Date of Conferral



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


Business Administration


Charles Needham


Small business owners with 50 to 100 employees in the physical and mental health care industry face a primary challenge of implementing health insurance under the Patient Protection and Affordable Care Act (ACA) while sustaining their business. The purpose of this multiple case study was to explore the strategies small business owners use to provide health insurance coverage under the ACA and sustained business operations. Semistructured interviews took place in Northeastern Ohio with 3 business owners in the physical and mental health care industry to acquire health care without increasing service cost. The conceptual framework for this study was strategic organizational change. Data were collected by semistructured interviews and business documents. The data were analyzed with a methodological triangulation and member checking collection method to bolster trustworthiness and credibility. The themes that emerged from the study included the importance of cost associated with health care plans, high employee turnover rates, and large insurance company participation. Purchasing affordable health care requires small business owners to make decisions that include resources and employees' reactions to change. The findings of the study may lead to social change because they include information that may benefit small business owners in the process of providing health insurance coverage to full-time employees and reducing insurance costs. The application of the results of the study may reduce the number of uninsured individuals.

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