Walden University ScholarWorks 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 Follow this and additional works at:https://scholarworks.waldenu.edu/dissertations Part of theBusiness Commons,Health and Medical Administration Commons, and theOther Education Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please [email protected]. 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