America’s poor face many obstacles including health disparities and limited access to affordable primary healthcare services. This study focuses on treatment seeking and knowledge of the Patient Protection and Affordable Care Act among the working poor in Tupelo, Mississippi, where research was conducted in 2014. The working poor cannot afford medical insurance even with government subsidies but earn too much money to qualify for Medicaid, leaving them with few options. Strategies to manage acute and chronic illnesses include frequenting organizations that attempt to fill the gaps in healthcare. This thesis presents a cultural model of health-seeking among the working poor as they attempt to navigate the changing healthcare marketplace. Research indicates that the working poor are largely uninformed and unable to utilize ObamaCare and are still relying on safety net providers.

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.

Healthcare spending in the United States has continued to rise with annual healthcare cost of $3.8 trillion in 2014. While costs and the population continue to rise, resources continue to dwindle. Consequently, Congress has imposed various price controls and healthcare reform measures over the past 20 years, including the recent Patient Protection and Affordable Care Act (PPACA), which aims to decrease spending while enhancing quality and safety of care delivery. As a result of the implementation of the PPACA, 34 million additional Americans may be eligible for healthcare in a system already needing additional resources, increased access to care, and strategies to offset increasing operational and fiscal challenges. The purpose of this descriptive study was to explore what strategies and changes 10 executive leaders of the nonprofit hospitals in Maryland used to address the operational and fiscal challenges of the PPACA. The conceptual framework for this study was built upon the general systems theory. The data were collected through semistructured interviews, cataloged and coded, analyzed using a modified van Kaam method, and reviewed by participants as part of member checking process. The findings revealed 3 emergent themes: investment in IT resources to support an EMR system, strategies to address healthcare workforce challenges, and strategies for sustainability for managed care outpatient services and patient safety and quality of care. The findings impact social change by presenting policies and processes that medical professionals can use to support local and national health care reform.

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.

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.

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.