A Note on the Affordable Care Act and the U.S. Health Care System

Joseph L. Bower; Michael  Norris

Background Note | HBS Case Collection | February 2015

A Note on the Affordable Care Act and the U.S. Health Care System

Abstract

This note provides an overview of the U.S. health care system as it stood in 2014, including an overview of hospitals, doctors, insurance companies, and other health care providers. It also discusses the major political actions on health care in the 20th century, including Medicare, Medicaid, and the early planning process for the Affordable Care Act at the beginning of the Obama presidency.

Keywords: health care; health care policy; political process; Health Care and Treatment; Health Industry; United States;

Language: English

Format: Print

39 pages

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Citation:

Bower, Joseph L., and Michael Norris. "A Note on the Affordable Care Act and the U.S. Health Care System." Harvard Business School Background Note 315-031, January 2015.

Related Work

Supplement | HBS Case Collection | February 2015

The Affordable Care Act (B): Industry Negotiations

Joseph L. Bower and Michael Norris

In 2009, the Obama administration and Senator Max Baucus, chairman of the Senate Finance Committee enter into talks with industry groups that will be affected by the health reform that the Congress is working on.

Keywords: health care; health care policy; Health; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (B): Industry Negotiations." Harvard Business School Supplement 315-033, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (C): Legislative Strategy in the Senate

Joseph L. Bower and Michael Norris

In 2009, the Senate begins drafting its health care bills. Jurisdiction in the Senate is shared between two committees, but the more important is the Senate Finance Committee.

Keywords: health care; health care policy; Government and Politics; Health; Government Administration; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (C): Legislative Strategy in the Senate." Harvard Business School Supplement 315-034, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (D): Making a Decision on the Employer-Sponsored Health Insurance Tax Exclusion

Joseph L. Bower and Michael Norris

In the summer of 2009, a meeting is called in the White House to discuss the impact of changing the rules on the employer-sponsored health insurance tax exclusion.

Keywords: health care; health care policy; Health; Government and Politics; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (D): Making a Decision on the Employer-Sponsored Health Insurance Tax Exclusion." Harvard Business School Supplement 315-035, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (E): The August 2009 Recess

Joseph L. Bower and Michael Norris

During the Congress's August recess in 2009, the Tea Party makes a big push to stop the health reform bill moving through Congress.

Keywords: health care; health care policy; Government and Politics; Health; Policy; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (E): The August 2009 Recess." Harvard Business School Supplement 315-036, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (F): Regaining Momentum

Joseph L. Bower and Michael Norris

In the fall of 2009, President Obama makes a speech to a joint session of Congress in an attempt to regain lost momentum on health reform and get a bill through Congress.

Keywords: health care; health care policy; Government and Politics; Health; Policy; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (F): Regaining Momentum." Harvard Business School Supplement 315-037, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (G): The Final Votes

Joseph L. Bower and Michael Norris

In the fall of 2009, the House and Senate each voted to pass health reform bills. These bills then had to be combined into the Affordable Care Act and the ACA had to be passed by both houses. Reconciliation had to be used because of Republican Scott Brown's Senate victory in Massachusetts.

Keywords: health care; health care policy; Government and Politics; Health; Policy; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (G): The Final Votes." Harvard Business School Supplement 315-038, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (H): Implementation Begins

Joseph L. Bower and Michael Norris

In the spring of 2010, after the ACA is signed into law, the government begins implementation.

Keywords: health care; health care policy; Government and Politics; Health; Policy; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (H): Implementation Begins." Harvard Business School Supplement 315-039, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (I): The Supreme Court

Joseph L. Bower and Michael Norris

In the spring of 2012, the Supreme Court hears arguments and releases its decision on the constitutionality of the ACA.

Keywords: health care; health care policy; Government and Politics; Health; Policy; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (I): The Supreme Court." Harvard Business School Supplement 315-040, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (J): Healthcare.gov

Joseph L. Bower and Michael Norris

In the fall of 2013, Healthcare.gov launches as an insurance exchange for consumers to buy health insurance. The launch is filled with glitches, and some worry if it will imperil the fate of the entire ACA.

Keywords: health care; health care policy; Government and Politics; Health; Policy; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (J): Healthcare.gov." Harvard Business School Supplement 315-041, February 2015. View Details

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Supplement | HBS Case Collection | February 2015

The Affordable Care Act (A): Legislative Strategy in the House of Representatives

Joseph L. Bower and Michael Norris

In early 2009, the Obama administration and the Democratically-led Congress began working on what would eventually become the Affordable Care Act. The (A) case in this series discusses the legislative strategy in the House of Representatives, where three different committees each had jurisdiction over health care legislation.

Keywords: health care; health care policy; Government and Politics; Government Administration; Health Care and Treatment; Health Industry; United States;

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act (A): Legislative Strategy in the House of Representatives." Harvard Business School Supplement 315-032, February 2015. View Details

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Teaching Note | HBS Case Collection | January 2016

The Affordable Care Act Case Series

Joseph L. Bower and Michael Norris

Citation:
Bower, Joseph L., and Michael Norris. "The Affordable Care Act Case Series." Harvard Business School Teaching Note 316-136, January 2016. View Details

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In 2019, Nadine Vogel, founder and CEO of Springboard Consulting, a firm that worked with Fortune 500 companies on issues related to disability and their workforce, faced the decision of the best path forward to grow her small company. Should she built more and better expertise to expand the topics she worked on with her current clientele? Or should she explore the possibility of moving into the new market of smaller businesses?

In the summer of 2019, Mike Klingensmith, CEO of the Minneapolis Star Tribune, the Twin Cities metro region’s largest newspaper, reviewed subscription trends and plans for future experimentation. The newspaper industry across the U.S. had suffered a steep decline for the previous several decades as digital offerings supplanted print subscriptions. Under Klingensmith’s leadership, the Star Tribune had fared better than many papers, emerging from bankruptcy with a robust newsroom and with print profitable and digital growing. But given ongoing shifts in consumer media habits, flat EBITDA was still the best-case scenario that the Tribune could reach for. To meet this goal, Klingensmith and his team had put in place new digital offerings and had developed a number of creative additions to the print paper to offset subscription declines and print ad losses. Klingensmith believed that the plans they had put in place would allow the paper to survive in the new news landscape of the 21st century, but as he prepared to meet with the paper’s owner, a local, family-owned holding company, he wondered how confident he could be in his forecasts.

Case | HBS Case Collection | June 2019 (Revised February 2020)

Eric Hawkins Leading Agile Teams @ Digitally-Born AppFolio (A)

Tsedal Neeley, Paul Leonardi and Michael Norris

Eric Hawkins, director of engineering at AppFolio—a digital technology firm that offered cloud-based business software to small and medium sized companies—was shocked by an unusual request from his senior leadership team. Could Hawkins and one of his agile teams build a check scanner feature inside their management software? AppFolio’s founders had instructed to never build a check scanner; providing technologies to help businesses move into the digital era was a primary company goal. A scanner for paper checks would contradict the hard-won culture of software innovation and project self-selection that AppFolio and Hawkins’ teams lived by. Hawkins also worried that creating a new team to work on the check scanning project would cause workload and morale issues. But the sales team believed that this technology could close deals with larger, more complex property management companies, some with managers who wanted the check scanner feature. Several large-scale deals were on the line. Hawkins quickly assembled an agile market validation team and considered two options: hold fast to the company’s values and refuse to build the check scanner feature or capitulate and build a basic check scanner with minimum functionality. Engineers would likely consider this a “loser” project, yet sales might get a boost that could open a new revenue stream. Hawkins had to make his decision quickly.

Keywords: digital transformation; values; Agile; vision; corporate culture; Leadership; Values and Beliefs; Organizational Culture; Decision Choices and Conditions; Technology Industry; United States; California;

Citation:

Neeley, Tsedal, Paul Leonardi, and Michael Norris. "Eric Hawkins Leading Agile Teams @ Digitally-Born AppFolio (A)." Harvard Business School Case 419-066, June 2019. (Revised February 2020.) View Details

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A Note on the Affordable Care Act and the U.S. Health Care System

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