Date of Conferral



Doctor of Business Administration (D.B.A.)




Christos Makrigeorgis


Following the enactment of the Affordable Care Act (ACA) in 2010, politicians, media, and lobbyists rendered a number of conflicting and confusing interpretations of its merits and demerits. Such interpretations intensified the skepticism and concerns of small business enterprise (SBE) owners. The purpose of this study was to develop a representative, prioritized list of SBE owners' concerns or resistance factors. The goal was to create a useful guide for SBE owners who are seeking ways to reducing the adverse financial impact of the law. With social choice theory as the theoretical framework, 50 randomly selected SBE owners across 5 distinct industry groups from Richmond, Virginia, participated in an online, cross-sectional, pairwise comparison survey. The overall results of an analytic hierarchy process indicated that the top-ranked resistance factor of SBE owners was insurance premiums, followed by quality of care and the tax burden. However, these rankings were not uniform among industry groups. With a focus on these crucial concerns, SBE owners could benefit by seeking approaches to reduce the business costs of health care. The implications for positive social change include the potential for business organizations, researchers, and policymakers to channel SBE owners' voice for a socioeconomic growth by addressing their concerns in seeking improvements from the ACA.