Influence of the Patient Protection and Affordable Care Act on Small Businesses

152 Pages·2017·0.99 MB·English

Walden University
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Walden Dissertations and Doctoral Studies
Walden Dissertations and Doctoral Studies
Collection
2016
Influence of the Patient Protection and Affordable
Care Act on Small Businesses
Sean Gallman
Walden University
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Walden University

College of Management and Technology

This is to certify that the doctoral study by

Sean Gallman

has been found to be complete and satisfactory in all respects,
and that any and all revisions required by
the review committee have been made.

Review Committee
Dr. Marilyn Simon, Committee Chairperson, Doctor of Business Administration Faculty

Dr. David Moody, Committee Member, Doctor of Business Administration Faculty

Dr. Roger Mayer, University Reviewer, Doctor of Business Administration Faculty

Chief Academic Officer
Eric Riedel, Ph.D.

Walden University
2016
Abstract
Influence of the Patient Protection and Affordable Care Act on Small Businesses
by
Sean Gallman

MS, Johns Hopkins University, 2005
BS, Howard University, 1999

Doctoral Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Business Administration

Walden University
January 2016
Abstract
Business leaders lack strategies to implement the employer shared responsibility
provision of the Patient Protection and Affordable Care Act (ACA). Small businesses pay
approximately 18% more than larger companies for the same health coverage. Within a
conceptual framework of management by objectives, the purpose of this qualitative
multiple case study was to explore the strategies small business leaders use to implement
the employer shared responsibility provision of the ACA. Data were gathered from the
review of company documents, observations, and semistructured interviews with 5 senior
business leaders from small business organizations in the Mid-Atlantic region of the
United States. Data were coded via Atlas.ti to identify themes from the narative
segments. Key themes that emerged from the study included business cost, lack of
transparency, and consultation. Recommendations include examining alternative health
providers to reduce company health premiums to improve business costs, network with
other small businesses for ACA clarity, and work with health consultants for new
business processes. Implications for social change include contributing to the effective
implementation of the employer shared responsibility provision of the ACA that can
improve the economic well-being of small businesses.
Influence of the Patient Protection and Affordable Care Act on Small Businesses
by
Sean Gallman

MS, Johns Hopkins University, 2005
BS, Howard University, 1999

Doctoral Study Submitted in Partial Fulfillment
of the Requirements for the Degree of
Doctor of Business Administration

Walden University
January 2016
Table of Contents
List of Tables ..................................................................................................................... iv
Section 1: Foundation of the Study ......................................................................................1
Background of the Problem ...........................................................................................1
Problem Statement .........................................................................................................2
Purpose of the Study ......................................................................................................3
Nature of Study ..............................................................................................................3
Research Question .........................................................................................................5
Interview Questions .......................................................................................................5
Conceptual Framework ..................................................................................................5
Definition of Terms........................................................................................................6
Assumptions, Limitations, and Delimitations ................................................................7
Assumptions ............................................................................................................ 8
Limitations .............................................................................................................. 8
Delimitations ........................................................................................................... 9
Significance of the Study ...............................................................................................9
A Review of the Professional and Academic Literature ..............................................10
Health Care Reform .............................................................................................. 12
MBO Theory ......................................................................................................... 43
Strategic Business Processes................................................................................. 46
Transition and Summary ..............................................................................................55
Section 2: The Project ........................................................................................................56
i
Purpose Statement ........................................................................................................56
Role of the Researcher .................................................................................................57
Participants ...................................................................................................................58
Research Method and Design ......................................................................................60
Research Method .................................................................................................. 61
Research Design.................................................................................................... 63
Population and Sampling .............................................................................................65
Ethical Research...........................................................................................................67
Data Collection Instruments ........................................................................................68
Data Collection Technique ..........................................................................................70
Semistructured Interviews .................................................................................... 70
Business Plan Review ........................................................................................... 72
Data Organization Techniques .....................................................................................73
Data Analysis ...............................................................................................................74
Reliability and Validity ................................................................................................76
Reliability .............................................................................................................. 76
Validity ................................................................................................................. 77
Transition and Summary ..............................................................................................79
Section 3: Application to Professional Practice and Implications for Change ..................81
Presentation of the Findings.........................................................................................81
Theme 1: Business Cost ........................................................................................ 86
Theme 2: Lack of Transparency ........................................................................... 88
ii
Theme 3: Consultation .......................................................................................... 91
Application to Professional Practice ............................................................................92
Implications for Social Change ....................................................................................94
Recommendations for Actions .....................................................................................95
Recommendations for Further Research ......................................................................97
Reflections ...................................................................................................................98
Conclusion .................................................................................................................100
References ........................................................................................................................102
Appendix A: Full List of ACA Tax Increases .................................................................133
Appendix B: Interview Protocol ......................................................................................137
Appendix C: Timeline for Data Collection Techniques ..................................................139
Appendix D: Business Plan Collection Tool ...................................................................140
Appendix E: Invitation E-mail .........................................................................................142
Appendix F: Case Study Protocol ....................................................................................143

iii
List of Tables
Table 1. Demographic Data for Small Business Leaders ................................................. 84
Table 2. Interview Questions and Themes ........................................................................ 85
Table 3. Participant Responses ......................................................................................... 86

iv
1
Section 1: Foundation of the Study
Health benefits are a significant expense for small businesses in the United States
with the implementation of the employer shared responsibility provision in the Patient
Protection and Affordable Care Act (ACA; Herrick, 2014). Leaders of small businesses
with 50 or more employees changed their business structure to adapt to new health
mandates that affected their business performance. The ACA includes an employer
shared responsibility provision designed to force business owners to provide full-time
employees with comprehensive health insurance (Herrick, 2014). The intent of this
research study was to explore the strategic business processes on the employer shared
responsibility provision of the ACA that business leaders must implement in 2015 and
2016 (U.S. Small Business Administration [SBA], 2013a). The specific business problem
was that some small business leaders such as chief executive officers (CEOs) do not have
the strategic business processes needed to implement the employer shared responsibility
provision addressed in the ACA.
Background of the Problem
Small business leaders need strategic business processes to implement the
employer shared responsibility provision addressed in the ACA. The intent of this
qualitative descriptive multiple-case study was to explore the strategic business processes
small business leaders used to implement the employer shared responsibility provision
addressed in the ACA. The ability to create knowledge to improve the business strategies
of small businesses could lead to improved business sustainability (Rosenthal & Strange,
2012). The results of this research could lead to positive social change by providing