Date of Conferral





Public Policy and Administration


Lydia Forsythe


In 2014, the individual mandate of the Affordable Care Act (ACA) came into effect. More than 7 million Americans paid a tax penalty for not carrying insurance during the previous tax year. Millions of others were forced to purchase a health insurance plan to avoid that penalty. This study filled a gap in public health policy research by incorporating qualitative data to offer narratives along with statistical data that could help explain health outcomes to make successful policy changes in 2019. The purpose of this study was to research the use of market competitive theory by learning people's lived experiences and how they made the decision to participate in the ACA. The theoretical foundation was based on the social justice theory when mandating that citizen's purchase or pay. The method for this research was a qualitative interpretive phenomenological thematic approach with triangulation using the snowball effect and the hermeneutic circle method of analysis. The sample size included 6 volunteers who identified as either purchasing health insurance or paying the individual mandate penalty during a recorded interview. The findings answered the first research question by showing that the 6 participants found reason to carry health insurance based on their lived experiences and desire to maintain wellness overall. Findings for the second research question indicated that the individual mandate penalty did not increase the likelihood that the 6 participants would purchase healthcare insurance based on their lived experiences. This study supports the need for continued ACA qualitative research to identify more themes on how people make decisions regarding their health care that could provide positive social health policy change for the future.