Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2018 Effects of Patient Protection and Affordable Care Act on Behavioral Health Access Godwin Oshegbo Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Public Health Education and Promotion Commons, and the Public Policy 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 contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral dissertation by Godwin Oshegbo 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. Kimberly Dixon-Lawson, Committee Chairperson, Health Services Faculty Dr. Bernice Kennedy, Committee Member, Health Services Faculty Dr. Sriya Krishnamoorthy, University Reviewer, Health Services Faculty Chief Academic Officer Eric Riedel, Ph.D. Walden University 2018 Abstract Effects of Patient Protection and Affordable Care Act on Behavioral Health Access by Godwin O. Oshegbo MA, Liberty University, 2009 BTh, Bethany Divinity College and Seminary, 2006 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Services Walden University May 2018 Abstract About 50% of adults in the United States suffer from at least 1 mental health challenge in their lifetime. Annually, mental health and substance use disorders cost the United States about $800 billion, leaving individuals with unaffordable cost of care and the nation with diminished productivity and revenue. With the Essential Health Benefits and Medicaid expansion under the Patient Protection and Affordable Care Act (PPACA), healthcare resources were created to address gaps in behavioral healthcare. There is a need to understand how the healthcare law has influenced the availability of behavioral health services and access to needed care. This study explored the lived experiences of 10 behavioral health service recipients to identify the benefits and challenges of the PPACA on behavioral health services. Participants from Anne Arundel County, Maryland, were purposefully selected and interviewed face-to-face. Relative advantage, compatibility, and complexity were characteristics of the diffusion of innovation theory used for the exploration of this research. Based on the interpretive phenomenological approach, Nvivo 11 Pro was used for data coding, management, organization, and analysis. There was the shared belief among participants that the PPACA improved their access to adequate and affordable behavioral healthcare. Effective network of care and having health insurance seemed to have improved health outcomes. Findings from this study highlight issues of common interest to healthcare stakeholders while providing reasonable platforms for objectively addressing complex challenges, which tend to undermine the possibility of adopting policies that could yield positive dividends for all parties involved. Effects of Patient Protection and Affordable Care Act on Behavioral Health Access by Godwin O. Oshegbo MA, Liberty University, 2009 BTh, Bethany Divinity College and Seminary, 2006 Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Health Services Walden University May 2018 Dedication First, I want to use this opportunity to publicly thank my Lord and savior Jesus Christ for saving me and giving me a chance at life. I dedicate this dissertation to the Lord God Almighty, who found it in His infinite wisdom to give me life and the grace to pursue my life’s purpose. I also dedicate this achievement to my late paternal grandmother (Mrs. Emuohwomuerhe Oshegbo), who despite lacking Western education used her gift of oral tradition to teach me the significance of resilience, excellence, and legacy. To my parents and siblings, you are the best family I could have ever asked for. And, finally, to my dearly beloved wife, Gloria Obiajulu Oshegbo. You are my best my friend, my partner in every sense, and the mother of our three precious children (Makarios, Evangel, and Basileus Oshegbo). I am indebted to your sacrifice, love, and dedication to our family. My father was right from the day I introduced you as my wife. He said I couldn’t have made any other better choice in my life, and he was right! My life’s dream is to bring you joy and fulfillment as we explore our life adventures together. Acknowledgments I want to express my appreciation to the members of the faculty and Walden University for their support in many ways during my study. I am proud to be a product of your intellectual investment. To my dissertation committee chairperson, Dr. Kimberly Dixon-Lawson, I am eternally grateful. Your empathy, thoughtfulness, and leadership guided my process to this point. I am thankful to my committee member, Dr. Bernice Kennedy, for her expert counsel and guidance. Also, I want to thank Dr. Sriya Krishnamoorthy, the University Research Reviewer; your feedback was instrumental for making the product of this dissertation a quality one. I want to thank Mr. Bamoyo and Mrs. LaToya Nkongolo for their support at various stages of this study. I also want to thank Ms. Angel Traynor, Ms. Izelle Van Zuylen, and Ms. Jeanette Cohen for their roles in this endeavor. In addition, I thank the Anne Arundel Department of Health for their contributions through this process. You guys are fabulous and the true face of change in Anne Arundel County, Maryland. My family and I are truly indebted to our pastors and mentors, Pastors Ezio and Van Ross, and the entire family of the Kingdom Center Ministries. You have continued to pray for us and have supported us through many seasons of our life. I am thankful to my family and friends. Elder Jim and Dns. Nancy Hill, Dr. and Mrs. Christopher Egelebo, Dr. and Mrs., Frank Akpati, Dr. Clara Agbedia, Reverend and Mrs. Peter Ebonoke, Wendie Fickling, and the OATS (UMMC) family…The list is endless! And once again, I am forever grateful to my wife and my three amazing children. Table of Contents List of Tables ..................................................................................................................... vi List of Figures ................................................................................................................... vii Chapter 1: Introduction to the Study ....................................................................................1 Introduction ....................................................................................................................1 Background of the Study ...............................................................................................2 Problem Statement .........................................................................................................6 Purpose of the Study ......................................................................................................8 Research Questions ........................................................................................................9 Theoretical Framework ................................................................................................10 Nature of the Study ......................................................................................................11 Definition of Terms......................................................................................................13 Assumptions .................................................................................................................14 Scope and Delimitations ..............................................................................................15 Limitations ...................................................................................................................16 Significance of the Study .............................................................................................17 Summary and Transition ..............................................................................................18 Chapter 2: Literature Review .............................................................................................20 Introduction ..................................................................................................................20 Theoretical Foundation ................................................................................................22 Diffusion of Innovation Theory ...................................................................................23 Structures of Diffusion of Innovation ................................................................... 23 i Diffusion of Innovation in Previous Research ...................................................... 31 Patient Protection and Affordable Care Act ................................................................34 Compromises in the PPACA ................................................................................ 37 PPACA Implications for Behavioral Health ................................................................39 Historical Trends in Behavioral Health ...............................................................