa mise en œuvre compliquée, offrent un cas d’étude de premier plan sur les évolutions de l'exécutif étasunien et sur la normalisation d’un entrepreneuriat présidentiel hétérodoxe. / This dissertation which falls within the intellectual tradition of American Political Development explores the dialectical links between the entrepreneurship of US presidents on health care reform, the development of the American health care system and its latest product, the Patient Protection and Affordable Care Act (PPACA), which was signed into law in 2010. This work analyses the mutual forces of influence at work between a deeply constrained executive in this particular field of public policy and a health care system whose foundations and contours are in constant mutation. Given its controversial nature, its complexity and its weight in the US economy, health care reform directly affects the dynamics of public governance. Health care reform must therefore be considered as a laboratory and an accelerator of innovations for the presidency, in a political system in which its sphere of action is limited, as much by checks and balances as by the influence of other entrepreneurs who enjoy equivalent if not greater legitimacy than the executive branch to take action on the thorny issue of health care. The passage of the PPACA, the fact that it was signed into law by a democratic president after a century of failed attempts at ambitious reform as well as its arduous implementation, are a picture perfect case study on the evolutions of the presidential institution and on the routinization of heterodox presidential entrepreneurship.

Americans spent nearly $2.6 trillion, or $8,000 per person for medical and administrative costs in 2010. By 2015, healthcare spending in the United States increased to 5.8% reaching $3.2 trillion or $9,990 per individual. By tackling healthcare administrative costs, it is estimated that healthcare providers could reduce these costs by $20 billion yearly. This case study explored strategies for streamlining hospital administrative procedures to reduce costs. The business process reengineering model formed the conceptual framework for this study. Data were gathered through semistructured face-to-face interviews guided by open-ended questions with a purposeful sample of 4 hospital managers in Atlanta, Georgia. This study identifies important themes regarding cost reduction and hospital administration based on participant interviews. Themes included participants' unfavorable perspectives of the Spell out PPACA (PPACA) legislation, employment of physicians, PPACA reimbursement method, follow-up services, hospital administrative governance, and lack of business education. The themes comprised steps hospital managers could take to streamline administrative procedures to reduce costs. The implications for positive social change included the potential to provide strategies for streamlined processes that could lead to savings passed on to patients from low socio-economic backgrounds through accessibility to affordable healthcare services.

美國前總統歐巴馬於2010年簽署之法案「病人保護暨可負擔醫療法」（Patient Protection and Affordable Care Act, PPACA）又稱「歐巴馬醫療法」（Obamacare），主要目的之一在於提升對人民醫療照顧的保障，擴大人民的醫療照顧覆蓋面，並讓醫療保險成為可負擔的，具體改革面向主要在公共醫療照顧的範圍擴大、對人民強制納保規定，與對於商業醫療保險之各種規制，而從歐巴馬醫療法內容中，得以探討美國如何在維持既有醫療照顧體系架構、商業醫療保險為主導的模式中，透過對商業醫療保險的規制來成就相當於社會保險所實現的社會安全，並與我國作比較，雖然主要採取之醫療照顧模式不同，但同樣在促成全民納保的社會國目的之達成，兩國背後的立法背景、操作上有何異同，以及會遇到之爭議與困境何在，並且進一步思考是否有讓我國在處理目前制度問題的值得參考之處。 本文先論述美國傳統對於醫療照顧的心態與背景，並介紹美國的醫療照顧制度與衍生的問題，並從中了解醫療照顧之相關權利、全民納保觀念在美國的發展狀況，接著介紹歐巴馬醫療法的發展過程與實際內容，聚焦在擴大醫療照顧覆蓋面與令醫療保險成為可負擔之相關規定，並了解幾個重要的聯邦最高法院對歐巴馬醫療法之違憲審查判決中對爭議的處理，之後觀察歐巴馬醫療法如何透過對商業醫療保險的規制來讓其能成就社會安全功能，並追蹤後續歐巴馬醫療法實施後之成效與未來可能變化。對照我國，在介紹我國全民健康保險之發展與內容後，比較兩國在促成全民納保的背景、立法與釋憲過程中的爭議為何且如何處理、全民納保的操作內容，以及醫療照顧相關權利的承認與否、商業醫療保險的角色等，也從中討論是否有我國在解決現今全民健保之問題上可參考之面向。